Biomedical subjects

N Ogowet-Igumu

Publications and source records attributed to N Ogowet-Igumu.

10 recordsLinked to original sources

PubMed1992

[Recurrent extra-uterine pregnancies. 63 cases treated at the Hospital Center of Libreville from 1985 to 1989].

Ectopic implantation of the fertilised ovum, whether for the first time or as a recurrence, is not uncommon in this department. In a study in the Libreville Hospital group from 1985 to 1989, the authors found 828 cases of ectopic pregnancy (EP) including 63 recurrences, i.e. 7.61 per cent. These recurrences most often involved young women (26 per cent of cases) and nullipara (30%). The chief common etiology for the first occurrence remained tubal infection (57.28 per cent of cases). Treatment consisted most often of radical macrosurgery because of the advanced state of tubal disease, thus leading to the permanent sterilisation of 48 patients, i.e. 71.2 per cent of recurrences. Nineteen patients had a history of previous conservative surgery, including 8 homolateral recurrences (43 per cent). Reducing the incidence of such pathology essentially involves the prevention of gynecological infections, and in particular sexually transmitted diseases, as well as the possibility of early diagnosis of EP. Despite the fact that it seriously compromises the subsequent fertility of these young patients, total salpingectomy remains the treatment of choice for avoiding recurrences.

Adolescent↗

PubMed1991

[Serology of Chlamydia and ectopic pregnancies. Incidence of Fitz-Hugh-Curtis syndrome].

The authors report a prospective study of anti-chlamydia trachomatis serology in extra-uterine pregnancies, which happened to coincide with an increase in the ectopic rate during the year 1989 (p less than 1.10(-6]. The subjects of the study were those patients operated on for ectopic pregnancy between the 1st January and the 31st May 1989. There were two control groups: the first were those that were delivered and the second were those pregnant women who were at risk of ectopic pregnancy because of their age, or the number of pregnancies they had had and their parity, without taking any account of the duration of the pregnancy. The level for sero-positive reading was 1 in 64 using an indirect immunofluorescent method (Spot IF, Bio Merieux). The results showed 81% sero-positive in those who had had ectopic pregnancies as against 63% in the control groups. The two control groups had identical readings. There was a significant difference statistically (p less than 0.01). There was no statistical difference in the incidence of HIV (human immunodeficiency virus) in the two groups (3% and 1%). The clinical study of the other tube showed no particular lesions. On the other hand, adhesions between the liver and the diaphragm (Fitz-Hugh-Curtis Syndrome) were demonstrated in 34% of those with ectopic pregnancy with a statistical significant level of igG above or equal to 1:128 (p 0.02). Perisplenitis was rare (3 cases). Histological finding of salpingitis isthmica nodosa in 49% of cases raises the problem of the pathology of chlamydial lesions being due to a host invader reaction. The increase in the incidence of ectopic pregnancy (1 in 44 deliveries) was accompanied by an increase in the prevalence of chlamydia trachomatis in the group with ectopics and the control groups. If the frequency of ectopics creates a major problem of public hygiene, the prevalence of chlamydia in the female population, apart from its effect on fertility, explains the action of sexually transmitted diseases as a factor in the heterosexual transmission of HIV in Africa.

Adolescent↗

PubMed1990

[Early prenatal diagnosis of diprosopic syncephalic joined twins].

The authors summarize the case of diprosopic syncephalic joined twins diagnosed at 22 weeks of pregnancy by ultrasonography performed because of hydramnios. The rate of separation anomalies of monozygotic twins is assessed by a review of the literature: from 1 to twenty to fifty thousands for joined twins to 1 per cent fifty thousand to fifteen millions for diprosopus. The etiology is the result of a late division of the egg between D12 and D16. Often an encephalic diprosopic joined twins cause elevated levels of maternal serum alpha protein. Early ultrasonography permits to consider a vaginal therapeutic abortion.

Abnormalities, Multiple↗

PubMed1990

[Diagnostic echography of extrauterine pregnancy (EUP). Apropos of 228 EUP confirmed by laparotomy].

The department of gynaecology and obstetrics of the University Hospital in Libreville carried out in the five years between 1984 and 1988 8,688 ultrasound examinations of which 1,234 (14.2%) were performed because an ectopic pregnancy was considered possible. 213 correct diagnoses (32.8%) were confirmed by laparotomy. 649 surgical procedures for ectopic pregnancy were carried out of which 228 (35%) were helped by the ultrasound examination. The diagnosis was made 138 times (60.5%) accurately and suspected 75 times (32.9%). On the other hand, diagnosis was wrong 15 times (6.6%). These false negatives are worrying: in 4 cases there was an intra-uterine pregnancy as well and in these cases the intra-uterine zygote gave a false sense of security for the diagnosis. The 11 other cases were false diagnoses of adnexal infections which were diagnosed correctly by laparoscopy or culdocentesis. There were also 27 false positive diagnoses mainly in tubo-ovarian infectious and rarely where an ovarian cyst or pedunculated fibroid had twisted or the pregnancy was developing in a blind hemi-uterus. The assessment of the results makes its possible to show that in 88.75% the procedure was valuable in making the diagnosis and in 98.5% was valuable for excluding the diagnosis. Since the sensitivity of the test is 93.4% and its specificity is 97.3% it follows that ultrasound examination should have a very important place in the diagnosis of ectopic pregnancy particularly because in our unit we cannot at present carry out biological tests (beta HCG estimations). The test is rapid, cheap and easy to perform (as long as one avoids the traps).(ABSTRACT TRUNCATED AT 250 WORDS)

False Negative Reactions↗

PubMed1990

[Unusual causes of hemoperitoneum of genital origin].

Extra-uterine pregnancy is the most common emergency in gynaecology and obstetrics in the Hospital Centre of Libreville, and the diagnosis of blood in the peritoneal cavity is synonymous with extra-uterine pregnancy. All the same, when the authors reviewed 429 cases of haemoperitoneum 17 were shown not to be due to ectopic pregnancy. Ruptures of ovarian cysts and uterine perforation from illegal abortions are often found but more rarely, have been rupture in the blind horn of a bicornuate uterus, choriocarcinoma in the tube, tubal bilharzia and thrombopenia due to AIDS. It is essential to carry out histological examination for the differential diagnosis between an ovarian pregnancy and a ruptured cyst as well as choriocarcinoma or bilharzia. If it is not possible to find the site of the bleeding even after looking underneath the mesocolon, a search must be made for coagulation disorders due to a virus such as HIV.

Choriocarcinoma↗

PubMed1990

[The sequela of peri-hepatitis due to Chlamydia trachomatis (Fitz-Hugh-Curtis syndrome) seen during an ectopic pregnancy].

Between January 1st and May 31 1989, there were 31 cases of perihepatic adhesions (Fitz-Hugh-Curtis syndrome) about 90 ectopic pregnancies (rate: 34 p. cent). The Chlamydia's serology is positive at 1/64 level in 97 p. cent of cases and at 1/256 level in 72 p. cent. Only three cases are not allied with pelvic disease. Peri-splenitis accompanies severe hepatitis (3 cases) and no perinephritis was observed in this study. The authors emphasize the wish to explore perihepatic space in all pelvic surgery. In the department of Gynecology and Obstetrics at the University Hospital of Libreville, increased the rate of ectopic pregnancy (1 for 44 deliveries), this coincides with the increased prevalence to Chlamydia trachomatis infection (81 p. cent ectopic pregnancies and 63 p. cent deliveries). This situation creates a new and greater problem of health in sub-Saharan Africa.

Abortion, Spontaneous↗

PubMed1990

[Büschke-Loewenstein tumor during pregnancy. Apropos of 2 cases].

The authors report two cases of Büschke-Loewenstein tumors during pregnancy. The considerable development of this giant condyloma requires a caesarean section, to prevent a possible neonatal contamination of the newborn. The course is complicated with recurrences and the treatments are disappointing during the pregnancy. After birth, regression may be spontaneous (case no. 2). Most of the time, after a surgical biopsy is performed, for an accurate pathological examination, electrocoagulation, cryotherapy or CO2 laser result in the cure of the patient. Monitoring must be long-lasting because of the risk of spinocellular degeneration and node metastases. The papillomavirus in cause is the type HPV 6 or 16 and a few cases are described with types 16, 18, 32. The high frequency of accumulated condylomas and the possibility of rapid spread make this disease very current: the human immunodeficiency virus is one of the cofactors of transformations into verrucous carcinoma.

Adult↗

PubMed1989

[Extra-uterine pregnancy. Study of 509 cases surgically treated at the University Hospital Center of Libreville].

Extra-uterine pregnancy is the principal emergency procedure undertaken in the University Department of Libreville. We study 509 cases treated surgically between 1984 and 1987, which is a level of 16/1,000 deliveries. The incidence of rupture of the tube has driven us to search for the best possible means to diagnose the condition earlier. Ultrasound gives the best results, dropping the level of ruptured tubes from 83% in 1984 to 50% in 1987. Extra-uterine pregnancy in nulliparous patients (25% of the group) presented a third of recurrent ectopics. The anatomopathological examination of the tissues emphasizes how common acute or chronic infections of the tubes are (25%) and salpingitis isthmica nodosa (31% of cases). If sexually transmitted diseases can be prevented the incidence of ectopic pregnancies will drop. We have tried since 1986 to be conservative in our surgery hoping that a secondary plastic operation will improve the fertility of these young patients. Mortality was high (13.75/1,000 ectopics). The principal factor responsible for this high figure is the absence of blood transfusion banks which delayed resuscitation and exposed the patients to the risk of coagulation defects when surgery is practised on these patients who are still shocked.

Adolescent↗

PubMed1989

[Perinatal and maternal risks in multiple pregnancies].

The perinatal risk in multiple pregnancies is part of the traditional gabonese culture. The authors study the perinatal mortality of twins which is four times higher than in single pregnancies. Prematurity represents the main etiology: 30 p. cent of twin deliveries occur before 32 weeks. The fetal prognosis improves from 2,000 g but deteriorates beyond 2,500 g, emphasizing the role of intra-uterine hypoxia aggravated by the obstetrical trauma. The increased mortality of the second twin, which was demonstrated by all, and the birth delay, become harmful beyond 30 minutes. The maternal pathology consists in frequent hypertensive complications and severe gravidic anemias. The maternal mortality is three times higher than in single deliveries and is related to delivery haemorrhages. The authors propose to improve the prognosis with early ultrasonographic diagnosis and pregnancy monitoring, along with social measures covering a number of prenatal tests, with hospital delivery supervised by obstetrical and neonatal teams. On the contrary, they do not believe that caesarean section is a determining factor in the improvement of fetal prognosis.

Female↗

PubMedDate not supplied

[Eclampsia at the Hospital Center of Libreville. 53 cases among 41,285 deliveries from 1985 to 1989].

Eclampsia is a serious complication at the end of pregnancy. This retrospective study over a 5-year period at the Libreville CHU hospital shows that the incidence of 0.12 p. cent is comparable to the incidence fond in other countries at a similar level of development. Promoting causes include youth of the patients, twin births, the "cold" season, the lack of follow-up after prenatal consultations. The consequences are increased maternal and perinatal death. Cesarean section remains the best way of dealing with an attack of eclampsia and improves both maternal and fetal prognosis. It is possible to eliminate, or at least reduce, the number of cases by developing conscientious and regular prenatal consultations.

Adolescent↗