Objective: To report the experience of surgical caravans for urogenital fistulas care. Methodology: This was a retrospective study covering the period from January 2014 to December 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomoclinical, therapeutic and evolutionary aspects were studied. Results: 346 patients were operated during 14 caravans. Their average age was 33.11 years (range: 12 to 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). The average duration of fistula progression was 6.08 years (range: 0 to 42 years). Obstetrical etiology was predominant (87.9%). According to the classification of Kees Waaldijk, fistulas were divided into type I (67.4%), type II (21.1%), and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Across the cohort, 80 patients (23.1%) were lost of sight for follow-up at 1 month and 245 (70%) at 3 months. The success rates evaluated in patients reviewed at 1 month and 3 months were respectively 70% and 64%. Conclusion: The incidence of urogenital fistulas is still high in Côte d'Ivoire. Various anatomoclinical varieties have been identified and treated with satisfactory results in poorly equipped local structures.
Objective: To report the experience of Gynecology Department of the University Hospital of Treichville in the management of the inflammatory breast cancers. Methodology: We conducted a retrospective and descriptive study on cases of the inflammatory breast cancers managed in the Gynecology Department of the University Hospital of Treichville, from January 2011 to December 2015. Results: We collected 44 cases of inflammatory breast cancer representing 17.9% of all breast cancers. The average age of patients was 46.5 years (32 -70 years) and among them, the majority had inadequate socioeconomic level (90.9%). The risk factor for cancer found in the majority of patients was the age of first menstrual periods before the age of 12 years (52.3%). The average consultation time was long (10 months) and several patients had extensive inflammatory signs (38.6%), with lymph node involvement (84.1%) and metastases (36.4%). At the histological analysis, the most common type was invasive ductal carcinoma (81.8%), SBR grade III (54.5%). Regarding treatment, mastectomy according to Patey associated with a chemotherapy was performed in 22.7% cases. The evolution has been marked by an overall 5-year survival of 20%. Conclusion: The management of inflammatory breast cancers was late and incomplete in our service making poor prognosis.
Objective: Describe the occurrence delays of metastatic relapses of breast cancer based on the characteristics of the original tumor. Methodology: This is a retrospective and cohort study conducted from January 2000 to December 2015 on patients with metastatic relapse of breast cancer. Results: Out of 178 patients collected, the metastatic relapses were estimated at 49%, occurring in patients with an average age of 53.4 years. The majority of the patients was educated (91.6%) and did not have a high socioeconomic level (88.2%). The initial tumors were mainly at a clinical stage III (47.8%), SBR grade III (47.2%), high index Ki 67 (46.5%), negative RH (79.3%) and HER2 negative (58%). Metastases were unique in general (62.9%), dominated by bone locations (36.6%), with an average age of occurrence of 2.4 years. After the occurrence of these metastases, the cumulative survival rate was 5% at 3 years, and zero to 5 years. Conclusion: Metastatic relapses were common with poor prognosis.
Objective: To improve the care of evacuees at the maternity of the University Hospital Center of Bouaké (CHUB). Methodology: This is a cross-sectional and descriptive study over a period of three months that covered 630 cases collected at the Maternity of the university Hospital of Bouaké. Results: Obstetric evacuation accounted for 42.5% of admissions to the delivery room. Patients under 20 years and over 34 years of age respectively represented 21% and 13.5% of the total. 62.7% of evacuees were not educated and 84.9% had low economic level. Nulliparous and multiparous women accounted for 54.9% of the patients and 88% had mean prenatal follow up. The evacuations were decided by midwives (91.3%), without previous adapted treatment (79.4%), with a badly filled evacuation card (49.7%) and no partograph. The taxi was the most used means of transportation (75.2%) and most evacuees took less than one hour to access the referral center (61.4%). The reasons for evacuation are mainly dominated by mechanical obstructions (34.8%); on admission the evacuees with no real reference reason were 243 (38.6%) and the diagnosis was inconsistent in 43% of cases. The majority of evacuated women delivered vaginally (69.4%). Most newborns had a satisfactory state at the 5th minute of life (79.4%) and we noted 54 cases (08.3%) of neonatal deaths. 7.8% of evacuees had a complication dominated by postpartum anemia (51.1%); we had lamented 17 cases (2.7%) of maternal deaths among evacuees, attributable to delivery haemorrhage (47.1%) and eclampsia (23.5%). Conclusion: A better organization of the reference and an equipment of the peripheral health structures would improve the prognosis of the evacuees.
Background: The urogenital fistula (UGF) which designate a solution of continuity between the urinary and genital tracts in women, are divided into several entities of variable gravity. The objective of this study was to describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesicouterine fistula during ‘fistulas surgical caravans’.Methods: This was a prospective and descriptive study on a cohort of 34 patients treated for Vesico-uterine fistulae during ‘‘fistulas surgical caravans '' from 1st January 2012 to 31st December 2016.Results: Vesico uterine fistulae represented 2.1% of all urogenital fistulae treated. At the time of occurrence of fistulas, the average age of the patients stay was 33.3 years, and the majority was not educated (88.2%), lived in rural areas without occupations (73.5%). All the fistulae were secondary to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was done by caesarean section in 97.7% of cases. Then the average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The cure rate after this surgical technique was 97.1% (33 patients). The only case of failure required a second operation by another technique which permitted the healing of the patient.Conclusions: The vesicouterine fistulae were rare and the satisfactory results of their management invite us to sustain these surgical caravans and ensure their widespread.
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