DEGENERESCENCE KYSTIQUE DE MYOMES UTERINS SIMULANT UN CANCER DE L’OVAIRE : ETUDE D’UN CAS AU CHU DE KARA, AU NORD DU TOGO

Objective : We repport a case of cystic degeneration of two uterine myomas mimicking ovarian cancer. Observation : It concerned a fourty yaers old patient with uterine polymyoma, receeved at jully 15th, 2014 for progressive abdominal tumefaction and recurrent menemetrorrhagia. Huge and renitent mass distended her abdomen. Hemoglogin concentration was 5,78 g/dl and renal assessment was normal. Abdominal ultrasound revealed a huge mixte tumor with ascendancy of the cystic component and uterine polymyoma. Abdominopelvic scanner noted the mixte character of the tumor and suspected his ovarian origin and his malignancy. Tumor was 38 cms of main line. Ther was neither vegetation, nor ascite and nor abdominopelvic lymphatic nods. Xyphopubian laparotomy was practised after correction of the anemia and after prevention of thromboembolic desaese. In the openning, ovaries were normal ; there was left hydrosalpinx ; uterus was polymyomatous with two pediculed cystic degenerescence sub serous myoma measuring 40 cms and 15 cms. Conclusion : Cystic degenerescence of uterus myoma, whatever is rare, can be huge and mimic ovarian cancer instead of médical imaging contribution. It’s necessary to think of behind renitent adnexial masse in clinical context of uterus myoma

Premature Rupture of the Membranes at the Sylvanus Olympio University Hospital of Lomé, Togo: Microbiological Findings and Outcomes

Abstract Introduction: To prevent the risk of infections in cases of premature rupture of the membranes (PROM), a pregnancy complication, gynecologists of the Sylvanus Olympio University Teaching Hospital used clavulanic acid and amoxicillin as empiric antibiotic therapy intravenously. This study aims to identify and assess the susceptibility to antibiotics of bacteria involved in PROM. Methods: A cross-sectional study was conducted from February 25 to June 06, 2014 on 60 pregnant women presenting a PROM and their 65 newborns, recruited in the Gynecology and Obstetrics Service of the Sylvanus Olympio University Teaching Hospital of Lomé, Togo. In mothers, cytological and bacteriological examinations of vaginal and endocervix swabs were carried out and among newborns, cytological and bacteriological examinations were performed on gastric fluid and ear swabs at the Microbiology Service of the university hospital. Results: The frequency of PROM was 6.8% of deliveries during the study period. Pathogens were isolated among 48.3% of mothers and 26.2% of newborns. Vaginal and endocervix swabs allowed isolation of pathogens in 45% and 28.3% of cases, respectively. The most isolated pathogens were Candida albicans (28.6%)(14/53) and enterobacteria (41.5%)(22/53), mainly represented by Escherichia coli (59.1%)(13/22). We also isolated Group B Streptococci (GBS) strains (7.5%)(4/53). Pathogen isolation rate among newborns was 26.2%(17/65). Of these pathogens, Escherichia coli represented 60%(15/25). Pathogens found in 10.7% of newborns were phenotypically identical to those isolated from their mothers. Among newborns, E. coli was the most isolated strain in gastric fluid (66.7%)(4/6) as well as from ear swabs (57.9%)(11/19). Conclusion: Half of PROM cases in this study were associated with presence of pathogen amongst pregnant women; E. coli and Group B Streptococcus known to cause neonatal meningitis were found. Unfortunately, a few isolated strains of E. coli were resistant to clavulanic acid-amoxicillin, a combination used as empiric antibiotic therapy by healthcare practitioners in our settings