HYDROCEPHALIE: UN CAS RARE DE TOXOPLAMOSE CEREBRALE DANS LE CADRE D\'UN SYNDROME D\'IMMUNO-DEFICIENCE ACQUISE

HYDROCEPHALUS: A RARE PRESENTATION OF CENTRAL NERVOUS SYSTEM TOXOPLASMOSIS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME SUMMARY The incidence of HIV infection and the neurological complications are increasing, especially in developing countries. Hydrocephalus due to cerebral toxoplasmosis is very rare and only 7 cases have been reported in the literature . The authors report a case of hydrocephalus related to toxoplasmosis of the 4th ventricles in a HIV patient successfully treated medically without shunting. The mechanism of the hydrocephalus is a necrotizing ependymitis and plexitis obstructing the CSF flow although the cerebral parenchyma has a normal CT appearance in many cases. CNS toxoplasmosis should be ruled out in any immuno-deficient patient with hydrocephalus of unknown origin. The permanent CSF shunting may not be necessary in hydrocephalus due to CNS toxoplasmosis, and external CSF shunting may only rarely be needed. RESUME Les auteurs présentent un cas d\'hydrocéphalie associée à une toxoplasmose du IV ème ventricule chez un patient HIV positif, traité médicalement avec succès, sans dérivation du LCS. Le mécanisme de l\'hydrocéphalie est une épendymite et une plexite nécrosante obstruant la circulation du LCS, même si le parenchyme cérébral apparaît normal au scanner dans plusieurs cas. Une toxoplasmose du système nerveux central doit être recherchée chez tout patient immunodéprimé avec une hydrocéphalie d\'étiologie indéterminée. Une dérivation permanente du LCS ne serait pas nécessaire au cours de l\'hydrocéphalie entrant dans ce cadre. La dérivation ventriculaire externe peut être implantée dans de rares conditions. Key Words: CNS toxoplasmosis, AIDS, hydrocephalus, medical treatment, Cameroon, Afrique, Cameroun, Hydrocéphalie, Toxoplasmose, VIH, SIDA African Journal of Neurological Sciences Vol.23(2) 200

Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital

Abstract Background The incidence of posterior urethral valve (PUV) is estimated at 1:5000–1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV. Methods Retrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality. Results A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%. Conclusion Many patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction

Infantile hypertrophic pyloric stenosis: a 4-year experience from two tertiary care centres in Cameroon

Abstract Objective This study aimed to describe the clinical characteristics of patients with infantile hypertrophic stenosis, management and its outcome in two tertiary care centres in Cameroon. Results A total of 21 patients were included from the two centres. The mean age at presentation was 5.2 ± 1.2 weeks, predominantly male with a male-to-female ratio of 4.25:1. The triad of vomiting, visible peristalsis and palpable mass was present in only 7 (33.3%) of the participants. The diagnosis was confirmed with ultrasounds in all participants. Ramstedt pyloromyotomy was done in all participants and in 9.5% of the participants it was complicated by intra-operative duodenal perforation whereas in the postoperative period the most common complications were vomiting (6, 28.6%), sepsis (2, 9.5%), and paralytic ileus (2, 9.5%). The mortality rate from the series is 9.5%. According to univariate logistic regression: severe dehydration [OR = 5.41, 95% CI = (3.11–6.97), p = 0.002], hypokalaemia [OR = 2.63, 95% CI = (1.02–5.91), p = 0.042] and surgical site infection [OR = 3.12, 95% CI (1.22–5.64), p = 0.023] were the main predictors of mortality whereas postoperative hospital length of stay > 5 days was significantly associated with surgical site infection [OR = 2.44, 95% CI = (1.12–6.44), p = 0.002] and postoperative nausea and vomiting [OR = 3.64, 95% CI = (1.18–6.64), p = 0.022]

Hypertrophie bénigne de la prostate: Étude comparative des résultats de la résection transurétrale et de l’adénomectomie

Introduction : L‘Hypertrophie Bénigne de la Prostate (HBP) représente la tumeur bénigne la plus fréquente de l’homme âgé de plus de 50 ans. Plusieurs modalités thérapeutiques sont possibles. Nous avons proposé ici de comparer les résultats entre l’Adénomectomie Trans-Vésicale (ATV) et la Résection Transurétrale Prostatique (RTUP). Matériel et méthodes : Étude transversale analytique sur 86 patients traités au Service d’Urologie de l’Hôpital Central de Yaoundé pendant 2 ans, soit 43 patients pour chaque groupe. Les données sociodémographiques, cliniques et thérapeutiques ont été saisies sur CSPRO version 7.1, analysées sur SPSS version 21.0 et Excel 2016 avec la valeur significative de P ≤ 0,05. Résultats : La moyenne d’âge des patients était de 67 ans et l’indication opératoire était l’échec du traitement médical, la rétention d’urine, le volume de la prostate ≤ 80g et le choix de la technique chirurgicale. Le groupe des ATV enregistrait une durée d’intervention plus longue, une transfusion sanguine systématique, une durée de cathétérisme et d’hospitalisation plus longue que la RTUP. Par contre, on n’enregistrait pas de différence significative en termes de débit urinaire, le Score International des Symptômes de la Prostate (IPSS) et la Qualité de Vie (QV) entre les deux groupes. Conclusion: Comparer l’ATV à la RTUP dans notre travail s’accompagne d’une durée d’intervention plus longue, une transfusion sanguine systématique, une durée de cathétérisme et d’hospitalisation plus longue pour le premier; par contre, en termes de résultats fonctionnels, il ne semble pas avoir de différences significatives entre les deux techniques. La RTUP reste la technique de choix si plateau technique disponible.   English title: Benign prostatic hyperplasia: a comparative study of the results, transurethral resection and adenomectomy Introduction: Benign prostatic hyperplasia (BPH) is the most common benign tumor in men aged over 50. Several therapeutic modalities are possible. We proposed here to compare the results between Transvesical Adenomectomy (TVA) and Transurethral Prostatic Resection (TURP). Materials and methods. Analytical cross-sectional study of 86 patients treated at the Department of Urology of the Yaounde Central Hospital for 2 years that is 43 patients in each group. Sociodemographic, clinical and therapeutic data were entered on CSPRO version 7.1, analyzed on SPSS version 21.0 and Excel 2016 with the significant value of P≤ 0.05. Results. The average age of the patients was 67 years and the operative indication was the failure of medical treatment, urine retention, prostate volume ≤ 80g and choice of surgical technique. The TVA group recorded longer operative time, systematic blood transfusion, catheterization time, and hospitalization time than TURP. However, there was no significant difference in urine output, International Prostate Symptom Score (IPSS) and Quality of Life (QL) between the two groups. Conclusion. Comparing TVA to TURP in our work is accompanied by a longer intervention time, a systematic blood transfusion, a longer catheterization and hospitalization time for the first one; on the other hand, in terms of functional results, there seems to be no significant difference between the two groups. TURP remains the technique of choice if technical platform available