Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012–November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n=1), urethral dilatation (n=1), vesicostomy (n=2), and urethral catheterization (n=3). With a median follow-up of 8.2 months (4–16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered

Limb lengthening in Africa: tibial lengthening indicated for limb length discrepancy and postosteomyelitis pseudarthrosis

Farikou Ibrahima,1,2 Pius Fokam,2 Félicien Faustin Mouafo Tambo11Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, 2Department of Surgery, Douala General Hospital, Douala, CameroonBackground: We present a case of lengthening of a tibia to treat postosteomyelitis pseudarthrosis and limb length discrepancy by the Ilizarov device.Objective: The objective was to treat the pseudarthrosis and correct the consequent limb length discrepancy of 50 mm.Materials and methods: The patient was a 5-year-old boy. Osteotomy of the tibia, excision of fibrosis, and decortications were carried out. After a latency period of 5 days, the lengthening started at a rate of 1 mm per day.Results: The pseudarthrosis healed and the gained correction was 21.73%. The index consolidation was 49 days/cm. Minor complications were reported.Discussion: Osteomyelitis of long bones is a common poverty-related disease in Africa. The disease usually is diagnosed at an advanced stage with complications. In these conditions, treatment is much more difficult. Most surgical procedures treating this condition use the Ilizarov device. The most common reported surgical complications are refractures and recurrence of infection.Conclusion: This technique should be popularized in countries with limited resources because it would be an attractive alternative to the amputations that are sometimes performed.Keywords: Limb length discrepancy (LLD), bone gap, Ilizarov devic

Traitement des fractures diaphysaires fémorales de l'enfant à Yaoundé : à propos de 22 cas.

Vingt deux fractures diaphysaires fémorales ont été colligées et traitées en 7 ans et 9 mois chez 21 enfants âgés de 0 à 15 ans. La prédominance masculine, la primauté du siège au1/3 moyen diaphysaire et du chevauchement comme déplacement ont été remarquables. Le traitement orthopédique a constitué l'essentiel du geste thérapeutique prenant en compte l'âge, le type de fracture, les lésions associées et le coût. Le traitement chirurgical chez un patient a été compliqué d’une pseudarthrose septique à distance. Quelque soit la méthode thérapeutique, 27,2% des patients ont présenté une inégalité de longueur des membres inférieurs d’au moins 10mm. Les auteurs soulignent les aspects thérapeutiques de ces affections.Mots clés : fractures diaphysaires, fémur, enfant

Les indications de la coeliochirurgie chez l'enfant: A propos de 36 cas en milieu Africain.

Les auteurs rapportent 36 cas de coeliochirurgie réalisés chez l'enfant, sur une période de 5 ans à Abidjan au CHU de Treichville et dans trois structures sanitaires privées. Ils soulignent les handicaps à la promotion de la coeliochirurgie chez l'enfant en milieu africain et notent que cette nouvelle voie d'abord est un bel exemple de transfert de technologies aux pays en voie de développement.Thirty-six cases of laparoscopic surgery in children seen over a 5 year period in Abidjan in the University Teaching Hospital in Treichville and 3 private health facilities are reviewed. Emphasis is placed on the obstacles in the promotion of laparoscopic surgery in children in the African context. It is also demonstrated that this modern surgery is a good example of transfer of technology to developing countries. Keywords: Coelio-chirurgie - Enfant- Milieu africain. Clinics in Mother and Child Health Vol. 3(2) 2006: pp. 579-58

Traitement des fractures supracondyliennes de l’humerus chez l’enfant a Yaoundé ; à propos de 27 cas

Les fractures supracondyliennes de l’humérus (FSCH) sont la lésion traumatique la plus fréquente du coude de l’enfant et imposent un traitement précoce et adapté afin d’éviter les complications hautement handicapantes. Cependant, le choix thérapeutique demeure discuté notamment dans ses formes déplacées.Nous avons mené une étude rétrospective sur une période de 13 ans avec réévaluation clinique des patients dans le service de chirurgie pédiatrique de l’Hôpital gynéco-obstétrique et pédiatrique de Yaoundé. L’objectif principal de cette étude était de décrire les indications thérapeutiques des FSCH dans notre contexte et d’en évaluer les résultats à moyen et long termes particulièrement le pronostic fonctionnel de ces patients.Nous avons colligé 27 cas de FSCH. L’âge moyen des patients était de 6,22 ans. Onze patients (40,74%) avaient préalablement eu recours à des rebouteux. 16 patients (59,26%) ont consulté audelà de 48 heures. Les fractures étaient majoritairement de types IV (62,96%) et III (18,52%) de Rigault et Lagrange. Le traitement chirurgical a été réalisé chez 21 patients (77,78%) et a consisté en une réduction sanglante par abord paratricipital associée à un embrochage en croix chez 17 patients (62,96%).Du fait des particularités telles que les retards de consultation et l’interférence des tradipraticiens,  propres aux pays à ressources limitées, la réduction sanglante avec embrochage en croix est une option thérapeutique satisfaisante dans les FSCH déplacées et vues tardivement.Mots-clés: Humérus, Fracture supracondylienne, Enfant, Embrochage, Blount, AfriqueEnglish AbstractThe supracondylar fractures of the humerus (SCFH) are frequent traumatic lesions of the elbow in children warranting an early and adapted treatment to avoid complications related to functional impairment of the limb. However, their therapeutic choice in this pediatric population remains a cause of orthopaedic debate, particularly for displaced fractures. The main objective of this study was to describe the therapeutic indications of pediatric SCFH in our resourcechallenge setting and to evaluate the functional prognosis of patients comparatively to the literature.Patients and method: We conducted a retrospective study over a period of 13 years with physical re-evaluation of patients in the pediatric surgical department of the Gyneco-Obstetrics and Pediatric Hospital of Yaoundé in Cameroon. We enrolled 27 children with SCFH. Their mean age was 6.22 years. Eleven patients (40.74%) had sought traditional treatment as first-line management. Sixteen patients (59.26%) consulted beyond 48 hours. Fractures were predominantly Type IV (62.96%) and III (18.52%) of the Rigault-Lagrange’s classification. Surgical treatment was performed in 21 patients (77.78%) and a cross-pinning after an open reduction was performed in 17 patients patients (62,96%).Due to particularities such as consultation delays and the interference of traditional healers in resource-limited settings, surgical reduction with  pinning of fracture is a satisfactory treatment option for displaced and late-seen SCFH in children.Keywords: Humerus, Supracondylar fracture, Children, Pinning, Blount, Afric

Emergency total gastrectomy for massive haemorrhage in a low income country

Background: Gastric cancer is the second most common cancer of the gastrointestinal tract behind colorectal cancer in Cameroon. Total gastrectomy which is recommended for proximal gastric cancer is rarely performed and has not been reported in this country.Aim: To report emergency gastrectomy  for life threatening haemorrhage of proximal gastric tumours.Methods: The case notes of all the patients who had total gastrectomy in two major hospitals in Cameroon from August 2002 to September 2009 were reviewed.Results: During the period, 15 patients had total gastrectomy for cancer. Five (5) patients out of these had emergency total gastrectomy for uncontrollable bleeding proximal ulcer cancer. All the cases were males with the mean age of 64.6years.  A total gastrectomy with a D2 lymph node dissection and a Roux-en-Y oesophago-jejunostomy was carried out. A splenectomy was done in cases when the spleen was involved. Histo-pathological report revealed an adenocarcinoma in 4 cases (80%) and a lymphoma in one case (20%). There was no perioperative mortality but there was a minor complication of superficial wound infection in one case. One patient was lost to follow-up. Two (2) patients died at 18 months and 2 years respectively after the surgery while 2 patients are still alive.Conclusion: Proximal gastric cancer is more common in men in Cameroon. From our results, it is implied that total gastrectomy can be performed in Cameroon with few complications and an acceptable survival rate. Keywords: Emergency total gastrectomy; Cancer; Bleeding; Oesophago-jejunostom

Challenges in the Diagnosis and Management of Acquired Nontraumatic Urethral Strictures in Boys in Yaoundé, Cameroon

Introduction. Urethral strictures in boys denote narrowing of the urethra which can be congenital or acquired. In case of acquired strictures, the etiology is iatrogenic or traumatic and rarely infectious or inflammatory. The aim of this study was to highlight the diagnostic and therapeutic difficulties of acquired nontraumatic urethral strictures in boys in Yaoundé, Cameroon. Methodology. The authors report five cases of nontraumatic urethral strictures managed at the Pediatric Surgery Department of the YGOPH over a two-year period (November 2012-November 2014). In order to confirm the diagnosis of urethral stricture, all patients were assessed with both cystourethrography and urethrocystoscopy. Results. In all the cases the urethra was inflammatory with either a single or multiple strictures. The surgical management included internal urethrotomy (n = 1), urethral dilatation (n = 1), vesicostomy (n = 2), and urethral catheterization (n = 3). With a median follow-up of 8.2 months (4-16 months) all patients remained symptoms-free. Conclusion. The authors report the difficulties encountered in the diagnosis and management of nontraumatic urethral strictures in boys at a tertiary hospital in Yaoundé, Cameroon. The existence of an inflammatory etiology of urethral strictures in boys deserves to be considered

A case report of Cowper′s syringocele in an 18-months old infant at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital

Syringocele or dilatation of the duct of the bulbo-urethral (Cowper′s) gland is usually of congenital origin but can be acquired. It is a very rare deformity, <10 cases have been reported in literature. The main objective is to describe an additional case of syringocele of Cowper′s glands and review the literature. An 18-month-old infant presented with a history of acute urinary retention 3 days after birth and a cystostomy was done. Voiding cystourethrogram was normal and cystourethroscopy showed a syringocele. Endoscopic incision was performed in our patient with satisfactory results. No complications were noted. Syringocele or cystic dilatation of Cowper′s gland duct usually has a congenital aetiology. Diagnosis is confirmed by endoscopy. Treatment is by marsupialisation in the urethra by endoscopy. Syringocele is a rare pathology usually congenital. It should be suspected in all case of lower urinary tract obstruction in children

Assessment of cardiac function in children with congenital adrenal hyperplasia: a case control study in Cameroon

Abstract Background High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group. Methods We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya’s Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured. Results We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values ​​were higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment. Conclusion This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function