Assessment of the side effects of progestogen only contraception in the immediate postpartum period: the case of implants with levonorgestrel Jadelle®

Background: The aim of this study was to evaluate the side effects of Jadelle® implants in the immediate postpartum.Methods: To do this, we inserted the implants at two different postpartum period: first, between the first and the seventh day for the immediate postpartum period (IPP) group; second, between the 45th and the 3rd postpartum months for the late postpartum (LPP) group. The variables studied were age, gesture, parity, abortions, number of live children, childbirth, caesarean section, quality of milky climb, age last child, pregnancy-attendant, pregnancy term at time of delivery, complaints, weight.Results: From May 2012 to December 2013, we collected two hundred patients, one hundred from each group (immediate postpartum and late postpartum). The average age of mothers in the IPP group was 28 years and 29 years for LPP group. After insertion, in both group, spotting were the most frequent complaints. The weight variations were between +800 g and -600 g for the group IPP and +260 g and -170 g for the other group; which makes a statistically significant difference. In both groups, at the end of the six months, no patient had menstruation.Conclusions: Our results are encouraging to further promote contraception in the immediate postpartum period in developing countries and thus reach a wide range of users. We can therefore say that the side effects are not different during this period and largely are also tolerated

Tumeur à cellules de Sertoli-Leydig de l’ovaire: à propos d’un cas chez une jeune fille de 22 ans

Les tumeurs à cellules de Sertoli et Leydig sont des tumeurs sécrétantes rares du mésenchyme et des cordons sexuels. Cependant elles constituentl’une des tumeurs le souvent responsables de syndrome de virilisation. La certitude diagnostique est histologique après la chirurgie et il n’ y'a pasde signe échographie spécifique malgré la forte présomption clinique. Le pronostic comme la plupart des néoplasies est lié au degré dedifférenciation cellulaire et la présence d’éléments hétérologue en leur sein. L’objectif de notre travail était de rapporter un authentique syndromede virilisation chez une jeune fille de 22 ans secondaire à une tumeur non épithéliale de l’ovaire à cellule de Sertoli et à cellule de Leydig. Lesformes peu différenciées des tumeurs de Sertoli-Leydig ont un potentiel de malignité non négligeable. Le traitement est chirurgical, lachimiothérapie par association de sels de platine et de taxanes constitue un adjuvant intéressant. Le pronostic après la chirurgie est dominé pardes récidives. Sertoli-Leydig cell tumors are rare secreting mesenchymal and sex cord-stromal tumors. However, they constitute one type of tumor most often responsible for virilization syndrome. A definite diagnosis is provided by histological examination following surgical excision of the tumor. It has no characterizing features on ultrasonography, in spite of the strong clinical presumption. Like many neoplasias, prognosis is related to the degree of cellular differentiation and to the presence of heterologous elements. The aim of our study was to report the case of a 22-year old woman suffering from a real virilization syndrome secondary to non-epithelial Sertoli-Leydig cell tumor of the ovary. Poorly differentiated Sertoli-Leydig tumors have high malignant potential. Treatment is surgical; taxane-platinum combination chemotherapy is an interesting adjuvant. Prognosis after surgical resection is related to the risk of relapses. 

Funiculars anomalies during childbirth: about 562 cases collected in Pikine National Hospital

Background: Establish an epidemiological description of the different types of umbilical cord anomalies in our reference structure and to assess their impact on the prognosis of childbirth.Methods: We conducted a descriptive study, cross over a period of one year in Obstetrics and Gynecology Service Level III of Pikine Hospital. We included all women in labor have reached the term less than 28 weeks gestation and delivering a newborn with umbilical cord abnormality diagnosed during labor or during the expulsion.Results: During this period, we compiled 562 anomalies of the umbilical cord, which gave a frequency of 23.8%. Length discrepancies were far the most frequent (67.4%). Only the prolapsed cord was an independent risk factor for cesarean section (p = 0.036). The rate of episiotomy and tear was significantly higher in case of brevity (primitive or induced) cord (p = 0.042). Apgar score ≤7 was significantly related to the presence of brevity (p = 0.000), excessive length (p = 0.048) or cord prolapse (p = 0.037).Conclusions: This study has allowed us to see that the funicular abnormalities impede the smooth running of childbirth. Their occurrence is facilitated by the excess amniotic fluid, prematurity and low birth weight. Their research during prenatal ultrasounds should be systematic

Laparoscopic management of cervical and endometrial cancer in Africa: experience of the National Hospital Centre of Pikine

Background: Laparotomy represents the standard historical surgical approach to these cancers. Process of treatment of benign adnexal pathologies to the emergence of a new pathway for the management of these cancerous pathologies.Methods: Our prospective study from December 2016 to December 2018 included 10 patients with early-stage uterine cancer and endometrial cancer confirmed by MRI. The characteristics of patients, their cancer, their intervention and morbidity were revealed.Results: Our results show that the average age of the patients was 63 years; There were 2 cases of cervical cancer and 8 cases of endometrial cancer. For cervical cancer, it was essentially squamous cell carcinoma; one patient was at stage Ia2 and the other at stage Ib1. For endometrial cancers, squamous cell carcinoma was 80%; 6 patients were in stage IB and 2 in stage IC. Of the 10 patients undergoing surgery, 9 had laparoscopic colpohysterectomy and lymphadectomy and one complementary laparoscopic lymphadenectomy. The average number of lymph nodes removed was 9 and no lymph node metastasis was found. In the immediate postoperative period, one patient had transient urinary incontinence and another had vaginal slice lymphorhea.Conclusions: The main interest of this practice is to be the least morbid possible for patients at the early stage. With our short experience, we obtained a reduction in operating time, a reduction in hospital stay, a decrease in the consumption of analgesics and antibiotics postoperatively and a reduction in per and postoperative complications

Tumeur à cellules de Sertoli-Leydig de l’ovaire: à propos d’un cas chez une jeune fille de 22 ans

Les tumeurs à cellules de Sertoli et Leydig sont des tumeurs sécrétantes rares du mésenchyme et des cordons sexuels. Cependant elles constituent l’une des tumeurs le souvent responsables de syndrome de virilisation. La certitude diagnostique est histologique après la chirurgie et il n’ y'a pas de signe échographie spécifique malgré la forte présomption clinique. Le pronostic comme la plupart des néoplasies est lié au degré de différenciation cellulaire et la présence d’éléments hétérologue en leur sein. L’objectif de notre travail était de rapporter un authentique syndrome de virilisation chez une jeune fille de 22 ans secondaire à une tumeur non épithéliale de l’ovaire à cellule de Sertoli et à cellule de Leydig. Les formes peu différenciées des tumeurs de Sertoli-Leydig ont un potentiel de malignité non négligeable. Le traitement est chirurgical, la chimiothérapie par association de sels de platine et de taxanes constitue un adjuvant intéressant. Le pronostic après la chirurgie est dominé par des récidives.The Pan African Medical Journal 2016;2

Pituitary microadenoma with prolactin, corticotropic and thyreotropic deficiency: from infertility to pregnancy : About a case

Pituitary adenomas are benign tumors developed at the expense of different cellular populations of the pituitary gland. Within the pituitary gland, several cell populations may be involved, but the lactotropic cells remain the most frequently affected by this hyperplasia. For both sexes, the overall frequency of adenomas is 100 per million, of which 40% are prolactinomas. The stimulating effect of estrogens (combined oral contraceptives and pregnancy) on lactotropic cells has long been demonstrated, and in general, only large tumors (macroadenomas) have an evolving risk to be feared during pregnancy. The diagnosis rests on the one hand on the evidence of a hormonal hypersecretion of the cell population concerned as well as a hormonal deficiency of the other cell groups which can be compressed by the tumor. On the other hand, this diagnosis uses hypophyseal magnetic resonance imaging (MRI) to distinguish, according to their size, microadenomas (diameter less than 10 mm) from macroadenomas (diameter greater than 10 mm) pituitary. The risk of increasing the volume of the adenoma during pregnancy depends on the initial size of the tumor. This risk is evaluated at 2% for microadenoma and 15-35% for macroadenomas. However, the most severe complication during pregnancy remains paroxysmal acute growth or pituitary apoplexy by necrotic-haemorrhagic phenomena. The management is mainly based on prolactinoma on bromocryptin or cabergoline and sometimes surgery, urgently in the presence of a pituitary apoplexy or in the presence of an evolutionary macroadenoma