Sexual Assault: Epidemiological Profile and Clinical Aspects at the Brazzaville University Hospital Center

Objective: to identify the socio-demographic profile of the alleged victims of sexual assault, to define the characteristics of the aggressors, to describe the types of clinical lesions, and to analyze the link between these different parameters.?During the study period, 5620 clients were admitted to gynecological emergencies, including 150 for sexual assault (2.6%). The alleged victims of aggression were 14 years old on average [range: 2?-?49 years]. Among these clients, there were 147 (98%) women and 3 (2%) men [sex ratio: 0.02]. They had a primary education level of 38%, secondary to 42.7%, and single in 87.2% of cases. Clients came from home (69.3%) or police station (24.7%). The perpetrator was male, with an average age of 25.5 years [range: 16 to 35 years]. Regarding the relationship with the victim, the neighborhood accounted for 83%. The perpetrator was alone in 76.7% of cases, two (14%) or more (16.7%), up to 18.?The aggressor’s home was the place of aggression (39.3%). The threats were made using knives (49.3%) and firearms (8.5%). The perpetrator used either his sex (79.9%), his fingers (34.2%) or an object (2.7%). The route of entry was vaginal (94.6%), anal (21.7%) and oral (10%). The abuser used the condom in 74.7% of cases.?Customers had viewed within 24 hours (40.7%). The general state and hemodynamics at admission was normal for all clients. Physical injuries were injuries (23%) and scrapes (34.5%). External genitalia included perineal tears (28%), vaginal tears (8.6%), hymenal tears (7.3%), and old deflowering (72.7%). The hymen was intact in 20%.?The bi-varied analysis found a correlation with a statistically significant difference in the age range of the alleged victims with the number of aggressors, the time of aggression, the path and type of penetration, and the weapon used for the threat.

Absence of Dressing versus Dressing in Gynaecological and Obstetrical Surgery at the University Hospital of Brazzaville

Objective: To compare the evolution of the operative site in the presence or absence of an occlusive skin dressing. Patients and methods: Prospective, comparative study that took place at the University Hospital of Brazzaville from January 1st to August 31st, 2016. 120 patients were randomly recruited divided into two groups: A study group consisting of 60 patients without a dressing and a control group consisting of 60 patients. Results: Sociodemographic characteristics were similar in both groups, as well as pre- and intraoperative characteristics. Postoperative complications included parietal infection (3 vs. 4 cases, p > 0.05), one case of disunion, and one case of skin irritation by the plaster in the study group. The duration of healing was shorter in the control group compared to the study group (11 ± 2 days vs. 12 ± 2, p > 0.05). The average cost of care equipment was 3.5 times higher for the group with dressing (5120 FCFA vs. 18620 FCFA, p 0.05). In the study group, only one patient was afraid of seeing her wound. Patients in the control group were less satisfied, indeed they dreaded the time of removal of the plaster because of the pain.

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl;P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml;P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA;P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Performance of the Vaginal Touch in the Diagnosis of Vertex Presentation in Posterior Variety

Objective: To evaluate the performance of the vaginal touch in the diagnosis of vertex presentation in posterior variety. Materials Populations and Methods: Transversal analytical study conducted during 4 months (November 2017 - February 2018) at the University Hospital of Brazzaville. This study included parturients with a living foetus in term and in vertex presentation.? The membranes were broken with less than 6 cm of vaginal dilatation. In each case the ultrasound was associated to verify the accuracy of the results of vaginal examination. The statistical tests used were: sensitivity, specificity, positive and negative predictive values, and Youden’s index. Results: One hundred and twenty-two vertex presentations were recorded, of which 31 (25.4%) had a posterior variety diagnosed successively with vaginal examination and ultrasound, while 23 (42.6%) were only on ultrasound. Parturients with foetuses in the posterior and anterior variety were similar in median age (30 [25.5 - 33.5] vs 27.5 [24 - 34], p > 0.05) and parity (2 [1.5 - 3.5] vs 2 [1 - 3], p > 0.05). Vaginal touch had: sensitivity of 57.4% [44.4 - 70.4], specificity of 94.1% [86.7 - 99.3], and Youden’s index of 0.52. The positive and negative predictive values were respectively 88.5% and 73.5%. The vaginal examination was influenced by: examiner (OR = 2.7 [1.21 - 6.07];p 25 kg/m2 (OR = 3.4 [1.07 - 11.07], p Conclusion: The vaginal touch is not very effective in the diagnosis of the vertex presentation in posterior variety.

Voluminous Phyllode Tumour of the Breast: A Case Report and Literature Review from Loandjili General Hospital in Pointe-Noire, Congo

Introduction: Breast phyllodes are rare. Histologically, it is a fibro-epithelial tumour that differs from the fibro-adenoma by a more abundant and more cellular stroma. Observation: We report a case of a large breast phyllode tumour in a 42-year-old woman in the Obstetric and Gynaecology Department of Loandjili General Hospital. This tumor has evolved for 3 years. It is by discomfort due to chest pain. The clinical examination showed a voluminous right breast in the form of a calabash that hung down the body with a large collateral circulation, associated with an appearance of “orange peel”, and an axillary lymph node. In addition, there were necrotic areas and retraction of the nipple. In addition to the clinical characteristics, the ultrasound images and the histological analyses following the biopsy made it possible to evoke the diagnosis of phyllode tumour of the breast. The treatment consisted of a full right simple mastectomy with a 50 cm breast with a major axis that weighed 9465 grams, supplemented by homolateral axillary lymph node dissection. At the section of the tumour measuring 40 cm long, the sectional sections alternately showed solid and cystic areas. The histological examination confirmed the phyllode nature of the tumour with intermediate grade 2 malignancy. The lymph nodes showed an inflammatory appearance, with no signs of malignancy. Early post operation period was uneventful. The patient’s follow-up was annual, and the last check dated 09/01/2017 proved to be normal. Conclusion: The phyllode tumor is a rare pathology. In our environment, it can be greatly increased by the lack of diagnosis and early management. In all cases, any tumour of the breast operated, must benefit from an anatomo-pathological analysis, to determine the benign or malignant character of it, allowing proposing a plan of management better adapted.

Childbirth in the Adolescent Female at the General Hospital of Loandjili (Congo)

Objective: To contribute to the knowledge of the characteristics of teenage birth. Patients and Methods: Retrospective, descriptive and comparative studies, from February 1st 2014 to April 31st 2015, carried out in the Obstetrics and Gynecology Department General Hospital of Loandjili. Included were births of less than 18 years of age at the end of a pregnancy of at least 22 weeks of amenorrhea on the one hand, and adults aged 18 and over, who had given birth at the same end of the pregnancy immediately after the teenager. Thus two populations consisted of 170 cases each. The parameters studied were: Sociodemographic, clinical and prognostic characteristics. Results: During this period, 4190 patients had given birth to 4341 births. Among them, 170 teenage girls are 4%. The average age of teenagers in our study was 16.2 years with a 17-year-age, versus 28.2 years for adults. The average parity was 1.19. While in adults, multiparity was represented at 45.89% with an average parity of 3.19. The average number of prenatal consultations (ANC) was 2.89 for adolescent girls and 31.2% had not been performed. By cons in adults, it was 4.23. These ANCs were started in teenage girls with an average of 22 weeks at the first ANC, while adults started on average at 18 weeks. The average delivery time was 38 weeks of amenorrhea for both populations. Thirty-four cases of premature newborns from adolescent mothers were observed, compared with 14 in adult mothers (p 0.05). The delivery mode was low in 66% of adolescent girls versus 75% of adults. Indications for caesarean section in adolescents were represented by complications of arterial hypertension (38.59%), followed by mechanical dystocia. While in adults, cervical dystocia and scar uteri were the most represented. During this study period, no maternal deaths were recorded among adolescent girls. Characteristics of the newborn: the condition of the newborn at birth was good according to the rating of Apgar among teenagers in 91%, and in adults in 96.5% and, with a birth weight at teenage girls normal in 74% versus 88% in adults. Low birth weight and prematurity were reported with a statistically significant difference in adolescent girls.

Non-Puerperal Uterine Inversion with Uterine Mülleroblastoma in a Teenager: A Case Report of Loandjili General Hospital Pointe-Noire (Republic of Congo)

Introduction: Uterine inversion is a reversal of the uterus into a glove. It is an obstetric complication of deliverance. Uterine inversion out from pregnancy is rare. The Müller duct is an embryonic tubular formation which will transform into the vagina, uterus, and fallopian tubes. The mixed Müllerian malignant tumor is a rare tumor to girl and woman in genital activity, which develops in the uterus at the expense of vestige of the Müller channels. The association of these two pathologies is rare. We report an observation of complicated uterine inversion mulloblastoma to a teenager. Observation: A teenager of 15 years old, admitted for a vulvar tumor, which has occurred about two months. Student in the first class of senior high school, she has no medical history, and no particular surgery. She had her threat at the age of 13, and has a regular menstrual cycle of 30 days, with 05 days of period. Two months before her admission, the patient noticed during her menstruation, the perception of soft intravaginal tissue but which disappeared when her period stopped. A week before her admission, she felt pelvic pain with expulsive colic, radiating to the external genitals, 3 days later, a protusion from the vaginal vestibule of a mass, so the volume gradually increased. It is in front of this situation that the patient consults a health center, which refers her to us for treatment. On admission, the patient was conscious with a good hemodynamic state. Vulva inspection revealed a large, rounded mass with an endovaginal implantation, with necrosis areas. This mass was resistant, bleeding in any manipulation, mobile, perceive neither the cervical relief nor the presence of the uterus. The ultrasound assessment had marked: a large abdomino-pelvic pseudo-mass with urinary repercussions right form of hydronephrosis uretero and associated with gastric distension, and MRI complete inversion of the uterus, with the uterine in the vaginal cavity associated with a large vulvovaginal mass. An apathetic examination of the specimen had made it possible to diagnose a botryoid sarcoma that affects the cervix and uterine body (Mullerian tumor). Laparotomy had revealed uterine inversion. This required a total hysterectomy with appendectectomy had been performed. Then the patient was transferred to the cancer service for treatment where in the seventh day, she died in the surgery post.