[Tuberculosis among hemodialysis patients in Dakar, apropos of 2 cases]. / La tuberculose chez l'hémodialysé a Dakar (à propos de 2 cas).

Hemodialysis permits a long term survival to patients with End Stage Renal Disease (E.S.R.D.). However the patients ongoing hemodialysis presented a immunodeficiency and a important modification of drugs biodisponibility. Tuberculosis is an endemic disease in our countries. Extrapulmonary tuberculosis is reported from these two cases among 13 patients treated in C.H.U.A. Le Dantec hemodialysis center. Clinical symptoms are not specific bacteria is not found. Diagnosis is obtained by a bundle of arguments. Antituberculosis treatment need to be adjusted in this field. Even if Rifampicine can be administrated at normal dose. The others drugs must be adapted on their clearance and the underlying disease. The two patients presented psychiatrical symptoms motivating a reduction of isoniazide dose witch threshold toxicity is lowered by renal failure state. These observations must increase watchfulness on nephrologist of undeveloping countries, confronted with tuberculosis renewed out break.

[Nephronophtisis in Senegal: first 3 cases]. / La néphronophtise au Sénégal: trois premiers cas.

Nephronophtisis is a familial tubulo-interstitial nephropathy with an autosomic recessive mode of transmission. To our knowledge, it has not been yet reported in Black Africa. We report here the case of a 17-year old female from Senegal who presented with renal failure related to a chronic interstitial nephritis characterized by polyuria, hypocalcemia, natriuresis of 23 mmol/l and serum creatinine level of 1070 mumol/l. The parents of this patient were first-degree cousins. Among the 6 siblings, 2 other males were found to have a renal disease. Ultrasound examination of the kidneys showed medullary cysts in the 2 affected brothers and the renal biopsy in one case showed tubular atrophy, with thickening of the basal lamina and an interstitial fibrosis without glomerular involvement. Molecular genetic analysis confirmed the diagnosis of nephronophtisis, with a homozygous deletion of the NPH1 region. In order to recognize this disease early in life, one has to look for it in patients with tubulo-interstitial nephritis, polyuria, childhood enuresia especially when it is associated with growth retardation or tetany. This case raises the issue of consanguinity and endogamy which are frequently encountered in Africa. It also extends the geographic and ethnic distribution of nephronophtisis, being the first cases reported Black Africans.

[Echocardiographic data from chronic dialysis patients in Dakar]. / Etude des données échocardiographiques des malades hémodialysés chroniques à Dakar.

The authors report the results of a prospective study about echocardiographic parameters of 14 chronic dialyzed patients. Mean age was 44.4 +/- 12 (extremes: 16 and 63). There are 12 men (86%) and 2 women (14%). The main renal disease responsible was nephroangiosclerosis (9 cases, 64.3%). Hypertension is found in all the patients, anemia in 13 (92.8%). The heart, as shown by echocardiography, was concerned in 13 patients (92.8%). The main abnormalities found were: left ventricular hypertrophy (13 cases: 92.8%), left ventricular dysfunction (4 cases: 28.5%), abnormality in left ventricular relaxation (3 cases: 21.4%), pericardial effusion (4 cases: 28.5%).

[Identification of HLA-DR alleles for susceptibility to rheumatoid polyarthritis in Senegal]. / Identification des allèles HLA-DR de susceptibilité a la polyarthrite rhumatoïde au Sénégal.

Rheumatoid arthritis is the most frequent inflammatory rheumatism disease. Several studies were aimed to understand its physiopathogenesis in particular the association between some HLA-DR alleles and rheumatoid arthritis. A prospective study was carried out in 34 patients suffering from RA (30 Women and 4 men). The diagnosis was clinically and radiologically made. The control group included 220 persons of which the HLA-DR distribution was known. The HLA-DRB1 alleles were typed by PCR-SSP (Sequence Specific Primers). The most frequent HLA-DR alleles found in patients group were: DR10 (85.3%), DR52 (53%), DR14 (38.2%), DR11 (26.5%), and DR13 (20.3%). A significant difference was observed between RA patients and control group for the following alleles: DR3, DR10, DR18, and DR52 (p < 0.001; Chi square with Yates' correction). HLA-DR3 and DR10 were positively associated with RA. The relative risk was up 30 for DR10.

[Frequency of Helicobacter pylori infection in symptomatic patients in Senegal]. / Fréquence de l'infection à Helicobacter pylori chez des sujets symptomatiques au Sénégal.

This prospective study was carried out in Dakar, Senegal, to assess the prevalence of Helicobacter pylori infection in symptomatic patients undergoing endoscopy and to evaluate the factors of risk for infection by this type of bacteria in the population. From October to December 1995, 134 patients were included in this study and replied to a standardized questionnaire designed to determine socioeconomic level and living conditions. Diagnosis of Helicobacter pylori infection was based on the combined results of the urea breath test (Clo-test) and histological findings. Helicobacter pylori infection was detected in 82.8% of patients with no significant difference according to sex, age, ethnic group, or living environment (urban or rural). The incidence of infection was also the same in all socioeconomic groups. It was already high in the age group between 11 and 20 years (90.9%). Helicobacter pylori was identified in 76.2% of patients with normal endoscopic findings and in 100% presenting ulcers, erosions, or gastritis. This study shows that the incidence of Helicobacter pylori infection is extremely high regardless of socioeconomic level and that infection begins at a young age. These findings are consistent with the poor hygiene of most people in Senegal.

[Low prevalence of ant-hepatitis c virus antibodies in hepatocellular carcinoma in Senegal]. / Faible prévalence des anticorps anti-VHC dans le carcinome hépatocellulaire au Sénégal.

Senegal is a country with a high incidence of hepatocellular carcinoma (HCC). The role of the hepatitis B virus (HBV) in the genesis of HCC is well established. To evaluate the role of the hepatitis C virus (HCV) in the occurrence of HCC in Senegal, second-generation serologic tests were used to compare the prevalence of anti-HCV antibody in subjects with HCC and in controls without liver disease. A polymerase chain reaction assay was used to look for HCV RNA in sera from patients with HCC and anti-HCV antibody. HBV markers were assayed in all study subjects. Prevalences of anti-HCV antibody were 10.9% (7/64) in the HCC group and 5% (3/58) in the control group (NS). In the HCC group, anti-HCV antibody was found in 2.4% (1/42) of subjects positive for the hepatitis B antigen (HBsAg) versus 27.2% (6/22) of subjects negative for the HBsAg (p < 0.01). HCV RNA was detected in five of six anti-HCV-positive HCC patients. Prevalence of the HBsAg was 65.6% (42/64) in the HCC group versus 17.2% (10/58) in the control group (p < 10-8). Anti-HBV antibody was detected in 48.3% (28/58) of controls versus 6.3% (4/64) of HCC patients (p < 10-8). These data do not support a close epidemiologic association between the HCV and HCC in Senegal, where the HBV remains the main viral cause of HCC.

Pefloxacin in the treatment of childhood nephrotic syndrome: a case report.

The idiopathic nephrotic syndrome (INS) of childhood is characterized chiefly by a remitting and relapsing course and its striking susceptibility to corticosteroid therapy. We report a case of relapsing nephrotic syndrome associated with urinary tract infection (UTI) treated with pefloxacin, which is a fluoro-quinolone derivative, in a dose of 800 mg per day. Steroids were avoided because of associated UTI. The UTI responded well and proteinuria disappeared after ten days of treatment with pefloxacin. However, the patient developed arthralgia involving the ankles, the knees and the neck. At this juncture, the drug was discontinued resulting in complete cessation of the joint pain. Pefloxacin increases the production of interleukin-2, a cytokine whose metabolism is modified during nephrotic syndrome. It has been used earlier in children with INS with equivocal results. The toxicity of quinolones for the joints seems more frequent in children, whose cartilage is immature and several cases have been reported. Studies on a larger number of patients are required before drawing any firm conclusions on the usefulness of pefloxacin in the treatment of INS.

[Current aspects of gastric cancer in Senegal. Epidemiological and clinical study of 220 cases (1984-1991)]. / Aspects actuels du cancer gastrique au Sénégal. Etude épidémiologique et clinique à propos de 220 cas (1984-1991).

220 cases of gastric cancer were selected from Dakar Hospitals during seven years (1984-1991). This retrospective study confirms that gastric cancer is the most common cancer of the Gastro-intestinal tract (48.4%). The sex ratio was 2.7 (M/F) with mean age of 50 years. However, a steady progression of gastric cancer was noticed beginning at 40 years. Despite the introduction of upper gastro-intestinal endoscopy the classical evolved form was the most commonly found (83.2%). The associated lesions known to be premalignant were found in 22.7% of cases. The patients were seen with a long delay after the first symptoms. This is why we have long delays of diagnosis in our centers. 61.7% of them are seen 3 to 12 months after their first symptoms. In 70% of cases, lesions were found on antropyloric region. The most common histological type remain adenocarcinoma (90% of cases). Even though endoscopy has contributed to increase the incidence of gastric cancer, it did not allow to discover early gastric carcinoma.

[A case of joint toxicity from pefloxacin in the treatment of nephrotic syndrome in a child]. / Un cas de toxicité articulaire de la pefloxacine dans le traitement du syndrome néphrotique de l'enfant.

In order to improve the nephrotic syndrome management, we tried to treat one patient by pefloxacin. A polytenosynotis was noticed during this treatment and motivated it stopping. Remission of proteinuria was obtained after an eleven days treatment. This case give us the opportunity to discuss the possible toxicity of quinolones on joints and the efficacy of pefloxacin in this disease.

[Tumor seeding of the abdominal wall after fine needle cytologic puncture of the liver. Apropos of a case]. / L'ensemencement tumoral de la paroi abdominale après cytoponction à l'aiguille fine du foie. A propos d'un cas.

Tumor seeding of the abdominal wall during fine needle puncture-aspiration of the liver is a very rare complication. The authors report a case of this complication affecting a 50-year-old Senegalese woman. She underwent echo-guided fine needle cyto-puncture of a hepatocellular carcinoma arising from the left lobe, followed by left lobectomy. The subcutaneous nodule was discovered 42 months after cyto-puncture. Histology following its excision revealed infiltration of carcinomatous hepatocytes between the fibers of rectus abdominis. There was no recurrence and the patient was well 10 months after excision of the subcutaneous nodule. With a review of 10 others cases reported in the literature, the authors feel that, although rare, this complication must be avoided and suggest a system for the protection of structures through which the needle passes.

[Congenital cystic dilatation of the choledochus: apropos of a case diagnosed in an adult Senegalese women]. / La dilatation kystique congénitale du cholédoque: à propos d'un cas diagnostiqué chez une adulte sénégalaise.

The authors report a case of congenital cystic dilatation of the choledochus diagnosed on a 37 years old senegalese woman. It is an uncommon affection in Africa. The clinical presentation with various signs is reviewed. Ultrasound or cholangiography confirms the diagnosis. Surgical excision of the cystic dilatation is the best treatment because of the high risk of cancerisation.

Detection of hepatitis B virus DNA by polymerase chain reaction in HBsAg negative Senegalese patients suffering from cirrhosis or primary liver cancer.

The polymerase chain reaction was used to search for hepatitis B virus (HBV)-DNA sequences in the sera of HBsAg-negative Senegalese patients suffering from liver cirrhosis or liver cancer. Amplified HBV-DNA sequences were detected by hybridization with a digoxigenin-labelled HBV-DNA probe. HBV-DNA was detected in 17% of HBsAg negative Senegalese subjects from the general population and in 44% and 58% of the patients suffering from cirrhosis or primary hepatocellular carcinoma (PHCC) respectively. In the control group, amplified HBV-DNA was detected in 25% of the subjects without HBsAg and anti-HBs antibodies, and in 6% of subjects positive for anti-HBs antibodies. This study confirmed the hypothesis that there is an etiologic link between HBV and PHCC in HBsAg-negative patients.

[Polycystic kidney. Clinical and familial aspects. Apropos of 29 cases]. / La polykystose rénale. Aspects cliniques et familiaux. A propos de 29 cas.

The polycystic kidney disease is a hereditary malformation seldom described in Africa. Nineteen cases among 6 men and 13 women were seen in the internal Medicine Service in seven years. The range of age was 28 to 77 years. Ten other patients (of whom four were less than 15 years old were discovered via systematic family investigations and confirmed by ultra sound. The diagnosis was based essentially on consistent clinical signs and the presence of at least 5 cysts in each kidney. Infectious manifestations were the most frequent, presented in 37% of the cases. These acute infections can affect either the urinary ducts or a hepatic or renal cyst. The family investigations established that a third of the subjects examined were asymptomatic or had lumbar pain and hematuria never associated with their underlying cause.

[Apropos of hepatorenal polycystic disease associated with cirrhosis]. / A propos d'une maladie polykystique hépatorénale associée à une cirrhose.

The authors report a case of association of cirrhosis with (autosomal dominant) polycystic kidney and liver disease, which is hereditary malformation. The occurrence of hepatic cysts during the disease is relatively common, and the development in general is benign. In this case, the large hepatic cysts are responsible of biliary ducts compression, with clinical and biological cholestasis. Portal hypertension like impaired hepatocellular function develop because of cirrhosis.

[Contribution of echography in the diagnosis ruptured liver abscess (Apropos of 4 cases)]. / Apport de l'échographie au diagnostic de rupture d'abcès du foie (a propos de 4 observations).

The authors report 4 cases of ruptured hepatic abscesses in peritoneum (2 cas) and in pleural (2 cases). The cases occurred in 3 men (two of them were alcoholic) and one woman who was in the postpartum period. The cases confirm the classic pictures according to which, ruptures of hepatic abscesses have unclear clinical presentation whether they are amoebic or bacterial in origin! In these cases, ultrasound is very useful in the rapid detection of peritoneal or pleural abscesses which can be confirmed by ultrasonically guided fine needle punction When the channel from the intra hepatic abscess can be visualised, or when they are a coexisting hepatic and peritoneal pleural abscesses, the diagnosis is clear. However when the abscess has been completely emptied of its contents the diagnosis may the difficult.

Antibody response to preS1 in hepatitis-B-virus-induced liver disease and after immunization.

Antibodies to the pre-S1-encoded sequence of hepatitis B virus (HBV) envelope were detected by ELISA using a synthetic peptide analogue of preS1 proteins, in different groups of HBV-infected subjects and also in hepatitis B vaccine recipients. Such antibodies were specifically found in only 1% of HBsAg chronic carriers including patients with cirrhosis and primary liver cancer. Anti-preS1 were detected in patients with acute hepatitis; in 13% of the HBsAg+ sera obtained before recovery and in 37% of the sera obtained after recovery. Anti-preS1 antibodies were detected in recipients of a plasma-derived vaccine, but not in those receiving a recombinant vaccine. The results indicate that anti-preS1 is an earlier serum marker of HBV clearance than anti-preS2 and anti-S antibodies.