ABSTRACT
Objectif : Decrire la situation epidemiologique; clinique et therapeutique de l'IMOC a Libreville et analyser les facteurs qui lui sont associes.Patients et methodes :Il s'agissait d'une etude observationnelle; retrospective et analytique de type cas-temoins realisee a Libreville durant la periode du 1er Juillet 2010 au 31 Juillet 2011; couvrant un intervalle de 2005 a 2010. Cette etude s'est deroulee conjointement au Centre Hospitalier de Libreville; a l'Hopital d'Instruction des Armees Omar Bongo Ondimba; a la Fondation Horizons Nouveaux; a la Polyclinique El Rapha; a la Fondation Jeanne Ebori et a la Clinique Medi-vision. Les enfants ages de 2 a 15 ans presentant un trouble moteur associe ou non a des troubles cognitifs ou ayant des troubles neurologiques avant l'age de 2 ans etaient eligibles. Pour chaque cas; les temoins etaient recrutes dans la meme structure et hospitalises pendant la meme periode. Les variables qualitatives etaient exprimees en pourcentage avec leur intervalle de confiance a 95 et les variables quantitatives en moyenne avec un ecart type. Les caracteristiques des deux groupes ont ete comparees par le test de chi 2 de Pearson; le test de Fisher (n5) et le test de Student. Les differences etaient considerees comme etant significatives pour p 0.05.Resultats :Durant la periode d'etude; 180 enfants etaient inclus dont 60 cas et 120 temoins. La repartition des enfants montrait une legere predominance du sexe masculin (96/120 soit 53;3) avec un sexe ratio de 1;14. Les troubles du langage (91;7); du tonus (85) et le deficit moteur (61.7) etaient les caracteristiques cliniques les plus observees chez ces enfants. Apres analyse multivariee par regression logistique nous avions releve que le risque d'avoir une IMOC etait plus eleve chez les enfants dont la grossesse n'etait pas suivie ou suivi par une personne autre qu'une sage-femme (p
Subject(s)
Cerebral Palsy/diagnosis , Cerebral Palsy/epidemiology , Child , Disease Management , Risk FactorsABSTRACT
Pulmonary blastoma is a rare malignant tumor. A new case is reported in a 3 years 6 month-old girl. An apparent clinical remission was first obtained after a surgical treatment followed by a conventional chemotherapy during six months. Afterwards the persistence of a microscopic residual pulmonary disease lead us to deliver successfully an intensive chemotherapy followed by autologous peripheral blood stem cells reinjection. The child remains disease free 12 months after graft. Problems set by the histogenesis of this tumor, its unspecific clinical and paraclinical features and the role of conventional and intensive chemotherapy followed by autologous bone marrow transplantation are discussed on the basis of a review of 50 cases in the literature.
Subject(s)
Lung Neoplasms/diagnosis , Pulmonary Blastoma/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemotherapy, Adjuvant , Child, Preschool , Combined Modality Therapy , Female , Hematopoietic Stem Cell Transplantation , Humans , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Pneumonectomy , Prognosis , Pulmonary Blastoma/pathology , Pulmonary Blastoma/therapy , Reoperation , Treatment OutcomeABSTRACT
The coronary anatomy of 69 patients with unstable angina, subgrouped according to response to medical therapy, was investigated. All patients received oral treatment with nitrates, calcium antagonists, and beta-blocking agents. When combined oral treatment was not effective, an intravenous infusion of nitrates (10-100 micrograms/min) was subsequently administered. Coronary arteriography was performed within hours (14 +/- 9 h) from the last episode of chest pain in 28 patients refractory to medical treatment, while in 41 patients who became asymptomatic during medical therapy, angiography was performed after an observation period of several days (8 +/- 6 days). On angiography, the nonresponder group was characterized by a prevalence of eccentric and multiple lesions, and by a 46% incidence of thrombi (p less than 0.001). Recurrent symptoms requiring emergency bypass operation were common in this group. In patients responsive to medical treatment, a high percentage of concentric lesions (37%) and totally occluded (34%) coronary arteries was found (p less than 0.05). No infarcts and low rate of recurrent angina were noted in these patients during hospitalization. In conclusion, the finding of intracoronary thrombotic material and eccentric or multiple lesions can be an accurate markers of the active phase of the disease, while "silent" occlusion of the involved vessel may be accompanied by relief of symptoms during medical therapy.
