[Ketoacidosis in type 1 diabetes mellitus: 73 cases in Dakar]. / Acidocetose Chez Le Sujet Diabetique De Type 1 : A Propos De 73 Cas Colliges A Dakar.

INTRODUCTION: The follow-up of diabetes mellitus in children and teenagers remains a challenge. Ketoacidosis is the most frequent acute metabolic complication and is of bad prognosis. The objective of this study was to evaluate etiologicals factors of decompensation and evolutions in type 1 diabetes. PATIENTS AND METHODS: We conducted a transversal and prospective study from January 2009 to October 2010. All type 1 diabetic patients hospitalized for ketoacidosis had been included. For every patient, we have studied the epidemiologicals, etiologicals and clinicals factors as well as the outcomes. RESULTS: The prevalence was to 55.3 % among all ketoacidosis. Sex-ratio (Men/Women) was 0.78, mean age to 25.73 years and mean duration of diabetes was 3.9 years. Ketoacidosis was inaugural in 26 % of cases. Except Kussmaul dyspnea, prevailed digestives symptoms (87.6 %). Coma was noted in 82.1 % among whom 54.7 % had no previous diabetic follow-up. A decompensation factor was found in 93.1 % of which an infection (78 %) or stop insulin (53.42 %). Prevailing infectious sites were urogenitals (24.6 %), respiratories (20.5 %). The outcome was fatal in 6.8 % of the cases. It was about 24.3 years middle-aged, 1,6 year diabetes mellitus mean duration, without regular follow-up in 80 % of the cases. Other associated factors were coma stage 2 or 3 (80%), infection (60 %), hypokalemia (40 %). CONCLUSION: Ketoacidosis is frequent in type 1 diabetic patients and has a bad prognosis. Infection and stop insulin are major factors of decompensation. Its prévention requires an adapted therapeutic education associated to a regular follow-up of patients.

[Descriptive study of diabetic foot at the Marc Sankale Diabetes Center. Report of 105 cases]. / Etude descriptive du pied diabetique au centre du diabete marc sankale. A propos de 105 cas.

INTRODUCTION: Diabetic foot is a major complication of diabetes due to its frequency and its high risk of evolution to amputation. We report 105 cases recruited at the diabetes centre Marc Sankale. METHOD: It's a prospective study including all diabetic patients who attended the diabetes centre for any foot lesion during a one year period. Besides clinical examination data, results of glycaemia, foot X-ray Doppler and bacteriological analysis of the pus were collected. RESULTS: foot lesion represented 2.8% of diabetologist causes of consultation. Mean age of occurrence was 55 +/- 14 years in 63% women and 37% men. Diabetes was type 2 in 90% cases, poorly controlled in 63.92 % cases. Foot lesion was dominated by infection (97%), isolated or associated to peripheral vascular disease (32.4%) or neuropathy (13.3%). 67 patients had medical treatment and healed their wounds in 3 months in 76% cases. 38 other cases needed surgery : major amputation (15%), minor amputation (13%) debridment (9%) and revascularization (1%). CONCLUSION: Diabetic foot is a frequent reason for consultation at the National diabetes centre. Despite all the improvements made after the implementation of the patient's educational program, treatment starts late because of economical and cultural reasons that increase morbidity.

[Toxic nodular goiter]. / Les goîtres nodulaires toxiques.

INTRODUCTION: To date no study in our country was specifically dedicated on toxic nodular goiter. They were just mentioned in generally studies about hyperthyroidism. METHOD: The authors report a retrospective series of 62 cases of toxic nodular goitre collected between 1979 and 1999 at the internal medical clinic of Dakar teaching hospital. The diagnostic of toxic nodule was retained on following criteria: to existence of one or several thyroid nodule with signs or thyrotoxicosis, the existence of a hyperfixating nodule at 131 iodine scintigraphy. Increasing of T3 and/or T4 thyroide hormone. The aims of the study was to analyse the epidemiological, clinical, and therapeutics aspects. RESULTS: We are collected 49 cases of solitary nodule (79.03%) and 13 cases of multi nodular goitre (20.97%). In the cases of solitary nodule, mean age was 40 years, sex ratio of 0.04 (47 female, 2 men). The nodule was clinically diagnosed in 47 cases (95.9%) and extinctive in 73.5%. 34.3% of patients have cardiothyreosis. In the cases of multi nodular goitre mean age was 45 years, all cases were female, goitre was clinically identified in 95.3% (12 patients) and 46.5% had cardiothyreosis. 62% of patients were lost to follow up during medical treatment. Only 2 patients on the 37 who were addressed for surgery come back after thyroidectomy. CONCLUSION: This study confirm the predominance of toxic nodular goitre in young female, its severity related to cardiothyreosis and underlines the difficulties limited to the therapeutical care.

Les goitres nodulaires toxiques

Introduction : Jusqu'ici; aucune etude dans notre pays n'avait porte specifiquement sur les goitres nodulaires toxiques. Elles n'ont ete citees que dans des etudes generales des hyperthyroidies. Methodes : Il s'agit d'une etude retrospective de 62cas de goitres nodulaires toxiques colliges entre 1979 et 1999 a la clinique medicale 2 du CHU de Dakar. Le diagnostic de nodule toxique a ete retenu sur les criteres suivants : la coexistence d'un ou plusieurs nodules thyroidiens et de signes de thyrotoxicose; l'existence d'un nodule hyperfixiant a la scintigraphie thyroidienne a l'iode 131; l'elevation des hormones thyroidiennes T3 et/ou T4. Nous nous sommes interesses aux aspects epidemiologiques; cliniques; aux complications et aux aspects therapeutiques et evolutifs. Resultats : Il s'agissait de 49 nodules uniques (79;03) et de 13 goitres multi nodulaires (20;97). Dans les cas de nodules uniques; l'age moyen etait de 40 ans; le sexe ratio de 0;04 (47 femmes; 2 hommes). Le nodule etait cliniquement decelable dans 47 cas (95;9) et extinctif dans73;5; La cardiothyreose existait dans 34;6des cas. En cas de goitre multi nodulaire; l'age moyen etait de 45ans; le sexe feminin dans tous les cas. Le goitre etait cliniquement decelable chez 12 patients (95;3). La cardiothyreose existait dans 46;15des cas. 62des patients ont ete perdus de vue en cours de traitement d'equilibration de l'hyperthyroidie. Sur les 37adresses en chirurgie; seuls deux ont ete revus apres thyroidectomie. Conclusion : Cette etude confirme la predominance du goitre nodulaire toxique chez la femme jeune; sa gravite par la frequence de la cardiothyreose et souligne les difficultes liees a la prise en charge therapeutique