Place de la scintigraphie osseuse dans le bilan d'extension des metastases osseuses du cancer du sein au Senegal : etude preliminaire a propos de 40 cas

L'etude portait sur 40 patients dont l'age variait entre 26 et 84 ans avec une moyenne de 46;9 et un ecart type de 13 ans. Le cancer du sein droit predominait avec 62.5 contre 32.5 pour le sein gauche. Seul deux cas de cancer bilateral ont ete retrouves (5). Douze (12) patientes sur 40 presentaient une hyperfixation (30).Parmi ces dernieres; 11 presentaient des localisations multiples a type d'hyperfixations diffuses et focales (91;67 ) et 1 cas (8;33) avait une localisation unique et focale. Deux patientes (5) avaient une scintigraphie non contributive. La duree d'evolution du cancer etait inferieur ou egale a 3 ans dans 66;67 et superieure a 3 ans dans 33;33 avaient des fixations extra osseuses associees du radio-traceur.Les sites associes les plus frequents sont le poumon (40); le cour; la rate et l'estomac qui representait chacun (20)

[Cryptosporidiosis in Senegalese children: prevalence study and use of ELISA serologic diagnosis]. / La cryptosporidiose de l'enfant au Sénégal : étude de la prévalence et apport du diagnostic sérologique par ELISA.

This is a prospective, descriptive and analytic study conducted from July 2011 to September 2011 at the Children National Hospital Albert Royer of Dakar and at the Vélingara Health District. It was focused on children under 15 without reference to HIV status. For each child, a sample of stool was examined by the Ziehl-Neelsen modified staining and by ELISA using the "Cryptosporidium Antigen Detection Microwell ELISA kit" designed to detect Cryptosporidium spp antigens. The aim of our study was to determine the prevalence of cryptosporidiosis in rural and hospital areas and to measure the performance of the ELISA kit that we used. Out of the 375 stool examinations performed with the Ziehl-Neelsen modified staining, 17 had revealed the presence of Cryptosporidium spp (4.53%). The prevalence in rural areas was 2% while the hospital prevalence was 7.4%, of which 1.8% (1/57) were from urban areas and 9.8% (12/122) from suburban areas. No positive case was observed in children over 10 years. By ELISA, 23 positives cases were reported corresponding to a prevalence of 6.13% (1.8% in children living in urban areas, 13.1% in children from suburban areas and 3%living in rural areas).The correlation of this assay with the Ziehl-Neelsen modified staining, considered as the reference method, found that this assay had a sensitivity of 58.82% and a high specificity reaching 96.37%. The positive predictive value (PPV) was 43.4% while the negative predictive value was 98%. Cryptosporidiosis is a significant cause of parasitic infection among children in Senegal. Antigen detection of Cryptosporidium spp by ELISA in stool can be a complementary tool in the diagnosis of cryptosporidiosis.

[Post-circumcision tetanus in Dakar, Senegal]. / Le tétanos post-circoncision a Dakar, Sénégal.

This study aimed at describing the epidemiology, clinical features and prognosis of post-circumcision tetanus at the infectious diseases clinic in Fann Hospital in Dakar. Data were collected retrospectively for analysis from patients' files recorded from January 1, 1999 to December 31, 2006. 54 cases were included, accounting for 4% of all tetanus cases admitted to the clinic during the study period (54 cases/1291). The patients' average age was 9 +/- 3.7 years old (range = 1-17 years) and 52% of them were schoolboys. In most cases (76%), tetanus symptoms occurred beyond 7 days after circumcision. The average delay from onset of the disease to admission was 2.3 days (range = 0-6 days). The circumcision took place at home in 39% of cases, in health center in 35% of cases and in unspecified area in 26% of cases. The majority of patients (85%) had never received tetanus vaccine and, in 72% of the cases, the circumciser was designated as a male nurse. Generalized tetanus was observed in all cases, most of which was a mild form of the disease (63%). During hospitalisation, thirteen patients (24%) had complications among which diaphragmatic and intercostal muscle spasms (3 cases), bacteraemia (5 cases), respiratory infection (4 cases), urinary tract infection (4 cases), and fracture of the vertebrae (1 case). The case fatality rate was 7.4% (4 deaths). Vaccination together with health education of the population as well as a better sensitization of the practitioners are necessary to eradicate tetanus after circumcision.

[Von Willebrand disease and menorrhagia]. / Maladie de Willebrand et ménorragie.

INTRODUCTION: Known since over than seventy years, von willebrand disaese is the most common herediary bleeding disorder. This condition was first described by Pr. Willebrand in 1926 in a family with (positive) history of excesive bleeding tendency. Von Willebrand desease is characterized by a lifelong tendency toward easy spontaneous mucosal or post operative bleeding. In females, excessive or prolonged menorrhagia could be a sign of von willebrand desease; symptoms that are often misunderstood to be gynecologic rather than hematologic problem. In the present work, we have tried to screen for this anomaly in females with menorrhagia, following a simple anamnestic, clinical and biological protocol. PATIENTS AND METHOD: In a seventeen month study, fifty two procreating females with menorrhagia were recruited in the haematology laboratory of Aristide le Dantec hospital with the cooperation of gynecology and obstetric departements of Aristide Le Dantec, Abass Ndao and grand yoff Hospitals. RESULTS: Eight patients were revealed to be von willebrand positive (prevalence: 15%). The diagnosis was retained on the basis of epidemiological, clinical and biological data. CONCLUSION: These simple and accessible criteria should allow better handling of patients with hemorragic disorders.

Maladie de Willebrand et menorragie

Introduction : Connue depuis plus de 70 ans; la maladie de Willebrand (MW) est la plus frequente des pathologies hemorragiques hereditaires. Decrite depuis 1926 par le Pr Von Willebrand au sein d'une famille dont plusieurs membres presentaient un syndrome hemorragique; la MW se manifeste surtout par des hemorragies muqueuses et post operatoires. Chez la femme; la MW est a l'origine de menorragies d'abondance variable. Nous nous sommes propose au cours de ce travail de rechercher la maladie de Willebrand chez des femmes presentant une menorragie en suivant une demarche simple anamnestique; clinique et biologique. Patients et methode : Cinquante deux femmes en age de procreer presentant des menorragies ou des menometrorragies ont ete recrutees au sein durant 17 mois au sein du laboratoire d'hematologie de l'hopital Aristide le Dantec; des services de gynecologie et obstetriques des hopitaux Aristide le Dantec; Abass Ndao et Grand Yoff. Resultats : Parmi 52 femmes recrutees 8 ont presentes une maladie de willebrand ; soit une prevalence de 15.Le diagnostic de maladie de willebrand a ete retenu sur la base de faisceaux d'arguments : anamnestiques; cliniques et biologiques. Conclusion : Ces arguments simples accessibles devrait permettre une meilleurs prise en charge des patients souffrant de maladie hemorragique aussi bien sur le plan diagnostic que therapeutique

[Sickle cell disease neonatal screening. First evaluation]. / Dépistage néonatal de la drépanocytose au CHU de Dakar: premier bilan.

A neonatal screening allows a preclinical diagnosis of major sickle cell syndromes and an early management of the affected children. That would improve their life quality and expectancy. The preliminary program was set up on 518 senegalese newborn aged from 1 to 4 days, and coming from all the country ethnic groups. Isoelectrofocalisation is the test used on dried blood eluate and the positive control on citrate agar gel. 478 samples out of 518 (92.5%) have been analysed. Haemoglobinopathy have been found in 11.1% of cases, distributed as follow: heterozygoty FAS and FAC: 9%, double heterozygoty FSC: 0.2% and homozygoty FSS: 1.9%. Sickle cell neonatal screening should be imperatively implemented, with regards in economical considerations. It would be relevant to integrate it in a larger program including information, training and genetic counselling in order to avoid homozygotes birth and to lower the spread of this disease.

[Traumatic injuries of newborns after forceps delivery at the Abass Hospital Center Maternity]. / Lésions traumatiques du nouveau-né après accouchement par forceps à la Maternité de l'Hôpital Abass Ndao.

The authors report the results of a retrospective study on the effect of traumatic injuries observed among newborns from forceps deliveries in the maternity ward of Abass Ndao hospital between January 1st, 1995 and December 31, 1996. Forceps deliveries represent 5.89 for 1000 of total deliveries and 47 for 1000 of nursery admissions. Traumatic injuries are found in 44.77 % of the newborn by forceps deliveries. They are dominated by the hematoma of scalp in 23 cases and facial nerve injuries in 6 cases. The were about 76.66 percent of primipare among which 30 percent were adolescents. Maternal age, parity, gravity as well as birth weight for forceps deliveries were not significantly different from those without any injuries (p < 0.05). However, traumatic injuries of the newborn were more frequent when the forceps were performed by medical resident. The neonatal mortality is 10.44%. We recommend the teaching of the technique for an improvement of technical competence.

[Risk factors for low birth weight: influence of maternal age, parity, gestational age, nutritional status and maternal pathology]. / Facteurs de risque du petit poids de naissance: influence de l'âge maternel, de la parité, de la gestité, de l'état nutritionnel et de la pathologie maternelle.

A retrospective study carried on between april 1st and september 31st 1997 has helped in collecting. 69 cases of low birth weight new-born (weight < 2500 g) at Abass Ndao hospital center in Dakar. The above population has been compared to 79 eutrophic new-born of mean birth weight equal to 3047.7 +/- 311 g (witnesses). The goal of this study is to appreciate the relationship between the maternal age, the number of the gestation, the parity, the nutritional status, the maternal pathologies during pregnancy and the low weight at birth. There was no difference between both groups as regards to the mean age (p = 0.44), the mean number of gestation (p = 0.7) and the mean parity (p = 0.48). On the other hand, the weight of the mother is smaller as for the group of low birth weight but the mean body mass index stand at normal in both groups. The pathologies during pregnancy period were obviously more frequent in the group of low birth weight new-born. There is a real need to insist on the preventive measures to be taken and the treatment of the maternal pathologies during pregnancy.

[Newborn infant with macrosomia: etiologic factors and perinatal complications]. / Nouveau-né macrosome: facteurs étiologiques et complications périnatales.

A retrospective study conducted between january 1st and december 31st 1993 allowed for the identification and comparison of 100 cases of new born with macrosomia accounting for 1.34% of birth. Males constitute the majority of those cases (60%) and the average weight found is 4212 g. Foetal complications are in the main made of lesions of the brachial plexus (9%). Hypoglycemia is found in 4% of cases. These complications are more frequent in forceps assisted deliveries or cesareans (P < 0.05). Obesity (20%), Fat child related past history (15%), Maternal diabetes (5%) are the most common risk factors. We therefore advocate a more effective prevention of foeto-pelvic disproportions through a close supervision of pregnancy among women at risk.

[Facial nerve paralysis in the newborn infant: apropos of 8 cases]. / Paralysie faciale néonatale: à propos de 8 observations.

The authors report 8 cases of facial palsy collected in the Abass Ndao hospital center. Risk factors are dominated by the instrumental manipulations during delivery. Prognosis is however generally good.

[Low birth weight: rate and risk factors in the Guédianwaye district (suburb of Dakar, Senegal)]. / Les faibles poids de naissance: fréquence et facteurs de risque dans le district de Guédiawaye (Banlieue de Dakar-Sénégal).

The authors report the results of a six months survey about the low weight of birth (L.W.B.) in the district of Guédiawaye, suburb of Dakar. The purpose is to determine the rate of L.W.B. in two main maternity hospitals of that locality and the associated risk factors. It is a survey with a control group. This survey results in a 10.7% rate, according to the data of another retrospective survey in the same maternity hospitals in 1992 (10.03%). The risk factors are mainly: celibacy, primiparity, an associated pathology with the pregnancy, the physical strain of mothers correlated to the income and to the previous L.W.B.