Minimal Setting Stroke Unit in a Sub-Saharan African Public Hospital.

Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE (n = 318) and POST (n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.

[Myocardial infarction as complication of acute pancreatitis]. / Pancréatite aiguë compliquée d'infarctus du myocarde à coronaires normales.

We report a case of an acute pancreatitis complicated by myocardial infarction with normal coronary arteries on angiography. This observation presents a double interest. First, it illustrates unusual forms of coronary disease represented by the non-atherosclerotic infarction. On the other hand, it shows that the multiple visceral damage associated with acute pancreatitis can include myocardial infarction which complications aggravate prognosis.

[Silent myocardial infarction and antiphospholipid antibody syndrome]. / Infarctus du myocarde silencieux chez une jeune femme de 18 ans présentant un syndrome des anticorps antiphospholipides.

We describe a case of 18-year-old woman followed for 3 years for systemic lupus erythematosis (SLE) complicated of a nephrectomy. Having like only factor of cardiovascular risk a balanced arterial hypertension. The patient was hospitalized because of choreo-athetosic's movement. We discovered fortuitously during this hospitalization an inferior myocardial necrosis as well as a mitral regurgitation. Coronary angiography was normal and the ventriculography showed an akinesy in the inferior territory. Biology made it possible to pose the diagnosis of antiphospholipid antibody syndrome (APS) on (SLE). We suppose that surgery started myocardial necrosis and underline through this case interest of early identification and appropriate treatment of APS as well as a narrow monitoring particularly in young patients candidates to surgery.

[Factors correlated with left ventricular mass in hypertensive patients]. / Facteurs corrélés à la masse ventriculaire gauche chez un groupe d'hypertendus.

UNLABELLED: Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.

[Pseudotumoral form of sclerochoroidal tuberculosis: a case report]. / Forme pseudotumorale de la tuberculose choroïdo-sclérale: à propos d'un cas.

The Authors report the US, CT and MR features of sclerochoroidal tuberculosis simulating a choroidal tumor in a 16 Year old female presenting with acute unilateral visual loss. Fundoscopic examination and fluorescein angiography showed a tumor at the posterior pole of the globe. CT and MRI showed the choroidal process and cerebral lesions suggestive of tuberculomas. The evolution was favorable with antituberculous treatment. Ocular tuberculosis is rare, especially the pseudotumoral form. It can simulate a choroidal tumor. Radiologists should be familiar with this appearance because the lesion is reversible with antituberculous treatment.

[Heart and sports: modifications of electrocardiogram, late potentials and echocardiography. Study of 75 sportsmen and 46 witnesses]. / Coeur du sportif: modifications électriques et échocardiographiques au repos. Etude de 75 sportifs et de 45 témoins.

The authors report the results of prospective study, which compared 75 sports subjects and 45 witnesses. All subjects were male, the differentiating parameter being the type of sport practiced. This work analysed surface Electrocardiogramme, thransthoracic echocardiography and high amplification ECG. The statistical study used the student test t compare means and the Chi2 test for the percentages, the signification limit was fixed to 5%. Clinically, our two series didn't show a significant statistical difference, concerning: age, weight, height or arterial pressure. On the electrocardiographical level, the sport's men have a lower cardiac frequency (p = 0.005), a larger PR space (p = 0.05), an important Sokolow parameter (p < 0.005), and repolarisation disorders represented, essentially by negative T waves (p = 0.02) and an upper movement of ST segment in V2-V3 (p < 0.005). Echocardiography showed a dilatation of the right cavities: right auricular (p = 0.0125) and right ventricular (p = 0.025). Move over, it has been showed that the sport's men left ventricular walls were tabor (septal wall, p = 0.0125), (posterior wall, p = 0.025), despite a difference in the values of the left ventricular telediastolic diameter (4 mm average in the two series). The signification limit was not reached and it was also showed that the left auricular was also dilated (p = 0.025). The study of the delayed Potentials, tried to bring an explication to certain sudden deaths of sport's men which are to date unexplained and which could have a rhythmical origin? It is also to be noted that sport's men present more delayed ventricular Potentials. However, the statistical signification was not reached (p = 0.07).

[Mobile and obstructive thrombus of the left atrium. Value and risks of transesophageal echocardiography. Report of a case and review of the literature]. / Thrombus mobile et obstructif de l'oreillette gauche. Intérêt et risques de l'échocardiographie transoesophagienne. A propos d'un cas et revue de la littérature.

Authors report the observation of a young woman of 30 years hospitalised for degeneration of a mitral biologic prosthesis. Transthoracic echocardiography visualizes a voluminous mass of the left auricle of which the character free and destitute of all parietal attachment, doesn't have can be established that by transoesophageal echocardiography that detects another thrombus also free and mobile of the left auricule, unrecognised by transthoracic way. The operative indication is carried in emergency but the patient dies suddenly some hours after this exam. From this observation and a revue of the literature, the contribution and risks possible transoesophageal echocardiography in the exploration of the mobile thrombi of the left auricle, are analysed. Account-held of the potential gravity of homodynamic and embolic complications, the emergency of the surgical indication is underlined.

Determination of access blood flow from ionic dialysance: theory and validation.

BACKGROUND: Several noninvasive techniques have been recently developed for calculating blood flow rate of vascular access in hemodialyzed patients from the on-line measurement of recirculation ratio by injecting a saline bolus when the blood lines are reversed. Here we describe a new noninvasive method based on ionic dialysance measurements without the need of a saline bolus. METHODS: Mathematical modeling allows to calculate blood flow in vascular access (QA) from the recirculation ratio (Rrev) measured when the blood lines are reversed, without the need to stop ultrafiltration, by using the formula: QA = (QB - QF) 1 - Rrev/Rrev where QB is the blood flow at the dialyzer inlet and QF the ultrafiltration rate. Because the ionic dialysance takes recirculation into account, we tested a new method to assess QA from the measurement of ionic dialysance at normal (D) and reverse (Drev) positions of the blood lines for the same QB. Assuming the absence of access recirculation at normal position of the blood lines, mathematical modeling provides the following relationship: QA = (D - QF)Drev/D - Drev. The estimation of QA from measurement of ionic dialysance (QA-ID) was compared in 28 patients to the estimation of QA by ultrasound dilution technique (QA-US). RESULTS: The two methods were strongly correlated (QA-ID = 1.24 * QA-US, r2 = 0.86, P < 0.0001). The difference between QA-ID and QA-US was 107 +/- 387 ml/min (mean +/- SD). CONCLUSIONS: Our method provides a valuable estimation of the vascular access flow and is fully noninvasive, easy to perform (no need of bolus injection and of accurate measurement of QB) and totally inexpensive. Consequently this method is suitable for monitoring access blood flow in hemodialyzed patients in order to predict access thrombosis and to treat significant stenotic lesions before thrombosis.

[Inflammatory pseudotumor of the lacrimal gland. Apropos of 2 cases]. / Les pseudo-tumeurs inflammatoires de la glande lacrymale. A propos de 2 cas.

BACKGROUND: Inflammatory pseudotumors of the orbit are relatively common accounting for 12 to 15% of all orbital diseases. Lacrimal gland location is exceptional. CASE REPORTS: We report 2 patients aged 30 and 25 years who underwent surgery for an isodense tumor of the lacrimal gland. Immunohistochemistry revealed an inflammatory pseudotumoral process. Both patients are recurrence-free 2 years follow-up. DISCUSSION: Inflammatory pseudotumors of the orbit, particularly those located in the lacrimal gland still raise unresolved questions concerning the pathogenesis, diagnosis and treatment. CONCLUSION: Lacrimal gland localizations of inflammatory pseudotumors must be recognized due to difficulties in diagnosis and therapeutic management.

[Predictive factors of atrial fibrillation in mitral stenosis. Clinical and echocardiographic study]. / Facteurs prédictifs de la fibrillation auriculaire dans le rétrécissement mitral. Etude clinique et échocardiographique.

The objective of this study was to define the predictive factors of atrial fibrillation in pure or very predominant mitral stenosis in a series of 472 consecutive patients divided into 2 groups according to the presence (group I: n = 113) or absence (group II: n = 359) of permanent atrial fibrillation. Univariate analysis showed that predictive factors for atrial fibrillation in mitral stenosis are age (40.3 +/- 9 years vs 31.4 +/- 9.5, p < 0.0001), history of commissurotomy or mitral angioplasty (13 cases vs 10, p < 0.01), functional class III or IV (36 cases vs 43, p < 0.01), history of valvular heart disease (8.4 +/- 7.3 years vs 6.4 +/- 9.2, p < 0.05), left atrial diameter (53.3 +/- 10.3 mm vs 46.5 +/- 8.5, p < 0.0001) and mitral surface area (1.1 +/- 0.4 cm2 vs 1.3 +/- 0.4, p < 0.0001). On multivariate analysis, age and left atrial dilatation were independent predictive factors of atrial fibrillation in mitral stenosis.

[Tumor of the lacrimal sac. Dangers of simple excision biopsy]. / Tumeur du sac lacrymal. Dangers de la biopsie exérèse simple.

Lacrimal sac tumors are relatively uncommon tumors which recur readily and have poor prognosis if adequate care is not provided early. We report here a case of lacrimal sac tumor in a 56-year-old patient with bilateral pseudophakia and an atypical chronic dacryocystisis aspect of the left eye. After clinical and paraclinical investigations, the patient underwent surgical excision of the tumor followed by external radiotherapy. During follow-up, the patient developed a local recurrence which required surgical removal and radiotherapy. Despite early and adapted management, the prognosis of this tumor remains poor.

[Muscle bridge and myocardial ischemia. Study of 6 cases]. / Pont musculaire et ischémie myocardique. Etude de 6 cas.

The authors analyse the clinical and therapeutic aspects of myocardial bridges in a series of 6 male patients between the ages of 41 and 61 years. In every cases, the presenting signs were ischaemic order: one myocardial infarction, three cases of unstable angina and two case of stable angina. On coronary angiography, these muscle bridges involved the left anterior descending artery in all cases. The causal relationships between muscle bridges and myocardial ischaemia are discussed. Among the various factors incriminated, spasm, tachycardia and thrombosis appear to play an important role. Depending on the case, treatment modalities consist of beta-blockers, platelet antiaggregants and calcium channel blockers. Surgical treatment is reserved for patients who remain symptomatic despite medical treatment.

[Predictive indices of the persistence of left ventricular dilatation after valve replacement for chronic aortic insufficiency. Echocardiographic study]. / Indices prédictifs de la persistance de la dilatation ventriculaire gauche après remplacement valvulaire pour insuffisance aortique chronique. Etude échocardiographique.

The objective of this study was to define the echocardiographic indices predictive of persistence of left ventricular dilatation one year after valve replacement for chronic aortic incompetence. Thirty four consecutive patients (32 men and 2 women, age: 35.6 +/- 10 years) operated for post-rheumatic chronic aortic incompetence, were included in this series. All patients were investigated by echocardiography less than 15 days before and one, six and twelve months after surgery. The parameters studied consisted of measurement of ventricular diameter, shortening fraction and ejection fraction as well as aortic incompetence Doppler indices (jet-left ventriculr outflow tract diameter, jet-left ventricular outflow tract diameter/subaortic diameter ratio, half-pressure time, aortic isthmus end-diastolic velocity). Preoperative echocardiographic data and the results one year after valve replacement were compared for each patient. The left ventricle remained more dilated at one year in patients with a preoperative end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, an ejection fraction < 50%, a jet diameter > 16 mm, a jet diameter/subaortic diameter ratio > 65% or a half-pressure time < 350 ms. In conclusion; an end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, a jet diameter > 16 mm, a jet diaméter/subaortic diameter ratio > 65% and a half-pressure time < 350 ms appear to represent the main predictive factors of the persistence of ventricular dilatation one year after aortic valve replacement for chronic aortic incompetence.

[Predictive factors of thromboembolic complications in mitral stenosis in sinus rythm]. / Facteurs prédictifs des complications thrombo-emboliques dans le rétrécissement mitral en rythme sinusal.

The authors analyse the predisposing factors to the development of thromboembolic complications in mitral stenosis in sinus rhythm and propose preventive therapeutic measures. Eighty five consecutive patients with pure or very predominant mitral stenosis in sinus rhythm were included in this study and divided into two groups according to the presence (Group I: n = 27, age: 34.2 +/- 8.31 years) or absence (Group II: n = 58, age: 32.6 +/- 9.7 years) of thromboembolic complications. No significant difference was observed between the two groups for age, sex and functional class. Patients of group I had a more dilated left auricle (57.3 +/- 4.5 vs 48.4 +/- 4.7 mm; p < 0.001) and a smaller mitral surface area (0.8 +/- 0.15 vs 1.1 +/- 0.21 cm2, p < 0.05). The spontaneous left intra-atrial contrast phenomenon was more frequently observed in patients with thromboembolic complications (23 out of 27) than in those not presenting this complication (17 out of 58), (p < 0.001). This phenomenon was the only independent predictive factor on multivariate analysis. In conclusion, left atrial dilatation, the severity of mitral stenosis and especially the presence of spontaneous contrast are the main predictive factors of the development of thromboembolic complications in mitral stenosis in sinus rhythm. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.