Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs des maladies thyroïdiennes à Bouaké (Côte d'Ivoire) / Epidemiological, clinical, therapeutic and evolutionary aspects of thyroid deseases in Bouake (Ivory Coast)

Contexte : la maladie thyroïdienne représente la plus fréquente endocrinopathie dans le monde après le diabète sucré. En Afrique, elle constitue un véritable problème de santé publique et sa prise en charge est souvent entravée par les moyens d'investigations. Le but était d'étudier le profil des affections thyroïdiennes à Bouaké. Méthodes : il s'agissait d'une étude rétrospective, descriptive, menée dans le service de consultation de Médecine Interne du Centre Hospitalier Universitaire de Bouaké du 1er janvier 2020 au 31 décembre 2021. Elle a porté sur les dossiers de 104 patients suivis pour une pathologie thyroïdienne. Résultats : Sur 2560 patients reçus, la pathologie thyroïdienne concernait 104 patients ; soit une fréquence de 4,1%. Il s'agissait de 93 femmes et 11 hommes avec un sex-ratio (H/F) de 0,12 L'âge moyen était de 42,03 ans ±15 ans. Dans plus de la moitié des cas (55,8%), le délai de consultation était supérieur à 06 mois. Sur le plan fonctionnel, 58 patients (55,8%) présentaient une hyperthyroïdie avec comme principales étiologies la maladie de Basedow (60,3%, n=35) et le goitre multinodulaire toxique (24,1%, n=14). L'hypothyroïdie était retrouvée chez 10 patients (9,6%), le plus souvent post thyroïdectomie (60%). Les goitres et nodules euthyroïdiens étaient retrouvés chez 36 patients (34,6%) dominés par le goitre multinodulaire euthyroïdien (36,1%, n=13) et le goitre simple (27,8%, n=10). Le traitement des hyperthyroïdies reposait essentiellement sur les antithyroïdiens de synthèse dans 96,7%. Seulement 1 patient hyperthyroïdien avait subi une thyroïdectomie. La majorité des patients (82,2%) étaient perdus de vue. Conclusion : La pathologie thyroïdienne au CHU de Bouaké est une maladie fréquente de la femme jeune. Les hyperthyroïdies dominent le tableau des thyréopathies avec comme principale étiologie la maladie de Basedow. On note un taux élevé de perdu de vue, d'où l'intérêt d'une éducation de nos patients.

Context: Thyroid disease is the most common endocrinopathy observed in the world. In Africa, thyroid diseases remain a real public health problem and their care is often hampered by the means of investigation. The purpose of this work was to study the profile of thyroid affections in Bouake. Methods: This was a descriptive study with retrospective data collection, carried out over the period from 1 January 2020 to 31 December 2021 at the Internal Medicine consultation at the University Hospital of Bouake. All epidemiological, clinical and therapeutic and evolutionary data from patients followed for thyroid pathology were collected. It focused on the records of 104 patients followed for thyroid disease. Results: Out of a total of 2560 consultations, 104 patients were involved in thyroid pathology, prevalence of 4.1%. They were 93 women and 11 men with a sex ratio of 0.12. The average age was 42.03±15.64 years. In more than half of the patients (55.8%) the evolution of the clinical symptomatology was more than six months. A total of 58 patients (55.8%) had hyperthyroidism. The etiologies of hyperthyroidism were dominated by Grave's disease and toxic multinodular goiter, with 60.3% and 24.1% of hyperthyroidism respectively. Hypothyroidism was confirmed in 10 patients (9.6%), among then 6 (60%) had undergone total thyroidectomy. The multinodular goiter was found in 36 patients and was dominated by multinodular goiter (36.1%) and single goiter (27.8%). The treatment of hyperthyroidism was exclusively with synthetic antithyroid drugs. Hypothyroidism was treated with hormone replacement therapy. The majority of patients (82.2%) were lost in view. Conclusion: The thyroid pathology at the University Hospital Center of Bouake is a frequent illness of the young woman. Hyperthyroidism were frequently found with as main etiology Grave's disease The majority of patients (82.2%) were lost in view hence the interest of patient's education.

Effect of Free-Volume Hole Fraction on Dynamic Mechanical Properties of Epoxy Resins Investigated by Pressure-Volume-Temperature Technique.

Dynamic mechanical analysis experiments were carried out to investigate the mechanical properties of four types of chemically different epoxy resins. Pressure-volume-temperature (PVT) experiments were performed to determine the free-volume hole fraction (hPVT) of each epoxy resin using the Simha-Somcynsky lattice-hole theory. Using the Williams-Landel-Ferry equation, the correlations between the relative hole fraction (1 - hPVTTr/hPVT, where hPVTTr is the hole fraction at a reference temperature Tr) and four typical parameters reflecting dynamic mechanical properties [storage modulus (E'), loss modulus (E″), damping factor (tanδ), and complex viscosity (|η*|)] were studied in the temperature range from Tg(PVT) (the glass transition temperature determined by PVT data) to Tg(PVT) + 100 °C. In the temperature range from Tg(Eonset') (temperature corresponding to the intersection of the two tangent fitting lines in the E'(T) curve indicating the glassy-state and glass-transition stages) to Tg(PVT) + 100 °C, the variations in the four dynamic mechanical parameters with a relative hole fraction could be separated into two distinct categories: (i) log[E'(T)] and log[|η*|(T)] decreased linearly to their minimum values and then remained nearly unchanged with increasing relative hole fraction, and (ii) log[E″(T)] and log[tanδ(T)] first increased monotonically to their maximum values and then decreased linearly with the increasing relative hole fraction. This study demonstrates that the PVT technique is a feasible and reliable experimental method to determine the hole fractions of thermoset polymers.

Measurement of beam characteristics from C(6+) laser ion source.

We developed a C(6+) laser ion source for a heavy-ion accelerator. A carbon target was irradiated with a Q-switched Nd:YAG laser (1064 nm wavelength, 1.4 J maximum laser energy, 10 ns pulse duration) to generate a high-density plasma. The laser ion source employed a rotating carbon target for continuous operation. Ion beams were extracted from the plasma through a drift space using a direct plasma injection scheme [B. Yu. Sharkov, A. V. Shumshurov, V. P. Dubenkow, O. B. Shamaev, and A. A. Golubev, Rev. Sci. Instrum. 63, 2841 (1992)] up to a maximum voltage of 40 kV. We measured the characteristics of the ion beams from the laser ion source and present the results of experiments here.

Salting-out taste-masking system generates lag time with subsequent immediate release.

Salting-out effects were utilized for developing a multiparticulate system balancing numbness masking and high bioavailability. A "salting-out taste-masking system" consisting of a drug core containing acetaminophen as a model drug, a salting-out layer containing sodium carbonate (Na(2)CO(3)) and hydroxypropylmethylcellulose (HPMC), and a water-penetration-control layer consisting of cetanol was designed and prepared. The system successfully generated a long lag time while achieving immediate drug release. In the system, the Na(2)CO(3) release rate was slower and the lag time was longer than when the water-penetration-control layer was not present. During the release of Na(2)CO(3) from the system, the release of HPMC and drug was suppressed. These results indicated that the water-penetration-control layer maintained a high concentration of Na(2)CO(3), prevented HPMC's dissolution, and generated a long lag time of drug release. The system generated longer lag time and released drug more immediately than formulation containing the water-penetration-control layer of same thickness without the salting-out layers. These results indicated the salting-out layers were necessary for obtain a long lag time and subsequent immediate drug release. This novel taste-masking system has the potential to be a useful multiparticulate dosage form for effective, safe, and user-friendly drug therapy.

A new index, the core erosion ratio, of compression-coated timed-release tablets predicts the bioavailability of acetaminophen.

Although compression-coated tablets are a commonly used timed-release drug delivery technology, their utility is often limited by poor bioavailability. To try to improve the bioavailability of these tablets, the effect of their core composition of compression-coated tablet on in vivo pharmacokinetics was investigated. First, the extent of mass reduction of cores in different compression-coated tablet core formulations was used to establish a new index, the core erosion ratio. The data show that adding excipients with high water solubility to the core results in a greater core erosion ratio. Next, to elucidate the effect of core erosion ratio on in vivo acetaminophen (AAP) release, three compression-coated tablet formulations with similar in vitro AAP release profiles but different core erosion ratios were administered to four fasted dogs. The time for first appearance (TFA) of AAP in plasma did not differ significantly among formulations, indicating that the in vivo lag time was the same for all formulations. In separate experiments, necroscopy revealed that 3h after oral administration, the tablets were located in the ileum and colon and that all three formulations had identical GI transit times. However, the area under the AAP plasma concentration-time curve was greater in dogs given formulations with larger core erosion ratios. These results suggest that a formulation with a large core erosion ratio can significantly increase in vivo drug release from compression-coated tablets, leading to increased drug absorption from the lower GI tract.

Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: value of proton magnetic resonance spectroscopy.

BACKGROUND: There have been some reports that radiation necrosis can be controlled conservatively. There are rare cases showing progressive space-occupying radiation necrosis (PSORN). It is very difficult to control PSORN by conservative treatment. The purpose of this study was to evaluate the early diagnosis of those cases and the timing of surgery for patients with PSORN. METHOD: We have experienced some cases where quality of life was improved by the removal of PSORN after stereotactic radiosurgery (SRS) for brain metastases. Therefore, we evaluated retrospectively the diagnosis and treatment of six cases of symptomatic PSORN at approximately 6-12 months after SRS for metastatic brain tumours. FINDINGS: In all six cases, on Magnetic Resonance Imaging with Gd contrast material (Gd-MRI), PSORN was revealed as a ring-like enhanced mass with large perifocal oedema coupled with the appearance of neurological deficit. Proton Magnetic Resonance Spectroscopy ((1)H-MRS) enabled us to differentiate PSORN from recurrence of metastases in all six cases. Single Photon Emission Computed Tomography with thallium-201 chloride (201TlCl-SPECT) enabled us to do this in four cases of the six. In four cases of the six, lesionectomy of the ring-like enhanced mass (PSORN) was performed, and in two of these cases the removal was performed within 4 weeks from the time when conservative treatment became ineffective, and the neurological deficit and perifocal oedema was improved as was the quality of life. However, in the other two patients who were left for more than 16 weeks, the deficit was gradually progressive. The two patients who did not receive lesionectomy were treated by conservative means with steroids and/or heparin and warfarin and they had progressive neurological symptoms. INTERPRETATION: Although, the number of patients is small in this study, and more data will be needed, it is recommended that lesionectomy is performed at an early stage, if possible, when conservative management has failed.

In vivo single-voxel proton MR spectroscopy in brain lesions with ring-like enhancement.

It is often difficult to make a correct diagnosis of ring-like enhanced lesions on Gd-enhanced MR brain images. To differentiate these lesions using proton MR spectroscopy (1H-MRS), we retrospectively evaluated the correlation between the 1H-MR spectra and histopathological findings. We evaluated proton MR spectra obtained from the lesions in 45 patients, including metastasis (n = 19), glioblastoma (n = 10), radiation necrosis (n = 7), brain abscess (n = 5), and cerebral infarction (n = 4). The rate of misdiagnosis was found to be lowest at the threshold level of 2.48 for the (choline containing compounds)/(creatine and phosphocreatine) ratio (Cho/Cr) obtained from the whole lesions, which include the enhanced rim and the non-enhanced inner region. That is, the positively predictive values of a Cho/Cr greater than 2.48 for diagnosing metastasis or glioblastoma was 88.9 and 60.0%, respectively, and the positively predictive value of a Cho/Cr less than 2.48 for diagnosing radiation necrosis or cerebral infarction was 71.4 and 100%, respectively. For further differentiating between metastasis and glioblastoma, information about the presence and absence of an N-acetyl-aspartate (NAA) peak and lipid- or lactate-dominant peak was found to be useful. In 73.7% of metastasis cases a lipid-dominant peak was observed in the whole lesion without an NAA peak in the inner region, whereas the same pattern was observed in only 10% of the glioblastoma cases. Correlation with the histopathological findings showed that a high Cho signal is suggestive of neoplasm. Lipid signal in the non-enhanced central region was correlated to necrosis. Lactate signals were often observed in glioblastoma, abscess and sometimes metastasis, presumably reflecting the anaerobic glycolysis by the living cells in the ring-like enhanced rim. Single-voxel proton MR spectroscopy may serve as a potential tool to provide useful information of differentiation of ring-like enhanced lesions that cannot be diagnosed correctly using enhanced MR images alone.

Putaminal hyperperfusion in dystonic posturing on subtracted SPECT: a case report.

Dystonic posturing (DP) is one of the most reliable lateralizing symptoms for mesial temporal lobe epilepsy, although the mechanism remains unclear. We demonstrated a hyperperfusion area in the right putamen on subtracted postictal SPECT by using the automatic registration technique in one patient with ictal DP of the left hand. The putamen may play a key role in DP, similar to other diseases with dystonia.

Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program.

To reliably estimate the prognoses of patients with hepatocellular carcinoma (HCC), both liver function and tumor-related factors should be accounted for. However, there are few worldwide staging systems that assess prognostic value in the context of selecting individual patients for randomized stratification in therapeutic and clinical trials. We investigated the value of known prognostic systems and verified the usefulness of the new scoring system proposed by the Cancer of the Liver Italian Program (CLIP), as determined from 662 Japanese patients. A retrospective analysis of the HCC diagnoses at 4 Japanese institutions from 1990 and 1998 was performed. Overall survival was the only end point used in the analysis. Discriminatory ability and predictive power of the CLIP score were compared with those of Okuda stage and AJCC TNM stage. Compared with the Okuda and AJCC staging systems, the CLIP score's enhanced discriminatory capacity, which was tested by the linear trend test and Harrels' c-index, revealed a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. Moreover, the likelihood ratio test showed that the CLIP score had additional homogeneity of survival within each score above that of the Okuda stage or the AJCC stage. This was true for 3 subgroups of patients who received surgery, transcatheter arterial chemoembolizations, and percutaneous ethanol injections. Collectively, these findings indicate that the CLIP score has the highest stratification ability with regard to prognosis in patients with HCC. The CLIP score could be used internationally to stratify randomization groups in therapeutic and clinical trials.

[A case of intracerebral and subarachnoid hemorrhage of unknown origin with preceding headache].

We report a case of a 31-year-old female with multiple intracerebral hemorrhage and subarachnoid hemorrhage. She presented with headache one week before hemorrhage, and a CT scan performed at that time showed no abnormal findings. Neurological examination on admission revealed mild disturbance of consciousness, papilledema, and mild left hemiparesis. CT scans demonstrated intracerebral hemorrhage in the right caudate head and left frontal subcortex, and diffuse subarachnoid hemorrhage. Cerebral angiogram and laboratory examination revealed no abnormal findings. Erythrocyte sedimentation rate, C reactive protein and antiphospholipid antibody were within normal ranges. The patient underwent removal of hematoma by craniotomy. One week after the operation, a subcutaneous hematoma in the area of the craniotomy was found. Cerebral angiography demonstrated an aneurysm of the right superficial temporal artery, which was remote from the craniotomy. This aneurysm was surgically removed and examined. Histopathological examination revealed the presence of a pseudoaneurysm but no inflammation. Although primary angitis of the central nervous system was suspected to be the cause of this disease, a definite diagnosis could not be obtained.

Increased band 3 protein aggregation and anti-band 3 binding of erythrocyte membranes on treatment with sesamol.

The influence of sesamol, an antioxidant in processed sesame oil, on oxidative modification of human erythrocyte membrane proteins was investigated. Human erythrocytes were incubated with sesamol at various concentrations up to 10 mM at 37 degrees C for 1 h. The amounts of hemoglobin bound to the membranes and detergent C12E8-insoluble membrane protein aggregates were increased as the concentration of sesamol increased. Western blot analysis indicated that aggregates of band 3 protein were increased by the treatment. Binding of anti-band 3 antibody to the erythrocytes was increased by the treatment. Isolated cell membranes were incubated with sesamol similarly. Aggregates of band 3 protein were also increased, indicating that the band 3 protein aggregation was little affected by hemoglobin bound to the membranes. Aggregation of band 3 protein in the treatment of isolated cell membranes was partially prevented when the treatment was conducted under anaerobic conditions, suggesting that augmentation of the protein aggregation by sesamol involved both oxygen-dependent and oxygen-independent pathways. Among phenolics, sesamol showed a distinctive feature to increase band 3 protein aggregation in erythrocyte membranes and to enhance anti-band 3 binding to erythrocytes.

[Muscle involvement of Stormorken's syndrome].

We described two patients, a mother and daughter, of Stormorken's syndrome. The syndrome is characterized clinically by autosomal dominant inheritance, congenital miosis, thrombocytopenia, asplenia and muscle weakness. Both patients had bleeding tendency, ichthyosis of arms, and muscle weakness. The daughter additionally had short stature (146 cm), low body weight (32 kg) and muscle cramp. Neurological findings of the patients included migraine-like headache, cognitive dysfunction, limitation of upward and lateral gaze, and amydriasis. Femoral muscle MRI of the daughter demonstrated decreased volume with patchy high intensity areas in the hamstrings. A muscle biopsy from the daughter showed myogenic changes with muscle fiber necrosis and regeneration, variation in fiber size, tubular aggregates in approximately 5% of fibers, and fibrous tissue proliferation. Dystrophin, dystrophin-associated proteins and dysferlin were normally expressed. Although both patients had elevated creatine kinase levels and generalized muscle wasting, muscle weakness was mild with slow progression. A certain membrane defect in the platelet and muscle fiber might be responsible for the pathogenesis of this syndrome.

Factors that predict intrahepatic recurrence of hepatocellular carcinoma in 81 patients initially treated by percutaneous ethanol injection.

BACKGROUND: In Japan, where liver transplantation has not been used to treat patients with hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) has been employed for those with small HCCs that are not amenable to surgical resection. In the current study, the authors evaluated PEI as a treatment for HCC patients by studying recurrence rates and survival after treatment. They then examined the clinicopathologic factors that predicted patterns of local and distant intrahepatic recurrence. METHODS: For 81 patients who underwent PEI as initial therapy between 1990 and 1997, the cumulative recurrence and survival rates and their correlations with 16 clinicopathologic factors were studied using the Kaplan-Meier method. RESULTS: The 3-year overall cumulative rates of intrahepatic recurrence and survival were 81% and 84%, respectively. At the end of the observation period, intrahepatic recurrence was detected in 56 patients (69%). In 21 (38%) of 56 patients, local recurrences were significantly associated with earlier stages of underlying cirrhosis, decreased indocyanine green retention at 15 minutes (ICG R15), larger tumor size, and histologically advanced tumor grade. Distant intrahepatic recurrence was also significantly associated with liver function and ICG R15. CONCLUSIONS: PEI is most effective as the initial treatment for patients with well-differentiated HCC when the tumor is less than 15 mm in greatest dimension. However, local recurrence depends predominantly on the biologic characteristics of the tumor, regardless of the efficacy of PEI. Surgical resection of HCC should be considered, especially for patients with mild liver dysfunction.

Unidirectional olfactory hallucination associated with ipsilateral unruptured intracranial aneurysm.

PURPOSE: We describe a patient with complex partial seizure with unidirectional olfactory aura associated with ipsilateral unruptured aneurysm. METHODS AND RESULTS: The patient felt a sweet pleasant smell coming from behind her right side every time before the attack. Cranial magnetic resonance imaging (MRI) and three-dimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of the right middle cerebral artery and compression of the right orbitofrontal cortex. Small spikes were recorded from the right orbitofrontal and superior temporal gyri and from the uncus by the cortical electrodes during clipping of the aneurysm. CONCLUSIONS: The orbitofrontal cortex may have a function related to the ipsilateral directional olfactory sensation.

Using Gaussian-like input rate function in the two-compartment model. Formulation and application to analysis of didanosine plasma concentration in two Japanese hemophiliacs.

We used a time-dependent input rate function in the two-compartment model to simulate drug plasma concentrations after an oral administration. The input rate term has a Gaussian-like structure with two parameters, time to maximum absorption rate (tm) and measure of the duration of the absorption process (s). This structure corresponds to the scenario in which the absorption rate of the drug into the central compartment changes unimodally with respect to time after administration with a single peak at time tm. We demonstrate the applicability of this formulation in the simulation of plasma concentration of didanosine after oral administration in two Japanese hemophiliacs. We found that we were able to simulate the time courses of the didanosine plasma concentrations in both patients using the theoretical equation with the input term included, and that we were able to determine the six parameters in the equation by the least squares estimation. Pharmacokinetic values derived from the best-fit curve were almost comparable to those reported in other literature except that the Cmax and AUC0-infinity seemed to be slightly higher than those reported elsewhere. Although we are unable to verify the accuracy of this formulation because of the lack of sufficient Japanese data, we are able to demonstrate its efficacy and convenience in the application presented here.

Hypothermia attenuates hyperglycolysis in the periphery of ischemic core in rat brain.

Hypothermia has proven to be neuroprotective against ischemic brain injury. However, the exact mechanism has not yet been fully understood. In this study, we investigated the effects of hypothermia on cerebral glucose metabolism and blood flow in focal ischemic rats. Rats were divided into normothermic (37+/-0.5 degrees C) and hypothermic (30+/-0.5 degrees C) groups. Focal cerebral ischemia was induced by middle cerebral and ipsilateral common carotid arteries occlusion. Two hours after ischemia, autoradiographic studies of 2-deoxyglucose and iodoantipyrine were performed to measure local cerebral glucose utilization (LCGU) and cerebral blood flow. LCGU in the ischemic core was excessively reduced in both groups. However, a marked increase in LCGU was observed in the boundary zone of the ischemic core in normothermic rats. On the other hand, hyperglycolysis in the boundary zone of the ischemic core was suppressed in hypothermia. This attenuation of hyperglycolysis might be closely related to survival of the ischemic penumbra in hypothermia.

Consecutive in vivo measurement of nitric oxide in transient forebrain ischemic rat under normothermia and hypothermia.

The effects of hypothermia on production of nitric oxide (NO) in ischemic brain were investigated by using in vivo microdialysis. Male Wistar rats were randomly divided into three groups; saline-treated normothermic group (37 degreesC, n=6), 30 mg/kg N-nitro-l-arginine methyl ester(l-NAME)-treated normothermic group (n=6), and saline-treated hypothermic group (30 degreesC, n=6). Transient forebrain ischemia was produced by bilateral common carotid artery occlusion combined with hypotension (MABP=50 mmHg). Saline-treated normothermic animals resulted in a reduction of LCBF to 9% of baseline. Saline-treated hypothermic rats revealed the similar changes of LCBF. In contrast, l-NAME administration reduced the basal CBF to 85% of saline-treated group and to 8% after ischemia. NO products were decreased during ischemia and transiently increased after reperfusion in saline-treated groups. However, the increase of NO products after reperfusion was less significant in the hypothermia. l-NAME-treated group showed a constant reduction of NO production during ischemia and after reperfusion.