[Coronary disease with normal coronarography in the black Africans: epidemiological and clinical data in 31 cases. Role of abnormal hemoglobins]. / Maladie coronaire à coronarographie normale chez le Noir africain: données épidémiologiques et cliniques dans 31 cas. Rôle des hémoglobines anormales.

The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8% of 104 coronary patients undergoing coronary angiography in this series. These 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ventricular aneurysms and 2 cases of silent ischemia in diabetic patients. Twenty-five patients were men (80.6%). There were 6 women (19.3%) two of whom presented in the post-partum period. The average age of these patients was 45 years (males: 47.7 years; females: 41.8 years). The following risk factors were noted: smoking (60%), hypertension (25.8%), obesity (29%), diabetes (12.9%), serum cholesterol (average 2.15 g/l), serum triglycerides (average 1.25 g/l). The risk index per patient was 1.29. In comparison with coronary patients with angiographic coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk factors (especially hypertension and diabetes), though this was not statistically significant. The prevalence of inaugural infarction was 81.2% in the cases of infarction with normal coronary arteries. These infarcts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6%) at coronary angiography. A provocative test was performed in only 2 cases and 1 was positive. This deserves further study and may have therapeutic implications. The authors emphasise the high incidence of hemoglobin S or C traits (57.1%). These heterozygotic hemoglobinopathies could be a risk factor in these coronary patients with normal coronary angiography.

Les arythmies dans l'endocardite parietale chronique : a propos de 160 cas

Dans cet article; il s'agit d'une etude dont le travail avait pour but d'evaluer la nature et la prevalence des arythmies au cours de l'endocardite parietale chronique (EPC) ou fibrose endomyocardique (FEM) et de determiner le role de certains facteurs tels que l'age; la taille des cavites; le niveau des pressions telediastoliques dans la survenue de ces arythmies. Cette etude retrospective portait sur 160 patients hospitalises a l'Institut de Cardiologie d'Abidjan du 1er janvier 1977 au 31 decembre 1989. Le diagnostic de EPC a ete porte soit par l'angiocardiographie soit par l'autopsie. Les explorations cardiologiques habituelles ont ete realisees et l'electrocardiogramme a ete systematiquement analyse pendant l'hospitalisation et a chaque consulltation.On y trouve des troubles du rythme les plus frequemment rencontrees. D'autres arythmies sont plus frequentes chez les enfants que chez les adultes. Les donnees quelque peu contradictoires conduisent a evoquer l'intervention d'autres facteurs dans le determinisme des arythmies; notamment supraventriculaires; rencontrees au cours de l'EPC

[Antiaggregation action of chloroquine]. / Action antiagrégante de la chloroquine.

The authors have studied in vitro the platelet aggregability induced with ADP, collagen and ristocetin. Chloroquine was added at increasing concentration (3,2 mgr/l, 16 mgr/l, 32 mgr/l). The results have been highly significant. They showed that chloroquine has an anti aggregating effect with the three inducing agents. This effect was increasing with the chloroquine concentration. Some previous works have been indicative of the inhibiting effect of chloroquine on platelet aggregability. In the treatment of the malaria, this inhibiting effect could be complementary with the specific antiparasitic effect. On the other hand the inhibiting effect on platelet aggregability could be useful for the prevention of thrombosis.

[Comparison of platelet activity, fibrinolysis and environmental factors in 50 Africans and 50 Europeans. Role of fish consumption]. / Activité plaquettaire, fibrinolyse et facteurs d'environnement comparés chez 50 africains et 50 européens. Rôle de la consommation de poisson.

The authors have studied 50 Ivorians and 50 Europeans people, all living in Abidjan for at least 10 years. Platelet aggregability with increasing ADP concentration (0.6, 1.2, 2.4 mumoles/l), collagen (0.4 mg/l), or ristocetin (1 g/l) was examined. Fibrinolysis and the euglobulin test were also studied before and after anoxia. Other blood parameters measured were: hematocrit, hemoglobin level, platelet count, bleeding time, Howell coagulation test, cephalin tests, prothrombin activity ratio, fibrinogen level. Metabolic tests included: glycemia, cholesterolemia, triglyceridemia, uricemia, A1 and B apoproteins, protidemia, gamma globulinemia. Environmental factors such as physical activity, alcohol and smoking habits, fish consumption, chloroquine prophylaxis were evaluated. The most evident result was lower platelet aggregability in Ivorian people as compared to Europeans. A more precocious and important fibrinolysis activity, either spontaneous or after anoxia was noted in the Ivorian group. Lower platelet number, fibrinogen level, and prothrombin activity were present in the Ivorian group as compared to the European people. The authors eliminated the influence of age, and considered environmental factors as predominant in the genesis of such difference, i.e., hypocholesterolemia, lower smoking and drinking levels. They emphasized the higher fish consumption in Ivorian people.

[Isolated replacement of the tricuspid valve with a bioprosthesis. Apropos of 22 cases in Abidjan]. / Le remplacement valvulaire tricuspidien isolé par bioprothèse. A propos de 22 cas observés à Abidjan.

The authors reviewed the operative and function results of 24 isolated tricuspid valve replacements with bioprostheses in 22 patients. The patient population was young (average age 15 +/- 8 years). The surgical indication was massive tricuspid regurgitation due to chronic parietal endocarditis in 19 cases and to bacterial endocarditis in 3 cases. Tricuspid valve replacement was associated with 19 right ventricular endocardectomies, 2 direct closures of ventricular septal defects, 2 Wooler mitral valvuloplasties and 1 pericardectomy. The operative mortality was 13.5% and the secondary mortality 13.5%. Of the 16 survivors, 13 are in the NYHA Class I with no regular medical therapy. Their cardiothoracic ratio has slightly decreased. Two patients have permanent atrial fibrillation, and 12 have acquired definitive complete right bundle branch block. Eight of these patients had significant improvement of atrial and right ventricular pressures, of Yu's index and cardiac index at postoperative catheterisation. Three of the 16 patients developed progressive calcific degeneration of their bioprostheses. They are among the 6 patients who have been followed up for more than 3 years. There was no mortality at reoperation. Isolated tricuspid valve replacement by bioprosthesis was chosen despite the young age of these patients because of the disadvantages of mechanical prostheses which are associated with a much higher mortality related to incarceration and thrombosis of the prosthesis. The relatively high operative and secondary mortality in this series of isolated tricuspid valve replacement compared to mitral, aortic or micro-aortic valve replacement, is related to the gravity of the underlying causal pathology.

[Tropical ataxia. Clinical and nutritional study]. / L'ataxie tropicale. Etude clinique et nutritionnelle.

The authors report on 21 cases of tropical neuropathy with simple or prevailing ataxia. They explicit the semiologic characteristics of this pattern. The difficulties of the discriminating diagnostic in the tropics are mentioned. Eleven among these patients have been submitted to a nutritional analysis, which shows a global deficiency of the contribution and strangely a lipid deficiency, the responsibility of which is debated.

[Functional colonic pathology in the Ivory Coast]. / La pathologie fonctionnelle colique en Côte-d'Ivoire.

Functional colic disorders such as the irritable bowel syndrome are very common in Ivory Coast. Etiologic, clinical, biological and roentgenological features were studied in 100 randomized cases. Findings were compared to the features encountered in Caucasians. Psychologic factors, constipation and therapeutic problems that seem to be of significance for understanding functional colic conditions in Ivoirians and other West Africans are discussed.

[Epidemiology of colorectal cancer in the Ivory Coast]. / Réflexions sur l'épidémiologie du cancer colo-rectal en Côte-d'Ivoire.

Several epidemiologic studies using data from hospital departments and from the pathological department of the Abidjan University show that colorectal cancer is infrequent in Ivory Coast (2% of all cancers). The incidence of the various factors classically incriminated in colic carcinogenesis is analyzed and discussed: precancerous conditions (adenomas, polyps, inflammatory bowel disease), histogenesis (condition of the colic mucosa) and nutritional factors. Constipation, which is very common in spite of a high intake of fibers, cannot be regarded as a predisposing factor.

[Significance of the presence of Australia antigen in liver diseases seen in a department of internal medicine in Abidjan]. / Réflexions sur la signification de la présence de l'antigène Australia dans les hépatopathies observées dans un service de médecine interne à Abidjan.

The exact responsibility of the hepatitis B virus in hepatic diseases seen in Ivory Coast is difficult to specify for several reasons, particularly technical ones. Nevertheless, we have tried to determine the prevalence of the HB virus in hospital practice and in patients hospitalized for liver diseases (viral hepatitis, cirrhosis, primary liver cancer). Comparison of the results to the prevalence of the virus in the ivorian population and statistical processing has led us to moderate the influence of HB virus in the different hepatic disorders. In primary liver cancer, the role of aflatoxine whose carcinogenic potential is now well established has not been disproved.

[Hepatic amebiasis: recent aspects. One hundred and sixty one case reports (author's transl)]. / L'amibiase hépatique: aspects actuels. Cent soixante et une observations.

The authors describe their experience of 16l patients (151 adults and 10 children) with hepatic amebiasis. Diagnosis and treatment were carried out at the Treichville Hospital University Center in Abidjan over a three-year period, from September 1976 to November 1979. Diagnosis was established without question in all cases. The indirect immunofluorescence reaction was particularly helpful. All patients were treated by metronidazole or it's derivatives. Semiology, course and therapy are described in detail. A comparison is made with cases published in the literature during the last 15 years. Most of the classical pictures were encountered in this study. The clinical picture may be misleading, for instance when it is suggestive of cancer or when jaundice is present. Immunology is particularly interesting in atypical forms. The authors insist on the unvarying and high morbidity due to this disease which accounts for 2% of all hospitalizations. Prognosis has improved, the mortality rate among adults was 4.5%. A fall in the number of surgical procedures was recorded. Only 10% of the patients underwent surgery. The therapeutic principles advocated by the authors are described. They can be used even when echotomography is not available, as is usually the case in regions where the disease is endemic.

[Hepatic manifestations in typhoid fever (author's transl)]. / Atteintes hépatiques au cours de la fièvre typhoïde.

Typhoid fever is always endemic in Ivory Coast. Among the various visceral injuries able to arrive during the course of the illness, a study of hepatic manifestations realized in 279 patients show, by the realization of systematic LBP, that, beside clinically and/or biologically certain forms, an hepatic injury is histologically constant. Aetiological, clinical, biological, diagnostic and therapeutic particularities connected with the hepatic localizations are considered and compared with findings of other authors. To remark, in Ivory Coast, on one hand the great predominance of Eberth bacillus aetiology, on the other hand the lack of statistically significative relation with drepanocytary waste. The pathogenic signification of the constancy of the hepatic injury and its peculiar histological pattern of non specific reactive hepatitis is discussed.