Detection of kdr and ace-1 mutations in wild populations of Anopheles arabiensis and An. melas in a residual malaria transmission area of Senegal.

In the central western Senegal, malaria transmission has been reduced low due to the combination of several effective control interventions. However, despite this encouraging achievement, residual malaria transmission still occurring in few areas, mainly ensured by An. arabiensis and An. melas. The resurgence or the persistence of the disease may have originated from the increase and the spread of insecticide resistance genes among natural malaria vectors populations. Therefore, assessing the status and mechanisms of insecticides resistance among targeted malaria vectors is of highest importance to better characterize factors underlying the residual transmission where it occurs. Malaria vectors were collected from three selected villages using nocturnal human landing catches (HLC) and pyrethrum spray collections (PSC) methods. An. gambiae s.l. specimens were identified at the species level then genotyped for the presence of kdr-west (L1014F), kdr-east (L1014S) and ace-1R mutations by qPCR. An. arabiensis (69.36%) and An. melas (27.99%) were the most common species of the Gambiae complex in the study area. Among An. arabiensis population, the allelic frequency of the kdr-east (22.66%) was relatively higher than for kdr-west mutation (9.96%). While for An. melas populations, the overall frequencies of both mutations were very low, being respectively 1.12% and 0.40% for the L1014S and L1014F mutations. With a global frequency of 2%, only the heterozygous form of the G119S mutation was found only in An. arabiensis and in all the study sites. The widespread occurrence of the kdr mutation in both An. arabiensis and An. melas natural populations, respectively the main and focal vectors in the central-western Senegal, may have contributed to maintaining malaria transmission in the area. Thus, compromising the effectiveness of pyrethroids-based vector control measures and the National Elimination Goal. Therefore, monitoring and managing properly insecticide resistance became a key programmatic intervention to achieve the elimination goal where feasible, as aimed by Senegal. Noteworthy, this is the first report of the ace-1 mutation in natural populations of An. arabiensis from Senegal, which need to be closely monitored to preserve one of the essential insecticide classes used in IRS to control the pyrethroids-resistant populations.

Diagnosis Dilemma of Angioimmunoblastic T-Cell Lymphoma in Tuberculosis Endemic Region.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic malignancy recognized in the WHO 2016 classification as a clinical and histological entity. It is a very poorly described disease in Africa due to its rarity and diagnostic difficulties, particularly differential diagnosis with tuberculosis. Here, we report a 57-year-old man who presented with fever, weight loss, and lymphadenopathies. The diagnosis of tuberculosis was carried out based on lymph node fine needle aspiration showing the image of tuberculous adenitis and CT images in favor of necrotic lymphadenopathies. The presence of autoantibodies and the failure of tuberculosis treatment led us to perform a biopsy with immunostaining that confirmed pathological features of AITL. The patient was treated by CHOP-based chemotherapy, and complete remission was achieved. This case highlights the difficulty of recognizing AITL and the importance of considering other potential differential diagnoses of tuberculosis in the endemic region.

[Diagnostic performance of imaging examinations in acute non-traumatic abdominal pain in the radiology department of the Kaolack Regional Hospital]. / Apport de l'imagerie dans la prise en charge des douleurs abdominales aigues non traumatiques au Centre Hospitalier Regional de Kaolack.

AIM: The aim of this work was to evaluate the diagnostic performance of imaging examinations in the presence of acute non-traumatic abdominal pain. MATERIALS AND METHODS: This was a prospective, cross-sectional and descriptive study over 6 months in the radiology and medical imaging department of the Kaolack Regional Hospital, including any patient received for acute non-traumatic abdominal pain with informed consent in whom the etiological diagnosis is supported by an imaging examination. We investigated the etiologies of acute abdominal pain and compared the imaging findings with surgical exploration. Our data were analyzed using SPSS 24.0 and Excel 2013 with a coefficient of significance of less than 5%. RESULTS: 106 patients were enrolled. The mean age was 32 years and the gender-ratio was 1.52 in favour of women. Acute abdominal pain was diffuse in 25.5% of patients and localized in 74.5%, of which 18.9% were at right iliac fossa.Abdominal X-ray was performed alone in 4 patients (3.8%), ultrasound alone in 46 patients (43.3%) and abdominal CT scan in 34 patients (32%). CT was combined with ultrasound in 6 patients (5.7%) and with abdominal X-ray in 16 patients (15%). The initial clinical diagnosis was corrected in 49.1% of patients. The sensitivity of the imaging compared to the final diagnosis retained was 96.2%. CONCLUSION: Imaging represents a turning point in the management of patients with acute non-traumatic abdominal pain by providing better diagnostic guidance and avoiding serious complications and unnecessary interventions.

BUT: le but de ce travail était d'évaluer les performances diagnostiques des examens d'imagerie devant des douleurs abdominales aigües non traumatiques. MATÉRIELS ET MÉTHODES: il s'agissait d'une étude prospective, transversale et descriptive sur 06 mois dans le service de radiologie et imagerie médicale de l'hôpital régional de Kaolack, incluant tout patient reçu pour douleur abdominale aigue non traumatique avec son consentement éclairé chez qui le diagnostic étiologique est appuyé par un examen d'imagerie. Nous avons recherché les étiologies des douleurs abdominales aigues et confronter les résultats de l'imagerie à l'exploration chirurgicale. Nos données ont été analysés avec les logiciels SPSS 24.0 et Excel 2013 avec un coefficient de significativité inférieur à 5%. RÉSULTATS: 106 patients ont été retenu. L'âge moyen était de 32 ans et le genre-ratio de 1,52 en faveur des femmes. La douleur abdominale aigüe était diffuse chez 25,5% des patients et localisée chez 74,5% dont 18,9% à la FID. L'ASP a été réalisé seul chez 4 patients (3,8%), l'échographie seule chez 46 patients (43,3%) et le scanner abdominal chez 34 patients (32%). Le scanner a été couplé à l'échographie chez 6 patients (5,7%) et avec l'ASP chez 16 patients (15%). Le diagnostic clinique initial a été rectifié chez 49,1% des patients. La sensibilité de l'imagerie par rapport au diagnostic final retenu était de 96,2%. CONCLUSION: L'imagerie constitue un tournant décisif dans la prise en charge des patients présentant une douleur abdominale aigüe non traumatique en apportant une meilleure orientation diagnostique évitant aux patients des complications graves et des interventions inutiles.

[Umbilical Artery Doppler Study Role In The Monitoring And Obstetric Management Of High-Risk Pregnancies]. / Apport De L'Echo-Doppler Dans Le Suivi Des Grossesses A Risque.

OBJECTIVE: to compare aspects of the diastolic component of umbilical artery flow with fetal fate parameters. MATERIAL AND METHODS: this was a prospective, cross-sectional study at the Kaolack Regional Hospital over 6 months including patients with an at-risk pregnancy and a gestational age greater than 20 SA. The aspect of umbilical artery flow, umbilical artery IR and cerebro-placental index were studied.We compared the velocity data with the rates of fetal suffering, low birth weight and perinatal mortality. The statistical analysis was done with EPI info software version 7, Excel 2010 and SPSS 20.0 with a p-value of less than 5%. RESULTS: 46 patients were included with an average age of 24.54 years. The mean gestational age was 33.7 AS. The diastolic component of umbilical artery flow was null in 19.6%; reversed in 10.9%; decreased in 21.7% and normal in 47.8%. Confrontation with fetal fate parameters found a rate of 78.6% fetal suffering in the null or reversed diastolic components group compared to 34.4% in the non-zero diastolic components group. For low birth weight, this rate was 92.9% compared to 28.1%. The perinatal mortality rate was 64.2% compared to 12.5%. CONCLUSION: The umbilical artery Doppler study plays a major role in the monitoring and obstetric management of high-risk pregnancies. Our results demonstrate the correlation between a diastolic component of the flow of the pathological umbilical artery and the adverse outcome of the pregnancy at risk.

OBJECTIF: confronter les aspects de la composante diastolique du flux de l'artère ombilicale aux paramètres du devenir fœtal. MATÉRIEL ET MÉTHODES: il s'agissait d'une étude prospective, transversale à l'Hôpital régional de Kaolack sur 6 moisincluant les patientes avec une grossesse à risque et un âge gestationnel supérieur à 20 SA. Etaient étudiés l'aspect du flux de l'artère ombilicale, l'IR de l'artère ombilicale et l'index cérébro-placentaire. Nous avons confronté les données vélocimétriques au taux de souffrance fœtale, de faible poids de naissance et de mortalité périnatale. L'analyse statistique a été faite avec le logiciel EPI info version 7, Excel 2010 et SPSS 20.0 avec une p-value inférieure à 5%. RÉSULTATS: 46 patientes étaient incluses avec un âge moyen était de 24,54 ans. L'âge gestationnel moyen était de 33,7 SA. La composante diastolique du flux de l'artère ombilicale était nulle dans 19,6% ; inversée dans 10,9% ; diminuée dans 21,7% et normale dans 47,8%.La confrontation avec les paramètres du devenir fœtal trouvait un taux de souffrance fœtale de 78,6% dans le groupe des composantes diastoliques nulles ou inversées contre 34,4% dans le groupe des composantes diastoliques non nulles. Pour le faible poids de naissance ce taux était de 92,9% contre 28,1%. Concernant le taux de mortalité périnatale on notait 64,2% contre 12,5%. CONCLUSION: L'étude Doppler de l'artère ombilicale joue un rôle majeur dans la surveillance et la prise en charge obstétricale des grossesses à risque. Nos résultats démontrent la corrélation entre une composante diastolique du flux de l'artère ombilicale pathologique et l'issue défavorable de la grossesse à risque.

[Performance of magnetic resonance imaging ang genourob laximetry in anterior cruciate ligament rupture in 30 cases]. / Performance de l'imagerie par resonance magnetique et de la laximetrie a genourob dans les ruptures du ligament croise anterieur a propos de 30 cas.

INTRODUCTION: The aim of this work was to evaluate the diagnostic contribution of magnetic resonance imaging and genourob compared to intraoperative arthroscopy. The objective was to implement a protocol based on magnetic resonance imaging and / or genourob. MATERIALS AND METHODS: We did a cross-sectional study from July 18, 2016 to July 19, 2017 at the Maltese hospital comparing the results of MRI and GNRB from 30 patients compared to intraoperative arthroscopy data. RESULTS: Complete break.- In MRI, we obtained a sensitivity (Se) of 95.7%, a specificity (Sp) of 85.7%.- At the GNRB, we found a Se of 87%, a Sp of 42.9%.Partially broken.- In MRI we obtained a Se of 85.7%, a Sp of 95.7%.- At the GNRB, we found a Se of 42.9%, a Sp of 87%. CONCLUSION: MRI is better than GNRB. The GNRB does not improve the results of the MRI. It has no diagnostic contribution in the rupture of the ACL knee. It is a device used by the orthopedists to evaluate knee laxity that does not depend on the ACL alone.

INTRODUCTION: Le but de ce travail était d'évaluer l'apport diagnostique de l'imagerie par résonance magnétique (IRM) et du genourob (GNRB) par rapport à l'arthroscopie per opératoire. L'objectif était de mettre en place un protocole basé sur l'IRM et / ou le GNRB. MATÉRIELS ET MÉTHODES: Nous avons fait une étude transversale allant du 18 Juillet 2016 au 19 juillet 2017au centre hospitalier de l'ordre de malte en comparant les résultats d'IRM et du GNRB de 30 patients par rapport aux données de l'arthroscopie per opératoire. RÉSULTATS: ✓ Rupture complète.- En IRM, nous avons obtenu une sensibilité (Se) de 95,7 %, une spécificité(Sp) de 85,7%.- Au GNRB, nous avons trouvé une Se de 87 %, une Sp de 42,9%.✓ Rupture partielle.- En IRM, nous avons obtenu une Se de 85,7 %, une Spde 95,7%.- Au GNRB, nous avons trouvé uneSe de 42,9 %, une Sp de 87%. CONCLUSION: L'IRM est plus performante que le GNRB. Le GNRB ne permet pas d'améliorer les résultats de l'IRM. Il n'a pas d'apport diagnostique dans la rupture du LCA du genou. C'est un dispositif utilisé par les orthopédistes pour évaluer une laxité du genou qui ne dépend pas du LCA à lui seul.

Performance de l'imagerie par resonance magnetique et de la Laximetrie a Genourob dans les ruptures du ligament croise anterieur a Propos de 30 cas

Introduction:Le but de ce travail était d'évaluer l'apport diagnostique de l'imagerie par resonance magnétique (IRM) et du genourob (GNRB) parrapport à l'arthroscopie per opératoire.L'objectif était de mettre en place un protocole basé sur l'IRMet / ou le GNRB.Matériels et méthodes:Nous avons fait une étude transversale allant du 18 Juillet 2016 au 19 juillet 2017au centre hospitalier de l'ordre de malte en comparant les résultats d'IRM et du GNRB de 30 patients par rapport aux données del'arthroscopie per opératoire. Résultats Rupture complète:En IRM, nous avons obtenu une sensibilité (Se) de 95,7 %, une spécificité(Sp) de 85,7%;Au GNRB, nous avons trouvé une Se de 87 %, une Sp de 42,9%.Rupture partielle:En IRM,nous avons obtenu une Se de 85,7 %,une Spde 95,7%;Au GNRB, nous avons trouvé une Se de 42,9 %, une Sp de 87%.Conclusion:L'IRM est plus performante que le GNRB Le GNRB ne permet pas d'améliorer les résultats de l'IRM. Il n'a pas d'apport diagnostique dans la rupture du LCA du genou. C'est un dispositif utilisé par les orthopédistes pour évaluer une laxité du genou qui ne dépend pas du LCA à lui seul

Varibaculum massiliense sp. nov., a new bacterium isolated from human urine with culturomics.

Varibaculum massiliense sp. nov. strain Marseille-P2802T (= CSUR P2802 = DSM 103074) is a new species within the genus Varibaculum in the phylum Actinobacteria that was isolated from the urine of a 59-year-old man treated with chronic haemodialysis for diabetic nephropathy.

Varibaculum timonense sp. nov., a new bacterial species isolated from human stool sample.

Varibaculum timonense sp. nov. strain Marseille-P3369T (= CSURP3369) is a new species from the order Actinomycetales that has been isolated from a fresh stool sample of a healthy French woman.

Corynebacterium urinapleomorphum sp. nov., a new bacterial species isolated from human urine sample.

Corynebacterium urinapleomorphum sp. nov. stain Marseille-P2799T (= CSURP2799; = DSM103272) is a new species from the order Corynebacteriales that was isolated from urine of a 2-month-old child with gastroenteritis.

Corynebacterium bouchesdurhonense sp. nov., and Corynebacterium provencense sp. nov., two new species isolated from obese patients.

Corynebacterium bouchesdurhonense sp. nov. strain Marseille-P2067T (= CSURP2067; = DSM100846) and Corynebacterium provencense sp. nov. strain Marseille-P2161T (= CSURP2161; = DSM101074) are two new species from the order Corynebacteriales that were isolated from obese French individuals.

Insecticide resistance in Anopheles arabiensis populations from Dakar and its suburbs: role of target site and metabolic resistance mechanisms.

BACKGROUND: Urban malaria is an increasing concern in most of the sub-Saharan Africa countries. In Dakar, the capital city of Senegal, the malaria epidemiology has been complicated by recurrent flooding since 2005. The main vector control measure for malaria prevention in Dakar is the community use of long-lasting insecticide-treated nets. However, the increase of insecticide resistance reported in this area needs to be better understood for suitable resistance management. This study reports the situation of insecticide resistance and underlying mechanisms in Anopheles arabiensis populations from Dakar and its suburbs. RESULTS: All the populations tested showed resistance to almost all insecticides except organophosphates families, which remain the only lethal molecules. Piperonil butoxide (PBO) and ethacrinic acid (EA) the two synergists used, have respectively and significantly restored the susceptibility to DDT and permethrin of Anopheles population. Molecular identification of specimens revealed the presence of An. arabiensis only. Kdr genotyping showed the presence of the L1014F mutation (kdr-West) as well as L1014S (kdr-East). This L1014S mutation was found at very high frequencies (89.53%) in almost all districts surveyed, and in association with the L1014F (10.24%). CONCLUSION: Results showed the contribution of both target-site and metabolic mechanisms in conferring pyrethroid resistance to An. arabiensis from the flooded areas of Dakar suburbs. These data, although preliminary, stress the need for close monitoring of the urban An. arabiensis populations for a suitable insecticide resistance management system to preserve core insecticide-based vector control tools in this flooded area.

[Evaluation of Physical Integrity and Biological Efficacy of Two Types of LLINs Aged 5 to 36 Months Sampled in 11 Districts of Senegal]. / Évaluation de l'état physique et de l'efficacité biologique de deux types de moustiquaires imprégnées à longue durée d'action utilisés depuis 5 à 36 mois et collectés dans 11 districts du Sénégal.

The long-lasting insecticidal nets (LLINs) have been promulgated to compensate the low re-impregnation rate of conventional mosquito nets. Today, the cornerstone of the fight against malaria vectors is based on a large distribution of these LLINs for universal coverage. Despite this promotion, the question of their effective life in operational conditions remains unresolved. Between September and October 2013, a survey was conducted in 11 districts of Senegal where LLINs were sampled and routed to the laboratory for assessing their physical integrity and biological effectiveness. A total of 207 LLINs that were sampled in the 11 districts have been monitored during this study. Our results showed that Olyset® Net and PermaNet® 2.0 are the most represented brands in the districts. These two major brands have a good biological efficiency providing a high rate of knockdown despite their failing physical integrity.

Les moustiquaires imprégnées à longue durée d'action (MILDA) ont été promues pour pallier le faible taux de réimprégnation des moustiquaires conventionnelles. Aujourd'hui, la pierre angulaire de la lutte antivectorielle repose sur une forte distribution de ces MILDA pour une couverture universelle. En dépit de cette promotion, la question de leur durée de vie effective en conditions opérationnelles reste toujours posée. Entre septembre et octobre 2013, une enquête a été menée dans 11 districts du Sénégal. Des MILDA y ont été échantillonnées et acheminées au laboratoire pour évaluer leur intégrité physique et leur efficacité biologique. Au total, 207 MILDA ont été collectées dans les 11 districts suivis au cours de cette étude. Nos résultats ont montré que les deux marques majoritairement distribuées présentaient une bonne efficacité biologique, car induisant un taux élevé de knock-down malgré leur état détérioré.

[Effectiveness of three biological larvicides and of an insect growth regulator against Anopheles arabiensis in Senegal]. / Efficacité de trois larvicides d'origine biologique et d'un régulateur de croissance contre Anopheles arabiensis au Sénégal.

Urban malaria is a major public health problem in Africa. In Senegal, the environmental changes seem to favor the persistence of malaria transmission in Dakar suburbs by creating, throughout the year, potential breeding sites of malaria vectors. In such a situation and in a context of a growing threat of insecticide resistance in anopheline vectors, the larval control making use of products from biological origin or growth regulators could represent an additional tool to the current strategies developed against anophelines. In this study conducted in 2012, the efficiency and residual effect of three biological larvicides (VectoBac® WG, Vecto-Max® CG, and VectoBac® GR) and an insect growth regulator (MetaLarv™) were evaluated on Anopheles gambiae s.l. larvae in seminatural conditions (experimental station) and natural breeding sites in the suburbs of Dakar. The formulations were tested according to the manufacturer recommendations, namely 0.03 g/m2 for VectoBac® WG, 0.5 g/m2 for VectoBac® GR, 0.75 g/m2 for VectoMax® CG, and 0.5 g/m2 for MetaLarv™. In experimental station, the treatment with larvicides was effective over a period of 14 days with a mortality ranging between 92% and 100%. The insect growth regulator remained effective up to 55 days with a single emergence recorded in the 27th day after treatment. In natural conditions, a total effectiveness (100% mortality) of larvicides was obtained 48 hours after treatment, then a gradual recolonization of breeding sites was noted. However, the insect growth regulator has reduced adult emergence higher than 80% until the end of follow-up (J28). This study showed a good efficiency of the larvicides and of the growth regulator tested. These works provide current data on potential candidates for the implementation of larval control interventions in addition to that of chemical adulticide for control of urban malaria.

Drug quality analysis through high performance liquid chromatography of isometamidium chloride hydrochloride and diminazene diaceturate purchased from official and unofficial sources in Northern Togo.

Trypanocidal drugs remain the most accessible and thus commonly used means of controlling tsetse transmitted animal African trypanosomosis. In Togo, trypanocides are sold on official as well as unofficial markets, but the quality of these trypanocides is undocumented so a drug quality assessment study was conducted from May 2013 to June 2014. Trypanocides supplied by European, Indian and Chinese pharmaceutical companies and sold on official and unofficial markets in Togo were purchased. In total fifty-two trypanocides were obtained, 24 of these samples from official markets and 28 from unofficial markets made up of a total of 36 diminazene diaceturate and 16 isometamidium chloride hydrochloride samples. The samples were analysed in the reference laboratory of the OIE (World Organisation for Animal Health), Laboratory for the Control of Veterinary Medicines (LACOMEV) in Dakar which uses galenic testing and high performance liquid chromatography (HPLC) testing as standard reference analysis methods. The results revealed a high proportion of trypanocides of sub-standard quality on the Togolese market: 40% were non-compliant to these quality reference standards. All of the HPLC non-compliant samples contained lower amounts of active ingredient compared to the concentration specified on the packaging. Non-compliance was higher in samples from the unofficial (53.57%) than from the official markets (25%; p=0.04).The main drug manufacturers, mostly of French origin in the study area, supply quality drugs through the official legal distribution circuit. Products of other origins mostly found on illegal markets present a significantly lower quality.

[Outcome of elderly patients in an intensive care unit in Dakar, Senegal]. / Devenir des sujets âgés en réanimation à Dakar (Sénégal).

OBJECTIVES: To determine the frequency of admission and its reasons, severity and outcome among elderly patients in our intensive care unit (ICU) and compare them with those for younger subjects. METHODOLOGY: Retrospective study covering a 5-year period (January 1, 2005, through December 31, 2009) in the ICU of the principal hospital in Dakar. We included as elderly patients all those aged at least 65 years and compared them with the young patients, that is, those younger than 65 years. RESULTS: During the study period, 2196 patients were admitted to the ICU, 374 of them elderly. The ratio of men to women was 1.43. The mean age among the elderly was 74.4 ± 6.5 years, and their mean duration of ICU stay was 5.6 ± 4.67 days. Nearly 80% had a serious medical history or preexisting condition, most often, myocardial infarction, stroke, or lung disease. The older patients were more seriously ill than the younger ones (p<0.01), but their care was less complex. Mortality was higher among the older, compared with the younger, subjects (42.80% vs. 28.4%). The only mortality-related factor that appeared to vary with age was cardiogenic pulmonary edema. CONCLUSION: The management of elderly subjects remains a problem in intensive care. High mortality is generally not directly related to their age but rather to their overall condition.

[Epidemiology and prognostic value of organ failure during severe malaria in the Principal Military Teaching Hospital of Dakar, Senegal]. / Épidémiologie et valeurs pronostiques des défaillances viscérales au cours du paludisme grave à l'hôpital d'instruction des armées principal de Dakar, Sénégal

We report the results of a retrospective study in the medical intensive care unit of the Principal Military Teaching Hospital of Dakar. The objectives were to determine the epidemiological and clinical aspects of severe malaria and to evaluate the prognostic values of the failure of different organs. Eighty-seven patients were admitted for severe malaria. Their average age was 35 ± 18.53 with a sex-ratio of 1.71 for men. Mortality was 33.3% and concerned mainly young adults. Neurological failure was the most frequent (79.3%). Hemodynamic failure was the most relevant prognostic factor for mortality, followed by hypoglycemia, respiratory and renal failure. The Simplified Acute Physiology Score II (SAPS II) was reliable in predicting mortality. The mean SAPS II was 44.85, with an expected mortality of 32.6%.

[Congenital choledocal cyst of adult: report of two cases]. / Kyste congenital du choledoque de l'adulte : a propos de deux observations.

INTRODUCTION: Congenital choledochal cyst is a congenital dilatation of the biliary tract often associated with a long common bilio-pancreatic duct without obstruction. PATIENTS AND METHOD: We report the case of two women who presented a congenital choledochal cyst. RESULTS: For the first patient, the diagnosis was effected during a laparoscopic cholecystectomy for a gall bladder lithiasis. The second one presented repeted access of angiocholitis. Echography and abdominal tomodensitometry found the congenital choledochal cyst. Percutaneous opacification of the cyst found a long common biliopancreatic duct in the second patient. A complete resection of the cyst with a cholangiojejunal anastomosis was performed for both patients. The treatment was successfull for the first one and the second one was deceased three days after the operation. CONCLUSION: This case report underlines the clinical polymorphysm, the morphologic anomaly and the treatment of congenital choledochal cyst which require total resection.

[Cerebral metastasis for the identification of carcinomas of the lung: the use of mulimodality medical images. A case repport]. / Metastase cerebrale revelatrice d'un carinome epidermoide pulmonaire: apport de l'imagerie multinodalite.

INTRODUCTION: Diagnosis of carcinomas of unknown primary site has proved to be difficult for many reasons. PATIENT AND METHODS: In this study, case in which cerebral metastasis is confirmed by biopsy technique with no identified primary site at the onset of treatment is presented here in. RESULTS: The multimolity medical images was used to detect pulmonary hearths compatibles with a malignant histology. Further analysis diagnosed a primitive neoplasm. CONCLUSION: This study illustrates the interest of this technology in medical imagery in the early detection of primitive cancers on which the forecast depends.

[Syndrome of "Coup de fouet". A case description and literature review]. / Syndrome du "Coup de Fouet" syndrome d'un cas et revue de la litterature.

The authors bring back the observation of a 48-year-old woman having induced a big painful left calf. The dread os a thrombophlebitis drew away the strarting of an anticoagulative treatment. This treatment was later supended in front of the putting in an a bvious place in echo-Doppler of a haematoma of the calf linked to a normal side of venous fluxes. This table made recall a syndrome of "coup de fouet". It is about a desease characterised by the unpromted rupture of a deep vein of the calf accomplishing a haematoma. It happens in repose or in step as at our patient. It posed a problem of differential diagnosis with a thrombophlebitis of lower limb. Evolution was favourable under treatment linking pause, an anti inflammatory and the haematoma paracentesis under echographique guidance .