[Tuberculosis in elderly persons]. / Tuberculose du sujet âgé

OBJECTIVES: The purpose of this study was to compare the epidemiology, clinical features and clinical course of primary presentations with pulmonary tuberculosis occurring in older and younger patients. PATIENTS AND METHODS: We undertook a prospective, comparative study in the Pneumology clinic of the National University Hospital of Fann in Dakar, from April 1, 2005 to March 31, 2006, collecting data on all patients presenting with a first episode of bacterially confirmed pulmonary tuberculosis. RESULTS: We studied 187 first presentations with confirmed pulmonary tuberculosis including 12.8% (n=24) elderly (>55 years) subjects (20 men and four women) and 87.2% (n=163) younger subjects (105 men and 58 women). In the older subjects, patients were more commonly men (sex-ratio: 5), without formal education, and working in the primary or informal sector. Comorbidities were more frequent in the older group, including smoking (P=0.002), alcohol consumption (P=0.01), diabetes (37.5%) (P<0.005) and obesity with BMI superior than 20 in 25%. Pulmonary shadowing was common (41.7% of the cases), P=0.008 and generally bilateral P=0.0001 with cavitation, but this observation was not statistically significant. COMPLICATIONS: Complications were more frequent in the older patient (20.8%), as was mortality (29.3%, P=0.000) and rate of clinical improvement in response to treatment was less satisfactory (50%) there.

[Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. / Apport de l'échographie dans la prise en charge de la ténosynovite de de Quervain: à propos de 22 cas.

PURPOSE: To assess the role of US in the management of de Quervain's tenosynovitis. MATERIALS AND METHODS: Using a high-frequency transducer (12 MHz), sagittal and axial images were obtained of the first extensor compartment. The US features of 22 symptomatic patients were reviewed (positive Finkelstein's maneuver). RESULTS: US findings included tendon thickening and synovial sheath thickening with peritendinous edematous changes resulting in a peritendinous hypoecoic halo in all patients. An intertendinous septum was identified in two patients. CONCLUSION: US can confirm the suspected diagnosis and provide follow-up of lesions. It can confirm the presence of an intertendinous septum and provide guidance at the time of steroid injection. It can increase the rate of conservative management by demonstrating the absence of septum.

[Clinical, biological and radiological spectrum of newly diagnosed pulmonary tuberculosis]. / Profil clinique, biologique et radiologique des nouveaux cas de tuberculose pulmonaire au Centre Hospitalier Universitaire de Fann-Dakar.

The aim of the present study was to describe the clinical, biological and the chest-X ray presentations of newly diagnosed pulmonary tuberculosis. A retrospective study of 200 patients was performed from January to October 2004 in the respiratory diseases unit of Dakar's University Teaching Hospital. Among the 200 cases, 140 (70%) were male, giving a sex ratio of 2.3. The mean age of our patients was 35.5 years (range: 14-81 years). The group age of 20 to 39 years was the most affected (55,5% of patients). The median diagnostic delay was 4 months (range: 7 days to 2 years). Haemoptysis revealed the disease in 27% of cases. The chest X-ray showed bilateral lesions in 65% of cases. When they were unilateral, the right side was the most concerned. Of the 200 patients, the lesions interested all parts of at least one lung in 106 (53%). Among our patients, 153 (76.5%) had cavitations and 145 (72.5%) had infiltrates. A pleural effusion was associated to the lung lesions in 10% of the patients. Biologically, we reported 80% cases (n=160) of hypochromic microcytic anaemia. Of the 27 HIV tests done, 18 (66.7%) were positive all for HIV1. Delay in the diagnosis of pulmonary tuberculosis was very long and our data illustrate the need for improved education of the community and event of healthcare workers about the benefit of early diagnosis of tuberculosis.

[Congenital absence of the patella: two cases reported]. / Absence congenitale de rotules: à propos de deux cas.

OBJECTIVES: To remind a rare disease, To emphasize the importance of patellar agenesis because it's a calling sign, To insist on the necessity to know child bony growth. MATERIALS AND METHODS: We reported observations of two negro-african children's, one female and one male, who were both 7-years-old. They were referred for troubles of the walk, knee pains for the male, and for the female frequent falls and hypotonia. We have noted previous history of second degree familial consanguinity and paternal grandfather's ungueal anomalies for the female. RESULTS: For the female, examination showed ligamentary hyperlaxity, anterior flattening and lateral dimple of the knee, so varied skeletal defects. Skeletal radiographies displayed absence of the patella, "console like" aspect of the superior tibial metaphysis. At the male, examination is normal. Standard radiographies showed semilunar opacities and tomodensitometry showed presence of a tissular formation who looks like the patella. Aplasia of the patellar apparatus is evocated for the female, even though for the male, the diagnosis of hypoplasia seems more probable. CONCLUSION: Absence of patella is rare. It can be transient and patellar nucleus appears lately. It can be permanent and in this case, it is isolated whether associated with other osseous malformations. Interest of such observations is in its rarity and its functional impact related to the biomechanical importance of the patella.

[Tuberculosis and diabetes]. / Tuberculose et diabète.

INTRODUCTION: We performed a retrospective case control study for the period between 1st January 1999 and 31st August 2004, comparing the radiological appearances of tuberculosis in 100 diabetics to those in patients matched for age and sex, with pulmonary TB alone presenting to The Chest clinic of the National Hospital of Fann. METHODS AND RESULTS: Diabetes was present in 4.7% of the 2116 patients hospitalized for pulmonary tuberculosis during the period of study and occurred more commonly in men (60%) with an average age of 51 years (73%). 82% had type II, non-insulin dependent diabetes. The various types of radiological lesions classically described in tuberculosis were found in nearly identical proportions in the two groups of patients, with parenchymal shadowing the most frequent appearance in both diabetics (N=86) and controls (N=88). Cavitation occurred significantly less frequently in diabetics (72%) than controls (88%) (p=0.04). Where radiological abnormalities were bilateral, they were worse on the left in the diabetics (27% versus 15% in controls). There was a trend for basal lesions to occur more frequently in diabetics (15%) than controls (3%) (p=0.06). CONCLUSION: Mortality was higher in diabetics (18%) than controls (6%), with death generally occurring within the first 24 hours of hospitalization.

[Infantile cortical hyperostosis: case report]. / Hyperostose Corticale Infantile : a propos d'un cas.

Infantile cortical hyperostosis (ICH) or Caffey-Silverman disease is affection that attained skeleton most frequently flat bones, contiguous fasciae and muscles. We reported the case of a 3 months old female infant of Mauritanian origin, referred for recurrent osteitis of the left clavicle. The present complaints are incessant snivelling and functional disability of the left upper limb. Examination showed clavicular and mandibular swelling, without fever. Biological check-up showed inflammatory signs. Radiographies showed cortical thickening of the left clavicle and mandible. Interest of such an observation is in the rarity of this affection, its originality as for the striking age limitation, in the disconcerting but suggestive symptomatology, at least in the classical sites and in the possibility of its antenatal diagnosis.

[Senegalese case of thromboangeitis obliterans or Buerger's disease]. / Premiere observation Senegalaise de thromboangeite obliterante ou maladie de Buerger.

INTRODUCTION: Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case. CASE REPORT AND DISCUSSION: A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning. CONCLUSION: TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.

[Sonographic evaluation of periportal fibrosis in children living in a Schistosoma mansoni endemic region]. / Fibrose périportale chez les enfants en zone d'endémie à Schistosoma mansoni: évaluation échographique.

PURPOSE: To assess with ultrasound periportal fibrosis due to chronic Schistosoma mansoni infection in children living in an endemic region. Materials and methods. A total of 441 children underwent two stool examinations and abdominal sonography. Liver echotexture was assessed by two observers and compared to pre-defined image patterns and a fibrosis score was assigned ranging from 0 to 8. Ultrasound features were correlated to age, sex, and parasitologic findings. RESULTS: Prevalence of Schistosoma mansoni infestation was 63%. Two cases of advanced fibrosis (E pattern or fibrosis score of 6) were observed. Fibrosis correlated with age. No correlation existed between fibrosis and intensity of egg-output. A correlation between the two examinors was noted in 84% of examinations with a kappa coefficient of 0.7. CONCLUSION: Although severe periportal fibrosis is a rare finding in this endemic region, follow-up sonography must be performed because it is the only non invasive and reliable tool for detection of periportal fibrosis.

[Spiral CT in aortic dissection]. / Place de l'angioscanner dans le diagnostic de la dissection aortique.

Patients with suspected dissection of the thoracic aorta require immediate diagnostic evaluation so that urgent therapeutic interventions can begin. Two women with suspected aortic dissection and one man with abdominal aortic aneurysm underwent color-flow Doppler echocardiography and CT angiography with multiplanar reconstructions. Spiral CT showed ascending aortic dissection (type A Stanford) in two cases and descending aortic dissection (type B Stanford) in one case. It also access the visualization of the intimal flap, the extent of dissection, the size of the aorta, and the presence of pericardial fluid. CT angiography is an accurate diagnostic procedure for patients with suspected aortic dissection and possesses several advantages over other modalities such as transthoracic echocardiography, transesophageal echocardiography and aortography.

Place de l'angioscanner dans le diagnostic de la dissection aortique

La dissection aigue de l'aorte thoracique est une urgence thérapeutique. L'imagerie doit rapidement poser le diagnostic et faire le bilan d'extension. Le but de ce travail est de montrer l'intérêt de l'angioscanner dans le diagnostic de DA à parti de 3 observations. Deux femmes de 40, 43 ans adressées pour dissection aortique thoracique et 1 homme de 60 ans pour anévrysme aorte abdominale ont bénéficié d'une échographie cardiaque et d'un angio-scanner de l'aorte thoraco-abdominale suivi de reconstructions multiplans. La TMD a permis de montrer une dissection de l'aorte ascendante dans 2 cas (stade A de Stanford) et de l'aorte abdominale dans 1 cas (stade B de Stanford) L'angioscanner a visualisé la membrane intimale décollée, précisé l'extension de la dissection, chiffré l'ectasie aortique dans les 3 cas et a monté des signes de gravité à type d'épanchement péricardique. L'angioscanner constitut une alternative fiable dans le diagnostic de DA. Elle est plus sensible que l'échographie transthoracique, moins opérateur dépendant que l'échographie transoesophagienne et plus facile à réaliser qu'une aortographie

[Commissural agenesis associated with inter hemispheric cyst]. / Agénesie commisurale associée a un kyste inter hemisphérique.

The Objectives of this study were to Report a rare malformation and to try to understand the embryological origin of such lesion. We reported the case of an eight-month-old female infant, without any particular past medical history, who was refered for seizures and vomiting. The examination revealed normal anthropometric constants, a soft painless and renitent tumefaction of the vertex and a psychomotor delay. Skull x-ray showed a parietal lacuna opposite to an opacity. Ultrasound scan showed an encephalocystocele communicating with dilated ventricles. CT x-ray revealed a single ventricle with an important back and upper extension, which evokes a cystic formation of the centre line. The existence of this cystic formation suppose an agenesis of diencephalic and telencephalic structures notably commissural. Interest of such observation is in its rarity, its complexity, the possibility of its antenatal diagnosis and in the etiopathogenic discussions that she gives rise to.

[Role of transesophageal echocardiography in the diagnosis of aortic dissection. Report of 5 cases]. / Apport de l'echocardiographie transoesophagienne dans le diagnostic de la dissection de l'aorte. A propos de 5 observations sénégalaises.

Aortic dissection is medical and surgical emergency. About 5 cases, the authors emphasized the role of transesophageal echocardiography in the diagnosis of aortic dissection. For all patients we realized a clinical examination, electrocardiogram, chest X ray, thoracic and transesophageal echocardiography and laboratory studies. Echocardiography were performed by an apparatus Hewlett Packard sonos 1000 with colour doppler and multiplanar transesophageal. Transesophageal echocardiography made the diagnosis by showing dilatation of aorta, intimal flap, false channel; this exam also allow to classify the aortic dissection.

[Growing skull fracture with cerebral and ventricular hernia after brain trauma]. / Fracture evolutive avec hernie cérébrale et ventriculaire post-traumatique.

Authors report the case of 3 years old boy. He represented a severe head injury with dura mater damage and skull fracture. He has been operated and few years later, he present a vault tumefaction. CT scan show a very large bone defect, a cerebral and ventricular hernia. Mecanism and causal factors are discussed.

[Arachnoid cyst with orbital meningocele: a case report]. / Kyste arachnoidien avec meningocele orbitaire: à propos d'un cas.

Arachnoïd cysts are rare. 1% of cranial neoformation. We report the case of a six years old boy who presented an arachnoid cyst impressive by its compressive phenomena. Present complaint are macrocrania and right orbitary tumor. Tomodensitometry reveal a huge liquid collection which starts from the right cerebellopontine angle to the frontal region and invading the orbital cavity. In addition we have a thalamic fusion Its congenital origin is obvious. The associated malformations seem to be related to an anomaly of the centre line. This case point out the primum movens of malformations which are often complex and whose antenatal diagnosis is rare in our countries

[Does renal transplantation increase the risk of breast diseases?]. / La transplantation rénale accroît-elle le risque de pathologie mammaire?

PURPOSE: To evaluate the risk of breast pathology occurrence in a group of kidney transplanted patients. MATERIAL: and methods. In the last five years, 30 kidney-transplanted women underwent systematic breast evaluation in our institution and were included in this retrospective study (exposed-group). To compare with this exposed-group, 90 non transplanted women undergoing breast evaluation in the same period at our institution (non-exposed group), were retrospectively randomized. In both groups, results of breast evaluation were classified in two categories (normal and abnormal) and distribution of benign and malignant breast pathologies were evaluated. The mean exposition-time was determined in months in the exposed-group. Comparative analysis of both groups included a comparison of mean patients age and evaluation of the relative risk (RR) of breast pathology occurrence. RESULTS: Mean exposition time was 72.7+/-66.6 months. The percentages of benign breast pathology were 93.7% in the exposed-group and 83.3% in the non-exposed group. Percentages of cancer were respectively 6.3 and 16.7%. Mean patient age was quite similar in the exposed-group (50.7+/-10 years) and in the non-exposed group (50.6+/-10.5 years). The relative risk of breast pathology occurrence was 1.70 (0.99

[Diagnostic x-ray computed tomography pf craniocerebral tumors. Apropos of 108 cases collected at the Soweto Center of Dakar]. / Diagnostic tomodensitométrique des tumeurs crânio-encéphaliques. A propos de 108 cas colligés au Centre Soweto de Dakar.

The authors report a retrospective study over two years in order to assess computed tomography (CT) in the diagnosis of intracranial tumors. Results were analysed on the epidemiological, clinical and CT point of view. CT is a sensitive and non invasive exploration which should be performed first when intracranial tumor is suspected. However its cost remain high for most of the patient.