[Unusual aspect of pernicious anemia during association of beta-thalassemia: a new case report and literature review]. / Maladie De Biermer De Presentation Inhabituelle Sur Un Profil Beta Thalassemique : Apport D'Un Nouveau Cas Et Revue De La Litterature.

Pernicious anemia appears classically by macrocytosis. We report a case of a late discovered Biermer disease, on a 42-year-old young black woman. The reason was an unusual aspect of this disease in a context of betathalassemia. The patient presented chronic anemia which evolved during about ten year. Biology showed a normocytosis and signs of hemolysis according to beta-thalassemia. This was confirmed by an electrophoresis showing 9.1 % of fraction F some haemoglobin. Since this date, the patient was treated by folic acid alone with periodic transfusions of red blood cell. She presented eight years after the beginning of her disease, neurological deterioration. Diagnosis of pernicious anemia was finally established up on histological gastritis, low level of the blood rate of vitamin B12, macrocytosis, and presence of intrinsic anti-factor and parietal anti-cells antibodies.

[Therapeutic impact of alpha interferon in chronic myelogenous leukaemia]. / Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique.

CONTEXT: Ten years after the use of alpha interferon in chronic myelogenous (CML) leukaemia treatment, we review this treatment. OBJECTIVE: We propose through this study to evaluate the therapeutic answer of the patients reached of CML in chronic phase and to study its impact on survival. MATERIAL AND METHODS: To be done we carried out a descriptive and analytical retrospective study concerning 40 patients carrying Chronic Myelogenous Leukaemia. RESULTS: The average age was 39.05 years and ratio sex was 0.9. 60% of the patients profited from the arm Hydroxyurea + Interferon alpha + Cytosine Arabinoside and 40% from Hydroxyurea + Interferon. The complete haematological answer was observed in 85.5%. The cytogenetic answer was documented only for two cases, and it acted of complete answer. On the evolutionary level, it was noted 27.5% of deaths related to a blastic transformation. The side effects were marked by occurred of alopecia, herpes and the gripal syndrome. The median of survival observed was 68.233 months or 5.68 years. The age, socioeconomic level, delay of treatment started, therapeutic protocol, length and regularity of treatment influenced the therapeutic response. CONCLUSION: Many factors influence the treatment response.

Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique

Contexte : Dix annees apres l'utilisation de l'interferon alpha dans le traitement de la leucemie chronique; dans le service d'hematologie clinique du CHU de yopougon; nous faisons le point de cette therapeutique. Objectif : nous nous proposons a travers cette etude d'evaluer la reponse therapeutique des patients atteints de leucemie myeloide chronique en phase chronique et d'etudier l'impact de ce traitement sur la survie. Materiel et methodes : nous avons effectue une etude retrospective descriptive et analytique concernant 40 patients porteurs de leucemie myeloide chronique. Resultats : l'age moyen etait de 39.05 ans et le sex ratio de 0.9. Les patients ont beneficie dans 60du bras Hydroxyuree + Interferon alpha + Cytosine Arabinoside et dans 40de l'association Hydroxyuree + Interferon alpha. La reponse hematologique complete a ete observee dans 85.5des cas. La reponse cytogenetique a ete documentee seulement dans deux cas; et il s'agissait de reponses completes. Sur le plan evolutif; il a ete note 27.5de deces lies a une transformation blastique. Les effets secondaires ont ete marques par la survenue d'alopecie; d'herpes et de syndrome grippal. La mediane de survie observee etait de 68.233 mois soit 5.68 ans. L'age; le niveau socioeconomique; le delai de prise en charge; le protocole therapeutique; la duree du traitement; la compliance influencaient la reponse therapeutique. Conclusion : de nombreux facteurs influencent la reponse au traitement

Profil etiologique des adenopathies cervicales en medecine interne : etude de 66 observations

Les adenopathies cervicales sont un motif frequent d'hospitalisation en Medecine Interne. Elles peuvent etre le temoin d'une affection severe necessitant un diagnostic precoce. Nous avons etudie les aspects cliniques et l'apport diagnostique des examens paracliniques en particulier de la biopsie ganglionnaire au cours des adenopathies cervicales en Medecine Interne au Senegal. Il s'agissait d'une etude retrospective sur une periode de cinq ans et huit mois allant du 1er janvier 2000 au 20 a out 2006 dans le service de Medecine Interne de l'hopital Aristide Le Dantec de Dakar. Soixante six dossiers sur les 8610 dossiers de patients hospitalises ont ete colliges. Un questionnaire structure avait permis de recueillir les caracteristiques sociodemographiques; cliniques et paracliniques. Les adenopathies cervicales etaient retrouvees chez 37 hommes (57) et 29 femmes (44); soit un sex-ratio de 1;2. L'age moyen etait de 34 ans avec des extremes de 15 et 73 ans. La region cervicale laterale etait le site privilegie des adenopathies; suivie du cercle peri-cervical et de la region cervicale anterieure. Trente six patients presentaient des adenopathies superficielles d'autres localisations : axillaire (39); inguinale (32) et epitrochleenne (1;5). Les etiologies d'adenopathies cervicales comportaient aussi bien la tuberculose; principale cause en milieu tropical; les lymphomes tres souvent responsables demacro- adenopathies; que certains cas anecdotiques comme le syndrome de Rosai Dorfman Destombes

[Etiologic profile of cervical adenopathology observed in an internal medicine department in Dakar, Senegal. A 66 case series]. / Profil étiologique des adénopathies cervicales en médecine interne: étude de 66 observations à Dakar (Sénégal).

Cervical adenopathy is a frequent reason for hospitalization in the internal medicine department. This finding can be a sign of severe disorder requiring early diagnosis. The purpose of this retrospective study was to describe clinical features and evaluate diagnostic tests especially lymph node biopsy associated with evaluation of patients presenting cervical adenopathies in an internal medicine department in Senegal. Records of a total of 8610 patients treated in the Internal Medicine Department of the Aristide Le Dantec Hospital of Dakar, Senegal over a 68-month period from January 1, 2000 to August 20, 2006 were reviewed. Sixty-six files were included for study. A structured questionnaire was used to collect sociodemographic, clinical and paraclinic data. There were 37 men and 29 women. Average patient age was 34 years (range, 15 to 73 years). The side of the neck was the most frequent location of adenopathy followed by the pericervical arterial circle and anterior cervical area. Thirty-six patients presented superficial adenopathy in other locations including the armpit (39%), groin (32%) and elbow (1.5%). The etiologies underlying cervical adenopathy included classic causes such as tuberculosis that is the main cause in tropical regions and lymphoma that frequently led to macroadenopathy as well as novel causes such as Rosaï Dorfman Destombes syndrome.

[Monoclonal gammapathy of undetermined significance and autoimmune disease: description of three cases in Senegal]. / Gammapathies monoclonales de signification indéterminée et maladies auto-immunes: étude de trois observations sénégalaises.

Monoclonal gammapathy of undetermined significance (MGUS) has rarely been reported in African literature. The purpose of this article is to describe 3 cases of MGUS observed in women aged 63, 54, and 44 years in Senegal. All three patients had previously documented autoimmune disease, i.e., auto-immune thrombopenia, multiple auto-immune disease (comprising Sjögren's syndrome, polymyositis and vitiligo), and Sjögren's syndrome. Diagnosis of MGUS was made thanks to routine protein electrophoresis that demonstrated a monoclonal peak in the gammaglobulin area in all patients. Serum protein binding showed the IgG lambda subtype in one case and IgG kappa subtype in two cases. Medullogram findings were unremarkable with nondystrophic plasma cell rates ranging from 1 to 4%. Bisphophonate therapy was undertaken along with the recommended treatments for the associated autoimmune diseases, i.e., prednisone, hydroxychloroquine, and methotrexate. Treatment was successful in all three patients with stabilization of the associated diseases and of the monoclonal peak on subsequent electrophoresis. As of this writing, the mean duration of follow-up was 3 years. MGUS that has been uncommon in the African hospital setting should be screened for in all older patients or in patients presenting infection (especially due to virus) or autoimmune disease (as in the three cases presented herein). More systematic use of serum protein electrophoresis should reveal an increased incidence of MGUS. Diagnosis of MGUS requires regular clinical and laboratory surveillance due to the risk for complications of malignant hemopathies, especially multiple myeloma.

[Frequency of hematological and immunological manifestations of lupus in Dakar]. / Frequence des manifestations hematologiques et immunilogiques de la maladie lipique a Dakar.

INTRODUCTION: The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immun pathology characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The discovery circumstances of diagnosis are variable and polymorphic. The hematologic signs and the immunological disorders constitute the diagnosis criteria of the lupic disease. METHODOLOGY: It is a multicentric and retrospective study undertaken study from January 1, 1997 to September 30, 2006. Patients were followed up in the Internal Medicine of Dakar. We have studied the hematological and immunological aspects of the SEL and have evaluated the prevalence of lupic disease. RESULTS: 142 patients with lupic disease were included with 125 women and 17 men; the ratio--sex was 0.13. The mean age was 34 years with extremes of 6 and 72 years. Our patients had hematological and immunological manifestations in 32.4% and 76.8% of the cases. The immunological tests showed the presence of antinuclear antibodies in 97.9% of the cases, native antibody anti-DNA in 45.7% of the cases, the anti-ECT in 8.95% (with the anti-RNP in 78.3 % of the cases, anti-Sm in 56.5% and of anti-SSA in 87% of the cases). Antibodies anti-DNAand anti-ECT were associated the hematologic demonstrations respectively in 92% and 95% of the cases (p 0.08). CONCLUSION: The hematologic and immunoligical signs of lupus disease are frequent and constitute diagnostic criteria of the disease.

[Anemic complications of sickle cell disease: frequency and evolution of 338 cases reported at Yopougon Teaching Hospital]. / Les complications anémiques de la drépanocytose homozygote: fréquence et évolution. A propos de 338 cas au CHU de Yopougon.

INTRODUCTION: Anemic complications of sickle cell disease are defined as all acute or chronical complications due to anemia. In order to describe complications of sickle cell disease, authors reported frequency and course of anemic manifestations. METHOD: This is a descriptive study based on retrospective analysis of data about 338 patients with sickle cell disease collected in the Service d'hematologie Clinique of Yopougon Teaching Hospital over a period of 11 years (March 1994 to September 2005). RESULTS: Mean age of our patients was 21.34 years, ranging from 7 months and 62 years.Majority of patients (68.93%) are aged 15 years or more. Male patients are predominant, with a sex-ratio of 1.36 and most of our patients (98.82%) are from low social condition. Anemic complications were the most occurring complications in our patients with a frequency of 18.78%. Acute anemic complications are the most frequently noticed (87.87%), among which acute crises of deglobulization are mainly present (94.27%). Chronical anemic complications are noticed in 23.67%of our patients and consist mainly of gall bladder lithiasis (20.12%). Death occurred in 10.35% of our patients and was due to anemic complications in 42.86% of cases. COMMENTS: The predominance of acute anemic complications may be due to the comorbidity observed in most of our major sickle cell disease patients. It may turn a chronical haemolytic anemia in acute hemolysis which is a major complication. CONCLUSION: Sickle cell disease has become nowadays a disease of little letality. Its anemic complications are the most important ones in our working conditions.

[Still disease in adult: a Senegalese case report]. / Maladie de still de l'adulte: etude d'un cas Sénégalais.

INTRODUCTION: The adult Still's disease is a systematic disease rarely reported in the black Africans. We are reporting a case characterized among other difficulties by its diagnostic difficulties. OBSERVATION: It is about a 29 years old black Senegalese woman patient, without particular antecedents, which presented a systematic chronic syndrome composed of a pharyngitis, a polyarthritis and general symptoms (fever, chills, sweats, change of the general state), a cutaneous eruption, a polyadenopathy, a hepatosplenomegaly. The biological analyses showed among others, an inflammatory syndrome (VS at 115 mm in the 1st hour, CRP at 100 mg/L, WBC at 10,400/mm3 with neutrophilia), a hyperferritinemia in 643 ng/l with collapse of the glycosylated ferritin at 13% (N between 60 in 80%). After elimination of any autoimmune or neoplastic suppurative infectious pathology in the decline of a check up as exhaustive as possible, the diagnosis of a Still disease in adult had been retained. Their was improvement under the combination of prednisone and methotrexate. CONCLUSION: Although it is exceptional in black African, this pathology shall be however part of the differential diagnoses of any unexplained systematic sign. The dosage of the ferritinemia and its glycosylated fraction as well as the resort to the criteria of Yamaguchi and Fautrel's classification of Still Disease in Adult shall allow to establish more prematurely the diagnosis of this potentially severe affection.

[Diagnostic and therapeutic features of tuberculosis in patients undergoing maintenance hemodialysis in Dakar]. / Caractéristiques diagnostiques et thérapeutiques de la tuberculose chez les hémodialysés chroniques à Dakar.

Tuberculosis in patients undergoing maintenance hemodialysis therapy presents a number of diagnostic and therapeutic challenges. This study was designed to assess the specific diagnostic and therapeutic features of dialysis-associated tuberculosis in a clinical setting. A total of 55 patients were enrolled in this retrospective study over the 5-year period from 1996 to 2000. Diagnostic techniques included questionnaire, clinical examination, chest X- ray, tuberculin skin test, Mycobacterium tuberculosis (MT) screening on biological fluids and tissue biopsy. Tuberculosis was diagnosed in 6 patients (11%). The disease occurred within the first two years after the beginning of hemodialysis. Initial signs were nonspecific, i.e., fever, weight loss, and cough. Tuberculin skin testing was negative in 5 cases. Tuberculosis was located in the lung in 2 cases, pleura in 2 cases, peritoneum in 1, and lymph node in 1. Isolation of the MT and confirmation by tissue biopsy was performed in only one case. Appropriate polychemotherapy was successful in 5 of 6 cases. Morbidity and mortality of tuberculosis in dialysis patients is closely related to early detection and treatment. Therapy is often based on strong presumptive evidence without definitive diagnosis.

[Non-Hodgkin's lymphoma in Dakar: study of 107 cases diagnosed between 1986 and 1998]. / Les lymphomes non hodgkiniens à Dakar: étude réalisée sur 107 cas diagnostiqués entre 1986 et 1998.

Non-Hodgkin's Lymphomas (NHL) are the most prevalent malignant hemopathies in Senegal. In this study we have investigated the epidemiological aspects considering the HIV infection pandemic, and evaluated the diagnosis means and evolutive features of this disease in Dakar. Between 1986 and 1998 (13 years), we collected 107 cases of NHL, all histologically confirmed. Average age of patients was 31.4 years (2-85 years) and sex ratio was 21. HIV infection was found in three out of 62 patients tested (4.8%). At moment of diagnosis, 72% of patients were in stage III or IV according to the Ann Arbor Staging System. Large cell lymphomas were predominant (67.2%), followed by small lymphocyte lymphomas (24.2%) and follicular lymphoma with 8.4% of cases. Localization of lymphomas was exclusively nodal (30.8%) or extra nodal (31.7%) or mixed (37.3%). In therapeutical field, 21.5% of patients were treated with only symptomatical means. Chemotherapy was used in 54 patients (78.2% of treated patients), surgery was performed in 6 patients (8.6%), association of radiotherapy and chemotherapy in 5 patients (7.2%) and 4 patients (5.7%) were treated with surgery + chemotherapy. The average survival time was 344 days. Four patients (3.7%) were alive 3 years after diagnosis and only 2 patients (1.8%) after 5 years.

[Gastrointestinal hemorrhage in cirrhosis at Dakar. Predictive factors study]. / Hémorragies digestives au cours de la cirrhose du foie a Dakar. Etude des facteurs prédictifs.

Our aim were to describe the epidemiological and clinical as well as therapeutical features and to look for predictive factors of occurrence of gastrointestinal hemorrhage among cirrhotic patients. We included all cirrhotic patients with acute gastrointestinal hemorrhage hospitalized in the Service of Internal Medicine of Aristide Le Dantec University Teaching Hospital from January 1990 to December 1999. The diagnosis of cirrhosis was established according to two situations: prebiopsic criteria with clinical, biological, ultrasound and endoscopic data or the histological criteria. Gastrointestinal hemorrhage was present in 28.9% of the patients with an average age of 38.7 years and a sex ratio of 1.4. It revealed the cirrhosis in 82% of the cases, whether alone in 45.2% or associated with other complications in 36.8%. Previous bleeding episodes were found in 76 cases (9.6%). Gastrointestinal hemorrhage is the first cause of death among our cirrhotic patients with an overall mortality of 29.4%. The gastrointestinal hemorrhage was significantly associated with the young age (< 40 years). On the other hand, the clinical and biological parameters did not seem predictive of bleeding. The risk of hemorrhage was positively correlated with the presence of esophageal varices and their stage, the gastric varices and the portal gastropathy. The other lesions (watermelon stomach and erosive gastritis) did not seem to play a role in gastrointestinal hemorrhage. However the CHILD-PUGH classification was a poor predictor of either first hemorrhage or re-bleeding in this present study. We conclude that gastrointestinal hemorrhage is frequent among cirrhotic patients in our country. It constitute in this study the first cause of death in this population. instrumental treatment methods might prevent most of gastrointestinal hemorrhages in patients with high risk.

[Tetanus osteoarticular complications in Dakar]. / Les complications ostéo-articulaires du tétanos à Dakar.

To assess the epidemiological and clinical features of osteoarticular symptoms during tetanus infection, we carried out a retrospective study in infectious Diseases Ward of the University Teaching Hospital in Dakar (Senegal). Over a period of 7 years (1990-1996), 1, 199 cases of tetanus of more than 1 month of age were diagnosed. Among those who survived (n = 948), 18 cases of osteo-articular manifestations were observed (1.8%): 15 presented with vertebral fracture located within the thoracical part T4-T8 (83.3%) while 3 patients had para-articular osteoma in the elbows (16.7%). These complications occurred on stage II (89%) and stage III (11%) of Mollaret's classification of tetanus infection. Males were more represented than females (sex-ratio = 5) and the median age was 13 years (range = 6-45 years). The mean hospitalisation duration was significantly higher for patients with para-articular osteoma (6 weeks) than for those with vertebral fracture (3 weeks). No major functional impairment was noticed during hospitalisation and patients required only physiotherapy and clinical and radiological surveillance. Although not frequent and of some little functional consequence, osteoarticular complications of tetanus, should invite to improve the antitetanic immunization strategies in developing countries.

[Immunologic thrombopenic purpura associated with an autoimmune hemolytic anemia or Fisher-Evans syndrome: apropos of a case]. / Purpura thrombopénique immunologique associé àune anémie hémolytique auto-immune ou syndrome de Fisher-Evans: àpropos d'une observation.

We report one case of thrombocytopaenia purpura associated with an auto-immune haemolytic anaemia (positive erythrocyte Coombs test) or Fisher-Evans syndrome, found in a child aged 6 and a half years. Etiopathogenic, clinical, therapeutic as well as evolutive aspects are discussed. Response to corticoids is satisfactory in case our patient, in opposite to most cases described in the literature.

[Epidemiological, clinical and therapeutic aspects of severe malaria in adults in the infectious disease department of Central University Hospital of Dakar]. / Aspects épidémiologiques, cliniques et thérapeutiques du paludisme grave de l'adulte dans le service des Maladies Infectieuses du CHU de Dakar.

To assess epidemiological, clinical and therapeutic features of severe malaria among adults in Dakar (Senegal), we carried out a 5-year retrospective study in Infectious Diseases Ward (January 1992-December 1996). Over this period, 222 cases of severe malaria were included according to WHO definition criteria, 120 of them (54%) being adult patients. Monthly distribution of cases showed 2 peaks, on October and November. Most of the patients were males (sex-ratio = 2.1) and lived in urban area (91.7%). The mean age was 28.9 years (range = 16-73 years). Clinically, all of the cases presented with stage II coma. Association existed with convulsion (20%), severe anaemia (29.2%), renal failure (19.2%), hypoglycaemia (17.5%) and jaundice (34%). Patients were treated using quinine intravenously. Case fatality rate reached 26.7%, indicating life-threatening potential of malaria in adults living in urban area.