[Descriptive study of diabetic foot at the Marc Sankale Diabetes Center. Report of 105 cases]. / Etude descriptive du pied diabetique au centre du diabete marc sankale. A propos de 105 cas.

INTRODUCTION: Diabetic foot is a major complication of diabetes due to its frequency and its high risk of evolution to amputation. We report 105 cases recruited at the diabetes centre Marc Sankale. METHOD: It's a prospective study including all diabetic patients who attended the diabetes centre for any foot lesion during a one year period. Besides clinical examination data, results of glycaemia, foot X-ray Doppler and bacteriological analysis of the pus were collected. RESULTS: foot lesion represented 2.8% of diabetologist causes of consultation. Mean age of occurrence was 55 +/- 14 years in 63% women and 37% men. Diabetes was type 2 in 90% cases, poorly controlled in 63.92 % cases. Foot lesion was dominated by infection (97%), isolated or associated to peripheral vascular disease (32.4%) or neuropathy (13.3%). 67 patients had medical treatment and healed their wounds in 3 months in 76% cases. 38 other cases needed surgery : major amputation (15%), minor amputation (13%) debridment (9%) and revascularization (1%). CONCLUSION: Diabetic foot is a frequent reason for consultation at the National diabetes centre. Despite all the improvements made after the implementation of the patient's educational program, treatment starts late because of economical and cultural reasons that increase morbidity.

[Pituitary carcinoma. Anatomic and clinical features of cases reported in literature]. / Carcinome ou adénocarcinome de l'hypophyse. Profil anatomoclinique à travers quelques observations de la littérature.

BACKGROUND AND PURPOSE: Pituitary gland tumors that became aggressive, implying adjacent bone structure and the brain as metastases outside of the cranial box, are referred to as pituitary carcinomas. METHODS: We reviewed 67 cases reported in the literature [44 corticotropic pituitary tumors, 11 PRL tumors, 3 GH tumors, 1 TSH tumor, 3 gonadotropic cell tumors and 5 non-functioning tumors]. RESULTS: The corticotropic tumors occurred in 23 female and 15 males. Signs of hypercorticism were characteristic: generalized melanosis before adrenalectomy (N=1); headache (N=1); altered visual (N=1); diabetes insipidus (N=1); amenorrhea (N=1); Cushing syndrome (N=2); weight loss (N=1); refractory hypokaliemic alkalosis (N=1); diabetes mellitus (N=1); hypertension (N=1). ACTH, beta-lipotrophin, betaendorphin, alphamelano-stimulating hormone, CRH, and beta-gamma MSH were contributive while ultrastructural microscopy provided little information, as did an equimolar Lph/ACTH ratio. The possible association of prolactin tumors with corticotrophin forms has been underlined. The characteristic feature is a time interval from the initial diagnosis of adenoma to that of cancer, which has ranged from 0.3 to 18 years (mean: 6.6 years; median: 5.0 years). CONCLUSION: Corticotropic tumors resistance to high-dose medical treatment are usually aggressive tumors with a risk of recurrence after surgical treatment or even radiotherapy with the risk of metastases. GH tumors appear to predominate although it is known that these cancers can develop in association with corticotrophin cancers or with prolactin cell tumors.

[Toxic nodular goiter]. / Les goîtres nodulaires toxiques.

INTRODUCTION: To date no study in our country was specifically dedicated on toxic nodular goiter. They were just mentioned in generally studies about hyperthyroidism. METHOD: The authors report a retrospective series of 62 cases of toxic nodular goitre collected between 1979 and 1999 at the internal medical clinic of Dakar teaching hospital. The diagnostic of toxic nodule was retained on following criteria: to existence of one or several thyroid nodule with signs or thyrotoxicosis, the existence of a hyperfixating nodule at 131 iodine scintigraphy. Increasing of T3 and/or T4 thyroide hormone. The aims of the study was to analyse the epidemiological, clinical, and therapeutics aspects. RESULTS: We are collected 49 cases of solitary nodule (79.03%) and 13 cases of multi nodular goitre (20.97%). In the cases of solitary nodule, mean age was 40 years, sex ratio of 0.04 (47 female, 2 men). The nodule was clinically diagnosed in 47 cases (95.9%) and extinctive in 73.5%. 34.3% of patients have cardiothyreosis. In the cases of multi nodular goitre mean age was 45 years, all cases were female, goitre was clinically identified in 95.3% (12 patients) and 46.5% had cardiothyreosis. 62% of patients were lost to follow up during medical treatment. Only 2 patients on the 37 who were addressed for surgery come back after thyroidectomy. CONCLUSION: This study confirm the predominance of toxic nodular goitre in young female, its severity related to cardiothyreosis and underlines the difficulties limited to the therapeutical care.

Les goitres nodulaires toxiques

Introduction : Jusqu'ici; aucune etude dans notre pays n'avait porte specifiquement sur les goitres nodulaires toxiques. Elles n'ont ete citees que dans des etudes generales des hyperthyroidies. Methodes : Il s'agit d'une etude retrospective de 62cas de goitres nodulaires toxiques colliges entre 1979 et 1999 a la clinique medicale 2 du CHU de Dakar. Le diagnostic de nodule toxique a ete retenu sur les criteres suivants : la coexistence d'un ou plusieurs nodules thyroidiens et de signes de thyrotoxicose; l'existence d'un nodule hyperfixiant a la scintigraphie thyroidienne a l'iode 131; l'elevation des hormones thyroidiennes T3 et/ou T4. Nous nous sommes interesses aux aspects epidemiologiques; cliniques; aux complications et aux aspects therapeutiques et evolutifs. Resultats : Il s'agissait de 49 nodules uniques (79;03) et de 13 goitres multi nodulaires (20;97). Dans les cas de nodules uniques; l'age moyen etait de 40 ans; le sexe ratio de 0;04 (47 femmes; 2 hommes). Le nodule etait cliniquement decelable dans 47 cas (95;9) et extinctif dans73;5; La cardiothyreose existait dans 34;6des cas. En cas de goitre multi nodulaire; l'age moyen etait de 45ans; le sexe feminin dans tous les cas. Le goitre etait cliniquement decelable chez 12 patients (95;3). La cardiothyreose existait dans 46;15des cas. 62des patients ont ete perdus de vue en cours de traitement d'equilibration de l'hyperthyroidie. Sur les 37adresses en chirurgie; seuls deux ont ete revus apres thyroidectomie. Conclusion : Cette etude confirme la predominance du goitre nodulaire toxique chez la femme jeune; sa gravite par la frequence de la cardiothyreose et souligne les difficultes liees a la prise en charge therapeutique

[Hypergonadotropic hypogonadism with sella turcica tumor syndrome: gonadotropic adenoma?]. / Hypogonadisme hypergonadotrope à grosse selle turcique. Faut-il évoquer le diagnostic d'adénome gonadotrope?

A 43-year-old patient, known for infertility for ten years, presented hypogonadism (low libido, impotence, low testosteronemia) with hypergonadotropism (high FSH contrasting with low LH) and a tumor syndrome of the sella turcica. The biological, immunohistochemical and clinical features of gonadotropic adenoma are presented.

[Menopause in Africa]. / La ménopause en Afrique.

Menopause occurs earlier in African women than European or American women. Multiple parity in a short period of time is the main reason. The myths and beliefs about this stage of life of the African woman are largely unknown. Symptoms do not vary greatly from those observed elsewhere, but social, economic and nutritional factors may influence the biological pattern. For some authors, the incidence of breast cancer does not decline at this age as it does in western countries. For other authors, 50% of breast cancers occur during the post-menopause period, revealing an aggressive form of the disease. Exceptional uterine cancers have also been observed. Osteoporosis is apparently milder in African women. This observation should be examined in more detail.

[Pheochromocytoma in Dakar: report of nine cases]. / Le phéochromocytome à Dakar: à propos de neuf observations.

Pheochromocytoma is a catecholamine-secreting neoplasm of chromaffin tissue. The most common symptom is hypertension but there are incidentally discovered forms at imaging. From 1981 to 1998, the authors observed nine pheochromocytomas through three hospitals in Dakar. This study included seven male and two female patients. The average age was 31.61 years. Hypertension was present in 77% of the cases. Headache, palpitations and sweating were the authors most frequent symptoms, occuring in 55% of cases. Measurement of vanillyl mandelic acid level in six cases and urinary metanephrines in three cases made the diagnosis. There were six adrenal and three extra adrenal pheochromocytomas with two malignant tumors features. In our countries, measurement of urinary metanephrines and computed tomography processing may improve detection of pheochromocytomas.

[Aspects of antihyperglycemic oral bitherapy in 76 cases of non insulindependent diabetes in Dakar]. / Aspects de la bithérapie antihyperglycémiante orale chez 76 patients diabétiques non insulinodépendants à Dakar.

Some reasons justify the introduction of the association of sulfonylurea and metformine when monotherapy is ineffective. Hereafter a period of monotherapy by sulfonylurea or metformine only bitherapy has been instituted. Socio-demography, number of consultations, type of monotherapy and of association, duration of treatment, body mass index, fasting blood glycemia and post-prandial glycemia, blood pressure and type of complication were studied. There were 2.5 times more women than men with lower mean age for women. The majority of patients were from Dakar (81.6%). More than half of patients were women at home (60.5%). Present obesity (plethoric diabetes) or past obesity (metaplethoric diabetes) concerned 90.3% of patients. Patients have done 9.14 4.39 consultations under bitherapy. The gliclazide-metformin association was observed 37 times and the glibenclamide-metformin association 67 times. The duration of monotherapy was 45.9 39.7 months and that of bitherapy 92.5 43.7 months. The variations of body mass index showed a diminution of 1.26 kg/m2 and for fasting blood glycemia and augmentation of 0.011 g/L and post-prandial a diminution of 0.05 g/L. The body mass index variations in diabetic patients showed a diminution of weight more in plethoric patients in bitherapy compared to monotherapy. This study is retrospective and cannot show the optimal efficacy of bitherapy. But the combination of enhancement of glucose captation and lowering of hepatic glucose production has been shown during this bitherapeutic association. Addition of metformine and treatment with sulfonylurea make a combination that significatively improves glycemic control but also cholesterol level and allows obtation of better weight in type 2 non insulin-dependent diabetes with insulinoresistance.

[Pheochromocytoma in Africa: rarity, gravity and ectopy]. / Le phéochromocytome en Afrique: rareté, gravité et ectopie.

Pheochromocytoma is one of the main curable etiologies of high blood pressure, although its diagnosis and therapeutic management can be problematical: an incorrect diagnosis or inappropriate treatment may lead to fatal complications. This disease was exceptionally uncommon in the 1950s, and 30 years later about 30 cases had been reported; however, since 1981 there has been a progressive increase in the incidence of pheochromocytoma (48 documented cases in Africa). In Africa, this disease has two particular characteristics: the gravity of the clinical symptoms, mainly due to the physiological and pharmacological effects of catecholamines which as a result of this disease are stored and liberated at very high rates; and the ectopic site in a number of cases. To facilitate the diagnosis of pheochromocytoma improved clinical investigation is therefore advocated, but the necessary medical equipment is not always available in Africa. On this continent, the ectopic factor confirms the observations made in the early 1980s, and should be taken into consideration in the diagnosis and management of this disease.

[Emergence of terminal diabetic nephropathy in insulin-dependent diabetes in young Black Africans: report of five cases from Dakar]. / Emergence de la néphropathie diabétique terminale du diabète insulinodépendant du jeune Noir africain: à propos de cinq cas dakarois.

The authors have reported five cases of end stage diabetic nephropathy. Thi growing disease has began to reduce vital prognosis of Black african insulin independent diabetic. So, economic and social problem for their resolution (hemodialysis, kidney graft) is going to appear.

[Dysthyroidism after 60 years of age]. / Dysthyroïdies à partir de 60 ans.

This work has been conducted on 162 subjects, aged over 60 years, living in Senegal, investigated in the Departement of Biophysics and Nuclear Medecine of Dakar for suspicion of dysthyroidism. The levels of T3, T4 and TSH US hormones were determined by a radio-immunological method. This technique, exhibiting good functionnal sensitivity and its high specificity, is likely to be beneficial to the diagnosis of dysthyroidisms. Besides, this experiment leads us to consider that the dosage of TSH remains an useful first intention examination for the old patients and could notably improve the screening of dysthyroidisms with a decrease in the cost of the investigation. However, because of the therapeutical implications, some biological profiles schould be interpreted cautiously. The equipment for the determination of the free fractions (T3 and T4) with the brought additional accuracy could allow to dismiss some diagnostci uncertainties.

[Sheehan's syndrome: experience in Africa]. / Le syndrome de Sheehan: une expérience africaine.

Ischemic necrosis of the antehypophysis is still observed in developing countries. Its prevalence is unknown, but a significant number of the patients are young women. Traditions of home delivery and lack of obstetrical facilities are the main risk factors. The clinical manifestations are often quite typical but atypical signs including neuropsychiatric ore water metabolism disorders are observed. The delay to onset of overt disease can be very long. Ischemic necrosis of the antehypophysis should be entertained as a possible diagnois in women with hypopituitarism.

[Diabetic retinopathy in Dakar and review of African literature: epidemiologic elements]. / Rétinopathie diabétique à Dakar et revue de la littérature africaine.

Literature review shows that in the African Sub-Sahara, prevalence of diabetic retinopathy is between 15 and 52%, the main age being the fifties (between 45.5 and 53.25 years in our cases); after 5 years of diabetes evolution (8.45 +/- 6.93 years in our cases) men being two to three fold more affected than women; non insulin dependent diabetes representing 77% and insulin dependent diabetes 23%. The type of retinopathy is usually mixed, both edematous and ischemic (88% being non proliferative). Retinopathy concerned mainly non obese, non insulin dependent diabetics in our cases. Risk factors are poor glycemic control and arterial hypertension. Diabetes duration was the sole and most evident risk factor. Diabetes duration was 5.28 +/- 5.28 years when retina was normal and reached 8.58 +/- 5.33 years for Stage II and 12.8 +/- 6.31 years for retinopathy Stage III and 16.75 +/- 7.25 years for retinopathy Stage IV. These factors, delayed diagnosis and diabetes progression in Africa justify improvement of diabetes care by multidisciplinary team to prevent blindness.

[Main complications of diabetes mellitus in Africa]. / Complications majeures du diabète sucré en Afrique.

In Africa, a rise in complications of diabetes mellitus has gone in hand with the growing disease prevalence, clearly demonstrating the importance of assessing complications. Diabetes mellitus constitutes a major financial burden in developing countries in Africa with relatively limited resources. Ketoacidosis is observed in 24% of juvenile diabetes and is the inaugural sign in 76% of all cases, progressing to coma in 34%. Even in type 2 diabetes, acidoketosis occurs in 34% of the cases. Infection is particularly frequent and is often fatal in tropical Africa because of the involvement of Staphyococcus and Gram-negative microorganisms. Hyperleukocytosis and anemia are correlated with ineffective antibiotic therapy. Pulmonary tuberculosis is the ninth most frequent complication of diabetes. Overall mortality is 14.9 per 1000 person-years of diabetes. Mean age at death is 51.6 years for women and 57.6 years for men after a mean 12.5 year disease duration. Thirty percent of all deaths result from acute metabolic complications, infections and stroke. More than half of the patients with insulin-dependent-diabetes have retinopathy. Differences observed in patients with different ethnic origins is linked basically to unfavorable social and economic conditions that worsen the risk of poor blood glucose control. Retinopathy accounts for 32% of all ocular complications, similar to other African data and more generally in ophthalmology centers. The rate of neuropathy is high, reaching 70% in patients with microangiopathy. Impotence concerns 48.7% of the diabetic population with a mean age of 41.4+/-15.5 years. Coronary artery disease had a recognized influence on hemoglobin diseases, particularly when the coronarography is normal. Lower limb arteriopathy is observed in 18% of the diabetic patients.

[Hyperthyroidism and diabetes mellitus: analysis of 10 African cases]. / Hyperthyroïdie et diabète sucré: analyse de 10 observations africaines.

This retrospective study of 10 patients with hyperthyroidisma and diabetes mellitus concerned 8 women and 2 men, aged from 15 to 77 years. The two disease developed at the same time in 8 cases. Diabetes mellitus occurred first in 2 cases. Common signs were loss of weight. Hyperthyroidism led to tachycardia at more than 100 bpm. Diarrhea was observed simultaneously in 2 cases and muscular weakness in 5. Goiter was found in 10 cases with a diffuse aspect. Graves' disease was diagnosed with exophthalmia in 9 cases and affected both eyes in 8. Elevated levels of thyroid hormones confirmed diagnosis in 8 cases. Diabetes was insulin-dependent in 3 cases and non-insulin dependent in the 7 others. IDDM patients (2 female and 1 male) were aged 15, 17 and 38. Keto acidosis was the first symptom in all cases. NIDDM patients (6 female and 1 male) were aged between 37 and 77.