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The intramedullary abscess (I.M.A.) is an uncommon and heavy etiology of intramedullary mass syndrom. Since the first description by HART in 1830, about 82 cases have been reported in literature and in one case, it was associated to H.I.V. infection. The authors report a new case in a 52 years old Senegalese man with per operative diagnosis of I.M.A. and post operative diagnosis of H.I.V. infection. They set up difficulties of pre operative diagnosis, and poor results of treatment in such an association. Also they discuss pathogeny and share Magnetic Resonance Imaging (R.M.I.) studies in management.

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

This is the presentation of an adolescent's clinical case who tried to commit suicide with a fire arm during a depressive crisis. An emphasis is placed on the family interaction model and on a more global approach of the patient's personality. The authors underlined some of the problems raised by the diagnostic approach linked to the delirious syndrome, full of psychotic elements: themes of persecution, mystico-religious themes associated with impulsive escapade, all of them going with a depressive state. They gave also an important place to a pluridisciplanary treatment in those particular stages of crisis.

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

The authors report a surgical experience on eight case of intra spinal lipomas. These lumbo-sacral malformations belong to post-neurulation defect, in such conditions spinal cord undergoes tethering while child growing that lead to a slow neurological disturbance. Through this study, authors show that female is more involved than male (5/3. On 6 cases the diagnosis have been made before the age of 2 years old. Three groups of signs characterize dramatically intra spinal lipomas: skin-median lumbo-sacral stigmata (8 cases) such as hypertrichosis, nevi etc. neuro-orthopedic disturbance(3 cases): club foot, paraparesis. sphincter disturbance: vesical or anal incontinence. In the lack of C.T. scan and M.R.I. contrast medium myelography confirm the diagnosis. Surgical excision lead to characterization of 4 extra dural lipomas, one sub dural, and 3 mixed lipomas. 75% of the patient improved well. One dealing with this kind of pathology must avoid the misdiagnosis of enuresis.

In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.

From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.

Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.

We report a case of giant ovarian cyst in pregnancy of 23 weeks of amenorrhea revealed by digestive and respiratory compression. As the absence of ultrasonographic and biologic malignancy criterias, several punctures of the cyst were done permitting the evolution of pregnancy until the preterm period. An annexectomy done in the immediate post-partum permitted to avoid the frequent mechanical accidents during this period. From this case, we discuss clinical and therapeutic problems of this association.

The objective of this work was to describe the clinical and therapeutical aspects of pathology of the peritoneo-vaginal process. We have performed a retrospective study including 160 patients operated between January 1990 up to December 1996. Mean age at diagnosis was 8 years, ranged from 1 month to 13 years old. All patients were male. The abnormality was located in the right side in 60% of cases and was bilateral in 6.7% of cases. The main clinical features were scrotal mass (81%) and scrotal pain (13.46%). The diagnosis was made at birth only in 20% of cases. A maldescended testis was associated in 7.5% of cases. A groin incision have been used in 91.25% of patients. The average hospital stay after surgery was 1 day. Thus, the pathology of the peritoneo-vaginal process is common and apparently banal. Need for treatment through a groin incision owing to the possibility of associated maldescended testis.

This is a contribution to the survey on psychiatric disorders of puerperality. We are particularly interested in the clinical signs and the ethiopathogenical facts of psychiatric disorders of the post-partum which appear-in our point of view-to be the main point on which we could probably act to reduce the effect of the disease. It is a retrospective survey going from January, 1st 1992 to December, 31st 1996. Here are included all the female patients whose age is more than 15, hospitalised during survey period and who presented a mental pathology linked with puerperality in accordance with diagnosis criterions of World Health Organization. In 1 627 hospitalisations, there were 658 women among whom 52 presented puerperality psychical disorders, that's meaning 7.9% of the female patients hospitalised in psychiatry, with an average age of 24.5 years. Concerning the classification of the diseases, the acute delirious psychosis and the depressive disorders are more important with respectively 56% and 19% of the sample. 92% of the women gave birth by the vaginal normal way and 61.5% presented disorders in the first week following their delivery. The married women are 94%. Concerning their occupations, 98% are house keepers. 52% are primiparas and 48% are multiparas. Psychical disorders of puerperality are frequent in Dakar. Acute psychosis and mood disorders are the main clinical aspects. The management of the future mother to her new roles by health education and prenatal check-ups in health centers by skilled and appropriate personnal is necessary.

The study aims to assess the epidemiology of relapse occurrence among inpatients at the Department of Psychiatry of Fann Teaching Hospital, in Dakar. A retrospective and prospective study was conducted from inpatients records during the year 1998. Demographic and disease related datas were collected and analyzed using a microcomputer with WHO/CDC Epi Info 6.0 software. Among the inpatients, 160 presented a relapse representing a prevalence rate of 40.8%. The most incriminated diseases were: schizophrenia and mood trouble (56.3% and 28.7% respectively). Relapses occurs more during the first admission and decreased with readmission. As a real public health problem, there is a need for better management of all psychiatric disease to prevent relapsus: early and efficient health care, social and familial integration.

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

The lyophilisat of Persea gratissima Gaertner almonds was administered in various quantities to eighty four rats divided in three groups of twenty eight. in the first group (negative reference group), each animal was forcefed with 5 ml of distilled water on a daily basis, in the second group (positive reference group), the rats were forcefed with 5 ml of distilled water per day, after they were intoxicated with 0,3 ml of carbon tetrachloride under cutaneous injection, in the third group (experimental animals), each animal after it was intoxicated by the same quantity of carbon tetrachloride, was forcefed on a daily basis with 14mg/100g PV of lyophilisat of avocado almonds diluted with 5 ml of distilled water. The results showed that the lyophilisat of avocado almonds have a anti-icteric activity which is reflected in the stimulation of the liver to conjugate and eliminate bilirubin, as well as hepatoprotective activity characterised by the normalisation of the aminotransferases enzymes (ASAT, ALAT) and the healing of hepatic lesions within 10 days.

In the current senegalese context, marked by a political will of autonomisation of health services, is proves very important to study the costs of the services provided in hospitals. Our study, which consists in a retrospective analysis of accounting archives of the psychiatric department of Fann Hospital during the year 1998, had the following objectives: determine the costs related to the functioning of the service of psychiatry, according to the source of financing, determine the average cost of the main services provided by the psychiatric department, analyze the recovery of the cost of these services. The operating costs of the psychiatric department came to 86.824.477 FCFA in 1998. 88% of the total amount were brought by the State and the remaining 12% came from community participation. The average cost of hospitalization in Clinique Moussa Diop was 91.398 F CFA. For the former patients the visit cost 6.664 F CFA; for the outpatients the price was 12,886 F CFA. The average cost of a child psychiatric visit was 8.140 F CFA and 28 days of hospitalization in the same service cost 354.825 F CFA. The share supported by the community participation is in general largely covered by the current fees in spite of the high cost of these services.

to study the particularities of the bladder lithiasis in our countries. This was a retrospective study of 94 cases (62 men and 32 women) of bladder lithiasis over a period of 13 years. The lithogenic factors; clinic, paraclinic and therapeutic aspects have been studied. Morphoconstitutional analysis has been carded out in collaboration with Cristal Laboratory (St Cloud hospital center in France).mean age was 24.2+/-20.7 years old. The principals mains of consultation were: dysuria (n =36), mictionnal pain (n = 28), hematuria (n = 15). Facilitating factors have been found in 27% of cases. In 10 cases, there was an association bladdder lithiasis and bladdder-vaginal fistula. Radiologic test was dominated by intraveinous urographic (53.19 of cases). The metabolic test showed hypercalcemia and cristalluria in 2 cases. In 7,45 % of cases, we have founding a renal failure. An urinary tract infection have been noticed in 42 % of cases. Open surgery has been the main treatement (96 %) associating in 15 % of cases the treatement of an uropathy. In one case the bladder lithiasis weighed 1120 g. The morphologic and spectrophotometric analysis of the lithiasis have been achieved in 13 % of cases showing the predominance of struvite.the bladder lithiasis is still common in our countries; it could be good for us to access endoorporeals and extracorporeals therapeutic equipements in orderto reduce the indications of open surgery.

A retrospective study of 9 cases of fronto-ethmoïdal encephaloceles is reported. Cases have been gathered from the files of Dakar University Neurosurgical Unit. Fronto-ethmoïdal encephaloceles were about 9.8% of all encephaloceles. In all the cases the exit hole from the anterior cranial fossa is at the site of the foramen caecum. The location of the tumor was fronto-nasal in seven patients and naso-ethmoïdal in two. The cranio-facial deformity consisted of increase of local volume and a lateral displacement of medial canthus in six cases, a down ward drift of the tip of the nose in two cases and one case of orbital hypertelorism. Eight cases were meningo-encephaloceles and the last a meningo-encephocystocele. Diola was the most ethnic group involved. All patients have been operated by a simple neurosurgical procedure without obstruction of the cranial defect nor bony displacement. In five cases mental and aesthetic results were good when operation was done during the first year of live. The authors stress early surgical treatment for fronto-ethmoïdal encephaloceles.

The adult T-cells lymphoma-leukemia is a serious complication by the HTLV-1 infection. It is a rarely described diseases in Africa, in spite of the frequency of the infection by this virus. We report two clinical observations of lymphomatous forms. The first observation concerned a 43 year old Senegalese woman, admitted for a deep alteration of her general status and peripheral polyadenopathies. The adenopathy biopsy set up the diagnosis of pleiomorph T lymphoma with great and medium cells. The HTLV-1 serology was positive. She had benefited of six polychemotherapy cures (cyclophosphamide, farmarubicine, oncovin, prednisone) within which she died in a cachectic presentation. The second observation concerned a 44 year old Senegalese man, admitted for peripheral polyadenopathies, ulcerated lesions of sole of the foot, and deep alteration of the general status. He presented a moderate hypercalcemia by 117 mg/l. The histological examination of a ganglionar biopsy concluded to a diffuse T lymphoma with great cells. The HTLV-1 serology was positive. The cutaneous lesions were due to a phaeohyphomycosis of Exophiala jeanselmei. The symptomatic therapeutic measures had been applied and he died within four weeks in a septicemic clinical manifestation. The adult T-cells lymphoma leukemia due to the HTLV-1 ought to be researched before any lymphomatous and leucemic manifestation by T-cells through a serological research. The prognostic stays very bad.

Because of frequency and seriousness of myelo radicular complications of narrow lumbar canal, the authors studied its radiological and anatomical measurements in order to specify the standards for senegalese negro african. For that purpose, they collected samples of 21 lumbosacral spines from new cadavers through medico legal necropsies. Pieces have been first X rayed, then treated. They measured the antero posterior diameter of vertebral corpse, the anterio posterior diameter of vertebral canal, the narrowest transversal diameter of vertebral corpse and the inter pedicular distance. The authors found no significant differences between radiological and anatomical measurements, but the latest changed from one stage to another. The variations also were not important comparatively to standards established by two authors.

From 1980 to 1990, 64 cases of Lumbar canal Stenosis have been recorded and operated on at the neurosurgical clinic. The male sex is prevailing and the breakdown by age groups showed a preponderance of the age sections between 31 and 45 and 46 and 60 years. The sciatic pain was the most frequent starting symptom. As far as the physical signs are concerned, the areflexy of the tendon predominates. The saccoradiculography has established the diagnosis in most of the cases. The laminectomy associated with another technique has permitted to obtain the best result of the treatment. With the advent of the T scan, a better estimation of the lumbar canal will be possible, so as to replace the laminectomy by a more adaptable technique: the remeasurement of the lumbar canal.

Prostate's surgery is an haemorrhagic one owing to difficulties of surgical haemostasis and anomalies of the blood coagulation. The aim of this study to assess haemostasis anomalies after protatectomy for benign prostatic hyperplasia (BPH). We have performed a prospective study including 50 men of more of 55 years old. All of them underwent suprapubic open prostatectomy. Significant pertubation of haemostasis, particularly fibrinolysis has been found. We have noticed fibrin degradation product in 88% of cases after intervention versus 62% before (p0.001) and a decrease of plasminogen rate in 94.4% of operated patients versus 82% before. The older the patient were, more important were the pertubations. Moreover, the anomalies were most important when the duration of surgery lasted more than one hour and when the BPH was voluminous. However, the disturbance of haemostasis was rarely associated to clinical symptoms. So, we do not recommend any therapeutic when clinical symptoms are absent. Biological screening the day of surgery, the day after and one week later are necessary to prevent haemorrhage.

From january 1975 to december 1988, 234 hydrocephalus cases of newborn and infant treated by ventriculo-peritoneal or ventriculo atrial shunt have been studied at Dakar CHU (University Teaching Hospital) neuro-surgery clinic. The non infectious complications of this type of surgical treatment using inert material, have been observed in 52 patients or 22 per cent even though infectious complications can be noted in 34 per cent of the cases. Among these non infectious complications the extra-cranial mechanical are the most frequent. Fistula or subcutaneous collection of CSF (13 cases), cutaneous necrosis (12 cases), shunt material disconnection (9 cases), obstruction (8 cases). Chronic subdural hematoma has been proved rare and cranio-stenosis secondary to drainage, exceptional. The treatment of mechanical complications by simple revision emphasizes the maintenance of shunt material in place contrary to the treatment of infectious complications that occurs almost always the removal of a material already expensive associated with a long standing antibiotic chemotherapy. Successive revisions and reinsertion of material can raise technical difficulties which will lead to delayed infection. Careful technical procedure of shunting constitutes the best mean prevention against these non infectious complications.

The association of benign prostatic hyperplasia (BPH) and inguinal hernia still pose the problem of the chronology of their repair. Indeed, first hernial repair without removing the cervicoprostatic obstruction exposes to a high rate of recurrence due to the dysuria. The objective of this work was to report our experience about the simultaneous cure of the BPH and inguinal hernia. We have performed a retrospective study including a non consecutive series of 92 patients presenting both BPH and inguinal hernia. Studied parameters was age, occupation, clinical symptoms, the procedure and operative continuations. Mean age was 70.22 years old, range from 57 to 90 years old. Past history of inguinal hernia repair was found in 18.5%. 19.13% had hernial recurrence while 6.5% had contralateral hernia. Main clinical features were inguinal mass (43.5%) and acute urinary retention (11.9%). The average weight of prostatic tumor was 87.1 g. Surgery was performed under spinal anaesthesia in 96.8%. All patients underwent suprapubic transvesical prostatectomy. Hernial repair was done according to Bassini procedure in 82.6%, Mac Way procedure in 14.2% and Forgues procedure in 3.2%. The overall morbidity rate was 15.2%. The hernial recurrence rate was 7.6%. There was no postoperative mortality. The simultaneous repair of BPH and inguinal hernia offers some advantages. First of all, it reduces considerably the anaesthetic risk owing to the importance of cardiovascular diseases in aging patients. On and other hand, the low recurrence rate of the hernia and the substantial savings are adjunct advantages. We conclude that simultaneous repair of BPH and inguinal hernia is simple, safe and economic.

The aim of this study was to analyze problems posed by adult renal malignant tumors both in the diagnostical and therapeutical viewpoints. We have performed a retrospective study including 48 cases of confirmed renal cancer. Have been included adult patients who presented a cancer of the kidney operated or not. Studied parameters were age, sex, clinical signs, complementary explorations i.e. biology, renal ultrasonography, IVU, Computerized tomography, the operative indication and the prognosis. We have used Robson's staging to classify our patients. The average age was 51 years with extremes of 18 and 83 years. However 60% of them were less than 50 years. Adenocarcinoma was the main histological form encountered. It has been found in 93% of cases. The flank mass has been the mode of discovery in 70.8% of cases. The classic symptomatic triad associating hematuria, pain and the renal mass has been found in 20.8% of cases. Ultrasonography and Intravenous urography (IVU) have allowed to pose the diagnosis in 93.75% of cases. Patients were often referred very late with an average delay of consultation of 14 month. So, 25% of them presented with metastasis at the moment of the diagnosis. Radical nephrectomy was performed in 60% of cases. 40% of patients have not been operated due to the advanced evolution of the tumor. The global mortality to 1 year was estimated at 38%. We conclude that renal malignant tumors in the adulthood, in our practice, presents some particularities. Indeed, patients are referred late when clinical symptoms are sufficiently evocative to suspect the diagnosis. At these advanced stages, there is no curative therapeutic. So, a precocious diagnosis is necessary in order to propose to patients radical nephrectomy which remains the only efficient therapeutical procedure of the localized renal cancer in the adulthood.

The association between Peyronie's disease and diabetes mellitus or Dupuytren's disease is well described in the literature with a certain frequency. Through our 10 patients with Peyronie's disease, when have noticed that only one of them is undergoing diabetes mellitus and no one has Dupuytren's disease. But 7 of them presented clinical and/or electromyographical signs of peripheral neuropathy. So after clinical examination in neurology and urology, we performed measurement of motor conduction velocity of tibial posterior nerves and peroneal nerves, then, we measured sensitive vetocity of sural nerves and dorsal nerve of the penis and we studied the cortical somesthesic evoked potential of the internal hontous nerve and the sympathetic evoked response of the skin. So we hypothesize that peripheral neuropathy with or without autonomic disorders might be an etiological co-factor of Peyronie's disease.

HTLV1 virus is a retrovirus that has been endemic in Africa. It is the responsible for tropical spastic paraparesis and adult's T Cell leukemia-lymphoma. Few cases of adult T-Cell leukemia-lymphoma have been described in Africa, contrary to Japan and Caribbean. Were are reporting two cases of acute adult T-Cell leukemia-lymphoma which characterised by blood lymphoma signs, tumoral nodes and extranods lesions, hypercalcemia and positive retroviral serology of HTLV1 virus. The prognosis of these acute forms was bad after a six month survey approximately. The treatment is disappointing. Investigations of this affection must be carried out in every patient who presents lymphoma manifestations all the more because they are associated with hypercalcemia.

Adolescence is a period of change where the person is seeking an identity. This period is characterized by an early sexuality with early pregnancies and risky deliveries. The objectives of our study are to show the epidemiologic aspects of adolescent pregnancy and to identify its obstetrical factors. It is a prospective study held in one year, from August 1st 1991 to July 31 1992 including all pregnant adolescents and those coming for delivery at the Obstetrics and Gynecology clinic at the University teaching hospital Le Dantec. The prevalence of adolescent pregnancy is 3.7% and 84% are primiparous. The non-educated represent 65% and 55% are married. Early sexuality and early pregnancy are mostly seen among Pulars. The complications during pregnancy are toxemia and its accidents (17.6%), premature rupture of membrane (4.4%) and anemia (2.5%). Adolescent who had not received prenatal care represent 11% and 38% had not received enough care. Normal delivery happened in 67.5% and the C-section represented 7.5%. 3% of the adolescents had done unsafe abortion. No maternal death was observed. 89.1% live births were reported, however, 18.4% needed intensive care. Because of the obstetric and neonatal problems, early pregnancy should be prevented through a active collaboration of divers partners.

This work was done at the Psychiatry Service of CHU of Fann in Dakar during the year 1994. It is a transversal study made by inquiry on the basis of a questionnaire centered on the clinical description and the starting factors in a population of 1025 adult-patients, received on external consultation. It enabled its authors to realize that hysteria was the second cause of consultation after schizophrenias. The starting factors of troubles are mainly conflicts (disturbance of inter-personal relationship) in 49.6% of the cases, and difficulties of daily life, causing annoyance and stress. On the clinical level, polymorphism of the hysterical signs has been found out as much in the level of paroxysmal signs, as in the level of lasting signs. The frequency of big Charcot attacks, often considered as unusual, has been observed in this study in 10% of the patients. Moreover, on the level of the personality structure, only 103 patients have been identified (i.e. 85.1%) to have shown a hysterical personality type.

From a psychiatric consultation of women, the authors have tried to bring up the psychosocial aspects being very much influenced by the cultural context. They have discovered two profiles of these sort of women, they are either, married women under the stress of uncontrolled child-birth and are very much influenced by local tradition or are women being at a turning points of their life; adolescence, premenopause, and menopause. The authors have a well demonstrated the primordial role they take as natural (helpers) aids when a member of the family gives evidence of mental disorder.

The authors present four cases of annuloaortic ectasia recently observed in Dakar Principal Hospital; two cases are MARFAN's syndrome, one is complicated by aortic dissection. Third cause of aortic regurgitation, this disease must be diagnosed early on account of its bad prognosis with the risk of the dissection of the aorta and issue to cardiac insufficiency. The diagnosis is more often affirmed by transthoracic echocardiography. Treatment is surgical with low operative mortality and excellent long term result.

Formerly known as a dreadful calamity for industrialized countries, drug abuse now seems to have spread all over the world. In Senegal, it has been very difficult to gather reliable statistics on its extensiveness. To better define the problem in Senegal, UNESCO has launched an epidemiological study on young people drug abuse and alcoholism in schools and elsewhere. The authors analyse the results of this study and draw the following conclusions: all types of drug use are linked to religious practice, drug use by young people is due to curiosity or their ignorance of drug drawbacks and their lack of education, school, family, religious education and social repression play an important role in the fight against drug use.

An epidemiological survey on 2.067 children from 7 to 12 years old in average carried in three urban, suburban and rural school environments, has shown that dental caries prevalence is not yet alarming in the district of Dakar, and that the caries index remain more high in the urban environment than in the rural environment. However face to the urbanization and the industrialization of this region, the modification of the alimentary habits appear to be facilitating factors of the raising of the dental caries prevalence in the coming years if nothing is done. It's why preventive measures have to be taken based over all on dental health education and dental health information in organized structures like school.

Fourteen cases of spinal meningiomas were reviewed. There were 5 males and 9 females, with an average age of 40 years who underwent surgical treatment at the Neurosurgical Division of Dakar University Teaching Hospital. The thoracic spine was involved in 10 cases. The location of the tumor in the spinal canal was epidural in 6 cases and subdural in 8 cases. 7 patients (50%) had marked improvement or stabilization: 4 patients died and in 3 cases, a recurrence was noted. The authors emphasize diagnostic difficulties encountered in the epidural forms.

The authors report five cases of mycetomas with an original localization, cranio-encephalic and vertebro medullary. Four times it concerned a dorsal or cervical mycetoma with deep enlargement responsible for compression of the spinal cord. In the 5th case, scalp infection reached the dura mater. All patients have got histopathological diagnosis. Therapeutic difficulties are evocated about these singular localizations in a pathology for which greater amputation stands as the rule.

15 sport men heart rate and central temperature were measured at rest and at the end of a progressive maximal exercise. Maximum consumption of oxygen (VO2 max) was estimated after the effort. The experience began in the morning from 9 to 11 a.m. and the afternoon from 4 to 6 p.m. In the first time subjects had a normal alimentation and in the second they observed a rigorous fast. The comparison of the results doesn't show difference induced by fast on VO2 max and maximal heart rate. However heart rate at rest and capacity of work decrease during fast and permit to think that a more intensive and long exercise in more strenuous climates than this one should give significative modifications.

The authors report 80 cases of collected cranio-encephalic suppurations observed in the Neuro Surgical Unit of the University Teaching Hospital of Dakar from 1969 til 1990. 13 cases were necropsy discoveries and 67 cas that were operated consisted of 55 abscesses of the brain and 25 extra-cerebral empyemas. 56 patients were under 20 years of age with an obvious prevalence of male patients. The collected cranio-encephalic suppuration complicated head trauma in 22 cases and was consecutive to an otorhinolaryngeal infection in 10 cases. The typical clinical aspect of progressive installation associated an intracranial hypertension, motor deficit of one side of the body and an epileptic crisis. A brutal beginning was not an exception in 16 cases. This is often in subdural empyemas. Concerning neuroradiology, cerebral angiography still constitutes our method of choice of investigation; echography can only be performed in infants with permeable fontanela, or during post operative surveillance, using the lacuna created by the craniotomy as an acoustic window. Simple puncture and drainage of the cerebral abscess of the classical cutting away in bloc and the utilisation of echography have considerably contributed for the amelioration of post-operative results.

Epidemiological and clinical analysis of a population of 118 cases o adult subdural hematoma in Sénégal led the authors to make some statements. The age histogram has shown a peak after 50 years old; this fact supports the belonging of subdural hematoma to brain aging pathology. Male were more involved than female (101/17). The head trauma is found in 55%, alcoholism in 3.4%, anticoagulating treatment in 1.69%; others etiological factors were discussed. The authors stressed out the swinging of the clinical picture of subdural hematoma which might lead to misdiagnosis; CT scan or cerebral angiography are useful to make the diagnosis. The pathology of subdural hematoma has given rise to a controversial issue. Surgical decompression allowed to get a complete recovery in 64%. The post operated death-rate was 18.75%.

Authors report three observations of Focal Nodular Hyperplasia, Tumor-like on two: senegalese female patients, 16 years and 37 years old, and a young senegalese man, 24 Years old. The mean age is about 25.5 years and oestro progestative intake has bean noted once. Diagnosis of Focal Nodular Hyperplasia was difficult and has been done twice after surgical intervention for chronic cholecystitis and blood peritonitis. The only complication reported, has been a rupture of nodular, causing the death of a patient. This benign tumor that never degenerates, does not need any particular treatment unless a stopping of oral contraception.

The growing fractures of the skull rarely complicate head traumatism among infant and new born. 6 cases have been observed out of 552 fractures of the skull (1.09%) during 10 years from 1979 to 1988 at the neurosurgical clinic of Dakar University Teaching hospital. The patients age varies from 8 months to 21 years. The delay between traumatism and the diagnosis of growing fractures ranges from 18 days to 8 years. The primary fracture can be detected by a skull radiography which allows also to follow the evolution. It can be completed by making a translacuna echography, a non invasive method of investigation easily realisable thanks to the existence of a skull lacuna which constitute a real acoustical window. This type of investigation has been worked on deux patients. Essentially porencephalic forms have been noticed (5 cas). Three have been successfully operated out of four patients, two patients have spontaneously performed evolutions towards the stabilisation of the lesions. The prognosis of the affection is tightly linked with the associated brain injuries.

The polycystic kidney disease is a hereditary malformation seldom described in Africa. Nineteen cases among 6 men and 13 women were seen in the internal Medicine Service in seven years. The range of age was 28 to 77 years. Ten other patients (of whom four were less than 15 years old were discovered via systematic family investigations and confirmed by ultra sound. The diagnosis was based essentially on consistent clinical signs and the presence of at least 5 cysts in each kidney. Infectious manifestations were the most frequent, presented in 37% of the cases. These acute infections can affect either the urinary ducts or a hepatic or renal cyst. The family investigations established that a third of the subjects examined were asymptomatic or had lumbar pain and hematuria never associated with their underlying cause.

The authors use data drawn from a wide review of literature with an exhaustive bibliography to confirm the rarity of single plasmocytoma in the cranial vault in comparison to other localizations for this tumour. The case observed well illustrates this conclusion and shows how the patients could survive for a long time because solitary plasmocytoma are so sensitive to radiology.

This report covers two cases of Crohn's Disease, one in a 27 year old Senegalese woman, the other in a 38 year old Senegalese man, both presenting abdominal pain, diarrhoea and loss of weight over several months. The ulcerated lesions were staged on the colon, respecting the rectum, and reached the ileum in one patient and the esophagus in the other. Following X-rays, endoscopy and consideration of the history, Crohn's Disease was diagnosed. Treatment with corticoids produced rapid improvement with the ulcers healing after one month. The unusualness of Crohn's Disease in Black Africans adds interest to these two observations.

Prolactin adenomas seem rare in Dakar. Only 4 cases were confirmed by a series of 63 Intracranial Expansive Processes (ICEP) in the sella area recorded between 1972 and 1987 at Fann U.H.C Neurological and Neurosurgical Unit. These ICEP are dominated by craniopharyngiomas. From analysis of observations on four women aged between 20 and 38 years is may be concluded that: 1. Patients consult late for this amenorrhoea-galactorrhoea syndrome associated with intracranial hypertension and reductions in the field of vision. 2. On the paraclinical level: angiography reveals voluminous ICEP in the sella region with sub-sellar expansion; dosage with prolactinemia was only possible in 2 cases (of which 1 was post operational), which underlines the difficulties of carrying out this examination and its high cost despite its obvious usefulness in diagnosis and therapeutic supervision. 3. All operations were accompanied by histological study of the operational part which confirmed prolactinemia. Bromocriptine is the best medicine to be employed before or after the operation, and, in one case, allowed preoperational prolactinaemia to be reduced. 4. Classical X-rays of the skull centred on the sella turcica, and prolactinaemia medication for any amenorrhoea-galactorrhoea syndrome, should lead to a better understanding of the incidence of prolactin adenomas in this area.

The report covers 27 cases of neuro-surgical exophthalmia treated at Dakar U.H.C. between 1970 and 1987. Unilateral forms are the most common (25 cases), usually discovered at the bulging stage. Exploration was undertaken by the usual means of X-ray without contrast, echography, arteriography, and fractioned, gaseous encephalography employed together in varying degrees. The main etiologies are tumours (70%), largely benign, and specific and non-specific inflammation (18.5%). Surgery was prescribed in 18 cases, including 11 orbitotomies--8 frontal and 3 fronto-temporal. Malformation syndromes, and above all very advanced pathologies challenged surgical skill in 9 of the cases. Generally speaking, post operational results are favourable, but 3 deaths are reported and one relapse. Tomodensitometry, modern anaesthetic and revival techniques, and the important collaboration between the ophthalmologist and the neuro-surgeon are all factors in successfully mastering neuro-surgical protrusions.

314 bowel cancers were discovered in 219 men and 95 women of negroid race in the course of 18,000 upper and lower endoscopies taken over the past 5 years at Dakar's Main Hospital. The average age of the sick persons is 50 years. Gastric cancer (170 cases) is the most frequent, followed by recto-colic cancer (71 cases) and oesophagian cancer (61 cases). The use of endoscopy and perhaps dietetic changes in the urban area, explain the large number of bowel cancers discovered in Dakar.

700 bronchial fiber endoscopies were performed at Dakar Main Hospital over a period of 3 consecutive years. 40 broncho-pulmonary cancers were identified (34 epidermoids, 4 adeno-cancers, 2 small cell cancers) among the 80 suspect cases. Comparison of clinical, radiological and endoscopic data revealed the following information: 1. most frequently radiology showed retractile, pulmonary condensation syndrome (40 cases); 2. a large predominance of close, bulging tumours (45 times) in relation to endoscopic bronchial stenosis (22 times); 3. almost exclusive identification of bronchial epidermoid cancer in this series (34 times); 4. the masculine sex and use of tobacco remain 2 unavoidable elements in this pathology. Bronchial endoscopy, a simple, indispensible examination, allows the lesion to be visualized, and a biopsy, on its own or associated with endoscopic cysto-brushing and alveolus washing, can then furnish conclusive histological proof.