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Introduction: Principal cause of legal blindness in industrialized countries, age-related macular degeneration (ARMD) have never been studied in West Africa. We report and analyse the clinical and angiographical characteristics of macular degeneration in our patients older than 50 years., Material and Methods: In this prospective study, we recruited during 13 months all patients presenting ARMD signs from our consultation department. Various clinic and angiography parameters were collected. The follow up varied between 6 and 20 months., Results: The prevalence of this pathology was of 6.5 per 1000. Sex ratio was 0.36 and mean age 61.6 years (53 to 80 years). No familial history of ARMD was found. Three patients were more exposed to sun because of their profession, 9 had high blood pressure, 6 were hyperopes and 1 was smoking. A drop of visual acuity was noted in all cases but no metamorphopsies. Signs founded were miliar drusen (20 eyes), serous drusen (4 eyes), association of those two kinds (4 eyes) and retinal pigmented epithelium abnormalities (PE) (8 eyes) alone or associated with drusen. These signs were significant of age-related maculopathy (ARM). The fluorescein angiography confirmed the type of lesions and showed no signs of neovascularization. An aggravation of the pigment migration was noted in one case after 20 months., Conclusion: Age related macular degeneration doesn't seem frequent in our population of patients and shows essentially under its initial form of ARM even though facilitating factors seemed identical, excepted tobacco addiction, sun exposition and systemic hypertension. This study which short terms results we are presenting would need to be continue to give more precisions on those data.

Objective: The aim of this study is to expose a secondary cause of venous insufficiency which surgical treatment., Observation: A 73 old man with a huge aneurism of the right common iliac artery which compressed the left common iliac vein was described. The patient had a unilateral left leg oedema and stasing ulcer. Examinations revealed an abdominal pulsate mass. Echography and T scan showed a right common iliac artery aneurysm and compression of the left iliac vein. Surgery was resected aneurism and replaced vascular prosthesis. After surgery, the unilateral left leg oedema was rapidly regressed and complete stasing ulcer healing., Conclusion: This case report showed difficult diagnosis and treatment of vascular disease in under development countries.

Introduction: The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine., Materials and Methods: We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery., Results: Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1., Conclusion: The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.

Strokes (AVC) represent the 1st cause of death in the department of neurology of Dakar. The main characteristic of stroke is the brutality of the method of formation of neurological deficit. The vascular territory in question amends the clinical expression. Besides the motor deficit stroke can cause neuropsychological disorders affecting language, memory, activity gesture, recognition of oneself and its environment, space and extra corporeal body with the result intellectual deterioration. The mechanisms of stroke are dominated by atherosclerosis and embolic heart disease for ischemic stroke and hypertension and ruptures of vascular malformations for hemorrhagic stroke. CT scan remains the key consideration in determining the nature ischemic or hemorrhagic stroke. Because of its acuteness and rapid progress to irreversible injury stroke is a dramatically high priority medical emergency. The therapeutic strategy should follow a pattern efficient and fast leading to a specific care, gradual and coordinated by the 3rd hour. There is a need to recognize stroke, what is the nature (ischemic, hemorrhagic) and the cause, in order to consider a therapeutic care consistent. The care must start at the very beginning of the stroke and continued during transportation. In the acute phase of stroke, lower blood pressure should be gradual and it is recommended to respect an HTA in the order of 180/105 mm HG except under certain conditions (acute lung oedema, aortic dissection, infarction acute myocardial) that requires a rapid stabilization of blood pressure. Thrombolysis using alteplase (rt-PA) is called in neurovasalar units in case of stroke seen before the 3rd hour and in the absence of contraindications. Anticoagulants are shown in prevention of recurrence of stroke in the embolic heart disease with high risk of recidivism, in the carotid stenosis or vertebral basilar tight with hemodynamic impact downstream and in the extensive thrombosis. The treatment antiplatelet medication is indicated in other cases. The screening and the control of risk factors for vascular constitute an effective weapon for primary prevention. The rehabilitation motor, speech and language and occupational therapy can improve rehabilitation for patients. The prognosis vital and functional depend partly in the early and appropriate management of stroke and also in increasing of education and awareness of population and health care personnel and especially on the diffusion of the means of prevention primary

Objective: Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal., Methodology: Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done., Results: The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%., Conclusion: It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

Introduction: Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias., Materials and Methods: We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year., Results: 55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis., Conclusion: Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.

Introduction: Vascular endothelium possesses biological properties that are involved in important physiological functions such vascular permeability, vascular tone regulation and angiogenesis. The difficulty of culture and long-term maintenance of sufficient amount of normal endothelial cells has proven to be the limitation for the understanding of the biological function of the endothelium. Therefore, the aim of this study was to culture and characterize the porcine coronary endothelial cells., Material and Methods: The endothelial cells were isolated by collagenase treatment and cultured in culture dishes coated with collagen, prepared from rat tail, containing medium RPMI1640/M199 and 15% fetal calf serum supplemented with antibiotics and fungizon. The cells were maintained to grown at 37 degrees C. The medium was changed one day after and then every two day. The cells were incubated with Dil-labeled-acetylated-LDL for determination of acetylated-LDL uptake. Confluence cultures of cells were examined by phase-contrast and confocal microscopy., Results: After a day of culture, the endothelial cells adhere to the collagen and began to grow. While multiplying themselves, they colonize little by little the body of the surface of culture to form to confluence a monolayer of flat cells relatively homogenous. To confluence, the proliferation of the endothelial cells is inhibited by the contact and the cells present a polygonal aspect. Our results show that all the cultivated cells were strongly positive for acetylated-LDL markers. The endothelial cells, cultivated until the second passage corresponding to the second culture of the primary cultures, continued to present a good fluorescence., Conclusion: Porcine coronary endothelial cells represent a useful in vitro model to study biological and physiopathological properties of vascular endothelium.

Traumatic manubriosternal joint dislocations are rare in adult and occur readily during a violent traumatism of the chest and/or the dorsal spine. We report two cases treated between September 1997 and August 2002 at the Surgical Emergency Department of Le Dantec Hospital. The first observation was related to a 26 year old lady. On September 27, 1997, she fell down from a tree and received all the weight of the body on her two arms. She was referred because of anterior chest pains, increasing with respiration associated with injuries of the 2 wrists. On conventional X-ray, a type II manubriosternal joint dislocation (anterior dislocation of the sternal body with respect to the manubrium) was diagnosed. The mechanism of the dislocation was indirect: flexion-compression of the sternum caused by a hyperflexion of the dorsal spine when the patient touched the ground. There was also a Pouteaux-Colles fracture of the 2 wrists. The dislocation was surgically treated: open reduction followed by manubriosternal stabilization using wires. The 2 wrists were treated by Kapandji procedure. At the 21st postoperative day, a traumatic rupture of the wires required a 2nd internal fixation of the sternum by wires. After 9 years, the patient is without complaint and the chest X-ray is normal. The second observation was that of a 19 year old young woman, referred on August 15, 2002 after a frontal crash with a car while crossing the road. She fell down on her back. She was complaining from severe posterior headaches with a normal Glasgow Scale (15), anterior chest and right hand pains. Radiological examinations showed a fracture of the occipital bone without embarrure and a type I manubriosternal joint dislocation (posterior displacement of the sternal body in relation to the manubrium) which mechanism was direct: direct shock against the sternum. There were also an isolated fracture of 4 right sided ribs and a fracture without displacement of the 3 last bones of the right metacarpus. An orthopaedic treatment was carried out for the lesions of the right hand and an abstention-monitoring suggested for the occipital fracture. The manubriosternal joint dislocation was surgically reduced and stabilized by using a braided polyester thread number 2. After 4 years, the patient is asymptomatic and the manobriosternal joint is stable. We emphasize on the scarcity and the mechanism of traumatic manubriosternal joint dislocations in adult, the frequency of associated injuries and the absence of consensus about their treatment.

Introduction: The Barr chromatin test is a medical cytogenetic test, very quick to make, consisting in determination of the percentage of Barr corpuscles that correspond to the condensation of the second X chromosome in female epithelial cells of mammal, which range between 20 and 50% the percentage of Barr corpuscles in male epithelial cells range between 2 and less than 5%). In the less developed countries where caryotype isn't realized, this test can give invaluable informations about individual sex. The aim of this study was to show the Barr chromatin test interest in the sexual ambiguity diagnosis orientation in some cases of these sexual ambiguities., Patient and Methods: To carry this study, we have done a Guard coloration on nude nucleus of epithelial cells taken on the cheeck internal side of our patient, a 19 years old woman that a gynaecologist had sent to us for sexual ambiguity. We have examinated the nude nucleus., Results: None of the nude nucleus had showed a Barr corpuscle (0% of Barr corpuscles, corresponding to male chromatin sex)., Conclusion: This rate has gived us a Morris syndrome diagnosis orientation; the diagnosis was confirmed later by the surgery and by the removal histological study. When caryotype or molecular biology are not available, the Barr chromatin test can represent a substitute biological test that can contribute to some sexual ambiguity diagnosis.

Significant advances have been noticed in the pathogenesis and the diagnosis of extrinsic allergic alveolitis during the last few years. Indeed the immune mechanism and the enabling conditions have been more precisely defined, the clinical stages and the diagnosis criterias clearly defined, new antigens incriminated and some etiological agents have been reclassified. The present pathogenic explanation insists on the type IV hypersensitivity reaction with sensitization of T lymphocytes, activation macrophages, the formation of IgG type antibodies and immune complexes, activation of complement and secretion of cytokines. The involvement of certain HLA classes (HLA2, DR3, DRB1, DQB1), interaction of genetics and environments factors, the role of infections agents and smoking have been demonstrated in several studies. The development of news clinical and biological diagnosis criteria have led the discovery of new extrinsic allergic alveolitis in the work places, a better knowledge of the prognostic elements and an appropriate adaptation of prevention measures.

The diagnosis of allergic conjunctivis begins by a meticulous questioning emphasizing the existence of ocular itching, the way of evolution of the signs and allergic preceeding. The examination searchs after follicles and papillae of the conjunctiva who usually go with serous discharges, blepharitis and keratitis. So four clinical forms may be described the chronic conjunctivitis, the vernal kerato-conjunctivitis, the atopic conjunctivitis and the giganto-papillar conjunctivitis. For the treatment, all non specific signs of allergy must be eliminated, the focal infections also and allergic substance isolated. If evolution is worse, an antiallergic eye drop is given until the disappearance of all the physical signs. In the same time, steroids and anti H1 drugs must be avoided. In case of failure, the specialist in allergy will be helpful to exam the patient.

Introduction: The treatment of hyperthyroidism includes different therapeutics means of which surgery. The objectives of this study were to evaluate the place of the surgery in the treatment of hyperthyroidism and to describes the complications., Patients and Methods: It is a retrospective study on 22 patients treated by thyroidectomy from March 2002 to April 2004. The biological confirmation was systematic. A medical preparation has been done in all the cases. A total thyroidectomy has been done in 13 cases and a subtotal in 9 cases., Results: The mean age was 37 years. There were 20 women and 2 men. An euthyroidism has obtained after surgery. There complications were: 1/22 temporary palsy of recurrent nerve 1/22 acute hypoparathyroidism 1/22 post-operative death (haematoma), Conclusion: Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.

Mediastinal lipoma is a rare mesenchymatous fatty tumor in child. Usually asymptomatic, it can cause asphyxiation. The authors report the case of an 18 month-baby-girl referred to us by the pediatric department for asphyxiation. The chest X ray was evocative of a mediastinal tumor. A sudden cardiorespiratory failure leads us to perform thoracotomy. A fatty tumor was found compressing the heart and the left lung. It was easily extirpated. The postoperative recovery was uneventful. Light microscopy showed a lipoma. This compressive form shows the severity of the mediastinal lipoma when it reaches a large size. The literature on this rare pathology is reviewed.

Introduction: Histopathological studies relating to last instars larvae of mosquitoes treated with neem products are very few. The objective were to study the action of Neem products on larvae mosquitoes of Culex quinquefasciatus., Materials and Methods: The neem products (Neemix, Formulated neem oil, Pure neem oil and Neem powder) are tested on 4 instars larvae of Culex quinquefasciatus. Moribund and witness larvae were fixed, for histopathologic study., Results: The results showed the following facts: an intestinal epithelium, a bross border, a fat body and others tissues are normals at the level of the untreated larva; Fat body and muscle are not touched during the treatment of the larva with Pure neem oil; Intestinal epithelial cells slightly hypertrophied with beaches of lysis on the level of the larva treated with Neem powder; a lysis of the microvilli of brush border on the level of the witness-solvent; a destruction of the epithelial cells recorded in larva treated with a Neemix; a disappearance of the food column and a destruction of the epithelial cells remarked on the level of the larva treated with Formulated neem oil., Conclusion: The neem products used in this study have a Larvaecidal action on Culex quinquefasciatus larvae.

Introduction: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications., Material and Methods: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment., Results: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms., Conclusion: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

Introduction: The casualties are indemnified according to two processes. First by transaction on rate proposition of insurance physicians, and the second process on rate proposition by a medical expert assigned by law-court. Indemnification scale failure justifies the Interafrican Conference of insurance Markets code adoption., Material and Method: Six insurance societies and the Automotive Guarantee Fund were debtors. Only 627 victims had been indemnified between 1986 and 2003. Expert valuations done at forensic medicine service were the support of the investigation. Inquired parameters were insurance societies, regulation type, aftermaths and the retained prejudices. The data collected on computer card have been analyzed by software Epi Info., Results: The partial permanent inabilities fixed since its adoption differ to inabilities fixed before this adoption. Transaction process concerned 567 victims (90.4%). Sixty victims were indemnified by judicial way. According to process type, the rates fixed in judicial process were 61.6% middle permanent partial inabilities. After 1997, there have observed a decrease in the high and middle permanent partial inabilities in the two processes. The appreciation of the pretium doloris is more subjective but must repair the aftermaths. The middle pretium was majority in the two processes, before and after 1997 with a high decrease of the middle pretium in the transaction process (-15.07) and a small pretium increase of 10.98 points., Conclusion: A common scale code has decreased the judicial litigation concerning casualties in spite of scales' limits. Only the patients with important aftermaths arrive in the judicial process since 1997.

Introduction: In the scope of this study, we had to do a qualitative and quantitative research of the current electrolytes as part of aqueous humour samples taken from patients suffering from cataract., Materials and Method: The tests were carried out by X-ray fluorescence and ICP/AES. The detection limit for the electrolytes varied from 0.005 to 0.1 ppm., Results: The test results show iron (minimum 0.82ppm; maximum 25.50ppm), copper (0.28ppm; 8.17ppm), brome (5.18 ppm ; 55.82ppm), zinc (0.70ppm ; 9.78ppm ), sodium (1274.83ppm, 5211.67 ppm), potassium (55.52ppm ; 255.02ppm), calcium (26.46 ppm ; 256.81ppm), magnesium (5.77ppm; 70.33ppm)., Conclusion: The data study have enabled us to establish reference value for each electrolyte. Study of the comparative reference values, together with the contents found in the normal aqueous humour, the normal and pathologic crystalline lens, has shown a noticeably low concentration of electrolytes and breakdown of the sodium/potassium pump which ensures ionic exchange between aqueous humour and the crystalline lens.

Introduction: The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar., Materials and Methods: This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months., Results: The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects., Conclusion: Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

The arch of the great saphenous vein cross receives numerous tributaries from the abdominal wall, male external genitalia and pelvic limbs. These collaterals present many variations relating to their number and mode of anastomosis. Their misappreciation may lead to post operative recurrences after surgical treatment of varices. For a last study of these variations, we dissected 40 inguinofemoral regions in fresh black african corpes. The conventional type in a "vein strar" shape was present in 4 cases. An abdominal common vein produced through the merging of the superficial epigastric and superficial circumflex iliac veins was found in 5 cases. A genital common vein summarising the external pudendal veins was present in 19 cases. In 8 cases the abdominal and genital common vein was simultaneously present. An anterior saphenous vein was found in 15 cases, and a posterior saphenous vein in 5 cases. These results, confirm the importance of anatomic variations. Their knowledge is necessary to avoid recurrences after surgery of varicose veins.

In Africa, little data has been published in Amyotrophic lateral sclerosis (ALS). We conducted a retrospective survey among the in-patients from December 1993 to March 2000 in the Department of Neurology of the University Hospital. This study reported epidemiological and clinical data of ALS. ALS has been diagnosed by El Escorial criteria. 33 patients were 16 to 77 years old. Parental consanguinity was found in 15.2%. On the basis of diagnosis criteria, ALS in our patients were established in 57.6% of cases, probable in 30.3% of cases, possible in 9.12% and suspected in 3% of cases. Evolution after hospitalisation is unknown for the majority of patients. Only one patient died after 12 months of evolution.

In Senegal, as in other under developed countries, the delays before seeking medical treatment are long varying from 2 to 12 according to studies. This is related to the fact that in traditional African communities, prejudices and believes delayed medical management which is seeked after failure of traditionnal treatments. The objectives of this study concerning therapeutic itinerary of epileptics in the EEG laboratory at the Neurology Department at CHU in Dakar were to evaluate the average latency of medical consultation and to identify the recourse path by patients receiving antiepileptic treatment. We conducted from March to may 2001, a cross disciplinary study, with a sample size of 212 patients. 79.2% of patients were less than 30 years old. They first seek treatment in hospitals in 36.8%, traditional practionners in 35.8%, health centers in 23%, and private clinics in 4%. The average delay of treatment in modern structures was by 13.4 +/- 4.7 months. The towards the healers was linked to faulty beliefs in 61.8% of the cases, lack of information (22.4%), or a lack of financial means (2.6%). The patients were refeared to traditional healers in 6.7% of the cases for reasons of confidence in traditional medecine. The orientation to neurology clinic was recommended by health personal in 83% of the cases, family (14.6%), or the healer (1.4%). The long and difficult journey of epileptics in Senegal remains marked by exclusion, absence or delay of medical attention.

The aims of this study were to appreciate how frequent asthma was named in the legal list of worker's compensation, state hazards and occupations involved and appreciate conditions required for a legal recognition of the disease. The study consisted of a review of the legal list of occupational diseases of all tables where asthma was stated. Medical, technical and administrative criteria allowing compensation were looked for. Asthma was listed in 12 among the 67 tables; causal substances listed were known as sensitizers and included mainly organic and metallic compounds. Numerous occupations were concerned in all primary, secondary and tertiary sectors. Medical conditions refered to "all asthma confirmed by functionally respiratory tests or regenerated by a new exposure". Time length of declaration was seven days. Variety of occupations concerned and numerous substances involved should invite to look for occupations in all patients with asthma. Physicians should be aware of theses legal conditions in order to recognize better occupational asthma and ease it legal compensation.

The objective of this study is to evaluate the performance of E-test method versus the standard proportion method, by testing susceptibility of Mycobacterium tuberculosis to four antituberculosis drugs: rifampicin, isoniazid, streptomycin, and ethambutol. Thirty strains isolated at Medical Biology Laboratory of Pasteur Institute of Dakar were tested. The strains were identified by morphological, cultural and biochemical characteristics (microscopy, time of growth, type of colonies, catalase, niacin-test). H37RV strain was tested as reference strain. The E-test method was performed on 7H11 agar with OADC, and the standard proportion method was performed on Lowenstein-Jensen agar. With results of these tests, the authors determined the E-test sensitivity and specificity, and the positive and negative predictive values (PPV, NPV). E-test method gave correct results from the eighth day, with stability of the zone of inhibition until the 21st day. The E-test method has 73% of sensibility and 100% of specificity, with 100% of PPV and 78% of NPV for streptomycin. For isoniazid, these results are respectively: 16.6%, 100%, 100% and 82.7%. There was found a good correlation between the two methods.

This prospective study included all the patients who, during the month of September 1995, were admitted for pulmonary baclliferous tuberculosis to the Pneumology Clinic of the Fann University Hospital, Dakar. The patient's escorts and the health personnel were also included in this study. The aim of the study was to find the different socio-economic and health factors impeding the hospitalization of tuberculosis patients in the Pneumology Clinic of Fann University Hospital. 22 members of the health team, 209 patients aged between 15 and 65 years and 209 escorts were interviewed. Out of the 10% of tuberculosis patients with HIV seropositivity, 80% admitted not to have informed their spouses of their infection. The decision to be admitted was made by the patient himself in 54.4% of cases and by his family in 45.5% of cases. Late admittance with regards to the beginning of symptoms was due to the recourse to traditional medicine in 43.7% of cases, wrong diagnosis in 24%, ignorance in 19.3% and, in 13% of cases, due to inappropiate anti tuberculosis treatment. Despite the fact that anti tuberculosis medicine was free of charge, each patient or his family spent an average sum of 87,500 CFA F (US dollar 175) for a month's admission (the minimal salary (SMIG) in Senegal is 32,000 CFA F (US dollar 64), and 40% of the patients and escorts had difficulties making this payment. 9 patients were judged to be poor by 25.7% of the patients and 8.7% found relations with the health personnel difficult. The escorts deplored the lack of toilets (only 1 out of 4 was functional), the time worn facilities, the overcrowding as well as the irregularity and poor quality of the hospital meals. The entire health team deplored the lack of adequate personnel and 30% of them deplored the lack of hygiene of some patients and escorts. Taking financial charge of tuberculosis patients at the Pneumology Clinic of the Fann University Hospital requires an increased financial effort from the State (rehabilitation of the facilities, recruitment of medical and paramedical personnel, improved meals) harmonisation on a national scale of anti tuberculosis therapeutic protocoles and an Information-Education-Communication (IEC) programme on tuberculosis and hygiene.

Sterno-clavicular dislocations represent an uncommon pathology in shoulder trauma. The authors describe the anatomical and clinical forms observed between January 1999 and December 2002, and evaluate the treatment process. The retrospective study addressed 9 patients (men only) with an average age of 26.6. Based on the duration of the consulting period, one could distinguish old forms from more recent ones. Diagnosis would help to see anterior forms from posterior forms. Evaluation criteria were: pain, mobility of the shoulder, visibility of the deformation of the sterno-clavicular joint. Six types of anterior dislocations were listed, including 4 recent and 2 old ones. There were 3 recent posterior forms. The anterior recent forms, which were treated in orthopedics, showed a positive evolution. As there was no functional disability, it was wiser to refrain from any treatment of the anterior old forms. The posterior forms, two of them were operated (osteosynthesis) revealed no functional deficit after treatment. However, one of the patients had a broken implant. Scanner facilitated the diagnosis of sterno-clavicular dislocations. The anterior forms, which are more frequent and benign, are different from the posterior forms, which are emergency cases due to the proximity of the aero-digestive and cardiovascular elements. Their surgical stabilization requires techniques related to ligamentoplasty rather than using osteo-synthesis equipment which may move away or break off.

Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

The Acute Chest Syndrome (ACS) is defined by the association of chest pain with dyspnea, fever, a recent radiological abnormality and hyperleucocytosis. Acute pulmonary complications are the primary cause of mortality in sickle cell patients. We report a 19-year old male patient with homozygous sickle cell anemia who consults for respiratory symptomatology and bone algia. The diagnosis of ACS by left pneumopathy due to pneumococcal infection was based on the clinical tests, chest x-ray and blood culture. The appearance of pneumopathy in patients suffering from sickle cell anemia is explained by the functional asplenia and the inability of phagocyte cells to destruct bacteria. These incidents are triggered by alveolar hypoventilation, fat embolism from bone infarction, infections, pulmonary oedema and thrombosis. The evolution of these ACS by pneumopathy depends on their early diagnosis and treatment but also on the sensitivity of the germs to antibiotics.

Hairy cell leukemia is a rare lymphoproliferative disorder which affect predominantly older males. Typical presentation includes pancytopenia, splenomegaly, presence of malignant cells with hairy projections, and some difficulty to perform a bone marrow aspiration. Reported is a 78 year - old female patient, who presented only neutropenia. There was no splenomegaly and the bone marrow aspiration was easy. Diagnosis was based on the presence of characteristic cells in a second bone marrow aspiration, whereas a treatment by recombinant human G-CSF was introduced for a suspicion of an idiopathic neutropenia. Confirmation was done with immunostaining by DBA 44 monoclonal antibody. This is the first case of hairy cell leukemia reported in Dakar, and with an uncommon clinical presentation making it difficult to be recognized.

The empyema thoracis remain a current pathology in under developed countries. The aim of this study was to evaluate the incidence of empyema thoracis in the Surgical Emergency Unit, to analyze their causes, therapeutic procedures and their results. Between 1997 and 1998, 54 patients were received in urgency for empyema thoracis; 34 of them had a complete and exploitable file. Mean age was 20 years (3 weeks and 83 years) with 64.70% of children (0 to 15 years) and the sex ratio 3.25. Fever (85.70%) and cough (73.52%) were the most frequent symptoms. Twenty nine patients (85.3%) had pleural empyema and 5 a hydropneumothoracic image. Empyemas were related to pneumonia in 11 cases, associated to tuberculosis in 5 cases and were primitive in 18 cases. Bacteriological exam of the pus performed in only 18 patients had revealed a pneumococcus in 4 cases (22.23%) and was negative in 9 cases (50%). Closed chest drainage associated with antibiotics, pleural washing and respiratory kinesitherapy was done in all the cases. The average duration of hospitalisation was 24.56 days (1 to 55 days). Five deaths (14.70%) occurred. Two cases of recurrence were noted requiring a second drainage. Three cases of pachypleuritis had required a thoracotomy for pleural decortication in average time of 6 months. The duration of follow-up was 1 year. For the other 24 patients (70.58%) the evolution was good. Urgent closed chest drainage of empyema thoracis combined with antibiotics, pleural washing and respiratory kinesitherapy allows a good evolution and reduces the risk of pachypleuritis.

A variety of occupational asthma is induced by important exposure to irritants. A case is reported, where le patient developed asthma symptoms like, following huge exposure to sulfur dioxide. All Books criteria were met, except for the metachlorine challenge which was not performed. Nevertheless the bronchial reactivity in the work place, shown by a portable pick flow eased le diagnosis. General practitioners and occupational physicians should be aware of this new medical entity for a better management.

The objective of the study was to describe risks factors of cerebral palsy and to determine clinical forms. From November 1998 to July 2000,we conducted a prospective study to select outpatients showing cerebral palsy symptoms: so 93 children with age between 5 months and 11 years old entered on this study. For 44.08% cerebral palsy was related on pregnancy abnormalities, 32.26% have central nervous system infection and 8.6% have convulsions unknown cause . The cause of cerebral palsy was untraceable in 13.98% of the cases. 82.8% of the children have cerebral palsy associated with other handicaps. The commonest type of cerebral palsy was spastic forms (74.2%) followed by hypotonic cerebral palsy (16.13%), dystoniaathetosis and ataxic forms in 5.37% and 4.3% of the cases respectively. The overall prevalence of epilepsy was 46.23%. The other handicaps were neurosensoriel abnormalities (visual impairment, deafness), speech disorders and behavioural problems. Computerised tomography (CT), performed in 45 cases showed cortical/subcortical atrophy as the commonest brain lesions. The electroencephalographic abnormalities were identified frequently.

Foreign body inhalation is a serious emergency which raises both diagnostic and therapeutic problems. Progress achieved in the domain of instrumentation and anaesthesia permit the endoscopic extraction with incontestable comfort and security However, child's anaesthesia often in respiratory distress can prove to be difficult. The aim of this study was to evaluate problems encountered during anaesthesia for endoscopic extraction of foreign bodies in lower respiratory tract and to submit an adequate management strategy. This retrospective study was about 161 cases of lower respiratory tract foreign bodies admitted to the clinic O.R.L. of le Dantec hospital from January 1986 to December 2000. Sixteen patients have had a tracheotomy immediately, before endoscopy. One hundred and fifty six patients have had endoscopy. All endoscopic procedures have been achieved under general anaesthesia with intubation by the bronchoscope. Three patients presented peroperative cardiopulmonary arrest and 8 patients died after endoscopy. The improvement of technical means will permit to reduce morbidity and mortality linked to foreign body inhalation.

Moringa oleifera is a bush of African savannah, used in folk Medicine for the treatment of rheumatic and articulary pain. We have tested the anti-inflammatory action of an aqueous extract of root in rats with weight between 120 and 160 g. We administered per os either distilled water (control group), the aqueous root extract (750 mg/kg or 1000 mg/kg) or indomethacin (10 mg/kg) 30 min before an oedema was induced in the rat-paw by subcutaneous injection of carrageenin. The rat-paw volume was measured 1, 3 and 5 hours after injection of carrageenin. At a dose of 750 mg/kg the Moringa oleifera treatment significantly inhibited the development of oedema at 1, 3 and 5 hours (reduction by 53.5, 44.6 and 51.1% respectively). Increasing the dose of Moringa oleifera to 1000 mg/kg did not increase the inhibitory effect on oedema development at 1 and 3 hours, whereas this dose potentiated the oedema at 5 hours. Treatment with indomethacin significantly inhibited the development of oedema 1, 3 and 5 hours (49.1, 82.1 and 46.9% respectively). These findings indicate that an aqueous root extract of Moringa oleifera at 750 mg/kg reduces the carrageenin induced oedema to similar extent as the potent anti-inflammatory drug indomethacin. Moreover, these results provide further evidence that the roots of Moringa oleifera contain anti-inflammatory principle that may be useful in the treatment of the acute inflammatory conditions.

The diagnosis and the management of the foreign bodies of the oesophagus in the children have benefited from the digestive endoscopy and the anaesthesia progresses the last ten years. A 120 files review concerning children who suffered from foreign bodies of the oesophagus is reported. The average age was 4 years. The sex repartition showed that the boys where prevailing (62 %). The interrogation revealed a caustic old stenosis of the oesophagus among 4 children. In 91% of cases, the diagnosis was obvious on the X-ray prints. The endoscopy assessment found 124 foreign bodies mostly represented by coins (81,4 %). We recorded 2 oesophagus perforation cases and to deaths. The foreign body of the oesophagus is not always harmless. It can determine complications often revealing ones. It seems necessary to us to stress the prevention of that accident by a vast sensitising compaign of the parents.

Every patient operated for nodular goiter by a partial surgery is exposed to recurrence. In order to verify this idea, the authors followed 36 patients operated on for nodulargoiterat least 10 years ago. A clinical examination for all the patients and echographic study for 24 of them allowed the detection of recurrence and the evaluation of survival and recurrence without any opotherapy. It seemed that clinical recurrence is observed in 16.65% of cases whereas echographic study revealed recurrence in 50% of patients examined. Only two patients were reoperated on. The predictive factors of the recurrence are geographic endemic origin and ethny, partial surgery and vesicular goiters. With 66.65% of survival without recurrence at 18 years without opotherapy, the authors argue about the utility of such treatment.

A rare clinical form of Charcot-Marie-Tooth (CMT) disease, estimated at less than 5% by a good many authors, it remains unknown at the neuropathological and genetic level. The prevalance of this form in our areas estimated at 16% allows to discuss its clinical, electrophysiological and neuropathological particularities. To define clinical electrophysiological and neuropathological criteria of neuromuscular biopsies of CMT associated with a pyramidal syndrome. forteen patients presenting a CMT disease associated with a pyramidal sign, sometimes sensory troubles pes cavus and ear and at times eye trouble, an electrophysiological exploration allowed to measure the motor conduction velocity (MCV) of the median nerve and the external popliteal sciatic. A neuromuscular biopsy on the peroneal nerve was performed in all patients with their free consent or that of their parents or relatives when necessary. Semi-thin cuttings coloured with toluidine hue were examined under photonic microscope with x10, x40, and x100 enlargements and the study of the dissociated nervous fibres (teasing) was curried out. The 14 patients aged 8 to 37 years (average 23+/-0.5). 7 females and 7 males clinically presented a CMT disease with a pyramidal syndrome Sensory troubles existed in 8 cases, a lesion of the cranial nerve was observed in 8 cases (II and VII) parental consanguinity existed also in 9 cases. The MCV of the median nerve were more > 40 m/sec in 8 cases whereas in 2 cases they were < 40) m/sec. All muscles showed an atrophy of neurogenous type. In 4 cases the nerves were histologically normal on semi-thin cuttings and <>. There were axonal degeneration lesions in 2 cases only and demyelinating lesions in 6 cases. No onion bulb lesion as observed nor images of regeneration (cluster). The CMT disease associated with a pyramidal syndrome is a clinical entity which constitutes a heterogenous group at the clinical, electrophysiological and anatomo-pathological and probably genetic level. A dominant autosomal transmission and some recessive forms were isolated but the chromosomic anomaly involved remains to be defined.

Varicose disease and venous thrombosis were reputed exceptional among black africans and almost all leg ulcers were called "tropical". We have treated 20 cases of postphlebitic ulcers in the teaching hospital of Dakar between march 1989 and december 1992. There were 12 men and 8 women. Mean age was 40 years (24 to 60 years). The initial venous thrombosis dated at mean 8 +/- 3 years. It was confirmed in a hospital in 10 cases and found in the medical history of all patients. All patients presented leg ulcers with non systematised venous varicose and trophic troubles. The ulcers treated only by dressings lasted a duration of 4 months (2 weeks to 9 months) without healing. In view of this failure we have added an ambulatory elastic contention with elastic bandage putted on at hospital after that biweekly dressing until cicatrisation followed by putting elastic socking with degressive compression. We have observed a quickly cicatrisation in mean time of 4 weeks (2 to 6 weeks) with good tolerance of socking. Only 3 patients showed recurrence. Elastic contention has a great place in the treatment of postphlebitic ulcers which are not that exceptional among black Africans.

Traumatic tracheobronchial rupture is a rare and serious complication of blunt chest trauma. Authors report the case of a 9 years old girl who was hit by a car. She presented to the admission, a respiratory distress with subcutaneous emphysema, hemoptysis, bilateral pneumothorax and pneumomediastinum. Apparently persistent pneumothorax in spite of clinic improvement after oxygenoterapy and pleural drainage, had made consider tracheobronchial rupture. The bronchoscopy achieved in emergency, had shown a low lesion of the trachea and a desinsertion of the left main bronchus. A right thoracotomy had permitted to repair the lesions. Post-operative outcome was good and authors insist in interest of early management.

Authors record a preliminary study led so as to develope techniques of preparation of the cardiac homograft valves. Eight human hearts have been appropriated in the course of medico-legal autopsy. Under sterile hodd, the heart was dissected, aortic and pulmonary valves as well as a mitral valve fragment were collected for a total of 24 valvular levies. After sterlization in an antibiotic solution, valves were preserved at 4 degrees C for the mitral fragment specimen of fresh allograft and to - 196 degrees C in Nitrogen liquidates for the pulmonary and aortic valves. The control of graft quality had consisted in tests of competence during the dissection, to the evaluation of the histological study as well as tests of sterility. Cellular cultures had shown a fibroblast proliferation in 3 cases. It concerned an indeed reliable method but difficult and little sensitivity. Histological tests had shown two types of injurie: the myxoid degeneration (7 times on 8 valves) cryopreserved and a coagulative necrosis whose distribution was identical forthe two modes of conservation. Antibiotic's solution seemed to induce these injuries as do heart ischemia, and the traumatism lihleed to the great cold. The tests of sterility had shown a rate of contamination to 25 % essentially by Pseudomonas. In view of the installation of a behle of allograft bank of quality, we'll need to improve conditions of leavy, to use a freezer adaptation for progressive cryocongelation and the choice of simple method to evaluate valvular viabilty.

In this study the authors report 5 cases of malignant lymphomas consisting in a Hodgkin's disease and 4 non Hodgkinian lymphomas. Patients aged from 16 to 55 years were 4 males and 1 female, consulting in Department of respiratory disorders of the University Hospital in Dakar, Senegal, West Africa, from 1986 thru 1992. Detoriation of the general status, cough, dyspnea and cervical adenopathy were remaked in all patients. Thoracic pain and syndrom of right pleurisy were diagnosed in one case of non Hodgkinian malignantlymphoma. X Ray exploration of the chest detected 4 cases of mediastinal adenopathies and 3 pleurisis in non Hodgkinian malignant lymphomas; and reticulonodular opacities of pulmonary basis in the Hodgkin's disease case. The diagnosis has been confirmed by pathologic anatomy studis of the biopsed ganglia. The endemic characteristic of tuberculosis in developing countries make necessary to evoke it in first of any adenopathy. When the clinical feature is atypical, a biopsy of ganglia must be performed to avoid diagnosis delay which could lead to agravate the prognosis of malignant lymphomas.

A clinicopathological study of parkinsonian syndrome witch occurred after stroke, is done by the authors. That is a retrospective study concerning 2 anatomic cases from 21 vascular parkinsonism. All the patients were admitted in the clinique neurologique de Fann from 1970 to 1990. They were 15 men and 6 women. Their age ranged between 45 to 75 years (mean 59.66). The 2 autopsied cases had lesions located in the thalamus as the superior part and a discreet cortical atrophy in the one case, and in the other case, we can see similar lesions in the right external capsule and in the inferior part of the putamen. Another lesion of haemorrhage infarct was located in the left temporal lobe. The locus niger was macroscopically normal in the 2 cases. Anatomical lesions observed have been localized in the putamen and in the external capsule in the associatical cerebral cortex in the second case and in the first one, lesions are located in the thalamus and in the cortex. These lesions were not well correlated with neurological signs. The different clinical aspects are discussed. From this study, it results that arterial damages associated with hypertension and atheromatosis might touch dopaminergic structures responsible of parkinsonism with sometime good sensitivity to levodopa.

Through a cohort of 93 neuroaids which has been diagnosed at Dakar in our Neurology Department, the authors evaluated the hospital prevalence of retrovirus, detected socio-demographic factors, related AIDS outline the mean neurological picture and try to correlate survival and neurological involvement of these patients. Among 1151 patients who got retroviral blood test, 93 were seropositive (8.1%). On these repartitions 36 were females (38.7%) and 57 males (61.3%). The age goes from 19 to 76 years old. 45 patients (48.4%) have been found positive for HIV-1 blood test, 21 patients (22.6%) for HIV-2 blood test, 11 patients (11.8%) for both HIV2, 11 patients (11.8%) for HTLV1, 3 patients (3.2%) for both HIV-1 and HTLV1, and 2 patients (2.2%) for both HIV-2 and HTLV1. In our study the transmission of AIDS occur mainly through heterosexual inter course and multiple parternship is a high risk group. The central nervous system deseases represented 68.8% of cases. The pathology were dominated by stroke, myelopathies, meningoencephalotis and spinal cord compression. The peripheral nervous system desease were found in 7.5% of cases. The peripheral facial paralysis occupied the first place in HIV infections of peripheral nervous system deseases (57.1% of cases). When neurological involvement set up the letality is higher for HIV-1 (57% of global letality) and for central system nervous involvement (76.2%).

Because of the apparition of new risk factors and numerous progresses in investigation methods, authors take stock of neurological diseases of patients admitted in Clinique Neurologique of Fann during the last ten years. The 8539 cases repartition is as followed: 4736 males and 3803 female. Their ages ranged between 3 and 80 years with 2130 deaths corresponding to 24.94%. Annual mean of admission is 853 +/- 42 cases. Aetiological data are: stroke (3910 cases 45.78% with 60.56% of death). The following is peripheral neuropathieswith 714 cases(8.61%) and the spinal cord compression with 692 cases (8.10%). Comparision of frequencies of different aetiologies with those of previous studies shows that the small capacity of the neurological department is a restricting factor for the entry frequencies of neurological patients; the principal pathologies got small variations from one decade to another. In the opposite, some aetiologies have disappeared (neurological syphilitis, trypanosomiasis, neurocyticercosis, cerebral mycosis). Some eatiologies remain unprecised (infectious diseases, peripheral neuropathies, degenerative diseases).

A retrospective study of Friedreich's ataxia was conducted from january 1960 to december 1997. Eighten cases had been collected. Friedreich's ataxia was the second disorder after Pierre Marie's ataxia among inherited ataxia. Parental consanguinity has been found in 27.77% of cases. The sex-ratio was 2.6 for males. 66,67% of Friedreich's ataxia cases began after 25 years. Clinical signs were: cerebellar ataxia, sensitive disorders in 70%, pyramidal syndrom and cardiomyopathy in 22.22%, bones dysmorphy in 50% of cases. Electromyography indicated severe axonopathy of members with decreased somesthesic potentials in six cases. Glycaemia was normal in all cases. Clinical future presented wide variation between one and fourth years old.

From January 1991 to July 1998, 24 patients were operated for pulmonary aspergilloma. All the patients presented previous tuberculosis treated. Hemoptysis had been the revealing elements of the illness in 80% of cases. Treatment was by resection in all the cases: 13 pneumonectomy (54%) and 11 partial resections (46%). The procedures were usually difficult and hemorrhagic. The global mortality was 20%, can be explained by the high number of major resections and the unfavourable general state of health of our patients. Post operative complications are mainly due to secondary empyemas encountered in 15% of the surviving ones. The surgical resection of pulmonary aspergilloma is still difficult and risky for extended underlying parenchymal disease. Minima procedures such as speleotomy and intra cavitary aspiration technique must be indicated in patients with very poor general condition.

A retrospective survey has been conducted from january 1979 to january 1999 about the young inpatients file records of the department of neurology of Dakar. 19 cases of Guillain-Barré's syndrome have been collected, representing 2.3% of the children admitted in the department of neurology. The children were 18 months to 16 years old. The sex ratio was 1.4. Infectious disease has been reported in 68.4% of the cases during the 4 weeks preceding the neurological features. The notion of vaccination was found in 5.3% of the cases. The motor deficit was frequent, represented by paraparesis in 63.2% and quadriparesis in 36.8% of the cases. The mean duration of the hospitalisation was 28 days. 52.6% of the patients have completely recovered from their motor deficit and this recovery was unachieved in 36.8%. No fatal event has been detected. The therapeutical means were represented by vitaminotherapy B1B6B12 associated with kinesitherapy. Our results reveal a less severe evolution and better prognosis of Guillain-Barré's syndrome affecting children, instead of the absence of more appropriate means of treatment such as plasma exchange and intravenous immune globulin.

The Fernand Widal syndrome combines a nasal polyposis, an asthma and aspirin sensitivity. It remains a nosological entity often unrecognized because of the trivialization of aspirin in-take on the one hand the other its etiopathogenesis which has not yet been clarified because of the inhibition of the cyclo-oxygenase. In actual fact the aspirin molecule has yet to reveal all its secrets (advantages and disadvantages). We report 2 cases of Fernand Widal syndrome observed in 2 women in their thirties with a notion of atopy in one at the Pneumophtisiology clinic at the Fann University Hospital in Dakar. The confirmed diagnosis was based on oral provocative test in addition to suggestive clinical signs which emphasize the classical triad with a chronological appearance more or less typical. The best treatment could combine inhaled corticotherapy, nasalization of sinus cavities, antihistaminics, no aspirin in take and educating the patient.

The course of hepatitis B virus (HBV) infection may be influenced by the host immune response. A prospective study was carried out in ninety-eight subjects (mean age = 23 years) HBs antigens carriers of hepatitis B and living in Dakar, Senegal. We analysed the HLA-A, -B, and C antigens distribution compared to that one of a control (HBs negative) healthy senegalese population (n = 96) living in Dielmo village where a longitudinal study was set-up since 1990. The HLA class I typing was performed by microlymphocytotoxicity assays. The most frequent HLA-A, -B, -C antigens found were: locus A: A23 (33.6%), A2 (25%), A30 (25%), locus B: B8 (31%), B7 (16.3%), B58 (11.9%), B35 (11%), B49 (11%), B53 (10.8%) and locus C: Cw7 (39.1%), Cw17 (39.1%), Cw3 (36.9%), Cw4 (36.6%). Significant differences (P < 0.001) were found between the donors and the control group for the following HLA antigens: A1, A23, B8 and Cw3. The detection of HBe antigen was positive in 26/84 blood donors. It was observed a significant difference (p < 0.01) between positive and negative HBe donors for HLA-A1 allele with an odds ratio of 6.25. All the donors carrying the HLA haplotype: A1-B8-Cw7 (11.5%) were positive in HBe antigen. HLA: B8-Cw7 haplotype (detected in 8.5% of positive donors) seems to be likely associated with a liver cancer according to many reports. An adequate follow-up should be set-up for positive HBe subjects carrying a susceptible HLA type.

The authors described the first cases in Senegal (West Africa) of the association Parkinson's disease and epilepsy. Almost studies on this feature, stressed on their different pathophysiology basis epilepsy is related on excess of neuronal excitation, and Parkinson disease is an expression of lack of motor neuromodulation. The diagnosis has been done because of the coming out two seizures in the year on two patients one 59 years old and the other 70 years old experiencing Parkinson disease well documented before and treated. Biological study, ultrasonography and Doppler, CT Scan lead to rule out a vasculopathy. Good outcome with antiparkinsonian and anticonvulsant medications confirm the diagnosis.

This study concerns a case-report about a 28 year old Senegalese woman suffering from a SHARP syndrome complicated by a bilateral bacillary pulmonary tuberculosis. The prevalence of this disease is underestimated but a female predominance is often reported. The mechanisms of this disease strongly depends upon the context in with it occurs. The diagnostic has been established by the ALARCON SEGOVIA criteria including clinical symptoms (Raynaud phenomenon, puffy fingers and myalgia) and biological features such as high positive immunofluorescent reactivity revealing the presence of anti RNP antibody at a level superior to 1/1000. The subsequent development figure of the disease emphasizes: persistence of polymyositis pattern revealed by higher limbs localized myalgia involving the thighs and symptoms of lupus including alopecia and glomerulonephritis remaining of the mixed characteristic comparable to the cases published in the literature. appearance of a bilateral bacillary pulmonary tuberculosis with a severe involvement of the right lung. The treatment composed by anti inflammatory and antituberculosis drugs lead to an early improvement of the clinical symptoms associated to a rapid cleaning of radiological manifestations. Sequelae were represented by cavities detected in the right lung and related to the pharmacological effects of corticosteroid drugs.