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The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism.This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire.We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P0.05).This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

In Senegal, psychological violence remains a taboo subject insofar as it often arises in the closed circle of family life. It has a highly negative impact on the health of pregnant women. The objective of this work was to study the epidemiological profile of female victims of psychological violence before and after birth in the Sédhiou region.An observational, cross-sectional and analytical study was carried out from December 4, 2018 to April 4, 2019. The study population consisted of all the women received for postnatal consultation in one of the referral health structures in the Sédhiou region. Data were collected using a survey form and a questionnaire administered to the women having met the inclusion criteria. The data were entered using CS Pro software and subsequently analyzed using R 3.4.4 software.The mean age of the women was 25.4±7.8 (14-43 years). A total of 222 women (55.5 %) had suffered psychological violence during the prepartum period. Isolated psychological violence represented 44.3 % of the surveyed population, while psychological violence associated with sexual or physical violence represented 8.0 % and 5.4 % of the respondent population, respectively. The factors associated with psychological violence during the prepartum period were pursuit of a professional activity [ORaj=4.7 (1.3-17.0)], high educational status [ORaj=7.0 (4.2-11.5)] and performance of fewer than 3 antenatal consultations (ANC) [ORaj=2.2 (1.2-4.0)]. Maternal, fetal and neonatal complications were more frequent among victims of psychological violence (P0.05). During the postpartum period, 26.5 % of the women who had been victims of violence during the prepartum period mentioned the fact that the aggression had ceased. The other women continued to endure violence, which was even more intense among 2.5 %.Psychological violence among pregnant women has a negative impact on the health of the mother and the newborn. This state of affairs should induce health care providers to increase popular awareness of its detrimental effects. Communication efforts aimed at behavioral change will need to be combined during prenatal consultations with strengthened screening for violence, the objective being to achieve improved care.

International audience; Anaplastic oligodendroglioma (AO), IDH‐mutant and 1p/19q codeleted (IDHmut+/1p19qcodel), is a high‐grade glioma with only limited prognostic markers. The primary objective of this study was to evaluate, by immunohistochemistry, the prognostic value of two proliferation markers, MCM6 and Ki‐67, in a large series of IDHmut+/1p19qcodel AO included in the POLA (“Prise en charge des Oligodendrogliomes Anaplasiques”) French national multicenter network. We additionally examined the transcriptome obtained from this series to understand the functional pathways dysregulated with the mRNA overexpression of these two markers. The labelling indices (LI) of MCM6 and Ki‐67 were obtained via computer‐assisted color image analyses on immunostained AO tissues of the cohort (n=220). Furthermore, a subgroup of AO (n=68/220) was used to perform transcriptomic analyses. A high LI of either MCM6 (≥50%) or Ki‐67 (≥ 15%) correlated with shorter overall survival, both in univariate (P=0.013 and P=0.004, respectively) and multivariate analyses (P=0.027; multivariate Cox model including age, mitotic index, MCM6 and Ki‐67). MCM6 and Ki‐67 LI also correlated with overall survival in an additional retrospective cohort of 30 grade II IDHmut+/1p19qcodel oligodendrogliomas. The prognostic value of MCM6 mRNA level was confirmed in The Cancer Genome Atlas (TCGA) IDHmut+/1p19qcodel gliomas. The transcriptomic approach revealed that high transcriptional expressions of MCM6 and MKI67 were both linked positively with cell cycle progression, DNA replication, mitosis, pro‐neural phenotype as well as neurogenesis, and negatively with microglial cell activation, immune response, positive regulation of myelination, oligodendrocyte development, beta‐amyloid binding, and postsynaptic specialization.In conclusion, the overexpression of MCM6 and/or Ki‐67 is independently associated to shorter overall survival in IDHmut+/1p19qcodel AO. These two easy‐to‐use and cost‐effective markers could thus be used concurrently in routine pathology practice. Additionally, the transcriptomic analyses showed that AO with high proliferation index have down‐regulated immune response and lower microglial cells activation, and bears pro‐neural phenotype.

To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.

The aim of this pilot study was to analyze the Hepatitis C Virus (HCV) genotypes circulating in Senegal among Drug User (DUs), using Dried Blood Spots (DBS) as RNA source for molecular assays. Heroin and/or cocaine users (n = 506) were recruited in Dakar from April to July 2011, using a Respondent Driven Sampling (RDS) method. DBS preparation consisted of five drops of whole blood from finger applied to a Whatman paper card. HCV infection was screened by the detection of anti-HCV antibodies, using a rapid immune-chromatographic test. HCV RNA was quantified on anti-HCV positive DBS, using the Abbott RealTime HCV® Genotyping was performed on DBS with detectable viral load with Versant® HCV Genotype 2.0 Assay (LiPA) and Abbott RealTime HCV Genotype II assay®. Among the 506 participants, 120 were tested as positive for anti-HCV antibodies and their samples were analyzed for HCV RNA viral load and genotype. Out of the 120 DBS tested, HCV RNA was detected on 25 (20.8%). The median viral load was 15,058 IU/ml (ranging from 710 to 766,740 IU/ml). All positive DBS were suitable for the genotyping assay, that showed a predominance of genotype 1 (21/25) including 16 genotypes 1a and 5 genotypes 1b. HCV genotype 1 prevails in a DU population in Dakar. DBS could be useful for HCV RNA genotyping, but optimal storage conditions should required avoiding RNA impairment. Acknowledging this limitation, DBS could be a great interest for detecting and genotyping HCV viremic patients. J. Med. Virol. 89:484-488, 2017. © 2015 Wiley Periodicals, Inc.

Despite the frequency of hysterectomy, several studies have reported physical and psychological sequelae of this intervention. BUT: To evaluate the consequences of hysterectomy, their level of importance and how patients experience hysterectomy.That is a prospective study of 70 patients who underwent a hysterectomy from January 2009 to June 2011 at Pikine National Hospital. The experience of hysterectomy was determined by the physical and psychosocial felt after surgery.Hysterectomy represented 5.9 % of gynecological surgical activities. The indications were dominated by myoma (57.1%). Hysterectomy was performed abdominally in 78.6% of cases and associated with bilateral salpingo-oophorectomy in 87% of cases. After surgery, new symptoms appeared: hot flushes, night sweats, urinary incontinence and urge incontinence in respectively 65.7%, 54.3%, 7.1% and 11.4% of patients. A proportion of 45.6% of them had resumed sexual activity after 90 days. The fear of pain at the time of intercourse was expressed in 55.7% of cases. A decrease in the frequency of sexual intercourse was found in 54.3% of patients. A drop of pleasure during sex was expressed in 38.6% of patients. Psychological effects were also reported by patients: decreased confidence in 31.4% of patients, feeling of being rejected by her husband in 5.7% of cases, sensation of mutilation in 24.3% of cases.Physical and psychological postoperative impacts of hysterectomy are real. Adequate accompanying measures are necessary, in addition to preoperative preparation, to allow patients to improve the experience of hysterectomy.

We report the surgical management of eight vulvar tumors occurred at the waning of female genital mutilation practiced in childhood. Patients were aged 19 to 38 years. It was essentially excision type 2. Surgical excision of the labia minora with a refund without clitoral plasty gave satisfactory aesthetic and functional results. Histological examination of these tumors showed a single cyst containing keratin without inflammatory reaction.

To demonstrate the feasibility of copper IUD insertion following cesarean deliveries and assess its safety.This is a prospective pilot study at Pikine national hospital from February 15 to November 15, 2012. Were evaluated the efficacy, incidence and spectrum of complications and continuation rates.Fifty-nine subjects were enrolled and 46 received an IUD. The average age of patients was 28 years. No patient had previously used IUDs. Forty-four patients (97.5%) were returned to the first follow-up visit at the first month, 41 patients (89.1%) at the second visit and 39 patients (86.9%) at the third visit. The rate of lost sight was 8.7%. Pain and bleeding were reported rarely: 2.3% at the first month, 4.9% at the third month and 7.7% at the sixth month for the bleeding and 6.8% at the first month, 2.4% at the third month and 2% at the sixth month for pain. The rate of expulsion was 2.2%.The insertion of the IUD following cesarean delivery has an acceptable rate of expulsion and no increased rate of adverse effects. This technique should be popularized.

To evaluate the management of patients with prostate cancer in Senegal.We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities.We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen.The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

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.

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.

Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali.This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models.The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa=0.59; 95% CI=0.34-0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome.Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality.

We report our experience with 79 intracranial meningiomas operated on between 1960 and 1995 in Dakar Senegal. In our geographical region issues concerning diagnosis, therapy and clinical course are still a topic of debate due mainly to the lack of high-performance technical units. All patients were admitted with evident symptoms. The classically described prevalence was not found in this series. Thirty-one cases presented intracranial hypertension with or without a focal syndrome which evidenced a motor deficit in 32 cases and irritative lesions in 24. External bulging of the meningioma was observed in a large number of cases (11.4%). Until 1994, angiography was the only available means of diagnosis. Mortality was high (30 cases) and results depended on delay to surgery, tumor localization and operative conditions. Our results have been improving over the years but cannot be sustained unless the technical unit is upgraded.

A retrospective study was carried out from January 2000 to December 2003 to assess the resistance of Mycobacterium tuberculosis to antituberculosis drugs and the impact of this on the treatment result. Two hundred and two patients' files were studied (average age: 36 years; sex-ratio: 1.7). Pulmonary localisation (85.7%) or extrapulmonary localisation (14.3%). HIV status is negative (71.3%), positive (10.8%) or unknown (17.9%). The overall recovery rate is 60.7% (61.4% in HIV-; 46.1% in HIV+), the rate of treatment failure is 2.7% (1.1% in HIV-; 15.4% in HIV+), the death rate due to tuberculosis is 6.3% (2.3% in HIV-; 23.1% in HIV+), and the rate of patients who disappeared from the system is 30.3% (35.2% in HIV-; 14.2% in HIV+). Hepatotoxicity that occurred during treatment is observed in 14.3% of cases (recovery: 56.2%; failure: 6.2%; lost from the system: 18.8%). Eighty-four percent of patients never received antituberculosis treatment (group A) versus 15.8% of patients who had already received one or more antituberculosis drugs (group B). The rates of resistance to isoniazid are 6.4% (A) and 12.5% (B), to rifampicin 1.7% (A) and 12.5% (B), to ethambutol 0.5% (A) and 0% (B), to streptomycin 24.1% (A) and 46.8% (B). The percentage of multiresistant strains is 1% in patients not treated previously and 11% in those who had already received antituberculosis treatment. When the patients are carriers of a strain that is responsive to the treatment administered, the recovery rate is 64.2% versus 46.7% in patients whose strain is resistant to at least one of the treatments administered.

In sub-Saharan Africa, problems of access to relevant and high-quality facility-based statistics hinder the assessment of safe motherhood programs. The objective of this study was to assess the quality of data collected in referral hospitals in Mali and Senegal after the routine information system (RIS) was strengthened.This was a multicenter observational study conducted during the pre-intervention period of a randomized controlled trial (trial QUARITE). The RIS was strengthened based on technical, organizational and behavioral factors. We included all women who gave birth in the 46 referral hospitals from October 1, 2007 to October 30, 2008. The completeness, completion and accuracy rates were monitored every 3 months in each hospital. The cost of investment needed to strengthen the existing RIS was also determined.The mean completeness rate ranged from 94 to 97% depending on the study period. The completion and accuracy rates increased during the study period from 72% and 79% to 87% and 93%, respectively (significant differences). The average investment per hospital was less than 1% of state subsidies for public hospitals.Strengthening the existing information system has set up an economically and technologically appropriate system for monitoring maternal and perinatal health in Senegal and Mali. We encourage policy makers and researchers from countries with limited resources to invest in RIS to improve and monitor the performance of health systems.

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

Nosocomial Infection (NI) is also observed in healthcare facilities in non-Western countries. The purpose of this report is to describe the findings of a survey undertaken to evaluate hygiene procedures implemented at the "Hopital Principal" in Dakar, Senegal and to assess perception and awareness of nosocomial risk among the hospital staff. A total of 264 healthcare workers were interviewed. Mean age was 39 years (range, 18-60) and the sex ratio was 1.3 (150 men/114 women). Sixty (22.7%) had university degrees, 106 (40.2%) had secondary school diplomas, 50 (18.9%) had attended middle school, and 13 (4.9%) had no schooling. Analysis of interview data showed that 56.1% (157/264) defined NI as infection acquired at the hospital but that only 9.8% (n=26) knew that a minimum 48-hour delay was necessary to distinguish nosocomial from community acquired infection. While understanding about NI was correlated with education level, data showed that 1 out of 3 physicians (13/39) failed to give the exact definition. Hand contact was cited as the second route of transmission. Isolation precautions were understood by 22.7% of personnel (60/264). Systematic handwashing was reported by 363% (96/264) but observation demonstrated that it was not performed properly regardless of the category of personnel. Care protocols were understood by 54.6% of persons interviewed (144/264). A hygiene-training course had been attended by 52.2% (n=138). Two thirds of the staff (69.7%: 54/264) was able to identify the hygiene nurse. Ninety-eight health care providers (37.1%) were familiar with the CLIN (Comités de Lutte contre les Infections Nosocomiales).

The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results.We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis.The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant.The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

Prostate cancer is common around the world, but rates of advanced disease differ substantially by race and geography. Although a major health issue, little is known about prostate cancer presentation in West Africa and India compared to the United States (US).The aim of this study was to compare prostate tumor characteristics in four populations of men from the US, Senegal and India.We recruited prostate cancer patients from four hospital-based populations. The sample included 338 African-Americans, 1265 European-Americans, 122 Asian Indians, and 72 Senegalese. Questionnaire and medical record data were collected on each participant.We found significant differences in age at diagnosis, BMI, and PSA levels across the groups. Senegalese and Indian men had a higher probability of high stage (T3/T4) disease compared to US men. Gleason grade was significantly higher in Asian Indians compared to other populations. African-Americans, Senegalese, and Asian Indians had a significantly higher probability of metastatic disease compared to European Americans. The odds ratios (OR) for metastasis were consistently higher in Asian Indians compared to American cases. As only 19/72 Senegalese were assessed for metastasis, OR could not be determined for metastasis.These results suggest that there are significant geographical and ethnic differences in the presentation of prostate cancer. Men in developing countries tend to present with advanced disease compared to US men. Identifying risk factors for advanced disease may help to decrease the rate of poor prostate cancer outcomes and associated mortality worldwide.

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.

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.

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.

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.

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.

The purpose of this study was to analyze self-destructive behavior in adolescents in Senegal. Based on four case reports the authors stress the central importance of family breakdown in the process leading to this behavior as opposed to the first descriptions implicating an offense against the honor of the group. The vulnerability of teenagers in the absence of structural initiation is also advanced. Systematic intervention may be recommended in such cases.

Norplant is a long lasting contraceptive method which protect again pregnancy for five years. We studied the side effects and the variations related to weight and blood pressure.The study was carried out in three family planning clinics in Dakar with 450 women who have had their implants for at least six months. Data collection was based on patient interviews and review of medical files.The side effects reported were mainly menstrual problems with 54.7% of the women reporting menstrual spotting. The other non-menstruel side effects were headaches (64.2%) and dizziness (59.1%). The side effects at the insertion site were pruritus (16%) and pain (3.1%). Regarding weight and blood pressure, an increase in weight was observed up to three years of Norplant use and a decrease to the initial weight was seen during the fifth year of use. No variation was noted regarding blood pressure.Norplant is a contraceptive method widely used in Senegal. Most of the side effects involve menstrual problems. A slight increase of weight was observed in general with no variation in blood pressure.

The authors report five cases of ureterocele during six years. Mean age of the patients was 34.2 +/- 11.1 years. There were four female and one male. Pain (N = 3) and dysuria (N = 3) were the most common symptoms at examination. Diagnosis was made by ultrasound (N = 3), IVU (N = 3) or cystoscopy (N = 1). Ureteroceles were bilateral in four cases, unilateral in one case and were always intravesical with single ureter. Two patients presented lithiasis enclosed in the ureterocele. Only four patients had been operated. Surgical treatment was ureterocelectomy with ureteral reimplantation according to Cohen procedure. With mean follow-up of 10.6 +/- 4.7 months results were stable without complications.

The investigation of this outbreak took place in Niakhar (IRD project study area), a rural area located 150 km East of Dakar. Covering 30 villages, with a population of about 30,000 inhabitants, the area has been under demographic and epidemiological surveillance. In 1999, the surveillance allowed 973 cases of shigellosis to be recorded out of 1,751 cases of dysenteric diarrhoeas. The outbreak reached a peak during the raining season (73% of the cases in September and October). All the villages and all age groups were concerned. The attack rate in the population was 3%. During the same period, 22 deaths were attributed to shigellosis, leading to a lethality of 2.3%. Children under five were the most affected. The bacteriological examination isolated S. flexneri in 72% of 12 stools samples and S. dysenteriae A1 (SD1) in 14%. All serotypes were resistant to ampicillin and susceptible to quinolones. Susceptibility to cotrimoxazole was unconstant. Apart from the usual factors involved in the spread of diarrhoeas, the main reason evoked to explain the duration of the epidemic has been the lack of adequate emergency antibiotherapy treatment. Quinolones, recommended by the health authorities, could not be provided by health services. The identification of the SD1 serotype confirmed its involvement in the outbreak of shigellosis. The exact role of S. flexneri in shigellosis epidemics should be further studied.

This report describes a case of mental confusion associated with ongoing adenitis and pulmonary tuberculosis in a 20-year-old man with no history of psychiatric disorders. Diagnosis was based on clinical and laboratory findings. Tranquillizers improved mental status and antituberculosis treatment was administered before referring the patient to an internal medicine department. The authors emphasize the rarity of these cases in the Senegalese medical literature and discuss possible diagnostic pitfalls.

Tea drinking after meals is a traditional practice in Senegal where more than 80% of the population from 15 to 60 years old drink tea. According to the tradition, in one session, each tea consumer has to drink 3 cups of decocted tea. The content of a cup is about 30 ml of liquid. Some people drink tea three times daily, that is to say after each meal. Tea plant is rich in fluoride. To determine the effective intake of the Senegalese population from this source, we measured the fluoride concentration not only for each component of the prepared tea but also for each cup of prepared tea. For this study, we used the two main kinds of tea existing locally. The analyses have been done at Rochester, NY Eastman Dental Center, Oral Biology Dept Fluoride Laboratory using the Taves Microdiffusion Method and the fluoride Ion Specific Electrode. The results so that the mean total fluoride concentration of each cup, from the first to the third one, is: 4.0 mg F-/L, 7.436 mg F-/L and 1.230 mg F-/L. It means that on an average in one session, a Senegalese tea consumer has a daily fluoride intake of 1.139 mg F-/L when taking in count the total fluoride and drinking only 90 ml of tea. If we consider the ionic fluoride the amount of daily ingested fluoride for someone who takes only 3 tea-pots of 30 ml each, is 0.830 mg. To conclude, we state that this traditional practice may have a caries preventive effect. Further studies will be grateful for that practice when setting up a caries preventive program in our country. We will also be careful in extending that practice to children less than 8 years old because it might cause dental fluorosis as in Senegal the optimal dose of fluoride is 0.8 mg F-/L.

The authors report 5 cases of uterovesical fistula (UVF) and analyse some of the clinical and therapeutic aspects of this disease. The mean age of these 5 patients was 31.2 +/- 6.9 years. The trauma responsible for the fistula was caesarean section in every case. The presenting complaints were dominated by cyclic haematuria (n = 5). Intravenous urography did not contribute to the diagnosis, while hysterosalpingography demonstrated the UVF in 3 out of 4 cases. Treatment was surgical for all patients and consisted of closure of the fistula in 3 cases and hysterectomy in 2 cases. With a mean follow-up of 2 +/- 1.2 years, no pregnancies were reported in the 3 patients treated by closure of the fistula. On the other hand, the urinary results were satisfactory with good continence and resolution of the cyclic haematuria. The authors emphasize the importance of prevention of UVF by well conducted caesarean section.

The three main penile emergency situations have been examined so as to better define the clinical and therapeutic aspects. In the present study, a fracture of the penis (n = 12) occurred following a coital accident in 8 cases. In general, a clinical diagnosis was made and emergency surgical treatment appeared to be the most efficient means of preventing possible erectile malfunction. Mutilation of the penis was observed (n = 12) following traditional circumcision or circumcision performed by paramedical staff; or was due to self-inflicted mutilation and pyschiatric disorder (n = 6), and in one case to sexual deviation (n = 1) This category of accidents could be more adequately managed by the psychiatric treatment of certain patients and by better training of the personnel carrying out the circumcision. Priapism (n = 42) was due to sickle cell disease in 50% of cases, and relapse was noted in 10% of patients.

The authors report the case of a patient presenting with recurrent urinary tract infection and deterioration of the general status. Ultrasonography, plain x-rays and especially cystoscopy demonstrated the presence in the bladder of an intrauterine contraceptive device inserted 4 years previously. Endoscopic removal combined with antibiotics ensured cure of this patient.

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.

A total of 343 HIV-1-positive samples obtained between June 1996 and March 1999 was genetically characterized in the envelope region by HMA and/or sequencing. The env subtype distribution was as follows: 290 (84.6%) A, 22 (6.5%) B, 16 (4.7%) C, 8 (2.5%) D, 1 (0.03%) E, 1 (0.03%) F1, 4 (1.2%) G, and 1 (0.03%) H. For 77 samples the p24 region from the gag gene was also sequenced, and for 9 (11.6%) the subtypes between env and gag were different. Phylogenetic tree analysis showed the predominance of AG-IBNG-like viruses among gag and env subtype A sequences. HMA is relatively simple and requires less sophisticated technical facilities compared with sequencing, and in Senegal 323 (94.2%) of the 343 samples could be identified by this technique. However, in the actual configuration of the assay, discrimination between the recombinant AG-IBNG-like recombinant viruses, which are predominant in Senegal, and the nonrecombinant subtype A viruses is not possible.

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.

An integrated multimedia campaign featuring family planning messages saturated the 900,000-person city of Bamako, Mali, for three months during the spring of 1993. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali, does not oppose family planning. A separate sample pretest-post-test quasi-experimental research design was used to evaluate the effects of the campaign and exposure to specific messages on changes in contraceptive knowledge, attitudes, and practice. Results indicate a high level of exposure to and agreement with the messages. A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project interventions, after controlling for relevant variables.According to the Demographic and Health Surveys conducted in Mali in 1987 and 1995-96, the current use of any form of contraception among currently married Malian women increased from 5% to 7% during the period between the 2 surveys. Family planning messages were disseminated throughout Bamako through radio and television for 3 months in a spring 1993 information, education, and communication (IEC) campaign. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television to convey information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for spouses to communicate with each other, and that Islam, the predominant religious faith of Mali, does not oppose family planning. Impact evaluation found a high level of exposure to and agreement with the campaign messages. The campaign also led to a dramatic decline in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with the intensity of exposure to the project interventions, after controlling for relevant variables.

The objective of this study was to report the epidemiological profile of erectile dysfunction in a population of diabetic men.This was a prospective study including 431 diabetic patients seen in the outpatients department. 69 of these patients suffered from erectile dysfunction. A control group of 138 patients was randomly selected according to age from among the remaining 362 patients. Each patient was submitted to complete clinical examination. The medical and surgical history, particularly vascular, neurological, endocrine and urological, was recorded. The patient's smoking and drinking habits and treatment with any antidiabetic or other drugs were also recorded. Statistical analysis was performed according to the case-control method. The limit of significance was p0.05.The overall prevalence of erectile dysfunction was 16%. This rate is lower than those reported in the literature. Among the various risk factors, only complications of diabetes, especially neurological complications, were clearly correlated with the risk of erectile dysfunction (p = 0.0004). Similarly, the prevalence of erectile dysfunction increased with the duration of diabetes (p = 0.049).The prevalence of erectile dysfunction in diabetic patients often appears to be overestimated in the literature. Methodological biases would explain the marked variation of reported prevalence rates. In contrast, our study confirms previous reports that neurological factors play a predominant role.

To study the electromyographic alterations of the urethral sphincter, perineal muscles and lower limbs observed in women with obstetric vesicovaginal fistula.We compared a group of 22 women with obstetric vesicovaginal fistula with a control group of 10 women without fistula. Each woman underwent a neurological examination of the perineum and lower limbs and electromyography of the lower limbs and urethral sphincter. According to the classification proposed by MENSAH, the fistulas were classified as simple (54.5%), complex (31.8%) and complicated (13.6%).Twenty women with VVF presented a peripheral nerve lesion. Five of these patients had a clinical and electromyographic lesion; while the other fifteen patients had a subclinical lesion. 68.18% of the fistula patients presented a clinical neuropathy in the perineum. This lesion was detected on electromyography in all patients with fistula. The severity of this denervation lesion ranged from moderate (36.37%) to severe (63.63%). No neurological lesions were detected in the control group. The degree of denervation has more severe in young women (21-25 years) and in primiparous women. In contrast, the severity of denervation did not appear to be related to the history of the fistula. The risk of treatment failure increased proportionally to the severity of denervation. 73% of fistulas with severe denervation remained "unsuturable", or required multiple operations with disappointing results in the form of persistent vesicosphincteric dysfunction.Although the psychosocial impairment and upper urinary tract repercussions have been well evaluated, the peripheral neurological lesion has always been underestimated in the management of obstetric vesicovaginal fistulas. The authors consider that the fistula is only the apparent manifestation of "neurovesical damage", which remains the decisive factor in the prognosis and which largely explains the high frequency of treatment failure.

Peripartum cardiomyopathy is a classic but uncommon entity in African women about which there is little etiologic understanding. From January 1990 to March 1996 a series of 30 cases of peripartum cardiomyopathy was collected at the Principal Hospital in Dakar, Senegal. Peripartum cardiomyopathy was defined as the occurrence of cardiac insufficiency in a woman with no previous history of heart disease, during the period between the second and twentieth weeks after delivery confirmed by ultrasound evidence of dilated cardiomyopathy. The overall incidence of peripartum cardiomyopathy during the study period was 30 out of 1200 deliveries. The mean age of the women in the study was 34 years and mean parity was 5.2. In 13.3% of cases births involved twins. There were no predisposing socio-economic or climatic factors. The clinical picture was severe cardiac failure in 80.3% of cases and left ventricular insufficiency in 16.6%. In all cases ultrasound findings were typical of dilated cardiomyopathy. Serum selenium and vitamin B1 levels were normal. Measurements of T CD4 and CD8 in eight patients were normal. Conversion enzyme inhibitors were administered to twenty patients. Complete remission was achieved in 14 patients, three patients died, and thirteen patients presented ultrasonic evidence of persistent dilated cardiomyopathy. One patient relapsed after a subsequent delivery. These findings are in agreement with previous reports concerning the clinical and prognostic features of peripartum cardiomyopathy in Africa.