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

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.

Five arbuscular mycorrhizal (AM) fungal species were isolated and propagated from surface and deep rhizospheres of Faidherbia albida trees growing in two ecoclimatic zones of West Africa: the semi-arid Sahelian and the more humid Sudano-Guinean areas. Of these species, Glomus aggregatum, Glomus caledonium, and Glomus mosseae were trapped by F. albida roots when cultivated with either surface or deep soils. Glomus fasciculatum was found exclusively at the semi-arid Sahelian sites of Louga and Diokoul and Gigaspora margarita was isolated only from 16.5-m and 34-m-deep samples. Comparable glomalean fungal species richness was identified in deep (1.5–34 m) and surface (0.15 m) samples. The isolation and the propagation of glomalean fungi from F. albida rhizospheres confirmed the presence of viable AM fungal propagules, down to the water table, as deep as 34 m.

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.

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

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

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

The management of posterior urethral injuries is still a matter of controversies. Some authors recommend a primary or delayed emergency repair procedure, while others prefer late repair. The analysis of our series of fifteen cases showed that when patients are treated by delayed emergency operation, the results are usually good. However, when repair is performed later, results are less satisfactory, and the rate of impotence is higher. We conclude that delayed emergency repair operation is the procedure of choice in the management of ruptured posterior urethra.

The results and complications of the treatment of hypospadias were studied in relation to the two pedicle foreskin mucosal flap techniques described successively by Duckett, "single surface" and "double surface". 91 urethroplasties were performed: 58 "single surface" and 33 "double surface" Duckett urethroplasties. The children were operated between the ages of 18 months and 16 years with a mean age of 4 years. 75% of children had a good result on long-term follow-up. In the case of major complications, essentially fistula, distal necrosis àf the urethra or stricture, a single reoperation increased the percentage of good results to almost 98% for the entire series. However, when the two procedures were compared, a good result was obtained immediately in 81% of cases for the "single surface" operation versus 66% for the "double surface" operation. The fistula rate was 27.2% with the "double surface" flap versus 13.7% with the "single surface" flap and the distal stricture rate was 15.1% with the "double surface" flap versus 3.4% with the "single surface" flap. In the light of these results, Duckett's "double surface" procedure has been abandoned in favour of the "single surface" flap.

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

The prevalence of multicystic dysplastic kidney has increased since the development of antenatal ultrasound diagnosis. Even though, the rarity of symptomatic forms and case reports of spontaneous regressions antenatally or after postnatal ultrasound follow-up have reduced indications of nephrectomy which is less and less appropriate. However, discovery of ectopic ureteric implantation in boys makes certain additional investigations as intravenous pyelography, cystography and ultrasound, essential before making any therapeutic decision. Nevertheless, some cases remain undescriptible. In these cases, operative opacification of any patent ureter can provide more precise information about ureteric implantation. Lastly, only a dissection and resection as complete as possible of any patent ureter and pelvic cystic dilatation can prevent subsequent complications.

Severe complications of urethral stricture, acute peri-urethral phlegmon can be localized or diffuse. They are characterized by polymicrobial infections. The mortality rates about 7% is the privilege of diffuses forms. The treatment associates medical and surgical procedures, and consists in polyantibiotherapy and excision of suppurative lesions. From a series of 155 cases we analyse the pathogenical, clinical and therapeutical aspects.

Injuries to the ureter and the bladder are common complications in female pelvic surgery. Unfortunately, they remain often unrecognized per operatively. Intravenous pyelography and renal ultrasonography are very efficient for post operative diagnosis. The indications of nephrectomy have became rare because of the efficacity of the procedures of plastic and reconstructive urological surgery.

Obstetrical vesico-vaginal fistulas are still very common in developing countries, because of to the difficulties of medical facilities. From a series of 123 cases recorded during 6 years, we analyse their epidemiological, anatomo-clinical, and therapeutic aspects. A simplified classification is purposed.

Fourteen pediatric cases of posterior urethral valves in patients aged 6 months to 14 years (with four infants and ten older children) are reported. The main symptoms were vesical, including dysuria, acute urinary retention and dribbling. One patient presented with diarrhea, vomiting and dribbling. Urethral valves were looked for as part of the evaluation for urinary lithiasis in one patient, and in another urinary lithiasis developed following the diagnosis of urethral valves. In half the cases, onset of symptoms occurred within one year of birth. Urethrocystography allowed to evidence the valves and to evaluate repercussions on the bladder including hyperplasia (7 cases) and diverticula (2 cases). The intravenous urogram disclosed bilateral ureterohydronephrosis in eight cases. Pathogens recovered from the urine included Klebsiella (3 patients), Pseudomonas (4 patients), Proteus (one patient), and E. coli (one patient). Most patients were treated by catheter lamination under antimicrobial therapy. Two patients died from renal failure. Results were considered satisfactory in nine cases with follow-ups ranging from 1 month to 4 years. Three patients were lost to follow-up. Early diagnosis is essential and management should rely mainly on endoscopic resection which reduces the length of the hospital stay and the risk of infection.

Undescended testis is a common congenital abnormality. The main complications are infertility and venue of malignant testicular tumor. If early orchiopexy can prevent infertility, it remains a high risk of venue of a malignant tumor. So, the best technique of orchiopexy is that which allows an easy clinical follow-up of the undescended testis after surgical treatment, and doesn't involv the hematoseminal barrier. From the analysis of fourty cases of scrotal pouch orchiopexy and a review of the literature, it appears that this procedure is efficient and gives more than 90% of good results.

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

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

Penile carcinoma is rare in Senegal representing 0.35% of all cancers and 0.97% of cancers in the male adult. Neonate circumcision widely used in this country seems to prevent this disease. With this series of 11 cases, clinical and therapeutical aspects are reviewed.

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

Introduction et objectifs L’evaluation des pratiques professionnelles (EPP) en milieu medical est une obligation ayant pour finalite, l’amelioration de la qualite des soins. Sa mise en pratique implique l’analyse des donnees cliniques et le suivi des resultats. Depuis plusieurs annees, le service de neurochirurgie du centre hospitalier de Limoges participe a la surveillance des infections du site operatoire (ISO). Ce travail s’est naturellement integre dans le cadre de l’EPP mise en place dans ce service depuis 2006. Materiels et methodes L’analyse semestrielle des dossiers des patients presentant des ISO a servi de base a cette EPP. La methodologie de la surveillance des ISO est largement inspiree du modele national propose par le R.A.I.S.I.N. (Reseau d’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales). Resultats De mai 2002 a juin 2008 nous avons suivi une cohorte de 6 514 patients representant un total de 7 569 interventions dont plus de la moitie etaient rachidiennes ou intra rachidiennes. Le sexratio etait de 1,8 : 2 856 femmes (âge moyen de 55,7 ans) et 3 658 hommes (âge moyen de 53,4 ans). Le taux global des ISO durant cette periode est passe de 3,9 % a 1,8 %. Il est passe en dessous de 2 % a partir de 2006, avec une baisse plus nette pour les interventions crânio-encephaliques. Conclusion Meme si la baisse du taux des ISO n’est pas uniquement le fait de la mise en place de l’EPP, la discussion des dossiers au cours de ces reunions multidisciplinaires permet l’amelioration des pratiques et contribue a la formation continue des participants. Ces resultats nous confortent dans la poursuite et l’amelioration de ce travail.

700 bronchial endoscopies were performed over a period of three years at the Dakar "Hôpital Principal". 40 bronchopulmonary cancers were identified (34 epidermoid, 4 adenocarcinoma, 2 with "small cells") out of 80 suspect cases. When we examine the clinical, radiological, endoscopic features, we are able to classify the following as the most established facts: 1. Higher radiological frequency of the pulmonary retractile condensation syndrome (40 cases). 2. Main frequency of proximal granulated tumors (45) in comparison with endoscopic bronchial stenosis (22). 3. Identification almost exclusive of bronchial epidermoid cancer in that series (34). 4. Male sex and smoking are two unequivocal elements of that pathology. Bronchial endoscopy, absolutely necessary test easy to perform and to get, enables to visualize a lesion and to bring forward the indisputable histological evidence through the biopsy either alone or associated with endoscopic brushing and alveolar washing.

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

Undoped silicon films have been deposited from disilane in a tubular hot wall LPCVD reactor and their physical properties have been analyzed. A two dimensional model taking into account a detailed gas phase chemical mechanism has been developed to simulate the growth rate distribution on a wafer. The numerical predictions have been compared with experimental results and a good agreement has been found in various conditions of temperature and pressure. This work has demonstrated that the main contribution to silicon deposition involves the radical silylene in the case of disilane, whereas in the case of silane as a gaseous source it involves silane itself, so suggesting a possible explanation for the very important differences observed in crystalline characteristics of silicon layers. From a more practical point of view, the much larger size of crystals obtained when starting from disilane opens interesting possibilities of industrial developments, in particular for the manufacture of thin film transistors.

The authors reported a case of orbital congenital serous cyst with anophtalmos. It was a third type of Duke Elder classification. Although it looked sporadic, this malformation is hereditary and due to a disharmony between optic cup growth and differenciation. Ultrasonography and scanner could confirm the diagnosis and helped to discard orbital and eyelid angioma and meningocele. After excision, a prosthesis must be adapted in the orbit.

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

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

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

In March 1985, we realised the first Bordeaux neo-bladder, with detubularized ileo-colic segment (15 cm of ascending colon and 20 to 25 cm of ileum). The urethra is anastomosed at the lowest point of the caecum. 61 male patients underwent total replacement of the bladder, and we analyse the results in 24 of them, with a follow up more than 2 years. The following results were noted: the sensation of voiding is always physiological, daytime continence is quite perfect, while nighttime continence is good for 71% of patients, the filling pressure of the neobladder is low with a maximum of 20 cm H 0 (range 5-20 cm H20), and its capacity ranged from 300 ml to 400 ml, the mean flow rate is 21 ml/s. We encountered no complication, nothing but 2 gall-stones and two patients with low vitamin B 12. We didn't note neither diarrhea, nor hyperchloremic acidosis. All patients maintained normal renal function. Initially, the indication of Bordeaux ileo-colic neobladder was limited to bladder replacement after cysto-prostatectomy for bladder cancer. Now, the good results obtained, and their durability without any major complication allow us to extend our indications to bladder enlargements in neurogenic bladders.

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

314 alimentary tract cancers were discovered in 219 black males and 95 black females at the occasion of 18.000 endoscopies (high or low) performed during the 5 past years at the Principal Hospital (Dakar-Senegal). Mean age of the patients was 50, gastric cancer (170 cases) was the most frequent localization, then rectocolonic one (71 cases) and oesophageal one (61 cases). The more frequent utilization of endoscopy and may be a modification of diet in urban milieu might explain such a high frequency of discovery of alimentary tract cancers in Dakar.

From November 28-30, 1989, the Centre D'Etudes et de Recherche sur la Population pour le Developpement (CERPOD) sponsored the Selingue Retreat (SR), outside of Bamako, Mali to discuss the role of population policy development among the 9 Sahelian countries following the adoption of the N'Djamena Program of Action (PAN) the year before. The key questions discussed were: 1) state of the art regarding implementation of population policy development among Sahelian countries; 2) strategies of technical assistance to support CERPOD for population policy development; 3) organizational matters; and 4) evaluation strategies to evaluate population policy development and CERPOD's programs. The SR recommended that due to the lack of an adequate information base for population policy development that collaboration continue between CERPOD and the Futures Group. The new project will begin with a detailed plan of action for Mali and Guinee-Bissau, followed by Niger and Burkina Faso.

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

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

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

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

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

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