Search

The joint manifestations of rheumatoid arthritis in tropical Africa are characterized by the discreteness of the involvement of the hips and perhaps of the cervical spine. The extra-articular manifestations are rare and principally of the pulmonary fibrosis type. It is difficult to conclude on the more frequent sero-negativity of the disease, as the studies are incomplete. The overall tolerance of the disease appears to be good despite the limited treatment available.

The authors report five cases of pheochromocytoma observed in black African people, followed in the Hospital University Center of Treichville. Three of these pheochromocytoma were in ectopic location. In connection with these observations, the authors review the African literature, regrouping 33 cases, which allows to define the principal aspects of the disease in black African patients. The over morbidity amongst the female patient, the frequent discovery during pregnancy or even at the onset of labour, the frequency ectopic localization are quite original characteristics.

Diagnosis and course of acute single amebic abscess of liver were studied in 983 cases followed up regularly until recovery. A simple but very precise classification is proposed based on course of disease as determined by ultrasound imaging. Early appearances prior to ultrasound are emphasized, these involving pronounced reversible biliary and pancreatic modifications that should be recognized in patients presenting before development of an abscess evident on liver ultrasonography. Ultrasound assists follow up during medical treatment. It very effectively demonstrates the dissociation between pathologic and clinical findings characteristic of this course, with clinical recovery usually within 8 to 10 days contrasting with persistence of liver abscess over several months.

Report on 27 cases of multiple myeloma recorded in 10 years and 24000 in-patients of Treichville University Hospital in Abidjan (Republic of Ivory Coast). The sex-ratio is 70% of males versus 30% of females and the frequency ranges from 25 years to a maximum between 55 and 75 years. First warning symptoms are pains (70%) then fractures (14,1%), biologic disorders (11,1%) and tumors (7,4%). Vertebrae and flat bones are most often affected with a special frequency for skull and jaw. Radiological aspects and biological changes are reviewed; a high blood sedimentation rate, rather common in Africans, has not the same value as in Caucasians.

Typhoid fever is always endemic in Ivory Coast. Among the various visceral injuries able to arrive during the course of the illness, a study of hepatic manifestations realized in 279 patients show, by the realization of systematic LBP, that, beside clinically and/or biologically certain forms, an hepatic injury is histologically constant. Aetiological, clinical, biological, diagnostic and therapeutic particularities connected with the hepatic localizations are considered and compared with findings of other authors. To remark, in Ivory Coast, on one hand the great predominance of Eberth bacillus aetiology, on the other hand the lack of statistically significative relation with drepanocytary waste. The pathogenic signification of the constancy of the hepatic injury and its peculiar histological pattern of non specific reactive hepatitis is discussed.

Functional colic disorders such as the irritable bowel syndrome are very common in Ivory Coast. Etiologic, clinical, biological and roentgenological features were studied in 100 randomized cases. Findings were compared to the features encountered in Caucasians. Psychologic factors, constipation and therapeutic problems that seem to be of significance for understanding functional colic conditions in Ivoirians and other West Africans are discussed.

The interaction between isofezolac and probenecid has been studied with the aid of a specific HPLC assay for isofezolac in plasma and urine. 8 healthy adult volunteers received a single 40 mg oral dose of isofezolac before and after 3 days of loading with 0.5 probenecid t.i.d. There was an increase in the maximum plasma isofezolac concentration from 2.44 to 3.38 micrograms X ml-1 when probenecid was given. The AUC of isofezolac in plasma increased from 6.73 to 11.28 micrograms X h X ml-1. After the last dose in a 7 day treatment with 40 mg isofezolac t.i.d., there was an increase in the maximum plasma isofezolac level from 2.84 to 4.96 micrograms X ml-1 when probenecid was given. The rate of absorption of isofezolac was not affected. An increase in the AUC of isofezolac in plasma was observed from 11.74 to 26.34 micrograms X h X ml-1. The major effect of probenecid on isofezolac metabolism was a 50% reduction in total isofezolac (free + conjugates) excreted inurine. Because of this interaction, patients given isofezolac combined with probenecid will have a higher steady-state plasma level of isofezolac than when probenecid is not administered.

The pharmacokinetics of a new sustained-release preparation of theophylline (Dilatrane à Action Prolongée capsules filled with homogenous microgranules) has been after its studied administration to 7 healthy volunteers at 8 p.m. in order to achieve therapeutic levels at night and in the morning. In separate trials the test dose of 500 or 600 mg was administered for 7 days, once daily at 8 p.m. Plasma theophylline levels were measured by capillary gas chromatography with a mass specific detector after pentylation, using internal standards labelled with stable isotopes (15N-1,3 and 13C-2 theophylline). The new sustained-release preparation showed a monophasic regular absorption phase with very low inter-individual variability. After administration, the plasma level stayed within 80% of the peak levels for 8.5 +/- 1.5 h. There was a good correlation between the dose and the steady state plasma level (r = 0.9587; p less than 0.05). This preparation can be chronically administered once daily day at 8 p.m. in order to achieve a therapeutic level during the night and the morning, and to provide sufficient protection during the nycterohemeral period, with a once dose a day schedule.

The authors describe their experience of 16l patients (151 adults and 10 children) with hepatic amebiasis. Diagnosis and treatment were carried out at the Treichville Hospital University Center in Abidjan over a three-year period, from September 1976 to November 1979. Diagnosis was established without question in all cases. The indirect immunofluorescence reaction was particularly helpful. All patients were treated by metronidazole or it's derivatives. Semiology, course and therapy are described in detail. A comparison is made with cases published in the literature during the last 15 years. Most of the classical pictures were encountered in this study. The clinical picture may be misleading, for instance when it is suggestive of cancer or when jaundice is present. Immunology is particularly interesting in atypical forms. The authors insist on the unvarying and high morbidity due to this disease which accounts for 2% of all hospitalizations. Prognosis has improved, the mortality rate among adults was 4.5%. A fall in the number of surgical procedures was recorded. Only 10% of the patients underwent surgery. The therapeutic principles advocated by the authors are described. They can be used even when echotomography is not available, as is usually the case in regions where the disease is endemic.

Sinusal histiocytosis with massive lymphadenopathy is a rare pathological entity since, as of 1983, only 200 cases have been published. Following the seminal description in 1965 by Destombes in Blacks, histological features of this disease were specified by Rosai and Dorfman in 1969 and 1972. We report three cases in young Ivorian subjects. The presenting finding is always chronically enlarged lymph nodes, but extranodal lesions are possible, most commonly involving the eye, salivary glands, upper respiratory tract, skin, bone, testis, and nervous system. Diagnosis can be ascertained only upon histologic examination of lymph node biopsy specimens which shows the three cardinal criteria, i.e. massive sinusal histiocytosis, lymphophagocytosis, and mature plasmocytosis. Although a few fatal cases have been reported, the disease usually runs a benign course, with exacerbations of variable duration. Great caution should therefore be taken in deciding upon management, particularly as regards corticosteroid therapy, radiotherapy or anticancer chemotherapy. Etiopathogeny of the disease is unsettled; there is general agreement as to the existence of a cellular immune dysfunction resulting in the lympho-histiocytic proliferation.

The goal of this work is to precise the respective aetiologic prevalence and the bases of diagnosis of pericarditis in Ivory Coast. The epidemiologic study has been done about 197 cases diagnosed between march 1972 and april 1978. These results are comparable to those collected previously in West Africa: the pericarditis is present in 1% of the patients admitted in the hospital and in 5.6% of the cardiovascular diseases of the unit of internal medicine in the Treichville Hospital (Abidjan). The semeiologic and evolutive study has been done with the 100 best documented records, with 90 acute and sub-acute pericarditis and 10 chronic pericarditis. The usual bases of diagnosis are used; the frequency of chest pain and signs of adiastole is emphasized. The aetiologic repartition is as follows: tuberculous 33%, septic 18%, benign acute pericarditis 15%, rheumatic 5%, uremic 13%, malignant 3%, undetermined 12%. These numbers are comparable to other author's numbers in West Africa. They confirm the important number of tuberculous and septic infections. These infections processus explain probably the frequency of constrictive pericarditis. However, the aetiology of constrictive pericarditis is often difficult to state precisely.U

Several epidemiologic studies using data from hospital departments and from the pathological department of the Abidjan University show that colorectal cancer is infrequent in Ivory Coast (2% of all cancers). The incidence of the various factors classically incriminated in colic carcinogenesis is analyzed and discussed: precancerous conditions (adenomas, polyps, inflammatory bowel disease), histogenesis (condition of the colic mucosa) and nutritional factors. Constipation, which is very common in spite of a high intake of fibers, cannot be regarded as a predisposing factor.

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.

From the starting point of two cases of ankylosing spondylitis, one of which began in youth, observed in Abidjan, Ivory Coast, a review of the literature concerning the major cases amongst africans is carried out. This disease is unusual in tropical Africa: about thirty published cases, of varied origin. This low incidence of ankylosing spondylitis is correlated to the rarity of the HLA B27 group and of seronegative spondylitic joint diseases in general amongst the black population of Africa. Whereas the high incidence of forms with juvenile onset in North Africa suggests some connection with undetected Reiter's disease, the infrequency of this form of onset of the disease in sub-Saharan Africa and the lack of bacteriologic evidence make it impossible to reach any such conclusions.

Reporting 75 original cases the authors review the clinical radiological and biological syndroma of hepatitic amoebiasis. They emphasize the recent advances in medical treatments which frequently give opportunity of avoiding surgery. But surgical intervention cannot be systematically discarded and has been necessary in 11 p. 100 of the reported cases. Drainage strengthens drugs efficiency. Antibiotherapy is generally useless.

From the statistics dealing with cancer yielded in the Internal Medicine Department, Treichville Hospital, secundary bone cancer appears with a low percentage. The short expectation of life and the reluctance of African patients to report to the hospital must be considered to appreciate these data. Most often, at their admittance, cases show numerous and large metastasises. Bone tumors related to a primitive liver cancer are rare. More often, metastasises in prostate cancer may be observed. They are generally osteocondensing. Breast cancer is, for its frequency, ranking just after it. In one third of the cases, the origine has not been cleared out.

Tumours of the glomus jugulare always raise diagnostic and therapeutic problems. We decided to review the pathology and clinical findings whilst reporting a typical case found on our neurology unit. After a brief review of the embryology, anatomy and histology of the glomus jugulare, the authors report the case of a patient who presented a recurrent intracranial form with involvement of several cranial nerves, together with associated involvement of the carotid glomus. This was a familial disease. The patient was operated on with excellent results. The authors then present a clinical description of the various signs in glomus tumours,; depending more on the origin of the tumours than on the length of history. They then criticize the diagnostic interest of radiology, emphasizing the interest of angiography which may demonstrate a pathological vascular focus derived from the internal carotid artery together with the vertebro-basilar system. Retrograde jugulography also provides important information. The treatment of glomus jugulare tumours is, above all, surgical. They are approached through the ear in order to localise the intra-petrous part, or else, they may be approached through the skull. A combined otological and neuro-surgical approach to sometimes necessary for the lesion may involve both the petromastoid region and the posterior cerebral fossa. Radiotherapy is often advised after operation, in view of the importance of the vascular component of these tumours. The results of treatment are, on the whole, satisfactory.