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Introduction : L’insuffisance cardiaque estune pathologie grave qui constitue l’un des motifs de consultation et d’hospitalisation dans les services de cardiologie des centres hospitaliers et universitaires de Lome au Togo. Elle constitue le mode evolutif le plus frequent de la plupart des cardiopathies. Dans notre pays, l’absence de travaux anterieurs sur l’insuffisance cardiaque nous a incite a entreprendre cetteetude en vue de faire le point sur notre attitude vis-a-vis de cette pathologie dans nos services de cardiologie. Objectifs : Les objectifs de l’etude etaient de determiner la frequence hospitaliere de l’insuffisance cardiaque et d’evaluer sa prise en charge therapeutique. Materiel et methode : Il s’agissait d’une etude retrospective sur une periode de 12 mois (du premier janvier au 31 decembre 2004). Elle est realisee dans les services de cardiologie des CHU de Lome et a porte sur 104 dossiers des patients hospitalises pour insuffisance cardiaque. Les donnees epidemiologiques, cliniques, paracliniques, therapeutiques et evolutives sont relevees des dossiers sur une fiche d’enquete. Elles sont ensuite analysees dans le logiciel EPI-INFO 6.0 de CDC Atlanta. Resultats : L’insuffisance cardiaque representait 16,3% des hospitalisations. L’âge moyen de la population d’etude etait de 59,8 ans avec une predominance masculine (sex–ratio=1,48). Les cardiomyopathies (85,7%), les valvulopathies (68%) et l’HTA (59,6%) etaient les etiologies les plus frequentes. L’insuffisance cardiaque globale etait le tableau clinique le plus frequent. Les IEC, diuretiques, anti-aldosterones et la digoxine sont prescrits respectivement dans 61,5 %, 97,4 % 9,6 % et 51,9 % des cas. Les betabloquants ne faisaient pas encore partie du traitement de l’insuffisance cardiaque dans les services. Conclusion : Affection frequente a Lome, la prise en charge de l’insuffisance cardiaque n’est pas encore conforme aux referentiels scientifiques. Introduction : Heart failure is a severe disease which accounts for a substantial portion of consultation and hospitalization in the cardiological department of Tokoin Teaching Hospital of Lome in Togo. It’s frequently a principal complication of virtually all forms of heart disease. In our country, the lack of information about heart failure had urged to this study in order to sum up our practice in the department. Objective : The aim of our study was to determine the hospital frequency of heart failure and to evaluate its management. Method: It was a retrospective study carried out from 1st January to 31st March 2004 . It had concerned 104 records of in-patients. Epidemiological, clinical, laboratory findings and management aspects were studied. Data were analysed with Epi Info 6.0 of CDC Atlanta database. Results : Heart failure had been found in 11.8% of in-patients during the period of study. The mean age was 59.8 years with a male predominance (male-female ratio = 1.48). Cardiomyopathies (85.7%), valvular heart disease (68%) and arterial hypertension (59.6) were the most frequent causes. ACE inhibitors, diuretics, antialdosterone and cardiac glycoside were respectively prescribed in 61.5%, 97.4%, 9.6% and 51.9%. Beta-blockers were not introduced in the management of in-patients. Conclusion : Heart failure is a frequent disease in Lome. Its management may be completed according to the newer international scientific standards.

Introduction : La fibrillation auriculaire est le trouble du rythme soutenu le plus frequent dans la pratique quotidienne (14,15%), dont la gravite est liee a ses complications hemodynamiques et thromboemboliques surtout cerebrales. Objectifs : Etudier les caracteristiques epidemiologiques et etiologiques de la fibrillation auriculaire chez l’adulte noir togolais en milieu hospitalier. Materiel et methodes : Il s’est agit d’une etude prospective, realisee sur une periode de deux ans (du 1er janvier 2008 au 31 decembre 2009) et qui a porte sur 143 cas de fibrillation auriculaire hospitalises a la clinique cardiologique du CHU-Campus de Lome. Resultats : Au cours de cette etude, la fibrillation auriculaire etait le trouble de rythme auriculaire le plus frequent dans la pratique quotidienne avec un taux de prevalence de 14,56 %. L’âge moyen des malades etait de 45,29 ± 11,58 ans, avec une predominance masculine (55,8%). La fibrillation auriculaire etait associee a une cardiopathie sous jacente dans 91,2% des cas, alors qu’aucune etiologie n’etait retrouvee dans 3,2% des cas. Les etiologies les plus frequentes etaient representees par les cardiomyopathies hypertensives (34,3%), les cardiomyopathies dilatees d’allure primitives (23,7%) et les valvulopathies rhumatismales (7%) Conclusion : La fibrillation auriculaire est frequente chez l’adulte noir togolais. Ses etiologies sont dominees par l’hypertension arterielle et les cardiomyopathies dilatees. complications and stoke. Aim : Our aim was to study epidemiologic and etiologic aspects of atrial fibrillation in black togolese in hospital circle. Material and et methods : It was a prospective study realized during two years (1st january 2008 to 31st december 2009), relative to 143 cases hospitalized at the cardiology clinic of the campus university hospital of Lome, the authors have studied the epidemiologic and etiologic aspects of atrial fibrillation in hospital circle. Results : The atrial fibrillation was the most frequent atrial arrhythmia in the practice with a prevalence of 14.15%. The average age of patients was 45.29 ± 11.58 years, with male predominance (55.8%). Atrial fibrillation was associated to a cardiac disease in 91.2 % of cases, where as none etiology was founded in 3.2% of cases. The most frequent aetiologies were hypertensive cardiomyopathies (34.3%), primitive dilated cardiomyopathies (23.7%) and rheumatic valvulopathies (7%). Conclusion : Atrial fibrillation is a frequent arrhythmia in black adult togolese in hospital circle. The most aetiologies are hypertension and dilated cardiomyopathies.

Introduction : La complication renale forme avec l'hypertension arterielle une association frequente et complexe dont la mauvaise prise en charge est a l'origine de l'insuffisance renale terminale. Dans les pays developpes, l'insuffisance renale chronique d'origine hypertensive est rare et est l’apanage des sujets de race noire. Neanmoins, sa prise en charge diagnostique et therapeutique adequate retarde la survenue de l'insuffisance renale terminale. Dans les pays en developpement, l’insuffisance renale chronique d’origine hypertensive touche les sujets jeunes avec une prise en charge diagnostique et therapeutique insuffisante et une survenue precoce de l'insuffisance renale terminale. Objectifs : Notre travail avait pour objectif d’etudier les differents aspects echographiques du rein au cours de l’insuffisance renale chronique d’origine hypertensive. Patients et methode d’etude : Les services de cardiologie, de nephrologie et de radiologie des Centres Hospitaliers Universitaires Tokoin et Campus de Lome (Togo), nous ont servi de cadre d'etude. Il s'est agi d'une etude retrospective et analytique portant sur 70 dossiers colliges durant une periode de cinq ans allant du 1er janvier 2000 au 31 decembre 2004. Ont ete inclus dans cette etude, les sujets de race noire, âges de 18 ans et plus, presentant une hypertension arterielle a l'entree ou ayant des antecedents d'hypertension arterielle, presentant des signes cliniques et biologiques de l’insuffisance renale chronique et ayant realises une echographie renale au cours de l'hospitalisation. Les femmes enceintes et les sujets porteurs d'une affection hepatique ont ete exclus. Les donnees ont ete recueillies sur des fiches d'enquete etablies a cet effet. Le manque de classement des dossiers et leur caractere incomplet ont ete les difficultes majeures rencontrees. L'analyse et le traitement informatique et statistique des donnees ont ete effectues par le logiciel Epi-info Resultats : Au cours de notre periode d’etude, un total de 3376 hospitalisations ont ete recensees. L’hypertension arterielle et ses complications ont represente 53,76% des hospitalisations. La complication renale constituait 15,26% de cet effectif. Il a ete note une predominance masculine avec un sex. ratio 1,19. L'âge moyen etait de 40,76 avec des extremes de 18 et 78 ans. Plus de 78% de nos patients etaient en insuffisance renale terminale avec une clairance de la creatinine calculee selon la formule de Cockroft et Gault inferieure a 10 ml/min. Des signes echographiques d’une souffrance renale au stade III ont ete observes chez 64,29 % des patients de l’etude. Plus de 75% des patients ayant moins de 40 ans presentaient des signes echographiques d’une souffrance renale au stade III. Pres de 75 % des patients en insuffisance renale terminale avaient des signes echographiques une souffrance renale stade III. Tous les patients presentant une atrophie renale avaient des signes echographiques d’une souffrance renale au stade III. Conclusion : L’association hypertension arterielle et insuffisance renale chronique constitue un redoutable probleme de sante publique dans les pays en developpement. Sa prise en charge diagnostique et therapeutique adequate passe par la realisation de l’echographie renale. Introduction : Chronic renal failure forms with essential hypertension a frequent and complex association whose bad care induced terminal renal failure. In developed countries, chronic renal failure due to essential hypertension is rare and it is exclusively observed with black people. An adequate care postponed the appearance of terminal renal failure. In developing countries, chronic renal failure due toessential hypertension concerned young people and its care is not sufficient. It induces an early terminal renal failure. Objective : The target of our study was to analyse different aspects of echocardiography of the kidney in chronic renal failure due to essential hypertension. Patients and method : It was a prospective and analytical study carried out during 5 years from 1st January 2000 to 31st December 2004 in the department of cardiology, nephrology and radiology of Tokoin and Campus Teaching Hospital of Lome (Togo). The targeted population was 70 Togolese inpatients of two gender from 18 years and over, with essential hypertension associated with terminal renal failure and who have been explored by renal ultrasound.Pregnant women and patients suffering from a liver complaint were excluded. Results : During our study 3376 in-patients were recorded. Essential hypertension and its complications were found in 53.76% of cases. Renal complications represented 15.26% of in patients. A male sharp predominance was observed with sex-ratio value equal to 1.19. Patients' age ranged from 18 to 78 years with an average of 40.76 years. More than 78% of in-patients had terminal renal failure with a value of the clairance of creatinine calculed with Cockroft and Gault formula, less than 10 ml/min. Ultrasound abnormalities of renal failure at level III were observed in 64.29 % of patients under study. More than 75% of patients of less than 40 years old had ultrasound abnormalities of renal failure at level III. More than 75% of patients with terminal renal failure had ultrasound abnormalities of renal failure at level III. Patients with renal atrophy had ultrasound abnormalities of renal failure at level III. Conclusion : Essential hypertension complicated by chronic renal insufficiency constitutes a dreadful issue of public health in the developing states. It's diagnose and care were suitable through the renal ultrasound examination.

Few cases of adenoid cystic carcinoma of the scalp have been described in the literature. Herein, we report a new case illustrating the difficulties of diagnosis and treatment of this rare form of tumour.A 49-year-old man consulted for a large ulcerated scalp tumour. The biopsy sample exhibited an aspect of cystic adenoid carcinoma. Bone invasion had occurred. Extremely wide surgical excision was carried out, extending down to the dura mater, with covering by means of a frontal flap with left temporal pedicle. Since the edges of the resection were also tumoural, postoperative radiotherapy at 56Gy was given. Twelve months later, the patient was still in remission.The standard treatment for adenoid cystic carcinoma is complete surgical excision but this approach may be complicated by difficulties relating to the degree of tumour spread or to the anatomical site. Postoperative radiotherapy appears to improve local control, as illustrated by our case.

Perineoscrotal gangrene is an acute disease, a rare and severe affection of the perineum, whose evolution is unpredictable and rapidly extensive. The diagnosis is clinical. The paraclinical examinations allow early diagnosis and assessment of anatomical and biological repercussions. We conducted a retrospective study of 45 patients spread over six years, involving a multidisciplinary team consisting of three specialists (urologists, visceral, plastic surgeons). The average age was 52 years. The largely male dominated our series. Fournier gangrene was the most common etiology. We noted five cases of death (11%) in the acute phase, secondary to septic shock (four patients) or multiple organ failure (one patient). The evolution was favorable in 40 other patients in the series, requiring an initial management in intensive care unit, and surgical treatment. The average hospital stay was 17 days. After the acute phase, all patients underwent a surgery for skin coverage, ranging from guided healing (two patients) to musculocutaneous flap of the gracilis (six patients) via the secondary suture (four patients), the burying the testes (18 patients) and half thick skin graft, with a functional and aesthetic result was acceptable, and minimal sequelae. In our series, the most predictive prognostic factors would be the delay of care, sepsis on admission and associated diseases.

Autrefois rare chez nous, de nos jours la frequence de la MTEV ne cesse d’augmenter. Nos objectifs : - Souligner l’interet de l’echo doppler dans le diagnostic de la MTEV, - Decrire les aspects therapeutiques de la MTEV. Malades et methodes : Il s’est agi d’une etude retrospective realisee dans 5 formations sanitaires de Lome durant la periode allant de janvier 2001 a decembre 2005. Seuls ont ete retenus les dossiers des malades presentant des signes evocateurs de MTE avec confirmation a l’echo doppler veineuse et/ou cardiaque. Le traitement des donnees a ete fait par l’outil informatique. Resultats : Durant cette periode, 65 dossiers de MTEV sur un total de 3851 hospitalises ont ete retenus, soit une frequence de 1,68%. Parmi ceux-ci, 51 cas de trombophlebite (0,78%) contre 14 cas (22%) d’embolie pulmonaire. Le sex ratio etait de 0,8, (29 hommes (36 femmes). La douleur du mollet (76,47%), l’oedeme unilateral d’un membre inferieur (56,86%) etaient les motifs les plus frequents d’hospitalisation des phlebites. Pour l’embolie pulmonaire (EP) les signes revelateurs les plus representes etaient : la dyspnee (78,57%) suivie des palpitations (57,14%). Les facteurs de risque de la MTEV predominants etaient la pathologie cardiaque (61,53%), l’insuffisance veineuse (30,73%). Du point de vue therapeutique, les heparines a bas poids moleculaire (90,76%) ont ete les plus utilisees. Le relaie par voie orale a ete fait entre le 2e et 10e jour par lacenocoumarol dans la majorite des cas (56 cas soit 86%). L’evolution a ete favorable dans 41 cas. Nous avions note 4 cas de deces dont 3 dus a l’EP. 13 malades ont ete perdus de vue. Conclusion : La MTEV fait partie des maladies emergentes en Afrique. Leur frequence est sous evaluee du fait d’une part de leur meconnaissance par le personnel soignant et d’autre part de l’insuffisance du plateau technique. Pour prevenir cette affection grave une education des populations et du personnel soignant doit etre faite en rapport avec les facteurs de risque qui sont les pathologies cardiaques, l’insuffisance veineuse, et les professions favorisant la sedentarite. Mots cles : Phlebites, embolies, echo Doppler, heparine, noir Africain.

Introduction : Nous rapportons le bilan de 10 ans d’activites de l’ONG « Terre des Hommes » (TDH) a Lome concernant le transfert sanitaire a l’etranger des enfants togolais porteurs de pathologies hors de portee medicochirurgicale au Togo. Objectifs : Nos objectifs ont ete de repertorier les affections ayant motive les transferts, d’evaluer leur prise en charge et l’evolution des patients. Patients et methode d’etude : Il s’est agi d’une etude retrospective de 235 dossiers d’enfants de moins de 15 ans porteurs d’affections chirurgicales inoperables au Togo, enregistres a « TDH » de Janvier 1995 a decembre 2004. Le processus de transfert, les traitements et l’evolution des affections ont ete etudies. Le traitement des donnees a ete fait par l’informatique. Resultats : Les affections cardio-vasculaires ont represente 40% des affections prises en charge par TDH ; les affections digestives ont represente 26,6% des cas ; les affections uro-genitales ont represente 14,5% des cas ; les affections ORL (9,8% des cas) et les affections orthopediques (6,4% des cas). Le sex-ratio a ete de 1,19 et l’âge moyen de decouverte a ete de 5,3 ans + 4,9. La Suisse a ete le pays le plus sollicite pour le transfert sanitaire (76,8% des cas). L’evolution a ete favorable chez 81,6% des enfants et 12,34% sont decedes. Conclusion : Les malformations congenitales posent un probleme majeur de prise en charge au Togo par manque de moyens materiels. Le depistage precoce et le transfert de la technologie dans la sous region ou au Togo passant par la creation d’unites chirurgicales specialisees avec des competences adaptees reduiraient la letalite de ces affections. Mots cles : Transferts sanitaires, malformations congenitales, enfants, Togo. Introduction: We are reporting on 10 yeans activities of the non governmental organization (Terre des Homme) «TDH» in Lome concerning sanitary transfer to foreign countries of Togoleese children who are having medico-surgical pathologys, which are out of hand in Togo. Objective: Our objectives have been to gather the affections which have instigated the transfers; to evaluate their take over and evolution. Patients and methods of study: It is about the retrospective study of 235 files, of children under 15 yeans suffering from surgincal affections which cannot be operated in Togo; registered at TDH from January 1995 to December 2004. The process of transfer the treatments and the evolution of the affections have been studied. The treatments of the reports have been done by computer. Results: The cardiovascular affections have regresented 40% of the affections taken over by (TDH). The digestive affections have represented 26.6% of cases, the ORL affections 9.8% of cases and the orthopedic affections 6.4% of cases. The sex ratio has been of 1.19 and the average age of discovery has been of 5.3 years ± 4.9. The Suisse have been often sollicited for the sanitary transfer. (76.8% of cases) the evolution have been faorable in 81.6% of children and 12.34% have died. Conclusion: The congenital malformation poses a major problem in the take over in Togo due to lack of materials. The early diagnosis and the transfer of the technology in the surrounding countries or in Togo passing by the creation of specialised surgical unit with good competence will reduce the letality of the affections. Key words: Sanitary, transfer, congenital malformation, children, Togo

Introduction : La pratique reguliere d'activites sportives entraine des modifications physiologiques, fonctionnelles et morphologiques cardiaques permettant au coeur de s'adapter a un entrainement physique intense et repetitif. Selon le mode d'entrainement effectue, il est habituel de distinguer deux types d'exercices : des efforts dynamiques et des efforts statiques. Objectif : L'objectif fixe a notre etude etait de comparer les aspects echocardiographiques de la morphologie du ventricule gauche chez les sportifs et les sujets sedentaires. Materiel et methode : Il s'est agi d'une etude prospective qui s'est deroulee sur une periode de six mois allant de janvier a juin 2004. L'examen a ete pratique avec un echocardiographe Doppler couleur de marque Sonos AC Prime. Pour chaque patient, les parametres suivants ont ete etudies : l'âge, le sexe, le type de sport pratique, le nombre d'heures de sport par semaine, les diametres telediastoliques et telesystoliques du ventricule gauche, les epaisseurs telediastoliques et telesystoliques de la paroi posterieure du ventricule gauche, les epaisseurs telediastoliques et telesystoliques du septum interventriculaire. Les donnees statistiques ont ete traitees grâce au logiciel Epi Info 6.0 de CDC Atlanta. Resultats : L'analyse des diametres ventriculaires a montre qu'il n'existe pas de difference statistiquement significative au niveau des diametres telediastolique et telesystoliques ventriculaires des differents groupes. L'epaisseur telediastolique de la paroi posterieure ventriculaire gauche a ete plus grande chez l'ensemble des sportifs. L'epaisseur telesystolique de la paroi posterieure ventriculaire gauche a ete significativement plus importante pour les sportifs endurants que pour les sportifs resistants. L'epaisseur telediastolique du septum interventriculaire a ete significativement plus importante pour les sportifs que pour les temoins. Conclusion : L'echocardiographie constitue un excellent outil du suivi medical du sportif dans l'appreciation de son adaptabilite cardiovasculaire a l'effort. Mots cles : Echocardiographie, ventricule gauche, sportif. I ntroduction: Regular sporting activities induce physiological, functional and morphological modifications which enable the heart to be adapted to intensive and repetitive physical training. According to the type of sport, it is common to distinguish two kinds of efforts: dynamic and static efforts. Objective: The aim of our study was to compare echocardiographic morphological aspects of left ventricle between sportsmen and sedentary subjects. Material and method: It was a perspective study carried out from January to June 2004. Sonos AC Prime Echocardiograph Doppler was used. For every sportsman the following parameters was analyzed : age, gender, type of sport, the weekly time span for training, left ventricular telediastolic and telesystolic diameters, telediastolic and telesystolic posterior left ventricle wall thickness, telediastolic and telesystolic interventricular septum wall thickness. Data were analysed with Epi Info 6.0 of CDC Atlanta database. Results: The study of left ventricular telediastolic and telesystolic diameters had shownthat there was no significant statistic difference between groups of sportsmen. Telediastolic posterior left ventricle wall thickness is bigger than normal in every sportsmen. Telesystolic posterior left ventricle wall thickness was significantly bigger in endurant sportsmen than in resistant sportsmen. Telediastolic and telesystolic interventricular septum wall thickness were significantly bigger in sportsmen than in sedentary subjects. Conclusion: Echocardiography is an excellent tool for regular medical assistance for sportsmen, in regard to their cardiovascular adaptability to sport. Key words: Echocardiography, Left Ventricle Wall, Sportsman

Introduction : Les cardiopathies congénitales (CC) sont des pathologies fréquentes, mais leurs incidences restent encore mal connues dans les pays en développement. Contrairement aux pays industrialisés, elles posent encore des problèmes diagnostiques et de prise en charge. Au Togo, certains enfants porteurs de CC ont bénéficié de l’oeuvre de bienfaisance de l’ONG « Terre des Hommes » TDH. Notre étude a été effectuée en vue d’évaluer le travail effectué par cette ONG. Objectif : Etudier l’épidémiologie, les aspects clinique, diagnostique et thérapeutique des CC au Togo. Matériels et méthodes : Il s’agit d’une étude rétrospective de 141 dossiers d’enfants de moins de 15 ans porteurs de CC vues de janvier 1990 à décembre 2002 à TDH - Lomé. Le traitement des données a été fait par l’outil informatique. Résultats : Les CC ont représenté 14,13% de toutes les pathologies prises en charge par TDH. Le sexe ratio était de 1,13% en faveur des garçons. L’âge moyen était de 3,8 plus ou moins 2,5 ans. La dyspnée, la toux à répétition, le souffle fortuit avaient constitué les principaux signes révélateurs. Le souffle systolique (83,5%), la tachycardie (49,0%) et la polypnée (42,0% avaient été les signes physiques dominants. Une cardiomégalie radiologique et une hypertrophie cardiaque échographique avaient été observées respectivement dans 89,0% et 87% des cas. La CIV (27,0%) suivie de la PCA (20,0%), la T4 de Fallot (17%) et la CIA 12%) étaient les principales CC. Les quatre cinquième de nos patients avaient bénéficiés d’un traitement chirurgical à l’étranger dont 74% en Suisse. L’évolution avait été favorable dans 89% des cas. Conclusion : Au Togo, la découverte des CC se fait tardivement posant alors un problème de choix thérapeutique. La mise en place d’une unité de chirurgie cardio-vasculaire dans la sous-région réduirait la létalité des cardiopathies congénitales.Mots clés : Cardiopathies congénitales, enfants, Togo, transfert sanitaire.Introduction: The congenital cardiopathies re frequent pathologies but their incidence is still badly known in developing countries. Contrary to the industrialised countries, this pathology still leads to big problems of diagnosis and treatment in our countries. In Togo, some children porters of CC have benefited the kindness of. “Terre des Hommes”. Our study has been done towards the evaluation of their take-over. Objective: To study the epidemiology, their clinic, diagnosis and thérapeutique aspects. Materials and methods: It is about the retrospective study of 141 files of the children suffering from CC from January 1990 through December 2002 at TDH Lome. The treatment of the results has been done by computer. Results: The CC have represented 14.13% of the pathologies taken over by the TDH. The sex ratio is of 1.13. The averages age of the parents is of 1.8+/ -5 years. The dyspnoea, the repeated cough and fortuity + ours souffle have constituted to the principal revelation sings. The systolic souffle (82.48%), the tachycardia (48.90%) and the polypnea (42.33%) have been the physical dominating sing. A cardiomegalie have been observed in 89.31% of cases. The cardiac hypertrophy had been found in 87% of patients. Come on top of the CC, the CIV (27.11%) followed by PCA (20.18%). The petrology of the Follot (16.96%) and the CIA (06.25%) 112 patients have been transferred to foreign countries of which 74.10% Suisse 107 CC have been operated. The evolution have been favourable in 89.18%. In Togo, the discovery of the CC have been done lately posing therefore a problem of therapeutic choice. The placing of a cardiovascular Surgical Unit will reduce mortality of the congenital cardiopathics.Key words: Congenital Cardiopathy, Children, Togo, sanitary transfer

Le coeur pulmonaire chronique (CPC) est l’une des causes d’insuffisance cardiaque droite. Il faut cependant le considerer comme une affection pneumologique car ses causes sont de ce ressort avec, au premier rang, les insuffisances respiratoires chroniques obstructives. Nos objectifs etaient d’etudier les aspects epidemiologiques, cliniques et paracliniques des CPC a la clinique cardiologique du CHU Campus de Lome. Patients et methode: Il s’agit d’une etude retrospective menee sur 4 ans, du 1er juin 2004 au 31 mai 2008 et portant sur 35 cas de coeur pulmonaire chronique. Resultats : La prevalence du coeur pulmonaire chronique etait de 0,61%. Il y avait une predominance feminine avec un sex-ratio de 0,75. L’âge moyen etait de 58,6± 17,03 ans avec des extremes de 22 et 90 ans. Les signes d’appels cliniques etaient domines par la dyspnee (88,6%), la toux (34,3%), les oedemes des membres inferieurs (45,7%), la condensation pulmonaire (40%), la tachycardie (34,3%) et la turgescence des veines jugulaires (25,7%). Les signes echocardiographiques etaient essentiellement domines par la dilatation du ventricule droit et l’hypertension arterielle pulmonaire (100%), la dilatation de l’oreillette droite (88,6%), le septum paradoxal (17,1%) et la dilatation de l’artere pulmonaire (11,4%). Les principales etiologies et facteurs de risque associes etaient : l’obesite (34,3%), l’asthme (28,6%), la bronchite chronique (20,0%), le tabac (8,6%) et la tuberculose (14,3%). Conclusion : Le CPC est relativement peu frequent dans notre milieu. La lutte contre l’obesite et le tabagisme, un suivi regulier des BPCO et un traitement precoce et correct de la tuberculose devraient permettre de minimiser cette affection. Mots cles : Coeur pulmonaire chronique, epidemiologie, diagnostic. The chronic cor pulmonale is one cause of right cardiac failure. It should however be regarded as a pneumologic affection because its causes are of this spring with, with the first rank, the obstructive chronic respiratory insufficiencies. Our objectives were to study the epidemiologic, clinical and paraclinic aspects of the chronic cor pulmonale to the cardiologic private clinic of the Campus university hospital of Lome. Patients and method: It is about a retrospective study undertaken over 4 years, of June 1, 2004 to May 31, 2008 and bearing on 35 cases of chronic cor pulmonale. Results: The prevalence of the chronic cor pulmonale was of 0.61%. There was a female prevalence with a sex-ratio of 0.75. The Middle Age was of 58.6±17.03% years with extremes of 22 and 90 years. The clinical signs of calls were dominated by dyspnoea (88.5%), cough (34.3%), the oedemas of the lower extremities (45.71%), pulmonary condensation (40%), tachycardia (34.29%), turgescence of the jugular veins (25.71%). The echocardiography signs were primarily dominated by the dilation of the right ventricle and pulmonary arterial hypertension (100%), the dilation of the right auricle (88.5%), paradoxical septum (17.1%), the dilation of the pulmonary artery (11.4%). The principal etiologists and associated risk factors were: obesity (34.3%), asthma (28.6%), chronic bronchitis (20.0%), tobacco (8.6%), tuberculosis (14.3%). Conclusion: The chronic cor pulmonale is relatively not very frequent in our medium. The fight against obesity and the nicotinism, a regular follow-up of the BPCO and an early and correct treatment of tuberculosis should make it possible to minimize this affection. Key words: Chronic cor pulmonale, epidemiology, diagnosis.

But : Souligner l’apport de l’echocardiographie transthoracique dans le diagnostic des thrombus intracardiaques et les myxomes, et le probleme lie a leur prise en charge au Togo. Materiel et methode : il s’agi d’une etude retrospective sur une periode de 6ans allant de janvier 2001 a decembre 2006 et effectuee a la clinique cardiologique du CHU-Campus. Etaient inclus dans notre etude les patients ayant beneficies d’une echocardiographie montrant la presence d’un thrombus ou myxome. Resultat : sur 2129 patients, 10 thrombus chez 8 patients et 2 myxomes chez 2 patients ont ete diagnostiques. Cinq thrombus etaient dans le ventricule gauche, 4 dans l’oreillette gauche, et 1 dans l’oreillette droite. Un myxome etait dans l’oreillette gauche et l’autre dans le ventricule gauche. Le tableau d’insuffisance cardiaque etait la circonstance de decouverte dans 9 cas. Il y avait 1 cas de decouverte fortuite pour un myxome. Les etiologies dans le cas de la thrombose etaient : 5 cas de cardiomyopathie dilatee, 1 cas de retrecissement mitral, 1 cas de cardiomyopathie ischemique et 1 cas de coeur pulmonaire chronique. L’anticoagulation a ete instituee dans tous les cas de thrombose. Le malade porteur du myxome du ventricule gauche a beneficie de l’exerese chirurgicale et l’autre patient est mort 1an apres dans un tableau de defaillance cardiaque global par manque de traitement chirurgical. Conclusion : le diagnostic des thrombus intracardiaques et de myxome est base sur l’echocardiographie. Cependant la prise en charge des cas chirurgicaux pose un probleme dans notre pays ou il n’existe pas encore de chirurgie cardiaque. Mots cles : Thrombus, myxome, echocardiographie transthoracique, anticogulation, chirurgie cardiaque. Object: to show the contribution of the transthoracic echocardiography in the diagnosis of the intracardiac thrombosis and myxoma, and the problem involved in their assumption of responsibility. Materiel and method: it was about a study retrospective on period of 6 years energy from January 2001 to December 2006 and carried out with the cardiologic clinic of the CHU-Campus. Were included in our study the patients having profited from an echocardiography showing the presence of an intracardiac mass. Result: on 2129 patients, 10 thrombi among 8 patients and 2 myxoma among 2 patients were diagnosed. Five thrombi were in the left ventricle, 4 in the left auricle, and 1 in the right auricle. One myxoma was in the left auricle and the other in the left ventricle. The cardiac table of insufficiency was the circumstance of discovered in 9 cases. There was 1 case of fortuitous discovery for a myxoma. The causes in the case of thrombosis were: 5 cases of dilated cardiomyopathy, 1 case of mitral stenosis, 1 case of ischemic cardiomyopathy and 1 case of chronic pulmonary heart. The anticoagulation was instituted in all the cases of thrombosis. One case of myxoma profited from the surgical treatment and the other patient died 1year afterwards in a table of cardiac deficiency total for lack of surgerycal treatment. Conclusion: The diagnosis of the intracardiac masses is based on the two-dimensional transthoracic echocardiography in our countries without of the transoesophageal echocardiography. However the assumption of responsibility of the surgical cases poses a serious problem in our countries in the process of development which do not lay out of cardiac surgery. Key words : Thrombosis, myxoma, transthoracic echocardiography, anticoagulation, cardiac surgery

Introduction: We conducted a prospective and analytical study in the Cardiology section of Campus University Hospital of Lome, from August 1st, 2005 to July 31, 2006 on 150 cases of hypertensive crisis.Objective: Our study was meant to estimate the effectiveness and safety of the captopril used through sublingual route in the reduction of the hypertensive crisis. Material and méthodes: Twenty five 25mg dose was administered, and the same dose was repeated after 45mn when the expected blood pressure failed to be seen (reduction of the systolic blood pressure: 20- 25%). Results: The average age of the patients was 45 years (extremes are 30 and 72 years), with femalepredominance (sex ratio: 1.5). With an optimum dose of 25mg, the rate of Captopril effectiveness was 94.67%. The average time of effectiveness was 36mn. There was a growing decrease in blood pressure with a good deal of tolerance. The obesity and the renal insufficiency were the two main causes of the therapeutic failure.Conclusion: The use of Captopril through sublingual route appears to be an accurate procedure in the reduction of hypertensive crisis due to its effectiveness, its lower price, its steady trend and its safe Introduction : Le traitement des poussées hypertensives pose de nos jours un problème dans nos pays en voie de développement. En effet, la nifédipine par voie sublinguale a été retirée de cette indicationdepuis 1997 car responsable parfois d’une chute brutale, importante et imprévisible de la pression artérielle pouvant entraîner une ischémie cérébrale. Ainsi, l’étude d’autres molécules bien tolérées, d’action moins brutale s’avère indispensable. Objectif : évaluer l’efficacité et la tolérance du captopril utilisé par voie sublinguale dans le traitementdes poussées hypertensives chez le noir africain. Matériel et méthodes : Nous avons mené à la clinique cardiologique du CHU Campus de Lomé du 1er Août 2005 au 31 juillet 2006 une étude prospective et analytique sur 150 cas de poussées hypertensives chez le noir africain. La dose de 25mg était administrée, puis renouvelée au bout de 45 mn lorsque l’objectif tensionnel n’était pas atteint (objectif tensionnel : réduction de 20 à 25% de la PAS). Résultats : L’âge moyen des patients était de 45 ans (extrêmes : 30 à 72 ans), avec une prédominance féminine (sex. ratio:1,5). Le taux d’efficacité du captopril était de 94,67% avec une dose optimale efficace de 25 mg. Le délai moyen d’efficacité était de 36 mn. La baisse tensionnelle était progressive, avec une bonne tolérance. L’obésité et l’insuffisance rénale chronique étaient les deux principales causes d’échec thérapeutique.Conclusion : Le captopril par voie sublinguale est donc aussi efficace chez le noir africain que chez le caucasien. Dans le contexte de pays en voie de développement, il apparaît comme un traitement de première intention dans la réduction des poussées hypertensives, du fait de sa simplicité, de son coût abordable, son efficacité , son action progressive et sa bonne tolérance.

Patent Ductus Arteriosus (PDA) Incidence is not exactly determined in Togo. Comprehensive data are currently unavailable on diagnosis and therapy in fact of inadequate structures. Some children with PDA have been operated on in foreign countries thanks to the NGO “Terre des Hommes” (TDH). This study was undertaken to determine the incidence, diagnosis conditions and therapy analyses on PDA in Togo. Methods: Retrospective study has been done. We investigated medical reported of 53 children under the age of 15 years with PDA admitted at TDH during the period of January 1er 1990 to December, 31, 2002. Data on clinical, Para clinical and postoperative follow up. Statistical analysis through chi-square was carried out threshold 5%. Results: The incidence of PDA was 25% of all congenital neart diseases (CHDS) admitted to TDH. There were more females than males (36 versus 17). Man age were 4.5 ± 4,5 ( 3 months to 15 years ). Infection of the upper respiratory treat (31.40%) and dyspnea (28.92%) were the most symptoms. Continuous heart murmur (98.11%)), poor growth (47.17%) and widely and fixedly split second heart sound (45.30%) were founded on physical examination. Cardiomegaly (94.33%) and pulmonary hyper vascularisation (73.60%) are been performed on thoracic radiography. Sinusal cardiac rate was founded in 93.33%. Velocity in pulmonary artery was increased in 69.44%. Left-to right shunt tensions have been founded in 56.77%. Overall latest morality was 3.84% by congestive heart failure. Conclusion: PDA is an CHDS frequently founded in our country but it’s treatment is unavailable here. Only creation of a cardiovascular surgery canter could reduce the morbidity and mortality of this pathology in our countries because; diagnosis and transfer of children are done with lateness. Introduction : L’incidence de la persistance du canal arteriel (PCA) est encore mal connue au Togo. Cette affection pose des problemes diagnostic et de prise en charge par manque de structures adequates. Certains enfants porteurs de PCA ont ete operes a l’etrange grâce aux oeuvres de bienfaisance de « Terre des Hommes » (TDH). Cette etude a pour objectifs de determiner l’incidence de cette pathologie, etudier ses aspects cliniques et analyser sa prise en charge au Togo. Materiel et methode : Il s’est agi d’une etude retrospective de 53 dossiers d’enfants de moins de15 ans porteurs d’une PCA enregistres a TDH au cours de la periode du 1er Janvier 1990 au 31 decembre 2002. Nous avons etudie les parametres cliniques, para cliniques, therapeutiques et evolutifs. Le traitement des donnees a ete informatise. Nous avions utilise le test de Khi2 au seuil 5% pour les comparaisons. Resultats : La PCA a represente 25% des cardiopathies congenitales (CC) enregistres a TDH. La sexratio a ete de 0,47. L’âge moyen a ete de 4,5 ans (3 mois -15 ans). Les infections broncho-pulmonaires (31,40%), la dyspnee (28,92%) ont ete les circonstances de decouverte les plus frequentes. Le souffle systolo diastolique (98,11%), le retard staturo-ponderal (47,17%) et les anomalies de B2 (45,30%) ont ete les signes physiques dominants de l’examen physique. La cardiomegalie (94,33%) et l’hyper vascularisation pulmonaire (73,60%) ont ete les principaux signes radiologiques. Le rythme cardiaque a ete regulier dans (93,33%) des cas. La velocite dans l’artere pulmonaire a ete augmentee dans 69,44% des cas. Le shunt a ete gauche droit dans 65,96% des cas et la PCA a ete associee aux CIV dans 56,77% des cas. Deux deces (3,84%) ont ete enregistres par complication hemodynamique. Conclusion : La PCA est une pathologie frequente dont la prise en charge n’est pas encore possible au Togo, seule la creation d’un centre de chirurgie cardiovasculaire reduirait la mortalite de cette affection encore elevee dans nos pays car le diagnostic et le transfert des patients se font avec un grand retard.

The epidemiological aspect of the CIV is badly known our countries. More over their takeover often gives a problem in one part with the reason of povety of the population in other part almost inexistence of a specialised centre in this area. Objective: describe the incidence of the CIV in childwood in Togo ; analyse the circumstances of their discovery and evaluate their takeover. Methodology: We have proceded retrospective study covering a period of 13 years. (I January 1990 to 31 December 2002) on 196 files of children who have benefitted the Service of Medico-Surgical care and the Sanitary transfer of nongourvement organisation (Terre des Hommes). The out come have been treated by computer. Resultats and discussion: During this period the incidence of the CIV have increased progressively (7.7% in 1990 39.13% in 2002). These represented 25% of the Congenital Cardiopathys taken over by (Terre des Hommes). The sex ratio is 1.58 in favour of boys. The average age is of 3.8 +/- 2 years. The effort dyspnea (75.5%). The brancho pulmonary infection (55.10%) and retardement of growth (36.73%) were the principal cause of consultation. The Systolique souffle, the sound of the B2 in the pulmonary chamber the tachycardia, the polypnea, the deformation of the thorax, the enlargement of the base of the heart have been the dominating physical Sings with respectively 93.88%, 75%, 63.26%, 51.02%, 40.81%. The Rx of the heart (tele coeur) have noted a cardiomegaly in 39 patients which is 79.59%. The “Echo-Doppler” have confirmed the CIV in all the cases. The form of CIV has been precised in 39 patients (small form in 9 cases, middle form in cases, large CIV in 19 cases). In conclusion: The CIV are the frequent CC in Togo. Their incidence increase progressively with the comming of the Cardiac Echo-Doppler. The discovery is done lately at the complication stage. In front of every cardiac souffle, “Echo-Doppler should be to enable early diagnosis of the CIV. This will permits their early surgical take over which is only in abroad. Les aspects Epidémiologiques des CIV sont mal connus dans nos pays. De plus leur prise en charge pose souvent des problèmes en raison d’une part de la pauvreté des populations et d’autre part de la quasi Inexistence des Centres Spécialisés dans ce domaine. Objectifs : - Déterminer l’incidence des CIV chez les enfants au Togo ; Analyser les circonstances de leur découverte ; et en évaluer la prise en charge thérapeutique. Méthodologie : Nous avons effectué une étude rétrospective couvrant une période de 13 ans (1 janvier 1990 au 31 décembre 2002) et portant sur 196 dossiers d’enfants ayant bénéficié du service des soins médico-chirurgicaux et des transferts sanitaires de l’ONG « Terre des Hommes ». TDH est la seule organisation qui s’occupe des transferts d’enfants malades au Togo. Les données ont été traité avec l’outil informatique (logiciel EPI info V. 06. 4) le test du Khi2 au seuil de 5% a été utilisé pour les comparaisons. Résultats et discussion : Durant cette période, l’incidence des CIV a augmenté progressivement (7,7% en 1990 à 39,13% en 2002). Ces CIV ont représenté 25% des cardiopathies congénitales prise en charge par Terre des Hommes. La sexe ratio est 1.58 en faveur des garçons. L’âge moyen était de 3.8 +/- 2ans. La dyspnée à l’effort (75,51%), les infections broncho-pulmonaires (55,10%) et le retard de croissance (36,73%) étaient les principaux motifs de consultation. Le souffle systolique l’éclat de B2 au foyer pulmonaire, la tachycardie, la polypnée, la déformation thoracique et le choc de pointe étalé ont été les signes physiques dominant avec respectivement 93.88%, 75%, 63,26%, 51,02%, 40,81%. Le télécoeur avait noté une cardiomégalie chez 39 patients soit 79,59%. Au cathétérisme cardiaque l’Echo-Doppler avait confirmé le diagnostic de C.I.V dans tous les cas. La raille de la C.I.V avait été précisée chez 39 patients seulement (petite taille dans 9 cas, moyenne taille dans 11 cas, C.I.V large dans 19 cas). En conclusion : Les CIV sont les CC les plus fréquentes au Togo. Leur incidence augmente progressivement avec l’avènement de l’Echo-Doppler cardiaque. Le dépistage se fait tardivement au stade des complications. Devant tout souffle cardiaque une Echo-Doppler doit être demandé afin de faire un diagnostic précoce des CIV. Ceci permettra leur meilleure prise en charge chirurgicale qui ne se fait qu’à l’étranger.

The epidemiological aspect of the CIV is badly known our countries. More over their takeover often gives a problem in one part with the reason of povety of the population in other part almost inexistence of a specialised centre in this area. Objective : describe the incidence of the CIV in childwood in Togo ; analyse the circumstances of their discovery and evaluate their takeover. Methodology : We have proceded retrospective study covering a period of 13 years. (I January 1990 to 31 December 2002) on 196 files of children who have benefitted the Service of Medico-Surgical care and the Sanitary transfer of nongourvement organisation (Terre des Hommes). The out come have been treated by computer. Resultats and discussion : During this period the incidence of the CIV have increased progressively (7.7% in 1990 39.13% in 2002). These represented 25% of the Congenital Cardiopathys taken over by (Terre des Hommes). The sex ratio is 1.58 in favour of boys. The average age is of 3.8 +/- 2 years. The effort dyspnea (75.5%). The brancho pulmonary infection (55.10%) and retardement of growth (36.73%) were the principal cause of consultation. The Systolique souffle, the sound of the B2 in the pulmonary chamber the tachycardia, the polypnea, the deformation of the thorax, he enlargement of the base of the heart have been the dominating physical Sings with respectively 93.88%, 75%, 63.26%, 51.02%, 40.81%. The Rx of the heart (tele coeur) have noted a cardiomegaly in 39 patients which is 79.59%. The “Echo-Doppler” have confirmed the CIV in all the cases. The form of CIV has been precised in 39 patients (small form in 9 cases, middle form in cases, large CIV in 19 cases). In conclusion : The CIV are the frequent CC in Togo. Their incidence increase progressively with the comming of the Cardiac Echo-Doppler. The discovery is done lately at the complication stage. In front of every cardiac souffle, “Echo-Doppler should be to enable early diagnosis of the CIV. This will permits their early surgical take over which is only in abroad.

Introduction : Infectious endocarditis are serious diseases in africa, in spite of progress of the antibiotherapy and cardiac surgery, especially with the VIH/SIDA pandemia. The diagnostic difficulties are raised by the insufficiency of contribution of hemocultures. Current practices of the transthoracic echocardiography or better of transesophagus echography (T.O.E) are one of the solutions to this diagnostic problem. Objectives : The aim of this study was to show the contribution of the echocardiography to the diagnosis and the follow-up of infectious endocarditis in a service of cardiology in black Africa. Material and methods: It is about a descriptive retrospective study relating to 32 exploitable files of infectious endocarditis, of African black patients (18 women and 14 men), hospitalized at the cardiology of the Campus teaching hospital of Lome, during 5 years (1st January 2000 to December, 31, 2004). These patients had profited from a clinical examination, 6 hemocultures at least and a transthoracic echocardiography in mode TM, two-dimensional coupled with continuous Doppler, pulsated and color, above all antibiotherapie. Results : The average age of the patients was 22 years (extremes 6 ans and 48 ans). We observed echocardiograhic lesions in 96% of the patients, whereas the hemo culture was positive only in 32% ofthe cases. There were especially valvular vegetations (82%), mutilating lesions 22%. The systolic function of the left ventricle was often normal (88%). The lesions prevailed on the valves of the left heart (79%). The lesions existed on healthy heart in 64,6% of the cases, on the rheumatic valvulopathies in 23%, congenital cardiopathies in 9,3% and prostheses in 3,1% of the case. Conclusion : The frequency of infectious endocarditis is under estimated in black Africa, because of the insufficiency of hemocultures. The echocardiography remains very important in the diagnostic approach of infectious endocarditis. This exam needs to be done currently in our hospitals.

Due to the recent establishement of the emergencies Units in Black Africa, their Epidemiological aspects are not well known.Our aim was to describe the epidemiology of these diseases in Togo. Through a retrospective analysis we study over a period of 42 mouths. From January first, 2001 to June 30th, 2004. It was carried out exclusively at CHU-Campus, the hospital of Lomé Campus, the second national medical center of reference. Included were all the patients with cardio-vascular emergency cases. We have studied the epidemiological aspects according to the age, sex, profession, morbidity, and mortality.The treatment of results has been done by Computer. The registered emergency cases were 733 in all with is a frequency of the patients admitted at CHUCampus. The average age is 56 ± 13 years with extreme ages from 20 to 97 years. The age group most affected is between 30 and 69 years - The ratio according to the sex is 1.09 in favour of men. Housewives are the professional category most affected (42.3%). Constitute the essential of the cardiovascular emergency cases with a ratio of the 78.3%. The mortality is 17.1% which in most registered between 30 and 69 years. The morbidity ratio is 64.1%We have to keep in mind that cardio-vascular emergency cases are very frequent in Togo. A very active population of young people is concerned. The poor are the most threatened. Henceforth theestablishment and equipment of cardiological units are absolutely necessary, for they constitute the only solution by which the level of morbi-mortality can be reduced.

Introduction: High blood pressure is a public health problem, with the dramatic socio-economic consequences. However, the prevalence of this major factor of cardiovascular risk is not well-known in professional environment.Objective: Our study aimed to determine the prevalences of high blood pressure and of the others principal factors of cardiovascular risk in professional environment in Lome.Materials and methods: It was a prospective and transversal study realised during 3 months (1st February to April 30th 2006) at Togo Telecom. We had included in our study all the permanent workers of thegeneral direction of the company without reference to sex or to rank. We had been excluded from our study the temporary trainees and workers. Each worker had profited from a clinical examination and a minimal assessment of WHO (World Health Organisation).Results: Our sample was composed of 714 workers out of the 721 who account the company. The average age of the workers was 41 years ± 08 with extremes of 21 and 60 years. The prevalence of the High blood pressure was 28,9% (207 workers:154 men and 53 women).The majority of hypertensive was men (74,4%) compared to the women (25,6%), that is to say a sex. ratio of 2,9.The prevalence ofthe other factors of risk were: obesity: 25,07% (n = 179); tobacco:11,48% (n = 82); stress:95,8% (n =684), diabetes:13,72%(n=98), hypercholesterolemia: 16,94% (n = 121); alcohol: 32% (n= 228), hypertriglyceridemia: 12,18% (n=87).Conclusion: The prevalences of high blood pressure and the principal factors of cardiovascular risk at Togo telecom in Lome are high. It thus proves essential to carry out sensitizings on the means of prevention and to change the worker’s life style.Introduction : Lfhypertension arterielle est un probleme de sante publique, aux consequences socioeconomiques dramatiques. Cependant, la prevalence de ce facteur de risque cardiovasculaire majeur nfest pas bien connue en milieu professionnel.Objectif : determiner la prevalence de lfhypertension arterielle et des principaux facteurs de risque cardiovasculaire en milieu professionnel a Lome.Materiels et methodes : Il sfest agit dfune etude prospective et transversale realisee sur une periode de 3 mois (du 1er fevrier au 30 Avril 2006) a Togo Telecom, une entreprise de Telecommunications. Nous avions inclus dans notre etude tous les travailleurs permanents de la direction generale de lfentreprise sans distinction de sexe ni de grade. Avaient ete exclus de notre etude, les stagiaires et les travailleurs temporaires. La definition de lfhypertension arterielle retenue etait celle de lfOMS et JNC VI (TA . 140/90 mmHg.Un examen clinique et un bilan minimal de lfOMS etaient realises pour chaque travailleur.Resultats : Notre echantillon etait compose de 714 travailleurs sur les 721 que compte lfentreprise. Lfage moyen des travailleurs etait de 41 ans } 08 ( 21 a 60 ans). Le taux de prevalence de lfhypertension arterielle etait de 28,9% (n= 207) avec une predominance masculine (74,4% ; n= 154) contre 53 femmes(25,6%) soit un sex ratio de 2,9. Les frequences des autres facteurs de risque etaient : obesite : 25,01% (n= 179) ; tabac :11,4% (n= 82) ; alcool: 32% (n= 228, diabete :13,7% (n= 98); stress : 95,8% (n= 684), hypercholesterolemie : 16,9% (n= 121) ; hypertriglyceridemie : 12,1% (n=87),Conclusion : La prevalence de lfhypertension arterielle et des principaux facteurs de risque cardiovasculaire est elevee a Togo Telecom de Lome. Il est indispensable de mener une sensibilisationenvers les travailleurs pour un changement du mode de vie.

Introduction : L’insuffisance cardiaque est une pathologie grave qui constitue l’un des motifs de consultation et d’hospitalisation dans les services de cardiologie des Centres Hospitaliers et Universitaires de Lome au Togo. Elle represente un probleme de sante publique dans notre environnement africain. Au Togo, aucune etude n’a ete faite sur l’insuffisance cardiaque ; c’est pourquoi il nous a paru necessaire de faire le point sur la question dans nos services de cardiologie. Objectif : L’objectif de notre etude a ete de determiner la frequence hospitaliere de l’insuffisance cardiaque de l’adulte et d’evaluer sa prise en charge diagnostique. Materiel et methode : Il s’est agi d’une etude retrospective, allant du 1er janvier au 31 decembre 2004, dans les services de cardiologie des Centres Hospitaliers et Universitaires Tokoin et Campus de Lome au Togo. Elle a porte sur 104 dossiers de malades hospitalises pour insuffisance cardiaque au cours de la periode d’etude. Le bilan realise etait clinique et paraclinique, incluant la radiographie du thorax, l’electrocardiogramme et l’echocardiographie Doppler. Les donnees ont ete collectees grâce a une fiche d’enquete concue a cet effet et ont ete analysees par le logiciel Epi Info 6 version 6.0 CDC Atlanta. Resultats : L’insuffisance cardiaque a ete enregistree chez 11,8% des hospitalisations. La population d’etude avait un âge moyen de 59,8 ans avec les extremes de 20 a 87 ans. Il existait une predominance masculine avec un sex-ratio homme/femme de 1,48. La dyspnee d’effort (75%), les râles crepitants pulmonaires bilateraux (62 ,5%) et les oedemes des membres inferieurs (60,6%) representaient les signes cliniques les plus rencontres. Le taux de realisation des examens complementaires etait faible en raison des difficultes financieres. Les cardiomyopathies (85,7%), les valvulopathies (68%) et l’HTA (59,6%) etaient les plus frequentes causes retrouvees. Conclusion : L’insuffisance cardiaque est une pathologie grave et frequente a Lome. Beaucoup d’efforts restent encore a fournir pour sa prise en charge. Mots cles : Insuffisance cardiaque, Diagnostic, Centres Hospitaliers Universitaires de Lome Introduction: Heart failure is a severe disease which accounts for a substantial portion of consultation and hospitalization in the cardiological department of Tokoin Teaching Hospital of Lome in Togo. It represents an issue of public health in our African environment. In our country, the lack of information about heart failure had urged to this study in order to sum up our practice in the department. Objective: The aim of our study was to determine the hospital frequency of adult’s heart failure and to evaluate its diagnostic management. Method: It was a retrospective study carried out from 1st January to 31st March 2004 in the cardiological department of Tokoin and Campus Teaching Hospital of Lome in Togo.. It had concerned 104 records of inpatients. Epidemiological, physical examination, laboratory findings including chest roentgenogram, electrocardiogram and echocardiogram aspects were studied. Data were analysed with Epi Info 6.0 of CDC Atlanta database. Results: Heart failure had been found in 11.8% of in-patients during the period of study. The mean age was 59.8 years with a bracket ranged from 28 to 87 years. There was a male predominance with malefemale ratio of 1.48. Exertional dyspnea (75%), pulmonary rales (62.5%), edema (60.6%) were the main symptoms found. The rate of laboratory explorations achievement is very low due to the financial straits. Cardiomyopathies (85.7%), valvular heart disease (68%) and arterial hypertension (59.6) were the most frequent causes. Conclusion: Heart failure is a frequent disease in Lome. Effort may be done to better its management. Key words: Heart failure, diagnosis, teaching hospital of Lome.

The congenital cardiopathies re frequent pathologies but their incidence is still badly known in developing countries. Contrary to the industrialised countries, this pathology still pose big problems ofdiagnosis and treatment in our countries. In Togo, some children porters of CC have benefited the kindness of. “Terre des Hommes”. Our study has been done towards the evaluation of their take-over.Objective: To study the epidemiology, their clinic, diagnosis and therapeutic aspects.Materials and methods: It is about the retrospective study of 141 files of the children suffering from CC from January 1990 through December 2002 at TDH Lome. The treatment of the results has been done by computer.Results: The CC have represented 14.13% of the pathologies taken over by the TDH. The sex ratio is of 1.13. The averages age of the parents is of 1.8+/ -5 years. The dyspnoea, the repeated cough and fortuity + ours souffle have constituted to the principal revelation sings. The systolic souffle (82.48%), the tachycardia (48.90%) and the polypnea (42.33%) have been the physical dominating sing. Acardiomegalie have been observed in 89.31% of cases. The cardiac hypertrophy had been found in 87% of patients. Come on top of the CC, the CIV (27.11%) followed by PCA (20.18%). The petrology of theFollot (16.96%) and the CIA (06.25%) 112 patients have been transferred to foreign countries of which 74.10% Suisse 107 CC have been operated. The evolution has been favourable in 89.18%. In Togo, the discovery of the CC has been done lately posing therefore a problem of therapeutic choice. The placing of a cardiovascular Surgical Unit will reduce mortality of the congenital cardiopathics.

Introduction: Thromboembolic pathology reaches the child as well as the adult. However, there exists between these two populations, a difference about frequency and the risk factors. Indeed, venous thromboses are less frequent in the child. Apart from venous thrombosis on central venous catheters, it is fundamental to search a hereditary thrombophilie. Objective: the aim of this observation was to stress the importance of the search for a constitutional anomaly of the haemostasis in venous thromboses of the child.Observation: It has been about a 12 year old child, Togolese, male sex, which was allowed on december 13th, 2005 at the International Polyclinic St Joseph of Lome. He had inflammatory oedema of the rightthigh and fever, evolving for one week, without traumatism. The blood pressure and the weight were normal. Venous echocardiography and doppler of the lower limbs sow a thrombosis of the right commonfemoral vein. The specific biological analyses carried out in the university hospital of Frankfurt in German permit to diagnose a resistance to the activated protein C related to the factor V Leiden. The evolution under anticoagulant treatment was favourable, without complication.Conclusion: Venous thromboses are less frequent in the child. However, it is fundamental to search a constitutional anomaly of the haemostasis.

Introduction: The myxoma of the left ventricle is a rare benign tumour, contrary to the myxoma of the left auricle which is frequent. It is generally responsible of syncopes. However, in rare cases, this tumour can remain asymptomatic and be fortuitous discovery during an echocardiography.Objectives: the objectives of this observation were to stress the importance of the echocardiography in the diagnosis of the cardiac tumours and to raise the problem of cardiac surgery in our under developed countries.Observation: It has been about a man of 51 year old hypertensive and regularly treated for three years which consulted in cardiology clinic of the CHU Campus of Lome, on Avril 5th 2005 for a check up. The patient did not present any functional symptomatology and haven’t not family antecedents of heart disease. The clinical examination was normal. The chest Xray was normal (CTR=0.48). The electrocardiogram noted a left ventricular hypertrophy. The echocardiographies showed a regular tumour with a diameter of 25 mm, developed in dependson the posterior pillar of the left ventricle. The imagery by magnetic resonance (IMR) showed a mass, hyperdense compared to the myocardium. The anatomopathologic examination after surgical resection of the tumour confirmed the diagnosis of myxoma.Conclusion: The diagnosis of the cardiac tumors and left ventricular myxoma especially, is made easy by the echocardiography, especially in the asymptomatic forms. However, the cardiac surgery is a serious problem in our under developed countries. Introduction : Le myxome du ventricule gauche est une tumeur bénigne rare, contrairement au myxome de l’oreillette gauche qui est fréquent. Souvent responsable de syncopes à répétition, cette tumeur peut rester dans de rares cas asymptomatique et de découverte fortuite lors d’une échocardiographie.Objectifs : Souligner l’importance de l’échocardiographie dans le diagnostic des tumeurs cardiaques et soulever le problème de chirurgie cardiaque dans nos pays en voie de développement.Observation : Il s’agit d’un homme de 51 ans hypertendu connu et régulièrement traité depuis trois ans, qui a consulté à la clinique cardiologique du CHU Campus de Lomé le 05 Avril 2005 pour un contrôle de routine. Le patient ne présentait aucune symptomatologie fonctionnelle et on ne notait pas d’antécédents familiaux decardiopathie. L’examen clinique était normal. Au télé coeur, le rapport cardiothoracique était normal (0,48). L’électrocardiogramme notait une hypertrophie ventriculaire gauche. Les échocardiographies transthoracique et transoesophagienne on mis en évidence une tumeur arrondie hyperéchogène aux contours réguliers, pédiculée,mobile, d’un diamètre de 25 mm, développée au dépend du pilier postérieur du ventricule gauche. L’imagerie par résonance magnétique (IRM) a mis en évidence une masse arrondie intra ventriculaire gauche, hyperdense par rapport au myocarde. L’examen anatomopathologique après exérèse chirurgicale de la tumeur a confirmé le diagnostic de myxome.Conclusion : Le diagnostic des tumeurs cardiaques en général et du myxome du ventricule gauche en particulier est rendu facile par l’échocardiographie, surtout dans les formes asymptomatiques qui sont de découverte fortuite. Cependant, la prise en charge qui est uniquement chirurgicale, pose un sérieux problème dans nos pays en voie de développement.

International audience; Hexagonal aluminium nitride (AlN) and zinc oxide (ZnO) thin films have been deposited by DC and RF reactive magnetron sputtering at room temperature. For a first set of samples, sputtered AlN films were deposited on silicon ZnO substrate. For a second set, ZnO films were deposited on AlN substrate. X-ray diffraction (XRD) and high resolution transmission electron microscopy (HRTEM) analysis of the synthesized AlN film on ZnO buffer layer have shown some amorphous zones close to the interface followed by a nanocrystalline layer exhibiting (10−10) and (0002) orientations of the hexagonal AlN crystalline phase. At the top of the film, a relatively well-crystallized layer with a single (0002) orientation has been observed. We have related the relatively bad interface to the presence of oxygen coming from ZnO substrate. This behaviour was different for the growth of ZnO film when AlN was used as substrate. In fact, we have observed thanks to HRTEM images and selected area electron diffraction patterns, that the ZnO film deposited on AlN substrate exhibits an epitaxial growth which is strongly dependent on the crystalline quality of AlN film.

The pacing rate response of a new acceleration driven pulse generator (SWING 100, SORIN BIOMEDICA) was compared with simultaneous normal sinus rhythm (NSR) during two different treadmill exercises. This pacemaker has a gravitational acceleration sensor able to discriminate between physical activities and vibrations. Six healthy volunteers (three male, three female; aged 21.7 +/- 4.3 years), with the pacemaker strapped to their right infraclavicular area, performed each test three times with different rise response curve (RRC) each time: fast, normal, and slow. The fall response curve used was the same as the rising one during each test. Pacing rates were recorded using the VEGA analyzer (SORIN BIOMEDICA) and compared with simultaneous NSR recorded by a 7-channel ECG recorder (MINGOGRAF 7, SIEMENS). During all tests immediate (within seconds) rapid increase in pacemaker rate was seen up to about 60 seconds, then a slower increase followed thereafter. The mean correlation between pacing rates and NSR during the Bruce tests were 0.7941 +/- 0.10, 0.8562 +/- 0.14, and 0.8292 +/- 0.07; during the discontinuous tests 0.7292 +/- 0.16, 0.7233 +/- 0.10, and 0.7480 +/- 0.11 for fast, normal, and slow RRC, respectively. Each 30 seconds, nonsignificant differences were present between pacing rate and NSR during all the discontinuous tests; similar responses were observed only during the first two stages of Bruce tests after which NSR was significantly higher than pacemaker rates. The speed of rise to upper rate was the main difference between the different programs (fast, normal, and slow). The discontinuous tests showed that the pacemaker responds more to speed than to grade.(ABSTRACT TRUNCATED AT 250 WORDS)

Les urgences cardio-vasculaires sont des situations particulierement preoccupantes dont la nature et l’importance sont encore mal connues en Afrique Noire en raison de l’organisation trop recente des unites de soins d’urgence en general et des soins cardiologiques en particulier. Aucune etude au Togo n’a ete faite en rapport avec leur epidemiologie. Partant de ce point, nous allons determiner le profil des UCV au Togo. Il s’agit d’une etude retrospective sur une duree de 42 mois allant du 1er janvier 2001 au 30 juin 2004. Elle s’est entierement deroulee au CHU-Campus de Lome, deuxieme centre de reference national. Ont ete inclus tous les malades qui ont ete hospitalises pour urgence cardio-vasculaire. Nous avons etudie les donnees suivantes qui sont l’âge, le sexe, la profession, la morbidite et la moralite. Les urgences repertoriees etaient de 733 cas soit une frequence de 18% des hospitalisations au CHU-Campus. L’âge moyen est de 56,9% avec des extremes d’âge de 20 a 97 ans. La tranche d’âge la plus affecte est celle 30 a 69 ans. Le sexe ratio est de 1,09 en faveur des hommes. Les femmes au foyer constituent la categorie professionnelle la plus touchee (42,3%). Les AVC constituent l’essentielles es urgences cardio-vasculaires avec un taux de 78,3%. Le taux de mortalite est de 17,1% ce taux est plus enregistre entre 40 et 39 ans. Le taux de morbidite est de 64,1%. Nous retiendrons que les urgences cardio-vasculaires sont tres frequentes au Togo et touche une population tres jeune et active. Les pauvres sont plus concernes. L’organisation et l’equipement des unites de soins cardiologiques sont indispensables, car c’est la seule solution qui permet de reduirez la morbi-mortalite trop elevee de ses affections. Cardio-vascular emergencies are particularly preoccupying cases which nature and importance are still not well known in black Africa due to the fact that the establishment of emergency treatment units general in too recent and in particular of cardiological treatments. No study is conducted in Togo in relation to their epidemiology. We describe the epidemiological aspects of cardio-vascular emergency cases in Togo. And through a retrospective analysis we study over a period of 42 mouths, from January first, 2001 to June 30th, 2004. It was carried out exclusively at CHU-Campus, the hospital of Lome Campus, the second national medical center of reference. Included were all the patients at the hospitals cardio-vascular emergency cases. We have studied the epidemiological aspects according to the age, sex, profession, morbidity, and mortality. The registered emergency cases were 733 in all with is a frequency of 18% of the patients admitted at CHU-CAMPUS. The average age is 56.9% with extreme ages from 20 to 97 years. The age group most affected is between 30 and 69 years. - The ratio according to the sex is 1.09% in favour of men. Housewives are the professional category most affected (42.3%). Constitute the essential of the cardio-vascular emergency cases with a ratio of the 78.3%. The mortality ratio is 17.1% which in most registered between 40 and 39 years. The morbidity ratio is 64.1%. We have to keep in mind that cardio-vascular emergency cases are very frequent in Togo. A very active population of young people is concerned. The poor are the most threatened. Henceforth the establishment and equipment of cardiological units are absolutely necessary, for they constitute the only solution by which the high level of morbi-mortality can be reduced.

Le diagnostic de l’infarctus du myocarde (IDM) chez les noirs n’est pas aise. Effet l’electrocardiographie (ECG) presente souvent chez ces derniers, des atypies de repolarisation. Le dosage des enzymes cardiaques devient donc incontournable. Notre objectif est d'evaluer les facteurs de risque chez les malades Togolais atteints d’IDM et de mesurer les activites biochimiques du myocarde chez ces patients, de preciser l’interet de ce bilan dans diagnostic et le suivi de ces derniers. Il s’agit d’une etude retrospective analytique, couvrant une periode de 12 ans. Chez nos patients les concentrations de CK et CK-MB sont respectivement : 1056±551U/L, 555±741U/L versus 202±59U/L, 4±6U/L chez les temoins. Le bilan biochimique a permis le diagnostic de 17,85% d’IDM au moment ou les modifications de l’ECG n’etaient pas patentes. Ce bilan a ete realise dans les 24 heures qui suivent la precordialgie, seulement dans 40% des cas. Le bilan chimique du myocarde permet un diagnostic precoce et efficace de l’IDM, lorsque l’ECG est encore non concluant. The diagnosis of the myocardial infraction in the blacks is not easy. Because the electrocardiogram in this case presents atypies of repolarisation. The dosage of cardiac enzymes is necessary. Our aim is to evaluate the risk factors upon the Togolese, to measure the biochemical activities of the myocardium and finally, to lay emphasis on the interest of these exams in the diagnosis and check-ups. It is about retrospective analyses covering a period of 12 years. In our patients the concentration of Ck and CK-MB are respectively 1056 ± 551 UL, 555 ± 741 U/L versus 202 ± 59 U/L, 4 ± 6 U/L in the witnesses. The biochemical exams have permitted to make diagnosis of 17.85% of the Myocardial Infaction during the moment when modification of the ECG is not visible. These exams are realised within 24h after the precordial pains only in 40% of the cases. The biochemical exams permit early and efficient diagnosis of the myocardial infarction whenever the ECG is still doubtful.

Ayant constate, grâce a une etude anterieure, que les cas d’hypertension arterielle chez l’enfant sont souvent reveles chez la plupart de nos patients par des accidents paroxystiques hypertensifs qui compliquent une hypertension arterielle jusque-la meconnue, nous avons mene une etude prospective sur la prise systematique de la tension arterielle au cours de l’examen clinique de l’enfant. Cette etude a concerne 162 examinateurs d’enfants : medecins, assistants medicaux et infirmiers, dans diverses structures sanitaires. Seuls 24% d’entre eux : 35% des medecins, 20% des assistants medicaux et 18% des infirmiers, possedaient un sphygmomanometre pediatrique sur leur lieu de travail. D’entre eux, 83% prenaient la tension arterielle surtout devant des accidents paroxystiques hypertensifs ou des symptomes persistants, mais jamais systematiquement lors de tout examen clinique de l’enfant, comme ils le font chez l’adulte. Le retard au diagnostic, les problemes de prise en charge des malades a l’hopital et hors de l’hopital, et l’insuffisance de la prise systematique de la tension arterielle au cours de tout examen de l’enfant, expliquent en partie le diagnostic de l’hypertension arterielle par ses accidents paroxystiques et le pronostic severe de celle-ci. A former study showed that about all the cases of high blood pressure in children were revealed by hypertensive paroxysmal strokes (HPS). In most of patients, these HPS complicated a high blood pressure unknown until then. This situation made us carry out a cross-study about systematic checking of blood pressure during any child examination. That study concerned 162 child health practitioners of all grades in various health centres. Only 24% of practitioners: 35% of physicians, 20% of medical assistants and 18% of nurses, had a paediatric sphygmomanometer in their work places and 83% of them took children’s blood pressure during examinations especially in case of attacks or some persistent symptoms, but never systematically as they did during adult examinations. The belated diagnosis, the care problems for in patients or outpatients, the lack of systematic checking of blood pressure in children, might explain the revelation of high blood pressure in children through paroxysmal attacks as well as its severe prognosis at HPS stage.

Nine patients of average age of 43.4 years (highest 19 to 73 years) haring made tamponade have been admitted in the cardiological clinic of CHU Campus Lome in 10 years. The means of diagnostic other than the clinic have been the cardiac Echo Doppler, during our study. It is an important exam in the tamponade. The etiology was tuberculosis (3) Lupus Erythematosus (1) HIV (2) Renal failure, Idiopathy (2). The pericondocentesis represents an emergency care of our patients. The average quantity of the liguid draimed is 62/ ml. There is no death during this salvatrice gesture. But at a distance i.e. Days, weeks even months it occurs due to causative affections Renal failure,/ VIH/ idiopathy probably Neoplastic. L’objectif est de Souligner l’interet de l’echo Doppler cardiaque dans la prise en charge des tamponnades cardiaques. Il s’agit d’une etude retrospective. Tous les malades ont beneficie d’un examen clinique et d’une echographie Doppler cardiaque. Neuf patients d’âge moyen 43,4ans (avec extremes 19 et 37 ans) ayant fait la tamponnade ont ete hospitalises a la clinique cardiologique du CHU Campus de Lome en 10 ans. Le moyen diagnostique, outre la clinique, a ete l’echo Doppler cardiaque au cours de notre etude. C’est un examen essentiel dans la tamponnade. L’etiologie etait tuberculose (3), lupus erythemateux (1) ; VIH (2), insuffisance renale (1) ; idiopathique (2). La pericardiocentese represente la prise en charge d’urgence de nos patients. La quantite moyenne de liquide evacue est 621 ml. Au cours de ce geste salvateur observe, aucun deces n’est survenu. Les trois deces sont plus lies aux affections causales : 1 insuffisance renale, 1 VIH, 1 idipathique probablement neoplasique. L’echo Doppler est devenu une technique incontournable dans la prise en charge des tamponnades cardiaques. En effet il permet le diagnostic, l’indication et le controle de la pericardocentese, seul geste salvateur dans ce genre d’urgence.

High blood pressure is a public health problem for which the assumption of responsibility remains especially difficult in older subjects. Generally, it is associated with other cardiovascular risk factors. The objective of this study is to determine the prevalence of high blood pressure in older subjects in a particular environment and to evaluate the cardiovascular risk among these patients.This is a longitudinal exploratory study undertaken on 1485 hypertensive subjects of 50 years of age or older, selected from 1999 patients received in three health professional training centers of the community of Lomé, between June 1, 2004 and June 30, 2007. Information had been collected using a card of investigation. Classifications of high blood pressure were those of the JVCVII and the European Society of Cardiology. The data analysis had been made by computer tools.The prevalence high blood pressure was of 74.29%. We had noted a female prevalence (63.8%) with a sex ratio of 0,57 and one middle age of 62.08±9.3 years. Dyspnea (45.9%), chest pains (16.2%) and palpitations (13.2%) were the principal found symptoms. The various listed risk factors were: dyslipidemia (58.1%), obesity (36.12%), alcoholism (16.7%) and diabetes (10.6%). The complications were cardiac (87.81%), ocular (79.8%), renal (19.86%), neurological (4.92%) and arterial (0.99%). The cardiovascular risk was very high at 58.05% of the patients. The mortality rate was of 1.9%.High blood pressure is the most frequent cardiovascular risk factor in our country from 50 years of age. Assumption of responsibility for it is by information, education of the population and requires the mobilization of all the social components.

According to the WHO, cardiovascular disease such as arterial hypertension and ischemic heart disease will be the main non-communicable diseases in developing countries in the next decades. In Togo, there is no statistic on this disease on this day. Our objectives were to study the epidemiological aspects and to describe the risk factors of this affection in our surroundings. It is about a multicentric transverse study from June 1st, 2004 to May 31, 2007, in 3 sanitary formations of the city of Lomé.The frequency of ischemic heart disease was 11, 46%. There was a feminine predominance with a sex-ratio of 0.71. The average age of the patients was about 55.3 +/- 13.4 years with extremes of 18 and 95 years. The cardiovascular risk factors were: dyslipidaemia (76.9%), hypertension (75.3%), left ventricular hypertrophy (72.8%), abdominal obesity (71.1%), hyperuricemia (50.5%), hyperglycemia (41.9%) of which overt diabetes (29%) and smoking (3%). There was a feminine predominance at the hypertensive and the obese. The women accumulated more modifiable risk factors than the men. The middle risk indication was of 2.34 +/- 0.9 at the men and 2.55 +/- 0.8 at the women. The different clinical forms were: stable angina (71.2%), unstable angina (1.7%) and myocardial infarction (5.2%); silent ischemia represented 21.9%. The antero-septal territory was the more reached in case of myocardial infarction and the antero-lateral territory in case of ischemia.A sanitary politic centered on the eviction of the risk factors should help to reduce the prevalence of this affection for a long time in our surroundings.

The cardiopathies occupy a place of choice in CVA (cerebro vascular accident) but in Togo no work have been done in this sector to realize it. Our work had for an objective to determine the prevalence of the association of cardiopathy and CVA (cerebro vascular accident). To determine the prevalence of embologenic cardiopathies. It was about a retrospective study on 91 files on 1102 cases of CVA (cerebro vascular accident) admitted from 1st January 2001 to 31st December 2005 in cardiological and neurological units in CHU Campus Lomé. The prevalence was of 8,25%, the average age was 59,19 years +/- 11,45. The sex ratio was 1,06. The principal affections found were embologenic cardiopathies 89,01% among which we can note troubles of the rhythm (41,75%), Ischaemia cardiopathies (27,47%), The valvulopathies (23,07%), The endocarditis (8,87%). The principal cardiovascular risk factors was arterial hypertension (60,43%), dyslipidémia (51,65%) and alcool (31,87%). The mortality rate was 27,47% and the morbidity rate was (50,55%), The association of the cardiopathies and C.V.A (cerebro vascular accident) constitute a public health problem in Togo. The embologenic cardiopathies occupy in this sector a preponderant place. The early prevention of this association must have for a target surely rhumatismal cardiopathy than arterial hypertension and its risk factors.

We report an observation of a double left thrombosis intraventriculaire and atrium at a subject 45 years. The diagnosis was made by the transthoracic two-dimensional echocardiography which showed a dilated cardiomyopathy and two bulky thrombi in the left ventricle and atrium. As the chirurgical treatment is not accessible, we use the medical treatment: anticoagulant treatment associated on the low salt diet, with diuretic and the inhibitors of the enzyme of conversion, the evolution was favourable without embolic accident.

International audience; We present a theoretical calculation and experimental results for an isolated acoustic wave. The experimental device is modeled by finite element method (FEM) for the structure AlN/ZnO/diamond. The phase velocity in the AIN/ZnO/diamond structure was investigated by theoretical calculations. It was found that the AlN thickness must he at least more than 3 lambda/2 to obtain a negligible surface displacement. In the same way the ZnO thickness for a fixed value of AlN at 2 lambda must be higher than lambda/4 to confine the acoustic wave. The coupling of the wave presents an optimum around lambda 2 for the ZnO layer thichness.

A closed form probabilistic formulation is presented for the determination of the fatigue deterioration of flexible pavements. This formulation is based on the simple phenomenological models which use Miner's law. The expected value and variances of the measure of damage are related to the statistical characteristics of the loading patterns and materials properties. A spatial coefficient of correlation is determined for the measure of damage and is used to determine the typical size of the cracked areas. This study emphasizes the need for obtaining more complete material characterization procedures which do include measurements for spatial variabilities.

International audience; TiO2 films were deposited in a low-pressure inductively coupled rf plasma in O-2/titanium tetraisopropoxide (TTIP). First, depositions were realized at floating potential using nitrogen as bubbling gas. The structural and optical properties of the films were studied, before and after annealing at 450 degrees C under air. As expected, as-deposited films are amorphous, with a columnar structure. A post-annealing under flowing air allows obtaining partially crystallized films in anatase phase. Secondly, films were deposited using nitrogen and oxygen as bubbling gas. In both cases, TiO2-like films exhibit very similar structure and optical properties. Finally, the effect of biasing the substrate was investigated. An improvement of film proper-ties has been found for a bias voltage of -15 V at T < 100 degrees C: deposited TiO2 film is dense (3.7) with a high refractive index (n = 2.32 at 634 nm) and partially crystallized in rutile phase.

The positive diagnosis of cardiac tumour has been made easier with the availability of cardiac Echo Doppler. The histological diagnosis is not undertaken, unless surgical ablation. The means to this form of assumption of responsibility, which is the only solution, is difficult in our countries. The aim of our work is to describe the clinical and radiological aspects of the myxoma in the left higher cavity of the heart and to raise conscience awareness on the assumption of responsibility in our country and the cardiovascular affections which deserve surgical intervention. The study concerns the analyses of cardiac tumour suspected Myxoma of the left higher cavity of the heart in a 24 years old Togolese student. The patient underwent clinical and para clinical check-ups including telecoeur, ECG, and cardiac Echo Doppler. The dyspnea effort, the cough and the paroxystic palpitations have been the primary symptoms. The patient was already suffering from heart failure with left predominance at the moment we met him. The heart sounding has revealed apexien rolling with breaking of B2 in mistral area. The cardiac Echo Doppler has enabled to undertake the positive diagnosis in visualising a capsulated pediculed mass prolapsing in the left ventricle during diastole. The patient died a year later after the diagnosis because of lack of means for the surgical intervention due to take place abroad. The myxoma of the left higher cavity of the heart is a benign heart tumour, the diagnosis of which is now made easier in developing countries with the advent of the cardiac Echo Doppler. The take over which is surgical remains a big problem Avec l'avenement de l'echo doppler cardiaque, le diagnostic positif des tumeurs cardiaques est devenu aise. Le diagnostic histologique ne se fait qu'apres l'exerese chirurgicale. L'acces a cette forme de prise en charge qui est l'unique solution, est difficile dans nos pays. Le but de notre travail est de souligner l’interet de l’echo doppler dans la pise en charge du MOG. Il s’est agit de l’analyse d’un cas de tumeur cardiaque presumee myxome de l’oreillette gauche chez un eleve de 24 ans de nationalite togolaise. Le patient a beneficie d’un bilan clinique et paraclinique comprenant un telecoeur, un ECG, un echo doppler cardiaque. La dyspnee d’effort, la toux et les palpitations paroxystiques ont ete les symptomes de debut. Le patient etait deja en defaillance cardiaque globale avec une predominance gauche au moment ou nous l’avons vu. L’auscultation cardiaque a note un roulement apexien avec un eclat de B2 au foyer mitral. L’echo doppler cardiaque a permis de poser le diagnostic positif en visualisant une masse en capsulee, pediculee, prolabant dans le ventricule gauche en diastole. Le patient est decede un an apres le diagnostic, faute de moyens pour se faire operer dans un pays etranger. Le myxome de l’oreillette gauche est une tumeur cardiaque benigne dont le diagnostic est maintenant aise dans nos pays en voie de developpement, grâce a l’echo doppler cardiaque. La prise en charge qui est chirurgicale pose un grand probleme dans nos pays.

Aretrospective study of 28 cases of high blood pressure in children, recorded during 18 months in the paediatric ward of the Teaching Hospital of Lome (Togo), showed that all cases were revealed by hypertensive paroxysmal strokes (HPS). These HPS occurred especially in 10-15 years old children (57%) and with severe high blood pressure. They were predominantly neurological (89%) and haemorrhagic (57%). Most of patient had symptoms few years or months ago, but their blood pressure had never been checked before occurrence of stroke. Death rate during hospitalization was 32% of cases and reached 43% one year after stroke discovery. The belated diagnosis, the care problems for in patients or outpatients, the lack of systematic checking of blood pressure in children, might explain the revelation of high blood pressure in children through paroxysmal attacks as well as its severe prognosis at HPS stage. Par une etude retrospective de 28 cas d’hypertension arterielle chez l’enfant, recueillis sur une periode de 18 mois dans le service de pediatrie du Centre hospitalier universitaire de Lome (Togo), nous avons constate que tous les cas ont ete reveles par des accidents paroxystiques hypertensifs (APH). Ceux-ci ont complique, surtout chez l’enfant de 10 a 15 ans, une hypertension arterielle severe. Il s’agissait essentiellement d’accidents neurologiques (89%) et hemorragiques (57%). La plupart des patients avaient ces signes depuis quelques mois ou annees mais n’avaient pas beneficie d’une mesure de la tension arterielle avant la survenue des APH. Nous avons enregistre neuf deces (32%) durant l’hospitalisation et en tout 12 deces (43%) au bout d’un an de suivi medical apres l’APH. Le retard au diagnostic, les problemes de prise en charge des malades a l’hopital et hors de l’hopital, et l’insuffisance de la prise systematique de la tension arterielle au cours de tout examen de l’enfant, expliquent en partie le diagnostic de l’hypertension arterielle par ses accidents paroxystiques et le pronostic severe de celle-ci.

Contrary to developed countries, the CIA still pose a big diagnostical and therapeutical problem in developing countries. In Togo, some children, porters of CIA have benefited the humanitarian work of the "Terre des Hommes" (TDH). Our study has been done to evaluate the work done. Our aim is to study the epidemiological, diagnostical and take over of the CIA in Togo. It is about retrospective study of 41 files of the children less than 15 years old, porters of the CIA registered at the TDH from January 1990 to December 2002. The clinical, paraclinical, therapeutical and evolutive perimeters have been studied and the treatment of results have been done by computer. The CIA represents 29.08% of the congenital cardiopathys registered at the TDH. The sex-ratio is of 1.14%. The average age is of 4.5 years. The frequent reason of consultation is dyspnea at 32.22%. The systolic souffle, the base of heart enlarged and deviated at left and the deformation of the thorax have been the physical dominative signs respectively in 100%, 34.15% and 32% of cases. The CIA in our study was associated with CIV in 19.51% of cases and with the tetralogy of Fallot in 4.88%. We had found 92.68% of CIA ostium secundum. The ¾ of children had been transferred and received in majority by Swiss (70%) where surgical curative had been done (90%). The take over of the CIA in Togo is still a major problem that only the creation of cardiovascular surgical unit will remedy. Contrairement au pays developpes, la Communication Interauriculaire (CIA) pose encore d’enormes problemes diagnostiques et therapeutiques dans les pays en voie de developpement. Au Togo, certains enfants porteurs de CIA ont beneficie de l’oeuvre de bienfaisance de "Terre des Hommes" (TDH). Notre etude a ete faite en vue d’evaluer le travail effectue. Nos objectifs etaient d’etudier les aspects epidemiologiques, diagnostiques et la prise en charge des CIA au Togo. Il s’agit d’une etude retrospective de 41 dossiers d’enfants de moins de 15 ans porteurs de CIA et enregistres a TDH de janvier 1990 a decembre 2002. Les parametres cliniques, paracliniques, therapeutiques et evolutifs ont ete etudies et le traitement des donnees a ete fait par l’outil informatique. Les CIA representent 29,08% des cardiopathies congenitales (CC) enregistrees a TDH. La sex-ratio est de 1,14. L’âge moyen est de 4,5 ans. La dyspnee etait le motif de consultation le plus frequent a 32,22%. Le souffle systolique, le choc de pointe etale et devie a gauche et la deformation thoracique ont ete les signes physiques dominants respectivement dans 100%, 34,15% et 32% des cas. La cardiomegalie avait ete observee dans 70,73% des cas. Les CIA de notre etude etaient associees aux CIV dans 19,51% des cas et a la T4 de Fallot dans 4,88%. Nous avions retrouve 92,68% de CIA ostium secundum. Les trois quarts des enfants avaient ete transferes et accueillis en majorite par la Suisse (70%) ou une chirurgie curatrice avait ete pratiquee (90%). La prise en charge des CIA au Togo reste un probleme majeur que seule la creation de chirurgie cardio-vasculaire remedierait.

International audience; A first generation of dielectric rib waveguides has been designed and shaped to support a monomode confinement by using organosilicon materials elaborated by plasma enhanced chemical vapor deposition (PECVD). Optical losses have been measured around 5.5dB.cm-1 and 11.5dB.cm-1 for TE00 and TM00 modes, respectively. Then, synthesis of titanium dioxide thin films by PECVD has been investigated to improve optical and propagation properties. The first results on these films exhibit a refractive index around 1.99 at a 633 nm wavelength with a 380 nm optical gap. When an rf bias is applied to the substrate, the refractive index reaches 2.36, from -5V, without significant optical gap variation.