Search

Introduction Fractures specific to the pediatric age group represent a particular injury due to their pattern, diagnosis, management, and outcomes. In sub-Saharan Africa, studies on this particular injury are scarce. This study reports sociodemographic, diagnostic, and therapeutic aspects and outcomes of these fractures. Methods We conducted a descriptive cross sectional study at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Dakar, Senegal, from January 2012 to December 2015. Results A fracture specific to children was diagnosed in 180, of whom 47.7% were school-aged, with 59.4% of males. The mean time from injury to the attendance of our department was 48.2 h. Domestic accidents occurred in 51.1%. A total of 243 fractures occurred, mainly on the upper limbs (75.3%), as the most affected bones were the radius (47.3%), ulna (22.6%), and tibia (13.6%). Greenstick fractures represented 46.9%, buckle fractures, 42.8%, plastic deformations 9%, and subperiosteal fractures 0.7%. In all patients, management was orthopedic, with associated analgesic treatment. No sequel nor other complication was registered. Conclusion Fractures proper to the child are a particular entity in children’s trauma, frequently happening in boys, with greenstick and buckle fractures being the most common. Their treatment is exclusively orthopedic, with excellent outcomes.

In atypical presentations, ultrasonography may be helpful to confirm the diagnosis of acute generalized peritonitis. Our study aimed to evaluate its accuracy at Albert Royer National Children’s Hospital Centre of Dakar, in Senegal. We conducted a two-year (2018-2020) retrospective cross-sectional study, with an analytical aspect. Fifty-one patients were included in our study. In 56.7% of cases, a radiologist realized the ultrasonography. The sensibility and specificity of ultrasonography for the diagnosis of acute generalized peritonitis were 70 and 75% respectively. Accuracy of diagnosis was reduced proportionally to the operator's experience, ranging from 82% for radiologists, 66% for interns in radiology to 46% for trainees in radiology (p=0,0145). In our environment, the accuracy of ultrasonography for the diagnosis of acute generalized peritonitis is poor, and largely influenced by the operator's experience, which relegates this investigation to the second line, behind clinical suspicion.

Introduction: Cardiovascular disease is a global public health problem. In Africa, they are increasingly common, however, data on the control of cardiovascular risk factors in the general Senegalese population are rare. The aim of this work was to assess the level of control of cardiovascular risk factors in semi-urban areas in the municipality of Gueoul in Senegal. Patients and methods: This is a cross-sectional, descriptive and exhaustive survey carried out from 3 November to 3 December 2012 among the population aged at least 35 years and living for more than 6 months in the commune of Gueoul. It was conducted using the WHO STEPS approach to study the prevalence of cardiovascular risk factors and assess their level of control. We looked at clinical history, lifestyle, and anthropometric data. Blood pressure was measured at both arms and fasting blood samples were taken for blood glucose, cholesterol and triglycerides. Results: We examined 1.411 subjects (1052 women) averaging 48.5 ± 12.7 years of age. The main cardiovascular risk factors were dyslipidemia (61%), sedentary (56%), abdominal obesity (53.9%), high blood pressure (46.4%) and diabetes (7.2%). Dyslipidemia was known in 22 subjects, 6 of whom were on treatment with dyslipidemia control in 1 subject (16.7%). Hypertension was known in 266 subjects. Of these, 205 subjects were prescribed medical treatment, 26 of whom were well controlled (12.7%). The level of hypertension control was lower in subjects at high cardiovascular risk (p = 0.0001) and those with a family history of hypertension (p = 0.001). The male gender (p = 0.24), the short duration of progression of hypertension (p = 0.95) and the noncompliance of the diet (p = 0.176) were not significantly associated with poor control of hypertension. In diabetics, subjects on oral antidiabetic drugs had met fasting glucose targets in 65.5% of cases according to the recommendations of the American Diabetes Association and in 58.6% according to those of the International Diabetes Federation (p = 0.0001). Age, regular physical activity and insulin treatment were not significantly related to fasting blood sugar control. Conclusion: Our study found inadequate control and high prevalence of cardiovascular risk factors in the general Senegalese population. This situation could be a cause of aggravation of cardiovascular diseases in Senegal and should promote to improve their management.

Context: Choledochal cyst is a rare malformation that mainly affects girls. Aims: The aim of this work is to report the diagnostic, therapeutic and evolutionary aspects of bile duct cyst in children in Dakar. Subjects and Methods: we conducted a prospective monocentre descriptive study from 1 July, 2016, to 30 June, 2019, in the Pediatric Surgery Department of Albert Royer Children's Hospital in Dakar. The studied parameters featured clinical, biological, radiological, therapeutic and evolutionary data. Overall, ten patients, including eight girls and two boys, were selected. Results: Two patients presented the classic triple-syndrome complex featuring an abdominal pain, an abdominal mass and jaundice. Most of the patients presented a symptomatology associating abdominal pain and vomiting. Biological cholestasis syndrome was present in six cases and biological cytolysis syndrome in five cases. The abdominal ultrasound-computed tomography (CT) scan confirmed the diagnosis and helped to set the Todani classification with a predominance of Types 1 and 4. Surgical treatment by laparotomy consisted of total excision of the cyst followed by a Y-en-Roux hepatico-jejunal anastomosis in nine cases, whereas we performed a drainage of the cyst in one case. Two patients presented a morbidity of anastomotic suture release and evisceration and had a good outcome after surgical repair. There was no mortality. Conclusions: The diagnosis of choledochal cyst dilatation (CCD) can be suspected in the postnatal period on the basis of a gastro-intestinal symptomatology with or without associated to jaundice. The combination ultrasound-abdominal CT-scan helps set the diagnosis. The laparatomic approach always has its place for the management of CCD, especially in our context.

Introduction: Road traffic injuries (RTI) are a major public health problem and contribute significantly to the global burden. The aim of this study was to assess the frequency of RTIs in children and to determine their socio-demographic and lesional characteristics. Patients and methods: This was a retrospective and descriptive study over a two-year period from January 2015 to December 2016 conducted at the Department of Pediatric Surgery at the Aristide Le Dantec Hospital in Dakar. Included were all children under the age of 16 victims of a RTI. We studied various parameters relating to the victims (sex, age, education) and the accident (location and time of occurrence of the accident, circumstances and mechanism, duration of admission to the emergency unit, localization and type of lesion). The data was entered and processed using Microsoft Office Word and Excel 2010 software. Results: Among the 425 cases received, 62.6% were boys and 37.4% girls. The average age of the children was 7.7 years. RTIs occurred mainly in pedestrian (63.8%) who wanted to cross the road. There were more accidents in the city-center area (64.9%) and during afternoons (61%). Lesions of the soft parts (wounds, contusion and decay) were predominated (89.6%) followed by fractures. The upper limbs were the main locations of trauma. Conclusion: RTIs are common among children in Dakar. Boys crossing roads are the largest number of victims. Soft tissue trauma predominates and is mainly found on the thoracic limbs.

The care of acute coronary syndrome with persistent ST-elevation (STEMI) is a time-trial race: ‘‘time is myocardium”. The treatment relies on myocardial reperfusion by percutaneous coronary intervention (PCI) or fibrinolysis as promptly as possible. The main objective of this work was to assess the care time delays and the delaying factors during STEMI. We conducted a prospective, descriptive and analytic study over a 6 months’ time period. Were included all the patients received for STEMI. We have studied the care time delays and the delaying factors. We have compiled 50 patients. The mean age was 58.4 years and the sex-ratio M/F 2.5. The chest pain was typical in 39 patients. The mean time elapsed between the beginning of the pain and the first medical contact was 12 h 16 min. Transport (76%) and self-medication (70%) were the significant delaying factors found (p = 0.0001). The mean time elapsed between the first medical contact and the electrocardiogram was 9 h 57 min. The main factors delaying the diagnosis were the unavailability of the electrocardiogram device and the absence of electrocardiogram prescription (p = 0.001). The mean time elapsed between the electrocardiogram and the admission in the cardiology department was 3 h 02 min. The transport was the principal factor lengthening that time delay (p = 0.0001). Among the patients admitted directly in cardiology department, the mean time delay to perform the ECG was 30 min. The mean time delay of fibrinolysis was 2 h 11 min. Streptokinase shortage was the most frequent delaying factor (p = 0.001). The mean time delay between the qualifying ECG and the PCI completion was 2 h 42 min. The unavailability of the medical team was the first factor lengthening that time delay (p = 0.0001). The care time delays were lengthened enough in our context. This testifies to the lack of a codified strategy for STEMI care. It is essential to develop pre-hospital emergency medicine and sensitize the population and healthcare professionals.

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

Deep vein thrombosis of the upper limb is a rare location of venous thromboembolic disease. Data on this form of thrombosis are limited. We report six cases collected in Dakar. The sex ratio was 0.5 and the average age was 27.6 years with extremes of 17 and 39. Painful limb edema was the most constant sign and involved the non-dominant limb in almost all patients. Thrombosis occurred in a field of peripartum cardiomyopathy in two patients and SS sickle cell disease in one patient taking oral contraception. There was neither cancer nor venous catheter in medical history. The diagnosis was made by venous Doppler ultrasound in all patients. Subclavian involvement was the most common. The thrombophilia assessment, done for two patients, was normal. It was about exertion thrombosis on three (3) patients. All the patients had received antivitamin K treatment relaying a low molecular weight heparin. Venous limb compression was associated with anticoagulation for all patients. The treatment duration was six (6) months. There were no reports of pulmonary embolism or death. One patient presented a post-thrombotic syndrome.

Introduction:la hernie diaphragmatique congénitale est une pathologie rarement rapportée en Afrique et dont la présentation peut être précoce ou tardive. Le pronostic dépend essentiellement des malformations associées. Le but de cette étude est de rapporter notre expérience au Centre Hospitalier National d´Enfants Albert Royer de Dakar au Sénégal. Méthodes:il s´agit d´une étude rétrospective considérant les patients pris en charge pour hernie diaphragmatique congénitale entre Janvier 2010 et Décembre 2019. Résultats:douze patients ont été inclus, dont l´âge moyen était de 8,9 mois. Les hernies de Bochdalek ont été retrouvées chez 10 patients. Les symptômes les plus fréquents étaient respiratoires (83,3%), puis digestifs (41,6%). La radiographie thoraco-abdominale a permis d´évoquer le diagnostic chez tous nos patients. Trois patients ont bénéficié d´une stabilisation préopératoire. Tous les patients ont bénéficié d´une laparotomie, le sac herniaire était présent chez 10 patients et 50% des patients avaient un défect mesurant entre 5 et 10 cm. Les suites opératoires ont été simples chez 10 patients et un décès a été enregistré, concernant un patient polymalformé. Conclusion:la hernie diaphragmatique congénitale est une réalité dans notre milieu, se présentant le plus souvent au-delà de la période néonatale. Son pronostic est globalement bon dans notre contexte.

congenital diaphragmatic hernia has been rarely reported in Africa. It can manifests early or late. Prognosis mainly depends on associated malformations. The purpose of this study is to report our experience in the Albert Royer National Children's Hospital, Dakar, Senegal.we conducted a retrospective study of patients treated for congenital diaphragmatic hernia between January 2010 and December 2019.twelve patients were enrolled, with an average age of 8.9 months. Bochdalek hernias were detected in 10 patients. The most common symptoms were respiratory symptoms (83.3%), followed by digestive symptoms (41.6%). Thoraco-abdominal X-ray was used to make a diagnosis in all patients. Three patients underwent preoperative stabilization. All patients underwent laparotomy. Hernia sac was found in 10 patients, and 50% of patients had a defect measuring between 5 and 10 cm. The postoperative course was simple in 10 patients; a polymalformed patient died.congenital diaphragmatic hernia is a reality in our environment; it most often manifests beyond the neonatal period. Prognosis is generally good in our context.

Nous rapportons l´observation d´un enfant âgé de 4 ans de sexe masculin, qui a été reçu pour un bourgeon ombilical congénital accompagné de saignements récents. L´examen physique retrouvait un bourgeon ombilical de couleur rosée, taché de sang sans fistule objectivée, d´environ 1,5 cm de diamètre. Une échographie abdominale a été demandée faisant évoquer un sinus de l´ouraque. L´exploration chirurgicale a mis en évidence un bourgeon ombilical communiquant en intra-abdominal avec un diverticule de Meckel à 90 cm de l´angle iléo-caecal hyperhémié, inflammatoire à l´intérieur duquel siégeait beaucoup d´ascaris. L´examen anatomo-pathologique de la pièce opératoire était en faveur d´une diverticulite. Ainsi, le diagnostic d´une diverticulite de Meckel d´origine ascaridienne a été retenu. Une résection-anastomose avec exérèse du bourgeon fut réalisée. Les suites opératoires étaient simples et après un recul de 6 mois.

Background: The management of biliary atresia is challenging in low-income countries, with delayed diagnosis and its consequences. We aimed to report its epidemiological, diagnostic, therapeutic aspects and outcomes in Dakar, Senegal. Methods: We conducted a 5-year retrospective review, which included 16 patients, admitted in the pediatric surgery services of Aristide Le Dantec University Teaching Hospital and Diamniadio Children's Hospital. Results: The mean age at admission was 105.6 (1 - 420 days), with 10 girls. Cholestatic jaundice was found in all cases, discolored stools in 43.7%, dark urine and hepatomegaly in 31.2%. All patients had biological cholestasis and cytolysis syndromes. The ultrasound was performed in all patients with a sensitivity of 56.2%. The mean age at the time of surgery was 145 days (22 – 540 days). The surgical exploration was conducted in 10 cases and found type IV Biliary Atresia in 50%. The Kasai procedure was performed in 4 cases and liver biopsy in 9 cases. Mortality occurred in 75% (50% post-operatively and 25% pre-operatively). In two cases, the postoperative course was unremarkable with the success of the Kasai Procedure after a 42-months follow-up. Two patients were lost to follow-up. Conclusion: Biliary atresia still has high mortality in our context. This is mainly due to delayed diagnosis, which is common in our environment. Multidisciplinary assessment of persistent neonatal jaundice is crucial to reduce biliary atresia-related mortality

Le but de cette étude était de déterminer les aspects épidémiologiques, diagnostiques et thérapeutiques de la fistule omphalo-mésentérique (FOM). Nous avons colligé quatre observations sur une période de 10 ans allant de janvier 2004 à décembre 2013. Les paramètres étudiés étaient la fréquence, l'âge, le sexe, les signes cliniques et radiologiques, les aspects thérapeutiques et évolutifs. La fréquence était de 0,4 cas par an. Les patients étaient âgés respectivement de 11 jours, 40 jours, 45 jours et 3 ans avec trois filles et un garçon. L´examen clinique avait retrouvé un écoulement de liquide intestinal à travers l´ombilic et un bourgeon ombilical cathétérisable dans tous les cas. Le bourgeon était prolabé chez le patient âgé de 45 jours. La fistulographie réalisée dans deux cas a permis de confirmer le diagnostic en montrant une communication entre la fistule et le grêle. Le bilan malformatif a révélé une cardiopathie congénitale cyanogène avec une communication inter ventriculaire chez l´enfant âgé de 45 jours, une malformation ano-rectale (MAR) de type cloacal associée à une fistule de l´ouraque chez le nouveau-né âgé de 11 jours. Tous les patients ont bénéficié d´un traitement chirurgical. La voie péri-ombilicale semi-circulaire était utilisée en l´absence de malformations abdomino-pelviennes associées. La communication de la fistule avec l´iléon était retrouvée dans la majorité des cas. Une résection intestinale avec anastomose termino-terminale était réalisée dans trois cas; la résection cunéiforme était faite dans un cas complet d´une exérèse complète du trajet fistuleux ouraquien et une suture vésicale, avec une colostomie de dérivation chez le nouveau-né présentant une fistule de l´ouraque et une MAR de type cloacal. Les suites opératoires étaient marquées par des crises convulsives non fébriles chez le 1erenfant ayant évolué favorablement, une suppuration pariétale superficielle suivie de décès par décompensation cardiaque chez le 3ecas. La fistule omphalo-mésentérique est une pathologie rare. Son diagnostic repose sur la clinique complétée par la fistulographie. Son traitement chirurgical par voie péri-ombilicale semi-circulaire donne de bons résultats. Cependant, le bilan malformatif est nécessaire.

Introduction: In Senegal, surveys have revealed areas of high endemicity of Schistosomiasis including the town of Richard Toll. We undertook this study to determine the echocardiocardiographic characteristics of school-agechildren in endemic bilharziasis. Methodology: We performed a descriptive cross-sectional study in Richard Toll and Dakar in school-age children. Results: A total of 250 children were included. There was male predominance, age between 4 and 16 (10 years old ± 2.77). Hematuria was reported in 69.6% of cases in endemic areas. Positive testing for Schistoma haematobium was found exclusively in Richard-Toll at 33.5%. The diastolic, systolic, basal and median left ventricle dimensions were larger in Richard Toll’s population compared to Dakar. It was the same for the right chambers dimensions. The average pulmonary systolic arterial pressure was greater in Richard-Toll: 26.38 ± 3.16 mmHg versus 21.82 ± 1.73 mmHg in Dakar (p Conclusion: The heart of the school-aged child in endemic area is characterized by larger cavitary dimensions.

Resume Introduction Les cardiopathies congenitales de l’adulte regroupent les malformations traitees dans l’enfance qui decompensent secondairement et celles qui, asymptomatiques a la naissance, se revelent tardivement. Les objectifs de ce travail etaient d’identifier les cardiopathies congenitales de l’adulte dans un service de cardiologie generale du Senegal et d’etudier les presentations cliniques, les traitements et l’evolution. Methodologie Nous avons mene une etude transversale, descriptive, portant sur les dossiers de patients âges d’au moins 16 ans, suivis pour une cardiopathie congenitale dans le service de cardiologie de l’Hopital General de Grand-Yoff de Dakar entre mai 2003 et mars 2015. Le diagnostic de la cardiopathie etait base sur l’echocardiographie. Resultats Nous avons collige 50 dossiers de patients soit une prevalence de 0,75 %, avec une predominance feminine (64 %). L’âge moyen des patients etait de 36,16 ± 18,4 ans (16–79 ans) et 29,76 ± 22,58 ans au moment du diagnostic. La dyspnee etait le principal signe revelateur (60 %). Les principales malformations etaient la communication inter-auriculaire (38 %), la stenose pulmonaire (14 %), la communication inter-ventriculaire (12 %) et la persistance du canal arteriel (10 %). Selon la classification de Bethesda, la cardiopathie etait de complexite simple (42 %), intermediaire (58 %) ou severe (10 %). Le traitement etait medical chez 43 patients et chirurgical chez 7 patients. Les principales complications etaient l’endocardite infectieuse (10 %), la fibrillation atriale (12 %), l’insuffisance cardiaque (24 %) et l’hypertension arterielle pulmonaire (50 %). Conclusion Les cardiopathies congenitales de l’adulte semblent sous-estimees dans nos regions et la correction chirurgicale y est rare. Il incombe d’assurer une bonne gestion de la transition entre l’âge pediatrique et adulte.

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

Aims Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. Methods and results Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. Conclusion The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

Resume Introduction Notre objectif etait d’etudier la prevalence des personnes porteuses de plaques d’atherome carotidiennes en population semi-rurale de Gueoul au Senegal et d’analyser les correlations avec les facteurs de risque et les atteintes vasculaires. Patients et methode Enquete transversale, descriptive durant 1 mois incluant les Senegalais âges d’au moins 35 ans residant depuis plus de 6 mois a Gueoul. La mesure etait faite avec un appareil d’echocardiographie Doppler portable. La plaque carotidienne etait definie notamment par une epaisseur intima media > 1,5 mm. Un seuil de significativite etait retenu pour une valeur de p Resultats Au total, 1411 sujets etaient inclus avec un sex-ratio femmes/hommes de 2,93 et un âge moyen de 48,5 ans. Les facteurs de risque cardiovasculaire etaient la dyslipidemie (61,1 %), la sedentarite (56,2 %), l’obesite abdominale (53,9 %), l’hypertension arterielle (46,4 %), l’obesite (12 %), le diabete (7,2 %) et le tabagisme (2,5 %). La prevalence des plaques d’atherome carotidiennes etait de 6,8 % dont 42,7 % avaient des plaques bilaterales. L’âge avance ( p = 0,001), l’hypertension arterielle ( p = 0,0001), le diabete ( p = 0,004) et le syndrome metabolique ( p = 0,008) etaient significativement correles a ces plaques. Concernant les atteintes vasculaires, 5,2 % des patients porteurs d’atherome carotidien avaient eu un accident vasculaire cerebral ( p = 0,01), 27,1 % avaient eu un infarctus du myocarde ( p = 0,02) et 31,2 % avaient une arteriopathie des membres inferieurs ( p = 0,5). Conclusion La prevalence des porteurs de plaques d’atherome carotidiennes semble faible. Cependant, l’association avec les facteurs de risque cardiovasculaire est a souligner, justifiant l’importance des strategies de prevention des maladies cardiovasculaires.

Pulmonary Artery Sling (PAS) is a rare congenital heart disease due to abnormal origin of Left Pulmonary Artery (LPA) from the Right Pulmonary Artery (RPA), then encircling the distal part of the trachea. The treatment is a surgical repair consisting of reimplantation of the LPA on the main pulmonary artery over cardiopulmonary bypass. The authors report a clinical case of PAS in a 5.5 years old boy diagnosed in Senegal then successfully operated in France.Cardiovasc. j. 2017; 10(1): 94-96

Abdominal tuberculosis is rare in immunocompetent infants. We report on two infants with peritoneal tuberculosis (6 and 8 months) who underwent laparotomy for suspected intussusception. In the first patient, characteristic lesions of peritoneal tuberculosis were observed intraoperatively with presence of multiple granulations. Tuberculin intradermal reaction (IDRt) was positive and tuberculous contagium could be cultured. In the second patient, the IDRt and GeneXpert tests were negative. In both patients, the histopathological examination of the biopsy specimens confirmed the diagnosis of peritoneal tuberculosis. The clinical courses under tuberculostatic therapy were favorable in both cases.

Pulmonary embolism and acute aortic dissection are two formidable cardio-vascular emergencies. Their association, although exceptional, is burdened with a heavy mortality in the absence of an early and adapted surgery. We report a case of Standford acute type A aortic dissection associated with fatal pulmonary embolism. This is a 66-years old man with a notion of a long trip received for prolonged chest pain since 3 days, of sudden onset, maximal intensity, tearing, transfixing, migratory, radiating towards the back and the loins, exacerbated by breathing. The examination noted 120 bpm tachycardia, 70% SaO2 desaturation, asymetric blood pressure and asymetric pulse, aortic insufficiency murmur and bilateral crackling rettles at lungs. The chest X-ray showed an enlargement of the upper mediastinum with double-contoured image. The electrocardiogram recorded a regular sinus tachycardia at 132 cycles/min, a lateral sub epicardial ischemia in lateral leads. CT scan revealed total thrombosis of the right branch of the pulmonary artery extending to part of the trunk and an intimal flap from the aortic arch to the abdominal aorta. The evolution was brutally lethal two days after hospitalization. The dissection of the aorta and the pulmonary embolism are medical emergencies whose association poses more difficulties as well on the diagnosis plan but especially therapeutic.