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We report a retrospective study of 800 cases of chronic renal failure (CRF) admitted in the Internal Medical Department at Teaching Hospital of Treichville in Abidjan from January 1990 to December 1990 for precising the etiological, radiological, biological, clinical and epidemiological aspects of this entity in our practice. Kidney renal failure represents 5.8% of the whole patients hospitalised at the same period. 61% of patients were less 45 years old with a weak or mild socio-economic status (92%). In clinical field, 84% of our patients had a variety signs and symptoms which referred to a late uremic state in 41% of cases. Chronic glomerulonephritis (49.1%) and nephrosclerosis (25.4%) were the two main revealed causes. In therapeutical field, 95% of our patients did not receive any treatment in dialysis. Only 5% of patients could be treated by dialysis. The analysis of the results has permitted us to describe clinical particularities of CRF in black African patient.

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

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

The rarity of cholelithiasis in black Africa is a very classical concept that must be called in question again. With the exception of pigmentary lithiasis frequently found in patients with an homozygous haemoglobinopathy, genetic as well as environmental (particularly food related) factors explain in part the low frequency of cholelithiasis with cholesterol gallstones in Africa. Yet the true incidence of cholelithiasis is too often unappreciated. Before the use of ultrasonography, only symptomatic cholelithiasis were detected, usually by the surgeon (19 cases admitted during a 6 years period in the Internal Medicine Department at Treichville University Hospital, Abidjan). The practice of ultrasonography will ease the detection of asymptomatic cholelithiasis. Since ultrasonography has been set up at Treichville University Hospital, 30 cholelithiasis of which 21 were asymptomatic have been detected during an 8 months period, a high detection level of course for a so-called rare disease.

The authors describe a case of gastric tuberculosis in a 23 years old African patient from Abidjan. Symptomatology included epigastralgia, post prandial vomiting, severe impoverishment of health state and dehydration. Endoscopy showed a pseudopolypoid diffuse gastritis with an infiltrated like mucosa. Endoscopic biopsy was carried out, but, because of clinical aggravation (epigastric muscular defense), the patient underwent a laparotomy before knowing the results of the biopsy. Gastrotomy showed an hypertrophied granulomatous hemorrhagic mucosa. By histological examination it was concluded in favour of a granulomatous gastritis with pan-parietal tuberculoid lesions without acid-alcohol-fast bacilli. The different causes of granulomatous gastritis were reviewed and a tuberculous etiology suspected. An antituberculous therapy was prescribed with excellent results on clinical and endoscopic standpoint one year after the treatment started.

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

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

An epidemiological study involving 616 subjects carried out in the Man region, Côte d'Ivoire, showed endemic goiter in 54,5% of the group overall and in 80% of females. Thyroid function of subjects chosen at random in the goitrous and non-goitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher. TBG level is high with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (-0,40) but the T3-TSH correlation for the G subjects was significantly lower (-0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently rencountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.

An epidemiological study involving 616 subjects carried out in the Man region, Côte-d'Ivoire, showed endemic goitre in 54,4% of the group overall and in 80 % of females. Thyroid function of subjects chosen at random in the goitrous and nongoitrous group (105 G and 71 NG respectively) was identical. Compared with a French control group T4 was significantly lower but T3 and TSH were higher, which represents a high TBG level with low iodine elimination. High levels of TSH are not necessarily associated with low T3 or T4 levels, or with clinical signs of a hypothyroid condition. They are probably the result of a transient reaction. T4-TSH and T3-TSH correlations for NG subjects were (--0,40) but the T3-TSH correlation for the G subjects was significantly lower (--0,23). These differences could be explained by the simultaneous high levels of T3 and TSH more frequently encountered in G subjects and by the fact that serious hypothyroid conditions are more frequent in the NG group (6 out of 9). The percentage of hypothyroid conditions is high in both clinical and biological investigations. No anti-thyroglobulin antibodies were found in any of the hypothyroid cases with goitre. The histograms illustrate the clinical and biological heterogeneity of a homogeneous non-medicalised population.