[Abdominal ultrasound abnormalities incidentally discovered in patients with asymptomatic HIV in Lome (Togo)]. / Anomalies échographiques abdominales de découverte fortuite chez le patient VIH asymptomatique à Lomé (Togo).

Few studies have examined ultrasound imaging of abdominal manifestations of HIV-AIDS, although these rank second only to its pleuropulmonary manifestations. Thus, this study sought to determine the features of abdominal ultrasound in HIV infection. This prospective, descriptive and analytical study took place in the radiology department of the University Hospital Campus Lomé and covered the three-year period of 2009-2011. It included all patients older than 15 years with positive HIV serology. During the study period, 566 patients met the inclusion criteria. Ultrasound examination showed the liver appeared normal in 153 patients (27.0%), but homogeneously hyperechoic and thus suggestive of hepatic steatosis in 107 (18.9%). The bile duct was dilatated in 12 patients or 2.1%. An anomaly in the corticomedullary differentiation in normal-sized kidneys was noted in 28.1% (159 patients). Diffuse homogeneous hypertrophy of the pancreas was found in 3 patients (0.53%). Splenomegaly was noted in 387 patients (68.4%); the echopattern of the spleen was diffusely micronodular in 6 patients (1.1%). Deep adenopathies were found in 29 patients (5.1%) and ascites in 46 patients (8.1%). Abdominal ultrasound is a medical imaging technique available in developing countries, less expensive than others, which can be considered an alternative to computed tomography (CT) in the countries of sub-Saharan Africa for the exploration of the abdominal manifestations of HIV.

[Anencephaly in twin pregnancy: a series of 6 cases]. / Anencéphalie sur grossesse gémellaire : une série de six cas.

OBJECTIVE: To report a series of cases of anencephaly in twin pregnancies and assess the prognosis of the normal twin. PATIENTS AND METHODS: Retrospective study covering 4 years, at the CHU Campus in Lomé, assessing the sonographic aspects and management of cases of anencephaly in twin pregnancies. RESULTS: Anencephaly was found in 6 twin pregnancies. The mothers' mean age was 31 years and all had a very low socioeconomic status. All had drunk a plant infusion of an unknown chemical composition in early pregnancy. Mean gestational age at diagnosis was 25 weeks. Ultrasound performed in all cases showed that 5 cases involved monochorionic diamniotic placentas, and 1 case a dichorionic placenta. Both fetuses were alive at diagnosis in all cases: one had anencephaly and the other twin was normal. The average estimated weight of the anencephalic twin at diagnosis was 659 grams, and of the normal twin, 749 grams; growth was thus discordant. Hydramnios was noted in all cases. Expectant monitoring was instituted; both twins died before 30 weeks in 4 cases. CONCLUSION: Anencephaly in twin pregnancy is a rare occurrence. Ultrasound can be involved in the diagnosis and management.

[Hygiene of transvaginal ultrasound probes in a developing country: case of Togo]. / Hygiène des sondes d'échographie endovaginale dans un pays en développement : cas du Togo.

The purpose of this study was to assess the knowledge and practices of hygiene rules for transvaginal ultrasound by sonographers practicing in Togo. Their knowledge of these rules is good. In practice, they mainly use condoms to protect the vaginal probe, which is sufficient to prevent horizontal transmission of infection. The shortcomings are at the level of hand hygiene; they do not routinely wash hands or wear gloves, nor do they follow guidelines for disinfection of the probes.

[System of telesonography with synchronous teleconsultations and asynchronous telediagnoses (Togo)]. / Système de télé-expertise échographique temps réel et de télédiagnostic échographique temps différé. Étude pilote au Togo.

INTRODUCTION: Ultrasonography is an important nonirradiating diagnostic medical imaging procedure, frequently used, especially in urgent circumstances. This relatively inexpensive noninvasive examination makes it possible to diagnose disorders in various parts of the human body, by examining, for example, the abdomen and pelvis, the cardiovascular system, and the muscles and joints. Ultrasound is also an operator-dependent examination, in that the quality of the result depends on precision in the manipulation of the probe. Unfortunately, many small medical centers and isolated sites do not have an appropriate well-trained sonographer to perform initial evaluations, and an untrained operator cannot capture the appropriate echographic views required for a safe diagnosis of current patients, even with realtime vocal guidance (personal data). The lack of experienced physicians or qualified technicians means that diagnostic ultrasound is not always accessible to patients for rapid examination worldwide, especially in Africa, Amazonia or near the North or South Poles. This situation has led to the development of a new concept of telemedicine: telesonography, with a remote ultrasound diagnosis either in real time (synchronous) or delayed (asynchronous; store-and-forward). These systems of real-time telesonography and data transmission require expensive and complex technology with sophisticated equipment not available in many developing countries. The purpose of this study is to design a low-cost real-time system of telesonography for teleconsultations with experts and a delayed telediagnostic mode between isolated peripheral hospitals and a University Hospital center (UHC). METHODS AND MATERIALS: An IP camera and an internet video server were installed in a geographically isolated site equipped with an ultrasound machine and an operator with basic training in its use. Synchronous teleconsultation (second-opinion diagnosis) is possible via internet with a UHC expert. If no ultrasound operator is available at the isolated center, volume capture-and-store software is used. Later on, the UHC expert uses Echo-Cnes 3D software to reconstruct the organs scanned. The expert can then navigate within the reconstructed volume and display any plane. Volume capture is performed by tilting (± 40°) to both sides vertically to the skin. To locate the probe on the organ acoustic window, the novice operator uses acoustic window mapping designed by our laboratory (UMPS-Tours). The system was tested between the Tsévié regional hospital in Togo (40 km from Lomé, Togo, and 4500 km from Tours, France) and the UHC at Lomé and the Trousseau UHC in Tours. RESULTS: With an average internet connection of 2 Mbps, the quality of transmission of the background video and ultrasound sequence videos from Tsévié towards Lomé was satisfactory (16 images/s) with a maximal transmission delay of 1.5 s (almost in real time). A video conference between the Trousseau UHC in Tours, the UHC Campus in Lomé and the Tsévié Hospital was possible and the bandwidth allowed the Lomé experts (radiologists) to perform real-time telesonography with very satisfactory results (ultrasound diagnoses obtained) for abdominal (n = 5), pelvic (n = 3), obstetric (n = 2), prostate (n = 2) and mammary (n = 2) ultrasound, both normal and pathological. Because the doctors at Tsévié had minimal experience with ultrasound, complete ultrasound diagnoses were obtained by combining remote voice instruction for image capture and full diagnosis by Echo-Cnes. Asynchronous telediagnosis was also performed with Tsévié operators who lacked ultrasound expertise but could perform the required tilt movements (after 3 training sessions). The expert at Trousseau UHC performed real-time telesonography with the Tsévié Hospital for two cases requiring abdominal images and another viewing of the prostate. He also performed asynchronous reconstruction of the abdominal organs with Echo-Cnes. A demonstration seminar of our platform was organized successfully for 2 days during the 9(th) Congress of the French-speaking Black Africa Society of Radiology (SRANF in French) held from 4 till 6 May 2011 at the hotel EDA OBA. During this seminar, 4 ultrasound teleconsultations were performed from the hotel by eminent African radiologists. DISCUSSION AND CONCLUSION: This preliminary study, although limited in the number of patients, allowed us to assess the technical features of our telesonography system. Togo, a developing country with a very modest infrastructure for information and communication, was an ideal site for a first test of this platform. Our system of remote ultrasound requires the local patient center to be equipped simply with a 2D ultrasound machine. The cost is quite low, in comparison to the asynchronous techniques requiring 3D devices. The high cost of 3D or 4D ultrasound machines and their fragility make it difficult to install them at the isolated sites and was a serious obstacle in the development of this system. If the center already has a 2D device and a computer, the cost to equip it with the remaining communications materials is 1,500 €. The experience in Togo clearly highlighted the possibility of teletraining and complete teleradiology with our system. The next stage of this work will seek to validate the results of this preliminary experience on a larger sample with more precise assessment criteria in 2012. The results will allow the widespread dissemination and routine use of this system in developing countries.

[Ulcerative colitis: a case in Togo]. / La rectocolite hémorragique : une observation au Togo.

Ulcerative colitis seems to be rare in sub-Saharan Africa. Because its clinical and radiological signs are non-specific, anatomopathologic studies are necessary for definitive diagnosis after exclusion of parasitic, bacterial, and viral causes. The purpose of this report is to describe a fatal case of ulcerative colitis in a 68-year-old woman in Togo.

[Contribution of the x-ray to the diagnosis of the non traumatic knee's pain in the teaching hospitals Tokoin and campus of Lomé]. / Radiographie Standard Dans Les Gonalgies Non Traumatiques Aux CHU Tokoin Et Campus De Lome.

GOAL: This survey has been realized in order to show the diagnostic interest of the standard radiography in the non traumatic knee's pain. OBJECTIVES: The main objectives of this work were to describe the elementary lesions, the etiological aspects of the non traumatic knee's pain and to list the met pathologies. PATIENT AND METHOD: It was about a prospective survey of six months (december 2007-may 2008) track in the departments of radiology of the Teaching Hospitals of Lomé and on a population of 187 patients enduring a non traumatic knee's pain. RESULTS: The frequency was of 2.5%. The average of age was of 48.55 years (extreme: 18 and 92 years). The feminine sex (63.10%) was the most represented. The housewives were the most represented (36.36%). of The bodily mass indication was consisted between 09 and 42 Kg/m2s with an average of 25.65 Kg/m2s. The osteophyte (26.67%) was the most observed elementary radiographic lesion. The arthrosic knee (47.71%) was the dominant pathology and the chondrocalcinose (02.74%) least represented. A predominance of the tricompartimentale arthrosic knee (38.46%) was cleared itself. The malformatives abnormalities were in 58.62% of the osteoarthritis cases seat. CONCLUSION: This survey reveals the importance diagnostic of the x-ray and the wealth of the pathology of the knee in Africa particularly in Togo.

Preliminary experience with tele-sonography and tele-mammography in Togo.

Many medical centres are equipped with a sonograph. However, a sonographist is not always present or is not trained in all of the specialised domains of sonography. . A sonogram is not always possible due to a lack of physicians. This situation has given rise to the concept of remote-controlled sonography: tele-sonography, a medical procedure used in remote sonographic diagnosis in real time or deferred time. Tele-sonography can now be carried out in real time by the transmission of the expert's procedure (robotic system) or by the use of a 3D sonograph in real time. These modes of real time tele-sonography rely on expensive technologies requiring budgets and an infrastructure that is not always possible in developing countries where the needs in tele-medicine are increasing. This paper aimed to present a preliminary evaluation of a "low cost" system of sonographic tele-expertise in real time and the deferred sonographic telediagnosis accompanied by a tele-mammography between expert sites (university hospitals) and isolated sites (peripheral hospitals, dispensaries).

[Heterogeneous testicle on ultrasonography: consider tuberculosis after cancer in endemic zone]. / Testicule hétérogène a l'echographie: penser egalement a la tuberculose après le cancer en zone d'endémie.

The purpose of this report is to describe findings of clinical examination and imaging in a 27-year-old man admitted for nonpainful left testicular enlargement. Initial diagnosis was testicular cancer based on ultrasonography and association with pulmonary metastasis. This diagnosis was revised after histological study demonstrated testicular tuberculosis.

[Kidney ultrasound scan performed on the adult patient with HIV serology positive in the University Hospital of Tokoin and campus of Lome]. / Echographie renale chez le sujet adulte porteur du VIH aux CHU Tokoin et campus de Lome.

PURPOSES: To describe the elementary lesions, to list the kidney pathologies, to determine the kidney reach frequency and to establish an interrelationship enters the gravity of the kidney reach and the kidney's structure at the ultrasound scan. PATIENT AND METHOD: It was about a prospective survey of ten (10) month, realized in the Departments of radiology of the Teaching Hospitals of Lomé (CHU Tokoin and Campus), concerning 281 patients aged of 18 to 71 years whose HIV serology is positive. RESULTS: The radiological frequency of the HIV/AIDS infection noted during our period of survey was of 3.27% (281/8583). The modal age group was of 30-40 years (32.38%). The female representativeness was 56.92% against 43.08% of men. The drivers (23.13%) follow-ups of the tradesmen were the more touched. The bachelors were more exposed (38.43%). The kidney increased size in 31.85% of the cases. The majority of the patients (88.19%) was at the echographic advanced stage of the renal suffering of which 70.08% were at the III stage. The length of the kidneys was generally normal (74.38%), their width was normal in 53.38% of the cases and increased in 44.42% of the cases. As for the thickness, it was increased in general (71.88%). The kidney suffering (49.03%) was the most dominant pathology. CONCLUSION: The wealth of the kidney pathology associated to the infection of the HIV/AIDS should bring the practitioners to integrate the ultrasound scan in the balance of this affection.

[Value of genitography after late discovery of abnormal sexual development: 5 cases in Lome, Togo]. / Génitographie dans les anomalies de développement sexuel de découverte tardive: 5 observations a Lomé (Togo).

The purpose of this report is to describe the value of genitography in management of abnormal sexual development abnormalities discovered at a late age (> or = 10 years). Genitography was performed in 5 patients ranging from 10 to 23 years of age. No procedural difficulty was encountered in any of these patients. Genitography allowed correct determination of anatomical sex in all patients.

[Crossed renal ectopia: a case report]. / L'ectopie renale croisee : a propos d'une observation.

The authors report a case of a crossed renal ectopia with fusion discovered in an outpatient admitted for abdominal pain to recall embryologic, epidemiology and diagnosis aspects using a literature review.

[Tuberculosis in newborns in a tropical neonatology unit]. / Tuberculose du nouveau-né dans une unité de néonatologie tropicale.

UNLABELLED: We report three cases of tuberculosis observed in a neonatal unit in a country characterized with a high endemia of tuberculosis. CASE REPORTS: Case 1. A term infant presented at the age of 35 days, with cough since day 18, respiratory distress and bronchopneumonia. Her mother had unrecognised tuberculosis since pregnancy. Post mortem biopsies of the infant confirmed the diagnosis of tuberculosis and social survey found out pulmonary tuberculosis in the newborn's aunt. Case 2. A term infant presented at the age of 30 days with cough since day 13, respiratory distress, nodular pulmonary lesions and right pleural effusion. Her mother had cough and stomatitis since the eighth month of pregnancy and nodular pulmonary lesions. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the newborn's paternal uncle. Case 3. A term but hypotrophic infant presented on the first day of life, with haemorrhagic troubles and respiratory distress. Tuberculosis and HIV were confirmed in the mother and the infant. Social survey found tuberculosis in the father, in a friend of her and in her three-month-old child. CONCLUSION: Congenital or neonatal tuberculosis is an under-estimated emergent disease, with a need for early diagnostic methods and consensual therapeutic protocols to improve its management.

[Spinal diseases in a rheumatology hospital unit in Lomé (Togo)]. / Pathologie rachidienne en consultation rhumatologique à Lomé (Togo).

A retrospective study was conducted to determine the different kinds of spinal diseases in patients attending the rheumatology unit of Lomé hospital, Togo. Among the 4927 patients seen over a 5-year period, 1966 (40%) had spinal involvement. The disease observed were as follows: degenerative spinal disorders: 1872 cases (95%); infectious discitis: 41 cas (2.1%); spondyloarthropathies: 33 cases (1.8%); tumors: 20 cases (1.1%). Degenerative spinal involvement affected mainly lumbar and cervical spine. The only unusual clinical feature was that Schober's index was often normal. Lumbar spinal stenosis was common (233 cases, 12.4%), especially in females, and occurred at an earlier age than in the Western world. Ankylosing spondylitis features included mildness of extra-articular manifestations and an often negative family history. Pott's disease was de leading cause of infectious discitis. The present study suggests that spinal disorders are as frequent in Africa as in Western countries.

[Coxofemoral pathology in rheumatology consultation in Togo]. / Pathologie coxo-femorale en consultation rhumatologique au Togo.

A retrospective study was conducted to determine the relative incidence and characteristics of the different forms of coxofemoral disease encountered in a hospital rheumatology clinic in Lomé (Togo). Hemoglobin electrophoresis was performed in all subjects included in the study. Of 2812 subjects examined over a 44-month period, 80, i.e. 2.8%, presented clinically and radiologically documented coxofemoral disease. Necrosis of the femoral head was the cause of coxofemoral disease in 36 subjects i.e. 45%, and was the most frequent etiology. In these 36 subjects hemoglobin was normal in 5 cases, type AS in 5, type AC in 1, type SS in 9, and type SC in 16. Coxarthrosis was detected in 31 subjects: either primary (n = 20) or secondary (n = 11). In this group, hemoglobin was normal in all but 3 subjects who exhibited type AS. The other etiologies observed were coxitis (n = 20) and epiphysitis (n = 3). This study documents the major role of hemoglobinopathy in the pathogenesis of coxofemoral disease in Black Africa. It confirms that AS and SC heterozygoses are not involved in the onset of aseptic necrosis.

[Degenerative spinal disease in an outpatient clinic in Lomé (Togo)]. / Pathologie dégénérative du rachis en consultation hospitalière à Lomé (Togo).

A survey was conducted to determine the frequency and semiological characteristics of degenerative spinal disease in patients attending a hospital rheumatology outpatient clinic in Lomé, Togo. Seven hundred and one of the 1,821 patients seen over a two-year period had degenerative spinal disease. Spinal disease included lower back pain (n = 385), lumbar and radicular pain suggestive of disk protrusion (n = 137), lumbar and radicular pain with claudication suggestive of stenosis of the spinal canal (n = 42), dorsal pain (n = 24), cervical pain (n = 68) and cervical and brachial pain (n = 45). Clinical patterns were similar to those seen in Western countries. However, lumbar and radicular pain with claudication suggestive of stenosis of the spinal canal occurred at a younger age and mainly affected females. These data are in contrast with previous studies suggesting that lumbar and radicular pain due to disk protrusion and stenosis of the spinal canal are uncommon in Black Africa.