Tuberculosis of the Breast in Togo: A Series of 28 Presumed Cases.

Our study aimed to describe the epidemiological, clinical and histological aspects of mammary tuberculosis in Togo. This is a descriptive cross-sectional study of breast tuberculosis for which the diagnosis was presumed on histological grounds in the pathology department (LAP) of the Lomé Tokoin university hospital from January 1995 to December 2016 (20 years). A total of 28 presumed cases of mammary tuberculosis were identified. There were 26 women and 2 men, with an average age of 34.2 ± 0.3 years. The clinical signs were nodule (84.1%), tumefaction (75%), abscess (63.6%) and tumefaction with cutaneous fistulization (59.1%). Breast involvement was isolated in 31.8% of cases and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was found in 63.9 % of cases. Histology showed inflammatory granulomas made of Langhans giant cells, epithelioid cells and lymphocytes around the foci of caseous necrosis. Thoracic radiography was abnormal in 16 patients (57.1%).Mammary tuberculosis is not rare in our country. Clinical presentation is often misleading and is a diagnostic challenge, more particularly with breast abscess or cancer.

Middle meningeal artery aneurysm: Case report.

BACKGROUND: Aneurysms of meningeal middle artery (MMA) are extremely rare. These aneurysms are of two types: true aneurysm and pseudoaneurysm. The true type is usually seen with pathologic conditions. Pseudoaneurysms, on the other hand, are associated with a skull fracture. Epilepsy caused by MMA aneurysm has never been described to our knowledge. We report a case of true aneurysm isolated from MMA revealed by epilepsy. CASE DESCRIPTION: A 57-year-old patient with a history of high blood pressure developed epilepsy which was treated by valproic acid. Initial scalp electroencephalography (EEG) showed seizure activity arising from the right temporal area. Epilepsy had become drug-resistant. Cerebral angiography revealed an aneurysm of the right middle meningeal artery without any other intraparenchymal anomaly. The interrogation did not reveal any history of family aneurysm. The patient underwent surgery with coagulation of the aneurysm and the MMA. The aneurysm was intradural in contact with the temporal cortex, and the surrounding brain tissues were preserved. The operative follow-up was favorable with amelioration of convulsions with a single antiepileptic. We planned to stop antiepileptic treatment according to electroencephalograms. CONCLUSIONS: Aneurysms of the MMA are rare. Their mode of revelation by seizures is unusual. The factors of rupture are not known. When isolated, their physiopathology is identical to that of the aneurysms of the Willis polygon. Their management uses the same techniques as for other cerebral aneurysms.

[Analysis of a series of 44 cases of peritoneal tuberculosis diagnosed in the pathology laboratory of the Tokoin teaching hospital of Lomé (1993-2014)]. / Analyse d'une série de 44 cas de tuberculose péritonéale diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé (1993-2014).

It is a descriptive and cross-sectional study on all issues relating to peritoneal tuberculosis histological diagnosed in the pathology department (LAP) of the Lomé Tokoin CHU from January 1993 to December 2014 (20 years). A total of 44 cases of peritoneal tuberculosis were included. They were 18 women and 26 men, with a mean age of 37.6±0.2 years. The circumstances of discovery were dominated by ascites (84.1%), fever (75%), weight loss (63.6%) and abdominal pain (59.1%). The peritoneal involvement was isolated in 31.8% of cases, and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was present in 63.9% of cases. Twenty-five patients (69.4%) with information about their social conditions had low socioeconomic level: unemployed (10 cases; 40%), workers (10 cases; 40%) and retired (5 cases; 20%). An increase in cell count was observed in 94.6% of cases. Histology revealed the epithelial giant cell granuloma associated with caseous necrosis in 38 cases (86.4%) and cheesy isolated in 6 patients. Peritoneal tuberculosis is not exceptional in our country. The diagnosis should be considered in febrile ascites, and will be confirmed by laparoscopy with histological samples for a histological diagnosis.

[Histological aspect of urinary schistosomiasis in Togo: results of a cohort of 192 cases]. / Aspect histologique des séquelles de la bilharziose urinaire au Togo: résultats d'une série de 192 cas.

The high prevalence of urinary schistosomiasis in Togo and its late management often lead to sequels. This study takes stock of these cancerous and non-cancerous lesions observed on histological pieces in the pathology laboratory of the Teaching Hospital of Lome in 10 years. We find 28.1 % of malignant tumor lesions, dominated by urothelial carcinoma.

[Disseminated cysticercosis: report of three cases in Togo]. / Cysticercose disséminée: trois cas au Togo.

We report 3 cases of disseminated cysticercosis (DC) in adult male subjects in Togo. All had consulted in dermatology for asymptomatic subcutaneous nodules. The diagnosis was confirmed by histology of a resected nodule. Computed tomography allowed us to bring out the widespread dissemination of cysticerci. The skin, brain, muscle, eye, thyroid, and pleura were the affected organs. Treatment was based on albendazole and betamethasone, with adverse side effects in 2 of our 3 patients. Our 3 observations seem to be the first of their kind in Togo. The mechanism of contamination in these disseminated forms is not yet elucidated, however ingesting a gravid proglottis could be the basis of the widespread dissemination of cysticerci in the body. No consensus has yet been established in the treatment of DC and the management should follow the guideline for treatment of neurocysticercosis and ocular cysticercosis.

[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.

[Diagnostic ultrasonographique d'une hernie inguino-labiale a contenu utero-ovarien. a propos d'une observation chez un nourrisson]. / Diagnostic ultrasonographique d'une hernie inguino-labiale a contenu utero-ovarien. a propos d'une observation chez un nourrisson.

Although indirect sliding inguinal hernias containing the ipsilateral ovary and fallopian tube are not uncommon in infant girls, those containing the uterus, ovary and fallopian tube are. We present the case of a 1-month-old girl with a palpable barely movable mass over the left labium major. Preoperative sonography was performed and revealed a hernia containing the uterus, ovary and fallopian tube. This diagnosis was confirmed during surgical correction. We suggest sonography be used for all diagnostic workup in female infants with an inguinal mass.

Bien que les hernies inguinales contenant l'ovaire homolatéral et la trompe soient relativement fréquentes chez la petite fille, celles contenant l'utérus, un ovaire et la trompe sont rares. Nous rapportons un cas chez une petite fille de 1 mois, né à terme présentant une masse peu mobile de la grande lèvre gauche. Une échographie réalisée a mis en évidence un sac herniaire contenant l'utérus, un ovaire et vraisemblablement la trompe ipsilatérale. Ce diagnostic a été confirmé durant l'opération. Nous suggérons que l'échographique soit mis à profit dans le diagnostic de toute formation inguinale de la petite fille.

[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.

[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.