[Internal Hemorroïd Disease In Digestive Endoscopy Center Of Chu Gabriel Toure Of Bamako]. / La Maladie HemorroïDaire Interne Au Centre D'Endoscopie Digestive Du Chu Gabriel Toure De Bamako.

the goal of this study was to investigate the internal hemorroid disease in our endoscopic center. METHOD: This transversal study went from December 2011 to December 2012. RESULTS: Sixty cases of internal hemorroid desease were enroled with36 men and 24 women and a middle age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pain (58.3%) and hemorrhoid prolapsed (18.3%). The anal and rectum scopy found only internal hemorrhoid in 78.4% of cases and the grade I was about 81.7% of cases. All patients were beneficied of medical treatement. CONCLUSION: hemorrhoid disease is a frequent pathology in general population mainly around third decade.

le but de ce travail était d'étudier la maladie hémorroïdaire interne. MÉTHODE: Il s'agissait d'une étude transversale déroulée au centre d'endoscopie digestive du CHU Gabriel Touré de Décembre 2011 à décembre 2012. RÉSULTATS: Nous avons colligé 60 cas de maladie hémorroïdaire interne dont 36 hommes et 24 femmes avec un âge moyen de 47 ±14,4 ans. Le tableau clinique était dominé par le saignement (66,7 %), la constipation (58,4 %), la douleur anale (58,3%) et le prolapsus hémorroïdaire (18,3%). L'anorectoscopie réalisée objectivait des hémorroïdes internes isolées dans 78,4% des cas et le stade I de la maladie était observé dans 81,7% des cas. Tous les patients ont bénéficié d'un traitement médical. CONCLUSION: La maladie hémorroïdaire est une pathologie relativement fréquente dans la population générale surtout vers la troisième décade.

[Infection with the Hepatitis B virus in pregnant women in the Gynecology and Obstetrics Department of the Gabriel Touré University Hospital Center]. / L'Infection par le virus de L'Hepatite B chez la femme enceinte dans le service de Gynecologie-Obstetrique du Centre Hospitalo-Universitaire Gabriel Toure.

PURPOSE: The purpose of this study was to study hepatitis B virus infection in pregnant women. METHOD: This was a one-year descriptive cross-sectional study carried out in the Gynecology-Obstetrics Department of the Gabriel Touré University Hospital. RESULT: During this period, 796 pregnant people were seen in antenatal consultations. Ween rolled 500 pregnant women in whom the search for HBs Ag was carried out, a rate of 62.81%. Of these pregnant 85 had HBs Ag a prevalence of 17%. The average age of these women was 26.9±5.6 years. Our patients were paucipare sin 52.9%. Of these, 17.7% had a family history of chronic liver disease and 37.6% had once given birth in a referral health centre. Blood transfusion, polygamous focus and tattooing/scarification were the risk factors associated with HBs Ag carriage. Alarming clinical signs were absent in 95.2% of cases. Hepatic cytolysis and anaemia were foundin 28.8% and 76.3% of cases respectively; viral replication was observed in 13.6% of pregnant women with a high viral loadin 37.2%. Abdominal ultra sound was normal in 90.8% of cases and esophageal varices were present in 6% of women who performed eso-gastroduduedenal fibroscopy. Fibrosis was significant according to an APRI score in 3.4%. CONCLUSION: The prevalence of HBs A in pregnant women followed remains high.

BUT: Le but de cette étude était d'étudier l'infection par le virus de l'hépatite B chez la femme enceinte. METHODE: Il s'agissait d'une étude transversale descriptive sur un an réalisée au service de Gynécologie-Obstétrique du CHU Gabriel Touré. RESULTAT: Durant cette période, 796 gestantes ont été vues en consultation prénatale. Nous avons enrôlé 500 femmes enceintes chez qui la recherche de l'Ag HBs a été effectuée soit un taux de 62,81%. Parmi ces gestantes 85 avaient l'Ag HBs soit une prévalence de 17%.L'âge moyen de ces femmes était de 26,9±5,6 ans. Nos patientes étaient des paucipares dans 52,9%. Parmi elles 17,7% avaient un antécédent familial d'hépatopathie chronique et 37,6% avaient une fois accouché dans un centre de santé de référence. La transfusion sanguine, le foyer polygamique et le tatouage/scarification étaient les facteurs de risque associés au portage de l'Ag HBs. Les signes cliniques alarmants étaient absents chez 95,2% des cas. Une cytolyse hépatique et une anémie étaient retrouvées chez respectivement 28,8% et 76,3% des cas ; une réplication virale était observée chez 13,6% des gestantes avec une charge virale élevée chez 37,2%. L'échographie abdominale était normale dans 90,8% des cas et les varices œsophagiennes étaient présentes chez 6% des femmes ayant réalisé la fibroscopie œsogastroduodénale. La fibrose était significative selon un score APRI chez 3,4%. CONCLUSION: La prévalence de l'AgHBs chez les gestantes suivies reste élevée.

[Epidemiology and prognosis aspects of upper gastrointestinal bleeding of NianankoroFomba hospital in segou]. / Aspects epidemiologiques et pronostiques des hemorragies digestives hautes a l'hôpital Nianankoro Fomba(HNF) de segou.

AIMS: The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital. PATIENTS AND METHODS: This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage. RESULTS: Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%. CONCLUSION: upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

BUT: Le but de notre travail était de préciser lesaspects épidémiologiques, cliniques, étiologiques et pronostiques de l'hémorragie digestive haute à l'Hôpital Régional de Ségou(HRS). PATIENTS ET MÉTHODES: Cette étude transversalequi s'était déroulée du 1eroctobre 2017 au 31 septembre 2018 a concernéles patients hospitalisés pour hémorragie digestive. RÉSULTATS: Les hémorragies digestives hautes ont représenté 9,7% de l'ensemble des hospitalisations. L'âge moyen des patients était de 50,94 ± 21,6 ans avec un sex ratio de 1,6 en faveur des hommes. Les femmes au foyer et les cultivateurs étaient représentés dans 37,7% et 34% des cas. Les principaux modes de révélation étaient l'hématémèse et le méléna. L'évolution était favorable avec une mortalité de l'ordre de 34%. CONCLUSION: Hémorragie digestive haute est relativement fréquente dans notre contexte. Cependant, la mortalité élevée est liée à un retard de prise en charge.

[Neuromeningeal cryptococcosis in Mali]. / La cryptococcose neuro-méningée au Mali.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Helicobacter pyloriinfection and gastric mucosa in cirrhotic patient]. / Infection a helicobacter pylori et muqueuse gastrique chez le cirrhotique.

The goal of this work was to study helicobacter pylori (HP) infection and gastric mucosa in cirrhotic patient. METHOD: The study was comparative (case-indicator) and transversal from October 2015 to June 2016 in the gastroenterology and hepatology center of CHU Gabriel Touré of Bamako. Hp was identified in pathologic center of CHU du point "G" de Bamako. RESULTS: At the end of the study Hp infection frequency was 73.6% without significative differency with the comparative group (p= 0,200). The mean age was 46,3 ± 20,8 years. The sex ratio was 2,11. The home workers women were more represented (32.1%). Ascites and jaundice were the main signs respectively in 64.3% and 53.6% cases. The upper endoscopy found varices in 89.2% of cases. His worsen histological lesions were mucosal atrophy (17.8%) and intestinal metaplasy (14.2%). CONCLUSION: Helicobacter pylori infection is frequent in cirrhotic patient in our country with sometimes worsen histological lesions.

Le but de ce travail était de déterminer les lésions de la muqueuse gastrique associées à l'infection à Helicobacter pylori chez le cirrhotique. MÉTHODE: Il s'agissait d'une étude comparative (cas-témoins) transversale à recrutement consécutif de patients d'octobre 2015 à juin 2016 dans le service d'Hépato-Gastroentérogie du CHU Gabriel Touré de Bamako. La recherche de l'Helicobacter pylori (Hp) a été faite dans le service d'anatomie pathologique du CHU du Point G. RÉSULTAT: Au terme de cette étude la fréquence de l'infection à Hp chez le cirrhotique a été de 73,6% sans différence statistiquement significative avec la population témoin (p= 0,200). L'âge moyen des patients était de 46,3 ±20,8 ans. Le sex ratio était de 2,11. Les femmes au foyer étaient les plus représentées (32,1%). L'ascite et l'ictère ont dominé le tableau clinique avec respectivement 64,3% et 53,6%. La fibroscopie oeso-gastroduodénale réalisée objectivait les varices œsophagiennes et/ou cardio-tubérositaires dans 89,2%des cas. Les lésions histologiques graves étaient associées à la présence de Hp avec 17,8% d'atrophie de la muqueuse gastrique et 14,2% de métaplasie intestinale. CONCLUSION: L'infection à Hp est aussi fréquente dans notre contexte chez le cirrhotique avec parfois des lésions histologiques sévères.

High level of primary drug resistance in Mali.

BACKGROUND: As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. METHODS: We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naïve individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. RESULTS: CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9-12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7-9.2%), 6% (95% CI 1.3-10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). CONCLUSION: Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9-37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

[Endoscopic And Therapeutic Aspects Of The Colo-Rectal Polyps At The Gabriel Toure Hospital And At The "Promenade Des Angevins" Clinic In Bamako]. / Aspects Endoscopiques Et Therapeutiques Des Polypes Colo-Rectaux Au CHU Gabriel Toure Et A La Clinique « Promenade Des Angevins ¼ De Bamako.

INTRODUCTION: The term polyp refers to any relief formation on the digestive mucosa.The therapeutic endoscopic polypectomy is an effective method to colorectal polyp resection. OBJECTIVE: The maingoal of this work is to study the endoscopic aspects of colo-rectal polyps and to bring our experience on their treatment with endoscopic polypectomy. PATIENTS AND METHOD: Our study was retrospective and descriptive from January 2013 to December 2017 in the endoscopic centers of hepato-gastroenterology department of CHU Gabriel Touré and clinic of "Promenade des angevins". The study concerned in whom polypectomy was performed. RESULTS: A total of 49 patients were included in our study. The main age of our patients was 26.2 2±1.7 years and the sex-ratio was 3.9. The sessile polyps were more frequents with 53.1%. The average size of polyps was 8.7±3.7 mm. The rectum localization was more reported (40.8%). All polyps(100%) were resected in monoblock and we used diathermol cove in 57.1% patients and the cold clamp in 42.9%. Histologically, we had 18 cases of hyperplasia (36.7%), 8 cases of tubulous adenoma (16.3%), 2 cases of tubulo-vilous adenoma (4.1%) and 2 cases of juvenil adenoma (4.1%). One patient was died by perforation five days after the polypectomy. CONCLUSION: The frequency of colorectal polyps is not negligible in our context.Endoscopic colorectal polypectomy is effective therapeutic method for resection of colorectal polyps.

INTRODUCTION: Le terme de polype désigne toute formation en relief sur la muqueuse digestive. La polypectomie endoscopique thérapeutique est la technique de choix pour la résection des polypes colo-rectaux. OBJECTIF: Le but de ce travail est d'étudier les aspects endoscopiquesdes polypes colo-rectaux et d'apporter notre expérience sur leur traitement par la polypectomie endoscopique. PATIENTS ET MÉTHODE: Notre étude descriptive et rétrospective s'est déroulée de janvier 2013 à décembre 2017 à l'unité d'endoscopie du service d'hépato-gastroentérologie du CHU Gabriel Touré et à la clinique promenade des angevins de Bamako.Elle a porté sur les patients adressés pour endoscopie digestive basse.Ont été inclus dans l'étude tous les patients ayant un ou des polypes(nombre < 10) à l'endoscopie et chez qui une polypectomie a pu être réalisée. RÉSULTATS: Au total 49 patients ont été inclus dans notre étude. L'âge moyen de nos patients était de 26,2 ±21,7 ans et lesex-ratio était de 3,9. Les polypes sessiles étaient les plus fréquents soit 53,1%. La taille moyenne des polypesétait de 8,7 ±3,7mm. Le rectum était le siège le plus fréquemment atteint (40,8%). Pour la polypectomie, 100% des polypes ont été reséqués en monobloc et nous avons utilisé l'anse diathermique chez 57,1% des patients et l'anse ou la pince froide chez 42,9%. Sur le plan histologique, nous avons eu 18 cas d'hyperplasie (36,7%), 8 cas d'adénome tubuleux (16,3%), 2 cas d'adénome tubulo-villeux (4,1%) et 2 cas d'adénome juvénile (4,1%). Nous avons enregistré un cas de décès survenu dans un tableau de perforation constatée cinq jours après la polypectomie. CONCLUSION: La fréquence des polypes colorectaux n'est pas négligeable dans notre contexte. La polypectomie endoscopique est un moyen thérapeutique efficace pour le traitement des polypes colo-rectaux.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]. / Cryptococcose neuroméningée chez des patients VIH négatif au CHU du Point G de Bamako (Mali): à propos de trois observations cliniques.

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

[Uper Digestive Tractus Caustic Injuries In Adult Patient In Bamako: Epidemiological, Semiological And Prognostic Aspects]. / Brulures Caustiques Du Tractus Digestif Superieur Chez L'Adulte A Bamako : Aspects Epidemiologiques, Semiologiques Et Pronostiques.

The main objective of this longitudinal and prospecting study from February 2013 to January 2014 was to analyze uper digestive tractus caustic injuries in adult patients at the service of gastroenterology of CHU Gabriel Touré Bamako-Mali. PATIENTS AND MÉTHOD: We include patients (age more than 16 years) hospitalized for digestive caustic injuries. RESULTS: During the period a hospital frequency was 2.1% (20/970). The mean age was about 33.1 ± 9 years. Over toxic substances was discovered in 45 % of patients. The caustic ingestion was intentional in 18 patients. Psychoaffective disorders were the main reason of caustic consumption. At the entry haematemesis was the main sign. The endoscopic lesions were in majority at stage IIIb of the Zargar et al classification. A case of inhalation pneumonia, a case of digestive perforation and 6 cases of digestive obstruction were the main complications of the caustics injuries. Early death was found in 3 patients. CONCLUSION: Upper digestive tractus caustic injuries are more and more met in our context. Preventive measures are necessary to prevent these serious lesions.

Le but principal de ce travail longitudinal, prospectif s'étendant de Février 2013 à Janvier 2014 était d'étudier les brûlures caustiques du tractus digestif supérieur dans le service d'hépatogastroentérologie du CHU Gabriel Touré de Bamako-Mali. PATIENTS ET MÉTHODES: Cette étude a porté sur tous les patients âgés de 16 ans ou plus hospitalisés pour ingestion de produit caustique prouvée. RÉSULTATS: Pendant la période d'étude une fréquence hospitalière de 2,1% a été retrouvée. La moyenne d'âge était de 33,05± 9,012 ans avec un sex ratio de 9. La prise de toxique a été retrouvée chez 45% des patients. L'ingestion était volontaire chez 18 malades. Un choc psychoaffectif était le principal motif de l'ingestion. A l'admission les signes étaient dominés par l'hématémèse. Les lésions endoscopiques étaient majoritairement au stade IIIb de la classification de ZARGAR. Un cas de pneumopathie d'inhalation, un cas de perforation digestive et 6 cas de sténoses ont compliqué les brûlures caustiques. Il y a eu 3 décès précoces. CONCLUSION: Les brûlures caustiques du tractus digestif supérieur sont de plus en plus rencontrées dans notre contexte. Des mesures préventives s'imposent pour espérer diminuer sa prévalence.

[Hepatic Amoebic Abscess: Clinical Aspects And Prognosis At CHU De Gabriel Touré De Bamako]. / L'Abces Amibiens Du Foie : Aspects Cliniques Et Evolutifs Au CHU Gabriel Toure De Bamako.

The main goal of this study was to analyze hepatic amoebiasis abscess at the service of gastroenterology of CHU Gabriel Touré, Bamako- Mali. MATERIAL AND METHOD: It was longitudinal and prospective study from January 2013 to February 2014 and concerned patients having hepatic abscess diagnosed by echography and amoebic serology or chocolate pus finding. RESULT: During the study the frequency of disease was 2.4% (24/970). The sex-ratio was 2 with a mean age of 36.8±10.9 years. Smoking was observed in 58.8% of cases. Abdominal pain, fever and hepatomegaly were found respectively in 87.5%, 83.3% and 79.3% of patients. The abscess was mainly located in right lobe. HIV serology was performed among 18 patients and was negative in all cases. The medical treatment by the metronidazol was systematically proposed and was associated to abscess tap in 42.2% of patients. A total recovery was observed in 23 patients and 1 patient was died by abscess rupture in the peritoneum. CONCLUSION: An early management cans evord complication.

Le but principal de ce travail était de décrire les aspects cliniques et évolutifs des abcès amibiens du foie dans le service d'hépato-gastroentérologie du CHU Gabriel Touré, Bamako-Mali. MATÉRIEL ET MÉTHODE: Cette étude longitudinale prospective étalée sur une période de 14 mois de janvier 2013 en février 2014 a porté sur les patients ayant un abcès du foie retenu sur la présence d'un abcès à l'échographie associée à une sérologie amibienne positive et/ou une ponction de l'abcès ramenant un pus chocolat. RÉSULTAT: Pendant la période d'étude une fréquence hospitalière de 2,4% a été retrouvée. Le sex ratio était de 2 avec un âge moyen de 36,8 ± 10,9 ans et des extrêmes de 20 et 62 ans. La prise de toxique (tabac et alcool) a été observée dans 58,8% des cas. La douleur abdominale, la fièvre et l'hépatomégalie ont été retrouvées respectivement chez 87,5%, 83,3% et 79,3% des patients. L'abcès le plus souvent unique était localisé sur le lobe droit à l'échographie. La sérologie VIH réalisée chez 18 patients était négative dans tous les cas. Le traitement médical par le métronidazole était systématiquement proposé associé à une ponction évacuatrice chez 54,2% des patients. L'évolution était favorable chez 23 patients et 1 décès par rupture de l'abcès dans le péritoine. CONCLUSION: La prise en charge précoce permet d'éviter les complications.

[Intestinal parasitosis during AIDS diarrhoea]. / Parasitoses digestives au cours de la diarrhée du sida.

The main goal of this work was to study the parasitic infections during AIDS diarrhoea. A longitudinal study was carried out from October 2000 to November 2001 in the Hepato-Gastro-Enterology department of Gabriel Toure Hospital and in the Department of Epidemiology and Parasitic infections of Faculty of Medicine, Pharmacy and Odonto-stomatology of Bamako (Mali), concerning HIV positive patients suffering from diarrhoea. Detecting microbes in stools has been done through direct microscopic examination and according to procedures of Henricksen Poblenz Baerman, Kato Katz and the PCR. Among the 70 patients involved, the sex-ratio was 53%, the average age was 35 +/- 8.4 years. Fever weight loss, skin affections and digestive mycosis were often associated. Opportunistic infections have been relatively frequent with Cryptosporidium parvum with 20%, Isospora belli with 8.5% and Microsporidium with 11.5% of cases. Other non-opportunistic microbes were found. Death within the first two weeks seems more important in case of infection by Cryptosporidium parvum. The frequency and the danger of those opportunistic infections require their efficient diagnosis and care management.

[Internal hemorroïd disease at the digestive endoscopy center of the Gabriel Toure University Hospital of Bamako]. / La maladie hemorroïdaire interne au centre d'endoscopie digestive du CHU Gabriel Toure de Bamako.

The goal of this study was to investigate internal hemorrhoid disease. This cross-sectional study was conducted at the digestive endoscopy center of the Gabriel Toure University Hospital from December 2011 to December 2012. Sixty cases of internal hemorrhoid disease were found - 36 men and 24 women and an average age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pains (58.3%) and prolapsed hemorrhoids (18.3%). The rectoscopy found isolated internal hemorrhoids in 78.4% of cases and stage I of the illness in 81.7% of cases. All patients were given medical treatment. CONCLUSION: Hemorrhoid disease is a frequent pathology in the general population mainly around the third decade of life.

Le but de ce travail était d'étudier la maladie hémorroïdaire interne. Il s'agissait d'une étude transversale déroulée au centre d'endoscopie digestive du CHU Gabriel Touré de Décembre 2011 à décembre 2012.Nous avons colligé 60 cas de maladie hémorroïdaire interne dont 36 hommes et 24 femmes avec un âge moyen de 47 ±14,4 ans. Le tableau clinique était dominé par le saignement (66,7 %),la constipation (58,4 %), la douleur anale (58,3%) et le prolapsus hémorroïdaire (18,3%). L'anorectoscopie réalisée objectivait des hémorroïdes internes isolées dans 78,4% des cas et le stade I de la maladie était observé dans 81,7% des cas. Tous les patients ont bénéficié d'un traitement médical. CONCLUSION: La maladie hémorroï-daire est une pathologie relativement fréquente dans la population générale surtout vers la troisième décade.

[Hematologic manifestations related to hepatitis A virus. 3 cases]. / Manifestations hématologiques liées au virus de l'hépatite A. Trois cas.

We report 3 cases of acute hepatitis A infection with haematological manifestations. In the first case, severe aplastic anemia occurred in a 6 year-old child, who underwent 3 bone marrow grafts before responding favourably. In the second and third cases, severe anemia and thrombocytopenia occurred in a 42 year-old man with cholestatic hepatitis, and in a 66 year-old man with fulminant hepatitis; there was a favourable outcome in both cases. These cases demonstrate that haematological manifestations in hepatitis A can be severe, independent of the severity of liver disease. Although these manifestations seem to be rare, we suggest performing systematic haematological evaluations in cases of viral hepatitis A with unusual outcomes.

Measurement of collateral circulation blood flow in anesthetized portal hypertensive rats.

AIMS: The aim of this study was to develop a technique to measure collateral blood flow in portal hypertensive rats. METHODS: Morphological techniques included inspection, casts and angiographies of portosystemic shunts. The main hemodynamic measurements were splenorenal shunt blood flow (transit time ultrasound method), percentage of portosystemic shunts and regional blood flows (microsphere method). In study 1, a model of esophageal varices was developed by ligating the splenorenal shunt. In study 2, morphological studies of the splenorenal shunt were performed in rats with portal vein ligation. In study 3, the relationship between splenorenal shunt blood flow with percentage of portosystemic shunts was evaluated in dimethylnitrosamine cirrhosis. In study 4, secondary biliary, CCl4 and dimethylnitrosamine cirrhosis were compared. In study 5, rats with portal vein ligation received acute administration of octreotide. In study 6, rats with dimethylnitrosamine cirrhosis received acute administration of vapreotide. RESULTS: Blood flow of para-esophageal varices could not be measured. SRS blood flow was correlated with the mesenteric percentage of portosystemic shunts (r = 0.74, P < 0.05), splenic percentage of portosystemic shunts (r = 0.54, P < 0.05) and estimated portosystemic blood flow (r = 0.91, P < 0.01). Splenorenal shunt blood flow was 6 to 12 times higher in portal hypertensive rats, e.g., in portal vein ligated rats: 2.8 +/- 2.7 vs 0.3 +/- 0.1 mL.min-1 in sham rats (P < 0.01), and was similar in the different cirrhosis models but was higher in portal vein ligated rats than in cirrhotic rats (1.2 +/- 0.7 vs 0.6 +/- 0.6 mL.min-1.100 g-1, P = 0.05). Octreotide significantly decreased splenorenal shunt blood flow: -23 +/- 20% (P < 0.01) vs -6 +/- 8% (not significant) in placebo rats. The variation of splenorenal shunt blood flow after vapreotide was significant but not that of the splenic percentage of portosystemic shunts compared to placebo. CONCLUSIONS: The splenorenal shunt is the main portosystemic shunt in rats. The measurement of splenorenal shunt blood flow is easy, accurate and reproducible and should replace the traditional measurement of the percentage of portosystemic shunts in pharmacological studies.

[Seroprevalence of human immunodeficiency virus infection (HIV) in Mali on 3,496 sera]. / Etude de la séroprévalence de l'infection par le virus de l'immunodéficience humaine (VIH) au Mali sur 3,496 sérums.

Our main objective has been geared toward the appreciation of the importance of the infection by human immunodeficiency virus in Mali. Our study was based on 3,496 sera deducted from March 1987 to January 1989. All positive sera at ELISA have been confirmed by Western Blot. The total seroprevalence of the study is 8.41%. This fact has been noticed higher in prostitutes, young men, more in women than in men in widows and divorced couples, in traders, in travellers of high endemic countries. The seropositivity is proportional to the number of sexual partners. The heterosexual way of transmission has been dominant. There has been no relationship between seropositivity and transfusion, antecedent of surgery, sexually transmitted diseases, of sexual intercourse type. The HIV2 has been more frequent than HIV1. Taking into account the importance of this infection, precautionary measures must be taken to avoid an evolution toward a catastrophic situation.

[ORL manifestations observed in AIDS. Apropos of 65 cases]. / Manifestations orl observées au cours du SIDA. A propos de 65 observations.

We realized a clinical study in 65 patients with acquired immunodeficiency syndrome, aged from 3 to 62 years old (mean, 34 years) (34 males and 31 females) interned or showed in consultations at the hospital Gabriel Touré in Bamako, Mali (departments of ENT diseases and of internal medicine), in order to analyse and to state precisely different otorhinolaryngologic manifestations in AIDS. Oropharyngeal candidiasis was the most prevalent otorhinolaryngologic manifestation (57 %). Other less common lesions were suppurative otitis media (29 %), atrophic pharyngitis (18,5 %), sinusitis (11 %), Kaposi's sarcoma (5 %) localized above all on the palate: they are however a frequent sign of infection by HIV. The manifestations merit a particular attention by otorhinolaryngologist because, although they have few influence on the general evolution of the disease, they appear as additional manifestations of infectious risks in AIDS patients.

[Gastrointestinal manifestations of AIDS in adults in Mali]. / Manifestations digestives du sida chez l'adulte au Mali.

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

[Study of antigen HBs and antivirus antibodies of hepatitis C during hepatopathies in Mali]. / Etude de l'antigène HBs et des anticorps anti-virus de l'hépatite C au cours des hépatopathies chroniques dans des services hospitaliers a Bamako, Mali.

A prospective study carried out in Bamako, Mali between July 1998 and January 1999 has assessed the seroprevalence of hepatitis C virus (HCV) in 91 carrier patients of chronic hepatopathy at a cirrhrosis stage (53) or of hepato-cellular carcinoma (38) and to compare with in 92 blood donors as a control population. Only seroprevalence confirmed by a complementary test has been taken into account (RIBA). HCV seroprevalence reached 25% including all hepatopathies, 24% in cirrhrosis and 26% in hepato-cellular carcinomae (HCC) versus 4% in blood donors. Antigen HBs of hepatitis B virus has been found in 55% of patients, versus 25% of the control cases (p = 0.0006). On the whole, the two markers have been notified a little more often in HCC than in cirrhosis and the combination of the two markers has been more frequent during cirrhosis as well. The role of HCV played in cirrhosis and HCC onset in Mali appears to be important.

[Esophagitis in Bamako. Apropos of 228 cases]. / Etude des oesophagites A bamako. A propos de 228 cas.

Our main objective has been to study the prevalence of oesophagitis by upper digestive endoscopy. Within 12 months, we have registered 228 cases of oesophagitis out of 612 oesophagean anomalies (37.25%) during 3019 fibroscopies. Oesophagitis has been found to 63.59% in cases in young adult men. Peptic oesophagitis has been most frequent and its congestive aspects most current. The main indication of endoscopy in patients suffering of oesophagitis has been epigastralgies.

[Anatomo-clinical study of chronic gastritis in Mali]. / Etude anatomo-clinique des gastrites chroniques au Mali.

The aim of our study was to evaluate the frequency of chronic gastritis and its anatomoclinical aspects in Mali. Within thirteen months of prospective study, we have recorded seventy four chronic gastritis histologically confirmed which represented 3.28% of the total oesogastroduodenal pathologies registered during the same period (2256 cases). Chronic gastritis has been most observed between 31 to 40 years (24.3%) and women were affected (sex ratio = 0.6). Households and civil servants were predominant. The precocious burning epigastralgy just after the meal was the main motive of the examination and chronic gastritis has been a fortuitous discovery. The basic alimentation included smoked or dried fish, peanuts, "tô" and salt. The most frequent endoscopic aspect was the congestive one. The duodenogastric reflux was not negligible. The diffuse form and antral localisation were more frequent. Five displasiae and four intestinal metaplasiae have been found.