[Adult-onset Still's disease: case report in Dakar, Senegal]. / Maladie de Still de l'adulte: une observation à Dakar (Sénégal).

Adult-onset Still's disease is a uncommon form of inflammatory rheumatism. It has rarely been reported in black Africa. The purpose of this report is to describe a case in a 49-year-old woman from Dakar, Senegal.

[Characteristics of acute coronary syndromes in Sub-Saharan African women]. / Particularités des syndromes coronariens aigus chez la femme en Afrique subsaharienne.

INTRODUCTION: Acute coronary syndromes have been rarely studied in the female population in Sub-Saharan Africa. This Sub-Saharan serie has shown an increase in the prevalence of acute coronary syndromes among the female population, compared to previous studies. Through this retrospective study, we evaluated the epidemiological, clinical, paraclinical, therapeutic and evolutionary features of acute coronary syndromes on women at the Principal Hospital of Dakar. METHODOLOGY: This was a retrospective study of patients hospitalized for acute coronary syndrome over a period of 5 years from January 1st, 2010 to December 31st, 2014, at the Cardiology Department of the Principal Hospital of Dakar. RESULTS: The prevalence of diabetes and obesity was statistically higher for women than for men. Atypical symptomatology was much more apparent (P=0.0000), admission times at the emergency department for acute coronary syndromes were relatively longer (=0.005). Therapeutically, medical care was almost identical regardless of gender. CONCLUSION: In Senegal, acute coronary syndrome in women is characterized by the atypical symptomatology with delayed diagnosis and management. The fight against this reputedly masculine pathology requires a good awareness campaign.

[Important pericardial effusions: apport of echocardiography guided pericardocentensis: about 30 consecutive cases]. / Péricardites liquidiennes abondantes: apports de la péricardocentése echoguidée: a propos de 30 cas consécutifs.

INTRODUCTION: Western countries have good mastery of abundant pericardial effusion while in Africa this still raises some problems regarding diagnosis and therapy. The aim was to see to what extent echo guided pericardiocentesis could contribute in severe cases. METHODS: All patients with abundant pericardial effusion diagnosed by echocardiography with or without compression were considered in a prospective study. They experienced a pericardiocentesis. Some patients did undergo an additional surgical biopsy. The liquid was preliminarily submitted to chemical, bacteriological, cytological analysis. Tissues were observed through an anatomic pathology in biopsy. Heart tuberculosis was diagnosed through histology for following therapeutic testing. RESULTS: Thirty consecutive patients aged 37 in average were included. The sex ratio was 3.75. Prior to draining off, 3 neoplasies (2 of lung bronchitis, 1 of cervix ), 1 leukaemia, 2 extra pericardium tuberculosis and 1 amoebic abscess were diagnosed . Clinical occurrence: the most frequent case, besides the tampon (10 cases, i.e. 30%), was isolated pericardial effusion associated or not with an alteration of the global state (13 cases, i.e. 4%). The average quantity of liquid extracted was 600c c which provoked a kind of haemorrhage in 18 cases, i.e. 60%. Tuberculosis was the major aetiology: 15 cases e i 50% out of which 4 were HIV positive. Three additional surgical biopsies were carried out. Seven patients died. CCONCLUSION In addition to its diagnostic contribution, echo guided pericardiocentesis offers an alternative to endoscopy surgery.

[Pulmonary arterial hypertension revealing pseudolymphoma associated with Sjogren's syndrome]. / Hypertension arterielle pulmonaire revelant un syndrome de Gougerot-Sjorgen primitif dans sa forme pseudolymphomateuse.

INTRODUCTION: The authors related a right heart failure related to a primitive pulmonary arterial hypertension without past medical. METHODS AND RESULTS: This diagnosis has been noticed on the cardiac catheterism as well as the cardiac echography (no shunt). Two years later systemic anomalies such as polyarthritis and salivary glands disease were noticed. The Biopsy revelated a primitive Gougerot-Sjorgen pseudolymphomas syndrom. CONCLUSION: Three years under conventional treatment were a failure as the evolution of the disease resulted to death.

[Resistance to acenocoumarol revealing a missense mutation of the vitamin K epoxyde reductase VKORC1: a case report]. / Résistance à l'acénocoumarol révélant une mutation faux sens Val66Met de la vitamine K époxyde réductase VKORC1 : à propos d'une observation.

A significant proportion of the interindividual variability of the response to vitamin K antagonist (VKA) treatment has been associated with genetic factors. Genetic variations affecting the vitamin K epoxide reductase complex subunit 1 (VKORC1) are associated with hypersensitivity or rarely with resistance to VKA. We report the case of a black women patient who presents a resistance to acenocoumarol. Despite the use of high doses of acenocoumarol (114 mg/week) for the treatment of recurrent pulmonary embolism, the International Normalized Ratio was below the therapeutic target. This resistance to acenocoumarol was confirmed by the identification of a missense mutation Val66Met of the vitamin K epoxide reductase.

[Maternal and fetal prognosis of hypertension and pregnancy in Africa (Senegal)]. / Pronostic maternel et foetal de l'association hypertension et grossesse en Afrique sub-saharienne (Sénégal).

OBJECTIVES: The aims of this study were to record the different types of hypertension associated with pregnancy and to assess the incidence of hypertension and its gravity in Senegal. METHODS: Over a two-year period, a cohort of pregnant women with hypertension according to the American working group classification of hypertension and pregnancy, was studied. A group of 47 non hypertensive women were matched for age and parity. Modalities of delivery were studied: maternal death, type of delivery, birth weight. RESULTS: Among 2,400 deliveries, hypertension was observed in 94 women wih, mean age 33 years. The incidence of hypertension was 3.9% and the incidence of preeclampsia was 2.5%. The different types of hypertension were: Type I: 44 (47%), Type II: 16 (17%), Type III: 18 (19%), Type IV: 16 (17%). Echocardiography showed 30 cases of left ventricle hypertrophy with 3 cases of systolic dysfunction. Thirty-five patients had undergone a caesarean. Forty-seven infants had a birth weight below 2,000 g. Maternal mortality was 12.7%, fetal and neonatal mortality was 50%. There was a 21-fold higher chance of caesarean section in hypertensive women (p<4 x 10-4). Neonatal mortality was 36 times higher (p (4 x 10-6) than in the control group with a birth weight lower birth weight 975 g (p<10-6). Women suffering from toxemia gave birth to children having a lower birth weight (-543 g) (p<5.10-3), but, there was no significant difference concerning caesarean (p<7*10-1) maternal, fetal and neonatal mortality (p<9. 10-1) compared with other sub-groups. CONCLUSION: In developing countries, hypertension in pregnant women is a severe condition responsible for disease and handicaps which could be avoidable at little cost through a better policy of detection and good quality multidisciplinary management.

[Muscle bridge and myocardial ischemia. Study of 6 cases]. / Pont musculaire et ischémie myocardique. Etude de 6 cas.

The authors analyse the clinical and therapeutic aspects of myocardial bridges in a series of 6 male patients between the ages of 41 and 61 years. In every cases, the presenting signs were ischaemic order: one myocardial infarction, three cases of unstable angina and two case of stable angina. On coronary angiography, these muscle bridges involved the left anterior descending artery in all cases. The causal relationships between muscle bridges and myocardial ischaemia are discussed. Among the various factors incriminated, spasm, tachycardia and thrombosis appear to play an important role. Depending on the case, treatment modalities consist of beta-blockers, platelet antiaggregants and calcium channel blockers. Surgical treatment is reserved for patients who remain symptomatic despite medical treatment.

[Predictive indices of the persistence of left ventricular dilatation after valve replacement for chronic aortic insufficiency. Echocardiographic study]. / Indices prédictifs de la persistance de la dilatation ventriculaire gauche après remplacement valvulaire pour insuffisance aortique chronique. Etude échocardiographique.

The objective of this study was to define the echocardiographic indices predictive of persistence of left ventricular dilatation one year after valve replacement for chronic aortic incompetence. Thirty four consecutive patients (32 men and 2 women, age: 35.6 +/- 10 years) operated for post-rheumatic chronic aortic incompetence, were included in this series. All patients were investigated by echocardiography less than 15 days before and one, six and twelve months after surgery. The parameters studied consisted of measurement of ventricular diameter, shortening fraction and ejection fraction as well as aortic incompetence Doppler indices (jet-left ventriculr outflow tract diameter, jet-left ventricular outflow tract diameter/subaortic diameter ratio, half-pressure time, aortic isthmus end-diastolic velocity). Preoperative echocardiographic data and the results one year after valve replacement were compared for each patient. The left ventricle remained more dilated at one year in patients with a preoperative end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, an ejection fraction < 50%, a jet diameter > 16 mm, a jet diameter/subaortic diameter ratio > 65% or a half-pressure time < 350 ms. In conclusion; an end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, a jet diameter > 16 mm, a jet diaméter/subaortic diameter ratio > 65% and a half-pressure time < 350 ms appear to represent the main predictive factors of the persistence of ventricular dilatation one year after aortic valve replacement for chronic aortic incompetence.

[Predictive factors of atrial fibrillation in mitral stenosis. Clinical and echocardiographic study]. / Facteurs prédictifs de la fibrillation auriculaire dans le rétrécissement mitral. Etude clinique et échocardiographique.

The objective of this study was to define the predictive factors of atrial fibrillation in pure or very predominant mitral stenosis in a series of 472 consecutive patients divided into 2 groups according to the presence (group I: n = 113) or absence (group II: n = 359) of permanent atrial fibrillation. Univariate analysis showed that predictive factors for atrial fibrillation in mitral stenosis are age (40.3 +/- 9 years vs 31.4 +/- 9.5, p < 0.0001), history of commissurotomy or mitral angioplasty (13 cases vs 10, p < 0.01), functional class III or IV (36 cases vs 43, p < 0.01), history of valvular heart disease (8.4 +/- 7.3 years vs 6.4 +/- 9.2, p < 0.05), left atrial diameter (53.3 +/- 10.3 mm vs 46.5 +/- 8.5, p < 0.0001) and mitral surface area (1.1 +/- 0.4 cm2 vs 1.3 +/- 0.4, p < 0.0001). On multivariate analysis, age and left atrial dilatation were independent predictive factors of atrial fibrillation in mitral stenosis.

[Cardiac pacing in West Africa: feasibility, problems, and perspectives]. / La stimulation cardiaque définitive en Afrique de l'Ouest: faisabilité, problèmes et perspectives.

BACKGROUND: The frequency of conductive trouble is not know in West-Africa where the evacuation to Europe and the cardiology institute of Abidjan has been for long time the only possibility to implant stimulators. We analyse our experience, the problems ant the perspectives. METHODS: Over a three year period 92 patients (47 men, 45 women) were implanted using new (47%) or a recycled pacemaker. The technique used was essentially endoveinous (sub-clavicular puncture) except 2 children. The medium length of treatment was 24 months. RESULTS: Syncope was noticed at the entrance in most 50% of cases. The degenerative etiology was dominant in 85%. Most cases (87%) used the VVI mode. Complications comprised 3 leads deplacements, 5 infections, 1 pacemaker syndrome and 1 death by mesenteria ischemia. Seven patients died later without any relation of cardiac pacing. CONCLUSION: Despite an intrinsically high cost, pacemaker implantation is feasible and useful in selected indications in developing countries.

[Kartagener's syndrome: a case report]. / Syndrome de kartagener: à propos d'une observation.

The authors report a rare case of Kartagener's syndrome in 8 years old girl revelated by congenital cardiopathy with chronic bronchitis and severe heart failure. Incomplet endocardial cushion defect with single atrium was found and situs inversus suspected, confirmed by ultrasonography. She undergone cardiac surgery in Europe: atrial septation and mitralvalve repair. Surgery redux was neccessary formitral insufficency and residual shunt. Persistent atelectasia in lower inferior lobe indicated bronchoscopy. Lung biopsy confirmed Kartagener's syndrome. Now, she has no cardiac symptom, but bronchitis and chronic pansinusitis.

[Hypertrophic obstructive cardiomyopathy in child. About two cases]. / Myocardiopathie hypertrophique obstructive du nourrison et de l'enfant. a propos de deux observations.

The authors report two cases of hypertrophic obstructive cardiomyopathy in young girls, age 3 months and 8 years old. The disease manifested itself as a cardiac heart failure in the infant's case and a syncop in the other case. Cardiac echocardiography showed in he first case asymetric hypertrophic cardiomyopathy with ventricular outflow tract obstruction gradient of 100 mmhg, and concentric hypertrophic with 120 mmhg in the second case. Its evolution was fatal in both cases and led to sudden death at home. This disease is severe as no therapeutic treatment can modify its course.

[Occurence of foot-and-mouth disease in Senegal]. / Apparition de la fièvre aphteuse au Sénégal.

From December 1975 to October 1976, 13 outbreaks of foot-and-mouth disease were studied in Senegal. The virus, SAT2, identified at Pirbright, was in all probability brought from Mali or from Mauritania by transhumant animals or animals imported illegaly. The disease, which attacks bovines, evolved in its rough form without lethality. Treatment was symptomatic. Only vaccination of imported breeding stock and draught animals was decreed.