[Tuberculosis and systemic diseases: study of 8 Senegalese cases]. / Tuberculose et maladies systémiques: Etude de 8 cas sénégalais.

PATIENTS AND METHODS: A retrospective study (2000-2007) of the tuberculosis observations during systemic diseases was conducted in the service of Internal Medicine of hospital Aristide Le Dantec of Dakar. RESULTS: 8 (4 men and 4 women) has been received. The mean age was 54.5 years. The localization of tuberculosis was lung (n=8) with pleurisy (n=2), ganglionic (n=1), vertebral (n=1) and an abscess of the psoas (n=1). The diagnosis of tuberculosis had been carried with the bacteriological analysis of the expectorations (n=7), the histology (n=1). The systemic diseases was: rheumatoid arthritis and Sjögren's syndrome (n=3), primary Sjögren's syndrome (n=4), autoimmune thrombopenia (n=1). The diagnosis of systemic diseases was previous to that of tuberculosis in 7 cases and concomitant in 1 cases. Under chemotherapy and corticosteroid therapy, the evolution was favorable in 6 patients. CONCLUSION: our study confirms the frequently character spread by the tuberculosis in patients affected by systemic diseases. This association enhances diagnostic and therapeutic problems.

[Destombes Rosaï Dorfman syndrome: description of one case and diagnostic challenges in the tropical setting]. / Syndrome de Rosaï Dorfman Destombes à propos d'une observation: difficultés diagnostiques en milieu tropical.

Destombes Rosaï Dorfman (DRD) syndrome is form of nonlangerhans cell sinus histiocytosis. The main symptoms are cervical adenopathy, fever and fluctuating hepatosplenomegaly. It can be confused with ganglionary tuberculosis especially in our region where tuberculosis is common. This report describes a case of Destombes Rosaï Dorfman syndrome in a 40-year-old woman from Senegal. The main presenting symptom was the presence of massive tumour-like lesions on the neck with altered general condition and fever. Based on these clinical findings, ganglionary tuberculosis was suspected and presumptive treatment was initiated in the local hospital. However further workup failed to confirm the diagnosis and the patient was transferred to the Internal Medicine Department. Clinical examination in our service revealed the presence of extensive adenopathy in the supraclavicular, axillary, and inguinal regions. Laboratory tests demonstrated a nonspecific inflammatory syndrome. Abdominal ultrasonography depicted extensive mesenteric and para-aortic adenopathy. Chest x-ray showed bilateral and asymmetric mediastinal adenopathy. Medullogram findings were normal. Histology confirmed DRD syndrome. DRD syndrome is rare disease of unknown aetiology. In tropical areas differential diagnosis with ganglionary tuberculosis, lymphoma, and reactive hemophagocytic syndrome can be challenging. Lymph node biopsy should be performed in all patients presenting fever and polyadenopathy.

[Monoclonal gammapathy of undetermined significance and autoimmune disease: description of three cases in Senegal]. / Gammapathies monoclonales de signification indéterminée et maladies auto-immunes: étude de trois observations sénégalaises.

Monoclonal gammapathy of undetermined significance (MGUS) has rarely been reported in African literature. The purpose of this article is to describe 3 cases of MGUS observed in women aged 63, 54, and 44 years in Senegal. All three patients had previously documented autoimmune disease, i.e., auto-immune thrombopenia, multiple auto-immune disease (comprising Sjögren's syndrome, polymyositis and vitiligo), and Sjögren's syndrome. Diagnosis of MGUS was made thanks to routine protein electrophoresis that demonstrated a monoclonal peak in the gammaglobulin area in all patients. Serum protein binding showed the IgG lambda subtype in one case and IgG kappa subtype in two cases. Medullogram findings were unremarkable with nondystrophic plasma cell rates ranging from 1 to 4%. Bisphophonate therapy was undertaken along with the recommended treatments for the associated autoimmune diseases, i.e., prednisone, hydroxychloroquine, and methotrexate. Treatment was successful in all three patients with stabilization of the associated diseases and of the monoclonal peak on subsequent electrophoresis. As of this writing, the mean duration of follow-up was 3 years. MGUS that has been uncommon in the African hospital setting should be screened for in all older patients or in patients presenting infection (especially due to virus) or autoimmune disease (as in the three cases presented herein). More systematic use of serum protein electrophoresis should reveal an increased incidence of MGUS. Diagnosis of MGUS requires regular clinical and laboratory surveillance due to the risk for complications of malignant hemopathies, especially multiple myeloma.

[Nephrotic syndrom with focal and segmental glomerulosclerosis in Dakar: epidemiological and clinicopathological characteristics (about 134 cases)]. / Le syndrome néphrotique avec hyalinose segmentaire et focale a Dakar: aspects épidémiologiques et anatomocliniques (a propos de 134 cas).

Focal and segmental glomerulosclerosis (FSGS) is common and non-specific patterns of glomerular injury encountered in human renal biopsies. Cortico-resistant nephrotic syndrome is the main manifestation. We report epidemiological, clinical and pathological aspects of FSGS in Dakar. We report the results of a retrospective study about focal segmental glomerulosclerosis (FSGS) identified from 258 kidney biopsies performed in the medical clinic 1 of A. Le Dantec hospital from January 1993 to December 2003. FSG is found in 134 cases (52%), membranous glomerulonephritis in 32 cases (12,4%), minimal change disease in 20 cases (7.7%). Ninety eigths files were exploitable. FSGS has male gender predominance with a sex ratio of 3. Median age of patients is 28 years (15 and 79 years). Symptomatology is dominated by oedema in 86 cases (87,7%), hypertension in 12 cases (12.2%), hematuria in 5 cases (5.1%), nephrotic proteinuria in 65 cases (66,3%) and no nephrotic proteinuria in 33 cases (33.6%), renal failure in 25 cases (25%)and leucocyturia in 18 cases (18%). FSGS involving more than 50% of glomeruli is encountered in 41 cases (42%), severe interstitial fibrosis is associated in 26 cases. Different pathological aspects are: classical FSGS in 88 cases (88.7%), FSGS " collapsing" in 7 cases (7.1%), FSG "tip-lesion" in one case, FSGS associated to membranous glomerulosclerosis in 2 cases and to diabetic glomerulosclerosis in one case. FSGS is primitive in 88 cases (89,8%) and secondary in 10 cases (10.2%). FSGS is the most common primitive glomerulopathy in Dakar. Nephrotic syndrome is the main manifestation of this disease. Collapsing FSGS is not correlated with the HIV Infection.

[Still disease in adult: a Senegalese case report]. / Maladie de still de l'adulte: etude d'un cas Sénégalais.

INTRODUCTION: The adult Still's disease is a systematic disease rarely reported in the black Africans. We are reporting a case characterized among other difficulties by its diagnostic difficulties. OBSERVATION: It is about a 29 years old black Senegalese woman patient, without particular antecedents, which presented a systematic chronic syndrome composed of a pharyngitis, a polyarthritis and general symptoms (fever, chills, sweats, change of the general state), a cutaneous eruption, a polyadenopathy, a hepatosplenomegaly. The biological analyses showed among others, an inflammatory syndrome (VS at 115 mm in the 1st hour, CRP at 100 mg/L, WBC at 10,400/mm3 with neutrophilia), a hyperferritinemia in 643 ng/l with collapse of the glycosylated ferritin at 13% (N between 60 in 80%). After elimination of any autoimmune or neoplastic suppurative infectious pathology in the decline of a check up as exhaustive as possible, the diagnosis of a Still disease in adult had been retained. Their was improvement under the combination of prednisone and methotrexate. CONCLUSION: Although it is exceptional in black African, this pathology shall be however part of the differential diagnoses of any unexplained systematic sign. The dosage of the ferritinemia and its glycosylated fraction as well as the resort to the criteria of Yamaguchi and Fautrel's classification of Still Disease in Adult shall allow to establish more prematurely the diagnosis of this potentially severe affection.

[Polyarticular gout in young adults: a curable rheumatic disease]. / La goutre polyarticulaire de l'adulte jeune: un rhumatisme curable.

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.

[Senegalese case of thromboangeitis obliterans or Buerger's disease]. / Premiere observation Senegalaise de thromboangeite obliterante ou maladie de Buerger.

INTRODUCTION: Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case. CASE REPORT AND DISCUSSION: A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning. CONCLUSION: TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.

[Diagnostic and therapeutic features of tuberculosis in patients undergoing maintenance hemodialysis in Dakar]. / Caractéristiques diagnostiques et thérapeutiques de la tuberculose chez les hémodialysés chroniques à Dakar.

Tuberculosis in patients undergoing maintenance hemodialysis therapy presents a number of diagnostic and therapeutic challenges. This study was designed to assess the specific diagnostic and therapeutic features of dialysis-associated tuberculosis in a clinical setting. A total of 55 patients were enrolled in this retrospective study over the 5-year period from 1996 to 2000. Diagnostic techniques included questionnaire, clinical examination, chest X- ray, tuberculin skin test, Mycobacterium tuberculosis (MT) screening on biological fluids and tissue biopsy. Tuberculosis was diagnosed in 6 patients (11%). The disease occurred within the first two years after the beginning of hemodialysis. Initial signs were nonspecific, i.e., fever, weight loss, and cough. Tuberculin skin testing was negative in 5 cases. Tuberculosis was located in the lung in 2 cases, pleura in 2 cases, peritoneum in 1, and lymph node in 1. Isolation of the MT and confirmation by tissue biopsy was performed in only one case. Appropriate polychemotherapy was successful in 5 of 6 cases. Morbidity and mortality of tuberculosis in dialysis patients is closely related to early detection and treatment. Therapy is often based on strong presumptive evidence without definitive diagnosis.

[Clinical and evolutionary aspects of polymyosite in internal medicine]. / Aspects cliniques et evolutifs de la polymyosite en medecine interne.

INTRODUCTION: Polymyositis is a chronic inflammatory disease possibly responsable of various systemic manifestations. PATIENTS AND METHODS: Reported is a retrospective done on polymyositis i n internal medecine department in patients from march 1997 to april 2002. RESULTS: Eleven cases were collected from a total of 6739 admissions giving a prevalence of 0.16%. Sex ratio was 1.2(F/H) with a mean age of 33 years. The most frequent clinical presentation was the muscle signs. It was dominated by the functionnal disability (90.9%), myalgia (81.8%) and dysphagia (36.3%). Systemic manifestations of polymyositis interested articulary, bronchopulmonary, cardiac and neurological areas. Association of polymyositis and other sytemic disease has been found in one patient, who presented also a rhumatoid arthritis. First step treatment was corticotherapy for all patients. Immunosuppressor with azathioprine have been introduced in 2 patients who presented an associated interstitial nulmonary disease. On this treatment we observed 4 cases of total remission, 3 cases of partial remission, 2 death occured and 2 patients have been lost from clinical follow up. CONCLUSION: The long term follow of these chronic disease is a major problem in developping countries. Most of the patients live far from hospital centers and don't have possibility to do complementary exams so as to buy regulary the drugs.

[Congenital choledocal cyst of adult: report of two cases]. / Kyste congenital du choledoque de l'adulte : a propos de deux observations.

INTRODUCTION: Congenital choledochal cyst is a congenital dilatation of the biliary tract often associated with a long common bilio-pancreatic duct without obstruction. PATIENTS AND METHOD: We report the case of two women who presented a congenital choledochal cyst. RESULTS: For the first patient, the diagnosis was effected during a laparoscopic cholecystectomy for a gall bladder lithiasis. The second one presented repeted access of angiocholitis. Echography and abdominal tomodensitometry found the congenital choledochal cyst. Percutaneous opacification of the cyst found a long common biliopancreatic duct in the second patient. A complete resection of the cyst with a cholangiojejunal anastomosis was performed for both patients. The treatment was successfull for the first one and the second one was deceased three days after the operation. CONCLUSION: This case report underlines the clinical polymorphysm, the morphologic anomaly and the treatment of congenital choledochal cyst which require total resection.

[Toxoplasmosis in Dakar. Seroepidemiologic sampling of 353 women of reproductive age]. / La toxoplasmose à Dakar. Sondage séroépidémiologique chez 353 femmes en âge de procréer.

Thanks to a serological survey carried out in Dakar from January to November 1993 among 353 procreative women, immune cover regarding toxoplasmosis was assessed using ELISA methodology: 40.2% of the surveyed population had antibodies of toxoplasmosis. No evidence of age, pregnancy, number of previous pregnancies was noted in antitoxoplasmosis antibodies prevalence. The seroconversion risk seems to be low even when it has existed during pregnancy. Contamination occurred during childhood. Some sanitary education should be provided to the procreative population in order to achieve a better compliance with basic hygiene regulations during pregnancy.

[Multicentric reticulohistiocytosis with a 20-year follow-up ]. / Evolution sur 20 ans d'une réticulohistiocytose multicentrique.

INTRODUCTION: Multicentric reticulo-histiocytosis also known as lipoid dermoarthritis is a rare systemic disease leading to a massive osteoarticular destruction and systemic complications. EXEGESIS: This case report is a 44 year old black woman who was first seen with a rheumatoid arthritis clinical presentation associated with the presence of rheumatoïd factor. Five years later the diagnosis has been reconsidered after skin nodules histological examination. After that the patient has been lost from the follow up clinic. After a twenty years evolution she presented a complex clinical picture including: a cutaneous syndrome with a non pruriginous and hyperchromic papulonodular rash on the arms and fore-arms; a very destructive polyarthritis with major handicap; and systemic manifestations like cardiomyopathy with heart failure. The heart failure treatment associated first corticosteroids and secondary chloroquine was successful. CONCLUSION: The rheumatoid factor presence should not avoid to consider the possibility of multicentric reticulohistiocytosis in case of polyarthritis associated with a papulonodular rash. Then skin biopsy must be performed. The severity of osteoarticular and systemic lesions require an early prescription of a treatment for which there is so far no compromise.

[Treatment of rheumatoid polyarthritis with methotrexate in Dakar: efficacy, tolerance and cost]. / Traitement de la polyarthrite rhumatoïde par le méthotrexate à Dakar: efficacité, tolérance et coût.

Methotrexate (MTX), which has been used for years in cancer treatment, is now being proposed as a first-line treatment for rheumatoid arthritis (RA), despite its potential side effects. The aim of this study was to investigate the short-term efficacy, safety and relative cost of low-dose MTX for the treatment of RA. We carried out an open, nonrandomized trial in which patients received a 7 mg injection of MTX once per week, with clinical and biological follow up. A single physician performed the weekly assessments, which involved evaluation of the duration of morning stiffness, the number of night awakenings, the number of painful and swollen joints and Ritchie's index. Blood cell count and erythrocyte sedimentation rate were determined monthly. Twelve RA patients were enrolled in the trial, over a mean treatment period of 356 +/- 175 days. A significant improvement was observed in all variables except the number of swollen joints. Ritchie's index decreased from a mean of 31.8 +/- 11.85 to 6.5 +/- 8.98 (p<1.6 x 10- 4). Minor adverse reactions were observed but none indicated treatment withdrawal: 6 cases of nausea, 2 of a moderate increase in transaminase activity, 1 of bronchitis, in which the responsibility of MTX was not definitely established and 3 cases in which hemoglobin levels decreased. The monthly cost of the treatment, including the drug itself and laboratory tests, is lower than that of gold salt injection. Three issues of key importance in our region were investigated in this study: 1) the possible desire to become pregnant of female patients undergoing MTX treatment. In addition, some of the young and unmarried patients did not understand or appreciate the contraceptive effects of the treatment; 2) poor compliance with the treatment due to limited financial resources. Many patients did not regularly attend for their follow-up appointments and many stopped taking the medication. One third of the patients were lost to follow-up during this study; 3) the prevalence of chronic hepatitis, which may limit the use of MTX in our region. Serological tests should be performed before the treatment is started and a liver biopsy is recommended for patients with chronic hepatitis B or C.

[Seroprevalence of toxoplasmosis in Dakar (Senegal) in 1993: study of women in their reproductive years]. / Séroprévalence de la toxoplasmose à Dakar (Sénégal) en 1993: étude chez des femmes en période de procréation.

To establish the seroprevalence of toxoplasmosis in women during their reproductive years, we examined 720 women, of whom 404 were pregnant and 306 were not, all residing in and around Dakar. Of the serum tested by indirect immunofluorescence, 40.3% contained antibodies recognizing toxoplasmosis. The seroprevalence did not vary significantly with the age of the women, the number of previous pregnancies, the place of residence or the length of residence in Dakar. It was higher in the pregnant women (44.4%) than in the nonpregnant women (37.2%), but this difference is not statistically different. The titers of antibodies were generally weak, varying between 10 and 320 IU/ml of serum. Also, IgM specific antibodies were absent. These results indicate that the seroconversion had occurred previously, probably at a young age. We observed seroprevalences higher than those obtained by authors using comparable techniques twenty years ago. This indicates an increase of the transmission of toxoplasmosis in the population. Few women during their reproductive years had antibodies against toxoplasmosis. Thus, they are at risk of developing a primary infection during a pregnancy. This undergoes the necessity of promoting measures to prevent toxoplasmosis infection in pregnant women.

[Secondary hyperparathyroidism of chronic hemodialysis]. / Hyperparathyroïdie secondaire chez les hémodialyses chroniques a Dakar.

Secondary hyperparathyroidism is defined as autonomic secretion of parathormon (PTH) whose 1-84 fraction level is up to 60 ng/l. The aim of this study was to determine incidence of secondary hyperparathyroidism on patients undergoing hemodialysis in Le Dantec Hospital of Dakar, and describe its diagnostic and therapeutical aspects. Between 22 patients followed in chronically hemodialysis, 11 patients had effective blood test of parathormon. Seven of them had high level of PTH and the other had normal rate. They were 5 men and 7 women with a mean age of 56 years. The mean duration undergoing hemodialysis was 42 months. Clinical signs were rare and non specific, dominated bony pains and anemia. Ectopic calcifications had been found in 3 cases. Hypocalcemia was present in 5 cases and high level of phosphoremia in all cases. The D3 vitamin was at a normal rate in all cases up to 10 ng/ml. Calcium supplementation with 1.5 to 2.5 g/day was effective associated with rich calcium dietary. This level of calcium supplementation appeared too low even though it must be closely estimated because of the possibility of improving ectopic calcifications. At the opposite, D3 vitamin supplementation seems to be unuseful under tropical areas.

[Diabetic ketoacidosis at an internal medicine service]. / Acidocétose diabétique dans un service de Médecine Interne.

Ketoacidosis as usual inaugural manifestation and the high frequency of infectious precipating events have been reported in our department on 1986. These same aspects were found in other African series. In this retrospective study of 34 patients presenting an ketoacidosis and managed from, July 1st 2001 to December 31st 2001, we have evaluated the precipating events, and analysed the evolution in comparison with our previous study. Age range was 15 to 74 years with a mean of 43.9. Sex ratio was 2.4. Ketoacidosis inaugurated the disease in 41.17% of cases. Diabetic type 2 was the most frequent one, with an evolution mean duration of 8.1 years. The presenting picture of admission was varied. In addition to the disturbance of consciousness, dehydratation and compensatory hyperventilation were common. With 82.3% in our series versus 43.22% in previous one, infection remain the main precipating cause in our internal medicine department and in tropical area. The disease course was favorable under therapy in 32 patients (94.1%) versus 64.32% on 1986. This might be explained by the lack of hypoglycemic episodes in this present series. The average hospitalisation duration was 20 days. This fact point out the importance of diabetic patients education and screening programs.

[Portal and splenic veins thrombosis reveling a miliary tuberculosis of the liver]. / Une thrombose portale et splénique révelant une tuberculose miliaire du foie.

The etiologies of the portal vein trombosis are dominated by the neoplasic forms with hepatocellular carcinoma; we report a rare case of portal and splenic veins thrombosis revealing a liver military tuberculosis occuring in a HIV 1 infected patient. A 42 years old senegalese woman with no personal or family history of thrombosis was admitted for abdominal upper right quadran, and epigastric pain, with fever and important weight loss. Ultrasound identified endoluminal echogenic images in the portal and splenic veins. There were no lymph nodes or liver tumor. Evaluations of proteins C and S were normal and there was no anticardiolipin antibody. In searching the aetiology of the thrombosis, a liver biopsy was performed, and showed a miliary tuberculosis. an HIV 1 infection was later on diagnosed. The antituberculosis treatment associated with heparine therapy was successful, the thrombosis resolved entirely. This portal and splenic veins thromboses occuring on a miliary tuberculosis of the liver seems to be an exceptional situation. We did not found in the literature a similar case.lt points out the interset of liver biopsy in searching the aetiology and the early heparine therapy set up

[Cutaneous leishmaniasis in hospital area: epidemiological and clinical aspects, about 16 cases]. / Leishmaniose cutanée en milieu hospitalier: aspects epidémiologiques et cliniques a propos de 16 observations.

Cutaneous leishmaniasis, a chronic infectious ulcerative skin disease caused by a protozoan parasite of the genus Leishmania, is transmitted by the bite of sandflies. We report 16 cases of cutaneous leishmaniasis observed in Dakar from 1990 to 2000. The aim of this retrospective study was to determine the epidemiological and clinical features. Their age range was 10 to 78 years (mean 41.12 years). The sex ratio was 3. The most commun presentation was the ulcero-crusted lesions (bouton d'orient) observed in 56.25% of cases. The other clinical presentation are the sporotrichoid lesions (25%), the lupoid lesions observed in 12.5% and the cutaneous diffus leishmaniasis in 12.5%. In all these cases, there were many lesions. On treatment we observed 87.5% of total remission.

[Non iatrogenic primary hypothyrodism in adults at Le Dantec Hospital : clinical features, diagnosis and treatment. Review of 19 cases]. / Hypothyroïdie primaire non iatrogène de l'adulte au CHU Le Dantec: aspects cliniques, diagnostiques et thérapeutiques (a propos de 19 observations).

The authors report 19 cases of non iatrogenic primary hypothyroidism in adults at Le Dantec Hospital of Dakar. Those cases had been found during a period of 6 years and half in the internal medicine service. The aim was to study clinical features, diagnosis and outcome of patients after treatment. The mean age of patients was 42.2 years with a sex-ratio of 0.33 M/F. The diagnosis delay was around 6,1 years. All patients presented clinical signs of hypometabolism: physical asthenia (63.15%), frilosity (26.3%), bradycardia (47.3%), constipation (36.8%). The cutaneomucal syndrom was composed by myxoedema (73.6%), macroglossia (26.3%), raucousness of voice (26.3%), alopecia (57.9%). Muscle weakness was found in 2 cases and genital troubles in 3 cases. Five patients presented goiter and 9 others had spontaneous thyroid atrophy. All patients presented a high level of TSH associated with decreased level of T4. Anemia was found in 7 cases and hypercholesterolemia in 13 cases. Treatment was based on substitutive hormonotherapy with L-Thyroxin (75 to 250 microg/day). Evolution was favorable after 10 month mean duration of processing. More alertness is necessary on behalf of the practitioners in front of any sign suggesting hypometabolism to reduce the diagnostic delay and prevent complete form of hypothyroidism that might be complicated, by cardiac involvement in particular.

[Diagnosis delay of multiple myeloma: report of 22 cases in an internal medicine department of Dakar]. / Diagnostic tardif du myélome multiple: a propos de 22 observations dans un service de médecine interne a Dakar.

Reported is a retrospective study conducted on in patients with multiple myeloma diagnosed from January 1990 to December 2000 in the departement of Internal Medicine I of Dakar University Hospital. Twenty-two patients were included. The mean age was 55 years (range 29-76). The sex ratio (male to female) was 2.6 (they were 16 males and 6 females). The presenting clinical features were dominated by bone manifestations with diffuse pain (41%) followed by pathologic fractures (22.27%) and lumbar pain (13.6%). At the hospital admission the type of clinical manifestations recorded were related to bone (91% general (60%), neurologic (36%) and infection (36%). The biological exams documented an anemia in 20 cases (91%) and increased serum protein in 13 cases (59%) and hypercalcemia in 11 cases (50%) and renal insufficiency in 6 cases (27%). Immunoelectrophoresis had been performed in 6 cases and revaled 4 cases of IgG and 2 cases of light chain myeloma. On the skeletal radiological exams it has been found lytic bone lesions in 66.6 % of cases. diffuse bone rarefaction (38.88%), pathological fractures (38.88%) and vertebral collapses (18.18%). The bone marrow aspiration showed in 17 cases over 19 a medullary dystrophic plasmocytosis. According to the Salmon and Durie classification 68% of the patients were pointed in stage III. Comparing our results to the series, we figure out our patients younger at the time of the diagnosis and an important diagnosis delay as previously suggested in the African litterature. This is confirmed by the fact that 68% of patients were one Salmon and Durie stage III. the frequency of severe anemia and pathological fractures We invite practitionners to conduct systematic exploration of mild symptoms like lumbar pain.