[Hepatocellular carcinoma (HCC) observed in Abidjan: aspects and role of ultrasonography]. / Carcinomes hépatocellulaires (CHC) observés a Abidjan: aspects et place de l'échographie.

In this retrospective study, we define the localization and ultrasound appearances of hepatocellular carcinomas observed in Abidjan. The study included 31 inpatients (23 males and 8 females), aged from 24 to 76 years (mean, 47.4). All patients had serum alphafetoprotein dosage and 21 patients had cytologic examination. Diagnosis was based on a high level of serum alpha-fetoprotein (> 500 ng/ml), with or without cytological proof. Tumor characteristics (size, number, echogenicity, nodular or diffuse form) and associated extratumoral signs were noted. Ultrasound identified 19 cases of small tumors (size < 5 cm), and 12 large tumors (size > or = 5 cm). The tumor forms were mostly nodular and multiple (24 cases), solitary nodule (3 cases), diffuse or infiltrative (4 cases). The liver was heterogeneous with hyperechoic tumoral nodules (16 cases), hypoechoic tumoral nodules (5 cases), hyperechoic and diffuse form (4 cases), and 2 cases of mixed form. We have noted a particular form in 4 cases represented by a heterogeneous liquid-like mass simulating tropical abscesses. Ascites (12 patient) was the most common extratumoral sign. Portal vein invasion or thrombus was rare (3 patients). Of the 31 patients, ultrasound was abnormal in all cases, alpha-fetoprotein test was positive in 12 cases (57.14%) and negative in 9 cases (42.8%). Cytological test was positive in 17 cases (80.95%), and negative in 4 cases (19.04%). Alphafetoprotein and cytologic tests were both positive in 8 cases and, nonconcordant in 13 cases; in 4 cases alphafetoprotein was positive while cytological tests were negative and, in 9 cases alphafetoprotein was negative while cytological tests were positive. Two negative tests were never observed. In Abidjan, hepatocellular carcinomas are commonly small or large, multinodular and hyperechoic tumors contrasting with the small nodular and hypoechoic tumors usually reported in western series. Ultrasound associated with cytologic examination, appears to us to be more usefulness than alphafetoprotein dosage in the diagnosis of hepatocellular carcinoma.

[Chronic calcifying pancreatitis in hospitals in the Ivory Coast]. / Pancréatite chronique calcifiante en milieu hospitalier en Côte d'Ivoire.

The authors report on 34 cases of chronic calcifying pancreatitis in Ivory Coast. Chronic calcifying pancreatitis is rare (0.24 P.C. of admitted patients) and appears mainly in man 40 years old, revealed by diabetes (73.5 P.C.). Principal aetiology was alcoholism, 50 P.C. Genuine tropical chronic calcifying pancreatitis exists in small number. It seems its physiopathological mechanism is not only nutritional.

[Colonic transit time in healthy Ivorian subjects]. / Détermination du temps de transit colique de sujets ivoiriens sains.

Colonic transit time (CTT) values obtained from healthy Western populations cannot be applied to the population of the Cote d'Ivoire, whose diet is very different. We report the first study of CTT among healthy Ivorian volunteers. This study included 20 healthy Ivorian volunteers (16 men, 4 women, mean age: 25). None was constipated, and all had at least three stools a week. They took no medication and presented no diseases that might affect their digestion. Vegetable fiber was not added to their diet. CTT was assessed according to the method described by Chaussade and al. in 1986: Subjects ingested three types of radiopaque markers in soluble medication capsules at fixed hours for three successive days; plain abdominal radiography was performed on days four, seven, and, if markers remained in the colon on day seven, again on day ten. The plain abdominal radiographs were divided into three parts, representing the right, left and rectosigmoid colons, and radiopaque markers were counted in each segment. CTT was calculated according to Arhan's formula. Mean values (m+/-SD) for CTT were 8.94+/-5.76 hours in the right colon, 12.6+/-8.29 hours in the left, 14.4+/-5.45 hours in the rectosigmoid and 34.94+/-15.09 hours for the entire colon. The corresponding upper limits (M + 2DS) for each segment were 20, 29, 25, and 65 hours. These results suggest the specificity of CTT in healthy Ivorian subjects. CTT norms obtained from healthy Caucasian subjects must not be used to assess CTT in Ivorian patients with constipation.

Exocrine pancreatic function of children from the Ivory Coast compared to French children. Effect of kwashiorkor.

One hundred nineteen children, either French or from the Ivory Coast, aged 1-8 years, were submitted to pancreatic function testing by duodenal aspiration. Trypsin, chymotrypsin, lipase, phospholipase, amylase, volume, bicarbonate, chloride, and calcium were estimated before and after an intravenous injection of 1 CU secretin + 3 CHR units pancreozymin per kilogram of body weight. Sixty-two patients were normal European children, and 11 were normal African children. Twenty-five African children presented with kwashiorkor and 10 African children had presented with kwashiorkor but had recovered at the time of the test. Three cases of recurrent kwashiorkor are also included. In the normal group of African children, phospholipase concentration, volume, and bicarbonate were significantly decreased but chymotrypsin and trypsin concentrations were not, when compared to the normal European population. In kwashiorkor patients, lipase, amylase, phospholipase, and chymotrypsin concentration were significantly decreased compared to normal Africans. Trypsin, volume, and bicarbonate were not affected. These modifications disappeared after refeeding. In cases of recurrent kwashiorkor, all enzymes, including trypsin, were decreased. Calcium was never modified. These modifications were very different from those observed in chronic alcoholic and hypercalcemic pancreatitis. In a two-year study, chronic calcifying pancreatitis (CCP) was diagnosed in 14 patients (13 males), hospitalized in Abidjan. The mean age at onset of the disease was 41 years (SD 12.71), which is very similar to European cases. The most frequent cause was alcoholism, as in Occidental countries. The nutrition of the population was low in protein, calories being provided mostly by manioc, but no apparent symptoms of malnutrition were observed in the parents of our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of the presence of Australia antigen in liver diseases seen in a department of internal medicine in Abidjan]. / Réflexions sur la signification de la présence de l'antigène Australia dans les hépatopathies observées dans un service de médecine interne à Abidjan.

The exact responsibility of the hepatitis B virus in hepatic diseases seen in Ivory Coast is difficult to specify for several reasons, particularly technical ones. Nevertheless, we have tried to determine the prevalence of the HB virus in hospital practice and in patients hospitalized for liver diseases (viral hepatitis, cirrhosis, primary liver cancer). Comparison of the results to the prevalence of the virus in the ivorian population and statistical processing has led us to moderate the influence of HB virus in the different hepatic disorders. In primary liver cancer, the role of aflatoxine whose carcinogenic potential is now well established has not been disproved.

Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1-infected adults in Abidjan, Côte d'Ivoire: a randomised trial. Cotrimo-CI Study Group.

BACKGROUND: In sub-Saharan Africa, various bacterial diseases occur before pneumocystosis or toxoplasmosis in the course of HIV-1 infection, and are major causes of morbidity and mortality. We did a randomised, double blind, placebo-controlled clinical trial at community-health centres in Abidjan, Côte d'Ivoire, to assess the efficacy of trimethoprim-sulphamethoxazole (co-trimoxazole) chemoprophylaxis at early stages of HIV-1 infection. METHOD: 843 HIV-infected patients were screened and 545 enrolled in the study. Eligible adults (with HIV-1 or HIV-1 and HIV-2 dual seropositivity at stages 2 or 3 of the WHO staging system) received co-trimoxazole chemoprophylaxis (trimethoprim 160 mg, sulphamethoxazole 800 mg) daily or a matching placebo. The primary outcome was the occurrence of severe clinical events, defined as death or hospital admission irrespective of the cause. Analyses were by intention to treat. FINDINGS: Four of the randomised patients were excluded (positive for HIV-2 only). 120 severe events occurred among 271 patients in the co-trimoxazole group and 198 among 270 in the placebo group. Significantly fewer patients in the co-trimoxazole group than in the placebo group had at least one severe event (84 vs 124); the probability of remaining free of severe events was 63.7% versus 45.8% (hazard ratio 0.57 [95% CI 0.43-0.75], p=0.0001) and the benefit was apparent in all subgroups of initial CD4-cell count. Survival did not differ between the groups (41 vs 46 deaths, p=0.51). Co-trimoxazole was generally well tolerated though moderate neutropenia occurred in 62 patients (vs 26 in the placebo group). INTERPRETATION: Patients who might benefit from co-trimoxazole could be recruited on clinical criteria in community clinics without knowing the patients CD4-cell count. This affordable measure will enable quick public-health intervention, while monitoring bacterial susceptibility and haematological tolerance.