Dermatophytic mycetoma of the scalp due to an atypical strain of Microsporum audouinii identified by MALDI-TOF MS and ITS sequencing.

Dermatophytic mycetoma of the scalp is a rarity, especially when not associated with tinea capitis. Here, we report a case of dermatophytic mycetoma of the scalp, that was not associated with tinea capitis, caused by an atypical Microsporum audouinii strain. To our knowledge, this is the second reported case, thirty-eight years after the first that was published in 1980.

[Abscess of the posterior cranial fossa. Report of 4 cases]. / Les abcès de la fosse cérébrale postérieure à propos de 4 cas.

The posterior cerebral fossa is an uncommon location for cerebral abscess. In most cases diagnosis is made at the encapsulation stage with the risk of life-threatening tonsillar herniation. The purpose of this retrospective study was to describe our experience in the management of four cases of abscess located in the posterior cerebral fossa between January 2000 and December 2004. All patients benefited from clinical examination and radiological study (CT-scan). Surgical treatment performed in all cases consisted of trepano-puncture of the abscess. The minimum duration of post-operative follow-up was 6 months. Mean patient age was 38.75 years. All patients presented infectious syndrome and intracranial hypertension. The male:female sex ratio was 3:1. A history of chronic middle ear otitis was noted in two patients. Diagnosis of abscess in the posterior cerebral fossa was confirmed by CT-scan in 2 cases. Cholesteatoma and triventricular hydrocephaly were noted in 2 cases. All patients benefited from trepano-puncture of the abscess. Bacteriologic study of pus was positive for Staphylococcus aureus in 1 case, and Providencia Sp associated with Bactéroïdes fragilis in another. Second-stage radical mastoidectomy was performed in 2 cases. One patient died. The outcome was favorable in 3 cases. Because of the small size of the posterior cerebral fossa, abscess in that location requires emergency treatment. Delay can be life-threatening due to the risk of obstructive hydrocephaly and tonsillar herniation.

Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study.

A door-to-door survey was used to determine the prevalence of epilepsy among 4500 people within the Pikine Health District (population 480,000) Senegal. Prevalence was 14.2/1000, and 23.4% of all people with epilepsy had never received appropriate treatment. Figures for the prevalence had increased since a previous survey in 1989. In parallel a study of knowledge attitude and practice was performed in the same district. Salient findings were that: two-thirds of interviewees had at some time witnessed a seizure, 51% agreed when asked if epilepsy is caused by evil spirits, 35% said epilepsy is contagious, only about 18% said that traditional therapy is best, 60% would not mind their child to play with a child with epilepsy but only 32% would agree if their child would want to marry a person with epilepsy.

[Risk behavior associated with the manipulation of dental amalgam in Senegal]. / Etude des comportements à risque liés à la manipulation des amalgames dentaires au Sénégal.

Dental amalgam is a combination of mercury, silver, tin and copper used in the treatment of the dental decays. Amalgam is used in dentistry since many years. Actually a large discussion held according to environmental pollution and risk of intoxication for the patient and the dentist himself. The aim of our survey concerning 103 dentists was to determine the quantity of mercury used in a year, to see the risks linked with the equipment and the manipulation of amalgam and to study the incoming of the trashes of amalgam. Our results showed that among the dentists: 44.66% used 250 to 500 g of mercury by year, 14.56% used their hands for insertion of amalgam in the cavities, 10.68% used their hands for condensation of amalgam in the cavities, 87.38% throw their amalgam on the trash.

Traumatic right diaphragmatic hernia in children: Diagnostic difficulties.

Traumatic right diaphragmatic hernia is rare in children. Its diagnosis can be difficult in the acute phase of trauma because its signs are not specific, especially in a poly trauma context. We report two cases of traumatic right diaphragmatic hernia following a blunt thoraco-abdominal trauma, highlighting some difficulties in establishing an early diagnosis and the need for a high index of suspicion.

[Urological emergencies in paediatric surgery: a survey of 40 cases]. / Les urgences urologiques en chirurgie pediatrique: a propos de 40 cas.

AIMS: The objective of this study is to report our experience on the epidemiology of urological emergencies in pediatric surgery, and to analyze the diagnosis and therapeutic process. MATERIALS AND METHODS: It was a prospective survey which was carried out between January 2010 and June 2011 in the pediatric service of Aristide Le Dantec Hospital (HALD). All the children who came for a urological emergency consultation were included in the study. THE RESULTS: the urological emergencies accounted for forty cases which represented 2.57% of pediatric surgery emergencies. The average age of our patients was 4.5 years with extremes of 10 days and 15 years of age. 29 cases of severe big bursae were observed and among them there were strangulated hernia and ten cases of suspicious spermatic cord torsion. The other admission motives consisted of three cases of urine retention, two pyelonephritis cases, two cases of post circumcision glans sections, two paraphimosis cases, one tight phimosis case, one case of penis traumatism provoked by a game incident. The scrotum ultrasound performed on six patients helped find out a specificity of 66.6%. 60% of strangulated hernia have been reduced through under sedation taxis. In case of confirmed torsion, a detorsion followed by an orchidopexy were performed. Two orchidectomy were performed for a testicular necrosis. CONCLUSION: the painful big bursa is the number one cause for a urology pediatric consultation. It implies a fast and adequate diagnosis and treatment so as not to miss a digestive or testicular pain.

BUTS: Rapporter notre expérience sur l'épidémiologie des urgences urologiques en chirurgie pédiatrique, d'analyser la prise en charge diagnostique et thérapeutique. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude prospective réalisée dans le service de chirurgie pédiatrique de l'hôpital Aristide Le Dantec de Dakar (HALD), de janvier 2010 à juin 2011. Tous les enfants reçus pour une urgence urologique ont été inclus. RÉSULTATS: Les urgences urologiques représentaient 2,57% des urgences chirurgicales pédiatriques. L'âge moyen des patients était de 4,5 ans avec des extrêmes de 10 jours et de 15 ans. Nous avons noté 29 cas de grosses bourses aigues dont 15 hernies étranglées et 10 suspicions de torsion du cordon spermatique. Les autres motifs d'admission étaient représentés par 3 cas de rétentions aigues d'urine, 2 cas de pyélonéphrites, 2 cas de sections de gland post circoncision, 2 cas de paraphimosis, 1 cas de phimosis serré, 1 cas de traumatisme pénien. L'échographie scrotale réalisée chez 6 patients avait une spécificité de 66,6%. Soixante pour cent des hernies compliquées ont été réduites par taxis sous sédation. Deux orchidectomies ont été effectuées pour nécrose testiculaire. CONCLUSION: la grosse bourse aigue est le 1er motif de consultation en urologie pédiatrique. Elle implique une prise en charge rapide et adéquate pour ne pas passer à coté d'une souffrance testiculaire ou digestive.

[Tinea pedis due to Fusarium solani in Dakar]. / Intertrigo interorteils à Fusarium solani à Dakar.

A patient presented with intertrigo at the second, third and fourth interdigitals spaces lasting for four years in which Fusarium solani was highlighted. The search for contributing factors revealed a concept of foot washing with water at least five times a day for ablutions, associated with wearing closed shoes all day and the absence of immunosuppression and diabetes. The diagnosis of Fusarium was made on the basis of direct examination and culture. Combined treatment with griseofulvin oral and topical ciclopirox was introduced and allowed healing after 45 days at which an antifungal powder was prescribed for relay. This case adds to the rare cases of intertrigo Fusarium sp. and confirms the frequent practice of ablutions as favoring factor.

[Nondermatophytic and noncandidal fungi isolated in Le Dantec University hospital of Dakar in 2014: Epidemiological, clinical and mycological study]. / Champignons non dermatophytiques et non candidosiques isolés au CHU Le Dantec de Dakar en 2014 : étude épidémiologique, clinique et mycologique.

In recent years, the incidence of superficial fungal infections involving nondermatophytic and noncandidal fungi increased considerably. The objective of this work was to analyze the epidemiological, clinical and mycological fungal infections due to nondermatophytic and noncandidal fungi diagnosed in the laboratory of parasitology-mycology of Le Dantec hospital in Dakar. With a retrospective study of the various cases of nondermatophytic and noncandidal fungi isolated in the laboratory of parasitology-mycology during the period of November 2013 to December 2014, we collected 22 cases of infections in 11 men and 11 women; age ranging from 17 to 75 years with a mean of 45.3 years (sex ratio=1): eight cases of intertrigo, seven cases of onychomycosis, four cases of palmoplantar keratoderma (KPP), a case of onychomycosis associated with interdigital intertrigo, a case of infectious myositis and one case of African histoplasmosis. We have isolated and identified a total of 22 nondermatophytic and noncandidal fungi: ten Fusarium, five Trichosporon, two Chrysosporium, two Geotrichum, one Rhodotorula, one Neoscytalidium dimidiatum and one Histoplasma capsulatum var. duboisii. So we are seeing the emergence of nondermatophytic and noncandidal increasingly isolated from superficial and local lesions. These fungi, generally contaminants or commensal, cause a problem regarding their direct involvement in pathological processes in which they are isolated. So we should respect the recommendations proposed for their involvement in pathological processes and, by a collaboration between clinician and biologist, demonstrate their real involvement through effective, targeted treatment.

[Epidemiological profile of Tinea capitis in Dakar (Senegal). A 6-year retrospective study (2008-2013)]. / Profil épidémiologique des teignes du cuir chevelu à Dakar (Sénégal). Bilan d'une étude rétrospective de six ans (2008-2013).

INTRODUCTION: Tinea capitis is considered as a public health problem in Senegal. The aim of this study was to investigate trends in the incidence, the mycological and epidemiological aspects of tinea capitis diagnosed at Le Dantec Hospital in Dakar. METHOD: Our work is a retrospective study concerning all scalp samples taken by the parasitology laboratory, over a 6-year period (2008-2013). RESULTS: A total of 1640 specimens were examined. Of these, 566 were positive with direct examination and after culture. We noted the reduction of patients and of the incidence of tineas during 6 years with variations of 147 (46.82%) to 37 (22.02%). The average incidence of the tineas during six years was 34.51%. Patients' age varied between 1 to 83 years with a mean of 27.33 years. Prevalence varied between age groups, with 10.61 % in adults between 20 to 29 years, 7.19% in children between 0 to 9 years, 6.04% between 10 to 19 years, and 5.91% in adults between 30 to 39 years. Women were more infected 469 (82.9%) than men 97 (17.1%). The main dermatophytes isolated were: T. soudanense in 318 cases (56.18%), T. rubrum in 104 cases (18.37%), M. langeronii in 72 cases (12.72%), M. canis in 36 cases (6.36%), and T. mentagrophytes in 26 cases (4.60%). CONCLUSION: Our study showed a decrease in the annual incidence of tinea capitis over the study period with an evident increase in trichophytic tinea. This study showed that tinea is endemic in Senegal mainly among women between 20 and 29 years.

[Keratomycosis due to Fusarium oxysporum treated with the combination povidone iodine eye drops and oral fluconazole]. / Kératomycose à Fusarium oxysporum traitée par l'association de la povidone iodée en collyre et du fluconazole per os.

In developing countries where systemic antifungal are often unavailable, treatment of filamentous fungi infection as Fusarium is sometimes very difficult to treat. We report the case of a keratomycosis due to Fusarium oxysporum treated by povidone iodine eye drops and oral fluconazole. The diagnosis of abscess in the cornea was retained after ophthalmological examination for a 28-year-old man with no previous ophthalmological disease, addressed to the Ophthalmological clinic at the University Hospital Le Dantec in Dakar for a left painful red eye with decreased visual acuity lasting for 15 days. The patient did not receive any foreign body into the eye. Samples by corneal scraping were made for microbiological analysis and the patient was hospitalized and treated with a reinforced eye drops based treatment (ceftriaxone+gentamicin). The mycological diagnosis revealed the presence of a mold: F. oxysporum, which motivated the replacement of the initial treatment by eye drops containing iodized povidone solution at 1% because of the amphotericin B unavailability. Due to the threat of visual loss, oral fluconazole was added to the local treatment with eye drops povidone iodine. The outcome was favorable with a healing abscess and visual acuity amounted to 1/200th. Furthermore, we noted sequels such as pannus and pillowcase. The vulgarization of efficient topical antifungal in developing countries would be necessary to optimize fungal infection treatment.

[A free meningioma of the cauda equina]. / Méningiome libre de la queue de cheval.

We report an unusual case of a cauda equina meningioma occurring in a young girl. This tumor was neurinoma-like. No meningeal attachment was identified in the neuroradiological study and during its microsurgical removal.

[Meningioma of the floor of the temporal fossa. Anatomo-clinical study of 11 cases]. / Méningiomes du plancher de la fosse temporale. Etude anatomo-clinique à propos de 11 cas.

The authors present eleven cases of middle fossa floor meningiomas. They describe the anatomical and clinical features of these tumors in this rare localisation. They emphasize the strait anatomical relations with the cranial base, eight cases were inserted above the superior surface of the petrous bone, two above the endocranial face of the horizontal part of the greater sphenoid wing, one above the horizontal part of the temporal squama. Headache (6 cases) and memory loss (4 cases) are the most frequent clinical feature, seizures (2 cases) and neuropsychologic troubles were probably undervalued. Auditory signs were present in three cases. There was no visual defect and cranial nerve impairment. They insist on the necessity to obtain a complete preoperative temporal bone CT scan exploration. They think that a well advised surgical act is sufficient for these meningiomas inserted above weak structures and with good prognosis: there's no recurrence in this study with a follow up from 12 to 132 months.

[Meningeal hemangiopericytomas. A retrospective reciew of 20 cases]. / Hémangiopéricytomes méningés. Revue rétrospective de 20 cas.

BACKGROUND AND PURPOSE: Meningeal hemangiopericytomas (MHP) account for 2% of meningeal tumours. Clinical features, radiology findings, therapy and outcome of 20 MHP operated in our department from 1965 through 1995 were analyzed to determine presurgical features for diagnosis, histologic diagnostic criteria and the role of adjuvant post-operative radiotherapy. METHODS: In conformity with the new WHO classification which differentiates MHP from meningiomas, 20 patients with tumors compatible with this definition were reviewed. RESULTS: The clinical features differed slightly from meningiomas. Only epidemiologic data were different. The CT and MRI scanning gave no preoperative distinction between MHP and meningiomas. Angiography played a predominant role in this distinction. The 20 patients were operated. Twelve received post-operative radiotherapy. The rate of local recurrency was 45%. Of these, 88% did not receive radiotherapy post-operatively. Two patients (10%) presented late recurrence and three patients (15%) one or more extra-neural metastases. Two patients received radiosurgical treatment. In one case with disseminated metastasis, chemotherapy was used without success. Three patients died during the follow up. CONCLUSION: Considering our review and the current literature, it seems that complete excision followed by adjuvant radiotherapy of more than 50 Gy significatively reduces the risk of recurrence (p < 0.0001). Radiosurgery is indicated for recurrent tumors measuring less than 30 mm in their greatest diameter.

[Expulsive hemorrhage (report of 2 cases)]. / L'hémorragie expulsive (à propos de 2 cas).

Two cases of expulsive haemorrhage consecutive to an operation of intumescent cataract responsible of major ocular overpressure (60 and 70 mmHg) are reported by the authors. No other risk factor has been found in our patients, one of 45 years old and the other 72 years old. First nor the operative wound suture neither the posterior sclerotomy were stitched, because of the inability to discover the site of choroidal haematoma with quat amount of blood in the operative field. The second reason was the use of an inadequate material of suture (vicryl 9/0). Finally both cases presented were eyes without any light perception. The final phase results in phtysis phenomena.

[Child cerebellar meningioma. A case report]. / Le méningiome cérébelleux "intra parenchymateux" de l'enfant: a propos d'un cas.

Meningioma is an uncommon tumor of childhood. In this group, supra tentorial forms predominate. We report the case of a 14 years old boy without any past medical history. He presented headaches, vomiting and cerebellar syndrome. CT scan shows cerebellar tumor, enhanced by contrast and surrounded by edema, looking like tuberculoma. After fail of tuberculosis treatment, the boy is operated by suboccipital approach. Histology and immuno histochemical examination show fibroblastic meningioma. Even if it is rare, meningioma can occur in childhood, without neurofibromatosis disease. It can present many points of likeness with tuberculoma and therefore biopsy is mandatory before tuberculosis drugs giving.

[Evolutive fractures of the skull]. / Les fractures évolutives du crâne.

The growing fractures of the skull rarely complicate head traumatism among infant and new born. 6 cases have been observed out of 552 fractures of the skull (1.09%) during 10 years from 1979 to 1988 at the neurosurgical clinic of Dakar University Teaching hospital. The patients age varies from 8 months to 21 years. The delay between traumatism and the diagnosis of growing fractures ranges from 18 days to 8 years. The primary fracture can be detected by a skull radiography which allows also to follow the evolution. It can be completed by making a translacuna echography, a non invasive method of investigation easily realisable thanks to the existence of a skull lacuna which constitute a real acoustical window. This type of investigation has been worked on deux patients. Essentially porencephalic forms have been noticed (5 cas). Three have been successfully operated out of four patients, two patients have spontaneously performed evolutions towards the stabilisation of the lesions. The prognosis of the affection is tightly linked with the associated brain injuries.

[Ocular manifestations of AIDS in Dakar]. / Manifestations oculaires au cours du SIDA à Dakar.

In this prospective study undertaken between november 1989 and december 1991, the authors report their observations of ocular lesions seen in a cohort of 67 AIDS patients hospitalised in the Infectious Diseases department CHU Fann Dakar. Ocular lesions were discovered in 52.23%. These lesions were observed in both HIV-1 and HIV-2 positive patients, however they were much more common in the former group (77.14%). Rétinal pathology was by far the most frequently observed (63%) and yet classic retinis was not discovered in our series. We feel that the ophtalmologist should play a key role in the routine care of AIDS patients especially in surveillance of retinal changes.

PIP: During November 1989 to December 1991 in Senegal, physicians regularly followed 67 HIV infected patients aged 20-76 (46 men and 21 women) who had been admitted to Fann University Hospital in Dakar. The HIV infection had progressed to AIDS in all but one case. 52.33% had ocular lesions, of which the most frequent were cotton-like nodules (14.2%), retinal bleeding and Roth's spots (8.5%), and ophthalmic herpes zoster (8.5%). Most lesions (63%) were located in the retina. Yet, there were no cases of classic retinitis. Among 21 AIDS patients with a known lymphocyte count, 62.5% of those with a CD4 count of less than 200 had a normal ophthalmological examination. Patients with CD4 counts between 0 and 200 had macular edema, hyalitis, cotton-like nodules, retinal uveitis, and microangiopathy, while those with higher CD4 counts had none of these ocular lesions. Patients with CD4 counts greater than 400 had conjunctivitis (one case, Kaposi sarcoma-related conjunctivitis), ophthalmic herpes zoster, and ocular dryness. The only ocular lesion in patients with CD4 counts between 200 and 400 was ophthalmic herpes zoster. 77.14% of HIV infected patients with ocular lesions were infected with HIV-1. The three ophthalmic herpes zoster cases were less than 30 and homosexual. During the two years of follow-up, only one case died. Based on these findings, the authors suggest that ophthalmologists should systematically be involved in the routine care of AIDS patients, particularly by screening for changes in the retina.

[Essential atrophy of the iris apropos of 1 case]. / Atrophie essentielle de l'iris a propos d'une observation.

The authors report a case of bilateral essential iris atrophy syndrome in a twenty two years old man associated with unilateral cataract and glaucoma. They stress the rarity of the syndrome (first case in their section) and the uncommon bilateral case. The cataract unusually described in the syndrome would be directly linked to the important and durable ocular hypertension.

[Congenital glaucoma (apropos of 58 cases)]. / Les glaucomes congénitaux (à propos de 58 observations).

In a retrospective study on 10 years, the authors analyse epidemiological clinical and therapeutic aspects of congenital glaucoma. From 1979 to 1989, 58 cases of congenital glaucoma were found in children between 0 and 12 years, of which 53 bilateral and 5 unilateral cases (111 eyes). The frequency of 0.10% is considered high. According to studies carried out by Europeans, it is estimated between 0.01 and 0.024%. The authors stressed the important rate of consanguinity (46.5%) and masculine prevalence (74.1%). Disappointing therapeutic results and bad prognostic depend on the advanced cases of clinical forms found during the first consultation. The authors advocate preventive measures by genetic counsel and an early surgical treatment for best functional results.

[Our experience with laminectomy in the treatment of spinal cord disease caused by cervical arthrosis: apropos of 42 cases]. / Notre expérience de la laminectomie dans le traitement de la myélopathie par arthrose cervicale: àpropos de 42 cas.

Cervical spondylotic arthRosis may lead to a myelopathy and the question which can rise is: posterior surgical decompression is adequate regarding the others surgical technics discussed? In this paper the authors describe the postoperative results of 42 patients who have been operated on by laminectomy from 1971 to 1995 at Fann Hospital in Dakar. The median age was 42 years and the median delay between the onset of neurological disorders and operation was 5.9 months. All patients showed symptoms of spinal cord and root disturbances. Neuro-imaging studies with plan X-rays and myelography reveal arthrosis and the impact of this arthrosis on nervous system. With a follow up of 6 months we found a mortality rate of 4.7% (two cases of death), 66.8% of good results and 28.5% of fail. Eighteen months post surgery results were respectively 52.3% and 45.7% of good and poor results. The complications of the laminectomy were peri operative hemorrhage (19%); sepsis (21.4%); spine cord traumatic injuries (9.5%) spondylolisthesis (4.7%). Laminectomy has been found to improve "spine syndrome"; paresthesia; fasciculations, and sensory deficits. Also three level laminectomy and surgery which can take place before six months are good prognosis factors. The authors stressed on laminectomy because of our low medical care situations particularly that no other surgical procedures through the modern literature leads to better results.