[Adnexal masses in the Surgical Clinic of the University Hospital Center of Dakar, 74 cases]. / Les masses annexielles à la Clinique Chirurgicale du CHU de Dakar à propos de 74 cas.

The aim of this study was to assesss epidemiological, clinical and the therapeutic aspects of annexial masses. We have performed a retrospective study from 15/09/1994 up to 31/12/1997 including 74 patients. The prevalence rate was 18.40% of the overall gynecologic surgery in our department. Mean age was 36 years old. The range 30-41 years represented 40.5% of our cases. The mean gestity was 4 and the average parity 4. The most common clinical features were pelvic pains (75.57%) and hypogastric masses (50%). The duration of the disease ranged from 1 to 10 years. The general status was good in 94.59% of cases, bad with ascites in 5.41%. The annexial masses were cystic in 87.83%. The ovarian cysts were located at the both sides in 45.94, and bilateral in 8.10%. The annexial masses were solid in 9.45%. An abscess was found in 6.75%. We have performed an annexectomy in 66.1% and a cystectomy in 16.21%. The post operative complications were wound suppuration in 13.51%. The mortality rate was 1.35%. At the long-term follow up we have noticed an eventration in 1.35% and a recurrence with need of reintervention in 16.21%. The pathologic exam found a benign tumor in 95.16% and a carcinoma in 4.84%. The annexial masses are very common in our practice. They involve young multipare women. The main clinical outcome is pelvic pains. Annexectomy is the principal treatment.

[Death from ammonia poisoning: anatomo-pathologic features]. / Décès par intoxication àl'ammoniac: aspects anatomo-pathologiques.

The authors report the results of a chronological study of anatomo-pathological aspects observed in the autopsy of subjects who died after a heavy ammonia poisoning. It is about a retrospective study based on the medico-legal autopsies of 91 cases of death an industrial ammonia tank explosion which occurred inside a factory in Dakar (SONACOS), on the 24th of March 1992. The census of the dead has been made during the three months following the explosion. The victims were between 3 months and 74 years old. Among the 91 dead there were 15 women and 76 of the male sex. The recent lesions were discovered in the subjects who died during the first three days. The consisted of some extended cutaneomucous burns, a sharp lung oedema sometimes associated with a pulmonary emphysema. Later on, results show that deaths are rather caused by the after effects of a pneumopathy (pulmonary infection, bronchiectasis, pulmonary fibrosis). Ammonia belong to the irritating and caustic gas. The intensity of the lesions and the mortal risk are proportional to the quantity of gas per m3 of air. If the lesions described in our research have similarities with the published description, the latter mentions only a few cases of death. The originality of our series is particularly found in the intensity of the lesions and the number of deaths. This shows the insufficiency of both means of prevention and emergency assistance.

[Scapulo-thoracic mycetoma. A rare localization, a particular form]. / Mycétome scapulo-thoracique. Une localisation rare, une forme particulière.

INTRODUCTION: An uncommon form and a rare localization of mycetoma is reported. The aim of this report was to distinguish this inhabitual form of mycetoma from some tropical diseases like onchocerca and other fungal diseases. CASE REPORT: A 55 year old man was admitted 10 years after a septic worm-hole for a scapulo-thoracic tumor. This encapsulated mass was a bending and rounded polyfistular one attached to the dorsal aspect of left shoulder. The fistula discharge a serosanguineous or purulent exudate. The characteristic red granule was not visible. The tumor was removed and histological examination was performed. A typical granuloma of red granule of streptomyces pelletieri was found. A good result was obtained with associated cotrimoxazole treatment. DISCUSSION: Scapulo-thoracic form included: scapular, axillary and chest form of mycetoma. All these localizations are rare. One of them can be complicated by osteitis or pleuro-pulmonary localization. Streptomyces pellitieri is the actinomycetic causal agent. This encapsulated form is uncommon. CONCLUSION: Scapulo-thoracic mycetoma is rare. Encapsulated and pedicular form is uncommon. Around Sahel areas, differential diagnosis must be evoked such as parasitic and mycobacterial infections.

[Cytological detection of cervical cancer in black Africa: what are the perspectives?]. / Le dépistage cytologique des cancers du col utérin en Afrique noire: quelles perspectives?

The authors report the study of the cytological screening for cervical cancer in Africa on the basis of the experience from four West African countries (Ivory Coast, Guinea, Mali and Senegal). The study reveals that in all these countries, the yearly coverage is inferior to one cervical vaginal cytological screening per 100 women of 15 years of age and above. This rate (< 1%) is too weak to act on the rate of mortality and morbidity of cervical cancer. Consequently, the authors advise like WHO the African authorities to define and to apply cervical cancer screening programs to reach the following goal: carry out one cervical vaginal cytology in each woman near the age of 40. Cervicography can be associated.

[Cystic form of extralobar pulmonary sequestration. A propos of a case]. / Forme kystique de séquestration pulmonaire extra-lobaire. A propos d'une observation.

Case of bronchogenic cyst associated with extralobar pulmonary sequestration is presented in a 10-month-old baby. At thoracotomy, the tumor was an extralobar pulmonary sequestration with a central cyst surrounded by two pulmonary lobes vascularised by systemic vessels. Resection was easy. The cyst had a respiratory mucosa and was benign. The pathogenesis of the malformation is discussed.

[Keratosis diffusa fetalis. Apropos of 2 cases]. / Le kératome malin diffus congénital. A propos de deux observations.

Keratosis diffusa fetalis is a rare autosomic recessive disorder, in which infants are covered with large parchment-like scales, split by deep fissures. Most affected infants die a few weeks after birth because of infections and respiratory problems. The authors present the clinical, histological and ultrastructural aspects of two cases of Ichthyosis congenita fetalis observed in negro-African newborns.

[Tumor seeding of the abdominal wall after fine needle cytologic puncture of the liver. Apropos of a case]. / L'ensemencement tumoral de la paroi abdominale après cytoponction à l'aiguille fine du foie. A propos d'un cas.

Tumor seeding of the abdominal wall during fine needle puncture-aspiration of the liver is a very rare complication. The authors report a case of this complication affecting a 50-year-old Senegalese woman. She underwent echo-guided fine needle cyto-puncture of a hepatocellular carcinoma arising from the left lobe, followed by left lobectomy. The subcutaneous nodule was discovered 42 months after cyto-puncture. Histology following its excision revealed infiltration of carcinomatous hepatocytes between the fibers of rectus abdominis. There was no recurrence and the patient was well 10 months after excision of the subcutaneous nodule. With a review of 10 others cases reported in the literature, the authors feel that, although rare, this complication must be avoided and suggest a system for the protection of structures through which the needle passes.

[Arterial vascularization of the sinoatrial and atrioventricular node (preliminary study apropos of 15 anatomic parts]. / Vascularisation artérielle du noeud sino-atrial et atrio-ventriculaire (étude préliminaire à propos de 15 pièces anatomiques).

Arterial supply to the sino-atrial and atrioventricular node is studied after coronary RHODOPAS injection on 15 adult hearts taken off during autopsy. Both coronaries were injected in 7 cases, left ostium in 2 cases and the right on in 6 cases. The sino-atrial node is supplied by the right sino atrionodal artery (S.A.N.A) in 6 cases upon 7 and in 3 cases by the left S.A.N.A. Anastomoses exist in 2 cases between the right S.A.N.A. and the left S.A.N.A. The atrio-ventricular nodal artery arises from the retro-ventricular trunk branching from the right coronary artery mainly. The authors emphasize that care must be taken to protect the vascular supply to the conduction tissue during cardiac surgery.

DNA histogram typing in retinoblastomas and neuroblastomas.

The nuclear DNA content characterization was carried out by means of both DNA index and DNA histogram type assessments in a series of 21 retinoblastomas, 11 neuroblastomas, 1 ganglioneuroblastoma, and 4 medulloblastomas. These measurements were performed by means of the cytophotometric digital cell image analyses of Feulgen-stained nuclei. The results indicate that as far as nuclear DNA content is concerned, retinoblastomas seem to be very different from neuroblastomas. In fact, in terms of DNA index, retinoblastomas are significantly more aneuploid than neuroblastomas. The DNA histogram type shows that the high level of aneuploidy found in retinoblastomas corresponds to genotypically polymorphic tumors, and this could reflect a serious degeneration of the genomic material in retinoblastomas. This type of degeneration seems to be much less frequent in neuroblastomas, which basically seem to be either diploid or hypertriploid.

[Thyroid oncology in everyday practice. Apropos of 105 cases]. / L'oncologie thyroïdienne en pratique. A propos de 105 dossiers.

The charts of 105 patients treated for histologically documented nodular thyroid disease from 1976 to 1991 were analysed to determine the various diagnostic and therapeutic problems posed by the management of thyroid nodules in everyday clinical practice. The incidence of solitary nodular and multinodular disease was almost identical, 45.7% and 41% respectively. Radionucleid imaging was performed in only 61.9% (65) of patients and showed a distinct predominance of cold nodules as compared to multiheteronodular goiters, 67.7% (44/65) and 21.5% (14/65), respectively. Histological confirmation of diagnosis, obtained after fixation of the surgical specimen in paraffin, revealed a vast majority of benign versus malignant disease, 89.5% and 10.5%, respectively. 13.6% of cold nodules proved to be cancers. Extensive surgical resection either subtotal or total thyroidectomy, was performed in 41.6% of patients. Improvements in clinical practice and screening of goiters in endemic areas must contribute to a better definition of the surgical management of thyroid nodules.

[Multiple enchondromatosis of the child apropos of 2 cases]. / Enchondromatose multiple de l'enfant à propos de deux observations.

Enchondromatosis or OLLIER's disease or multiple chondromatosis can be marked in his development by features like: malignant degeneration, pathological fracture, deformity or shortening of a limb. The limb deformity like a varus knee was for our two little patients their admission motive. The varus gravity (equal to 30%) was treated by a early tibial valgus osteotomy in one case and a femoral one in the other case. We evocate the unusualness of this disease, the clinical diagnostic difficulties composed by the knee varus in childhood, at the radiographic stage those of a benignant metaphysis or metaphyso-diaphysis tumor in the same year old. We discuss the osteotomy moment, its type, its site and expose the concomitant problems composed by the shortening of the limb.

[Christopherson's tumor. Review of the literature apropos of a retroperitoneal localization]. / La tumeur de Christopherson. Revue de la littérature à propos d'une localisation rétropéritonéale.

Alveolar soft-part sarcoma is rare, and its retroperitoneal localization in psoas major muscle, exceptional. Concerning a case occurred in a young woman, the authors focus on the characters of this tumor of unknown histogenesis which affects predominantly young adults, mainly females. This disease, which symptomatology is poor and which evolution is particularly long for such a neoplasm, leads inexorably to death despite surgical treatment that represents to date, the unique efficient therapeutic modality.

[Paravesical hemangiopericytoma. Apropos of a case]. / Hémangiopéricytome paravésical. A propos d'une observation.

Paravesical hemangiopericytoma is a vascular tumour that develops at the expense of the pericyts surrounding the blood capillaries. Its dim prognosis relates to its high potential of malignancy. With respect to the first case examined at the Dakar C.H.U. (the 10th case world wide), a literature review has been done. The diagnosis is based on histology while arteriography provides guiding elements. This particular case strikes especially the young individual, with no preference for a given sex. Therapy-wise, radiotherapy seems efficient. But, surgery remains, at the moment, the choice treatment of paravesical hamangiopericytoma. It consists of a large exeresis associated with radiotherapy. Chemotherapy still hold a limited place within the therapeutic arsenal against paravesical hemangiopericytoma.

[Apropos of hepatorenal polycystic disease associated with cirrhosis]. / A propos d'une maladie polykystique hépatorénale associée à une cirrhose.

The authors report a case of association of cirrhosis with (autosomal dominant) polycystic kidney and liver disease, which is hereditary malformation. The occurrence of hepatic cysts during the disease is relatively common, and the development in general is benign. In this case, the large hepatic cysts are responsible of biliary ducts compression, with clinical and biological cholestasis. Portal hypertension like impaired hepatocellular function develop because of cirrhosis.

[Dermoid of the cornea. Report of 2 cases of Ida Mann's 2nd type]. / Dermoïdes de la cornée. A propos de deux observations du 2e degré de Ida Mann.

At the opposite of epibulbar dermoids (which are isolated or combined), dermoids of IDA MANN's second type are uncommon. The two cases reported had a big size and covered almost the cornea, without damage on the descemet's membrane, the endothelium and the other eyeball structures. This lesion is classified by the W.H.O. among choristomas. It's made of skin recovering fat which includes in different figures, hair follicle, eccrine and sweat glands. Total excision is the best treatment, but couls become complicated by cornea perforation. It could be followed in some cases by keratoplasty. Amblyopia could go with this malformation.

[Apropos of 2 cases of female genital tuberculosis discovered at operation]. / A propos de deux cas de tuberculose génitale féminine de découverte opératoire.

The authors report two cases of female, genital tuberculosis with predominantly abdominal symptomatology, which required a laparotomy. In one case, the affliction was discovered during the gynecological period, whereas the second was found during the gravidic period and led to an abortion. The authors cover the classical clinical, biological and radiological aspects of this affliction, which is still current in their region. They stress the need to intensify anti-tubercular prophylaxis as the only means of improving obstetrical prognostic for the genital localization.

[Fibrous histiocytoma of the orbit]. / A propos d'un histiocytome fibreux de l'orbite.

The authors reported a case, a large orbital fibrous histiocytoma, in a 14 year old girl. They emphasize nosologic problems and histologic aspects of this benign tumor. Because of the localisation and the size of the tumor, a double anterior orbitotomy (superior and inferior) was necessary for complete renoval. Anatomic, functional and esthetic results were satisfactory.