Dépistage de l'artérite des membres inférieurs chez les patients ayant un pied diabétique en attente d'une chirurgie à cotonou

Objectifs : L'étude a été initiée afin de dépister l'artérite des membres inférieurs chez les patients ayant un pied diabétique. Méthodologie : L'étude est transversale, descriptive et analytique. La population d'étude est consti-tuée des diabétiques hospitalisés pour pied diabétique au CNHU-HKM de Cotonou. L'artérite des membres inférieurs est dépistée par l'échodoppler artériel.Résultats : l'artérite des membres inférieurs a été dépistée chez159 patients soit uneprévalence de 80,76%. Les facteurs associés à l'artérite sont la durée de dépistage du diabète d'au moins 10 ans, l'hypertension artérielle, les signes d'ischémie etl'absence du pouls pédieux.Conclusion : l'artérite des membres inférieurs chez les patients ayant un pied diabétique est fré-quente. Le dépistage systématique de l'artérite est fortement recommandé en cas de lésion du pied chez les diabétiques

Evaluation de l'observance thérapeutique chez les diabétiques au Bénin

Introduction : Le diabète sucré est devenu un véritable problème de santé publique par sa prévalence sans cesse croissante et ses complications redoutables. Malgré les efforts dans la prise en charge des diabétiques, on remarque que le diabète n'est pas équilibré chez la majorité de nos patients. D'où l'importance de cette étude qui a pour objectif d'évaluer l'observance thérapeutique chez nos patients diabétiques au Bénin.Patients et méthodes : Il s'agit d'une étude prospective et transversale. Les patients ont été recrutés dans deux centres (Cotonou et Porto-Novo) de prise charge du diabète. Il s'agit du Centre de dépistage, de traitement et de suivi des diabétiques "Banque d'Insuline" de Cotonou et du Service de médecine interne du Centre Hospitalier Universitaire Départemental de l'Ouémé-Plateau (CHUD-OP). Cette étude s'est déroulée sur une période de sept mois allant du 2 mars au 16 septembre 2015. L'observance thérapeutique a été évaluée grâce au questionnaire TEO de GIRERD. Seule l'observance médicamenteuse a été évaluée dans ce travail.Résultats : Au cours de la période d'étude allant du 2 mars au 16 septembre 2015 soit une durée de 7 mois nous avons recruté 330 patients diabétiques. L'âge moyen des patients était de 54,67 ± 12,69 ans avec des extrêmes de 12 et 87 ans. Les femmes étaient majoritaires (70%), soit une sex-ratio de 0,43. Il y avait 97,0% de diabétiques de type 2 ; 1,8% de type 1 et 1,2 % de diabète secondaire. La majorité des patients (77%) avait un diabète déséquilibré (HbA1c ≥ 7%). Les diabétiques hypertendus représentaient 56,1% de la population d'étude. Seuls 9,1% des patients avaient une bonne observance thérapeutique selon le questionnaire de Girerd ; 71,2% avaient un minime problème d'observance ; et 19,7% avaient une mauvaise observance. Seuls le revenu mensuel, le type de diabète (le type 2) et l'hypertension artérielle étaient identifiés comme facteurs favorisant l'inobservance médicamenteuse chez nos patients diabétiques.Conclusion : L'observance thérapeutique est mauvaise chez nos patients diabétiques. D'où l'importance de l'éducation thérapeutique au cours des consultations de diabétologie

Glucose Tolerance in Non-Diabetic Adult Subjects of an Urban West-African Population.

The present study was carried out to determine glucose tolerance and insulin sensitivity in adult subjects of a west African population. 103 subjects recruited in the town of Cotonou were included in the study. After anthropometric measurement, they were subjected to an oral glucose tolerance test (OGTT). Serum glucose and insulin levels were determined throughout the OGTT. Homeostatic model of assessment of insulin resistance (HOMA-IR), MATSUDA insulin sensitivity index (MATSUDA-ISI) and insulinogenic index (IGI) have been determined to evaluate insulin sensitivity and beta cells function. Normal glucose tolerance (NGT), isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined glucose intolerance (CGI) were observed in respectively 53.40%, 1.94%, 35.92% and 8.74% of subjects. The prevalence of IFG and or IGT (IFG/IGT) was higher in obese subjects (66.67%) than in subjects with normal BMI (41.17%). Fasting hyperinsulinemia was observed in 82% of subjects. Mean values of HOMA-IR were not significantly different in NGT (6.86 ± 0.7) and in IFG/IGT subjects (7.47 ± 0.57). In contrast to HOMA-IR, mean value of Matsuda-ISI was significantly lower in IFG/IGT than in NGT subjects (1.47 ± 0.1 versus 1.96 ± 0.13, p<0.01). Matsuda-ISI values were also significantly lower in obese subjects (1.33 ± 0.12) than in subjects with normal BMI (1.93 ± 0.13). The mean insulinogenic index value in IFG/IGT subjects (42.5 ± 4.36) was not significantly different of that in NGT subjects (50.3 ± 5.21). These data show that the glucose tolerance disorders observed in subjects of the present study are more related to a decrease in insulin sensitivity than to an alteration of the beta cells function.

[Perceptions and practices of people with diabetes to diabetes mellitus at the Centre National University Hospital Hubert Maga Koutoucou Cotonou]. / Perceptions et pratiques des diabetiques face au diabete sucre au Centre National Hospitalier et Universitaire Hubert Koutoucou Maga (CNHU-HKM) de Cotonou.

OBJECTIVES: The study was initiated to assess patient knowledge about diabetes mellitus, identify food claims and finally to identify the daily practices. MATERIEL AND METHODS: The study was sectional and descriptive. The study population consists of diabetic seen in CNHU-HKM the outpatient Cotonou. Data collection is done by a questionnaire. RESULTS: Deficiencies were noted in knowledge of patients on diabetes mellitus.Several allegations have been identified. Patients think that the diabetic should not eat fruits, rice or corn dough. The practice of physical activity is low. Difficulties were encountered preventing compliance with diet, the practice of physical activity and glycemic control. CONCLUSION: Of challenges remain to improve the knowledge, attitudes and practices of patients. Therapeutic education is necessary for all diabetics.

BUT: L'étude a été initiée afin d'apprécier les connaissances des patients sur le diabète sucré, de recenser les allégations alimentaires et enfin d'identifier les pratiques quotidiennes. MATÉRIEL ET MÉTHODES: L'étude est transversale et descriptive. La population d'étude est constituée des diabétiques vus en consultation externe du CNHU-HKM de Cotonou. La collecte des données est faite par un questionnaire. RÉSULTATS: Des insuffisances ont été relevées au niveau des connaissances des patients sur le diabète sucré. Plusieurs allégations ont été recensées notamment l'interdiction de la consommation des fruits, du riz ou de la pâte de maïs. La pratique de l'activité physique est faible. Des difficultés ont été rencontrées empêchant le respect de régime alimentaire, la pratique de l'activité physique et le contrôle de la glycémie. CONCLUSION: Des défis restent à relever afin d'améliorer les connaissances, les attitudes et les pratiques des patients. L'éducation thérapeutique est donc nécessaire pour tous les diabétiques.

Hyperuricémie chez les diabétiques de type 2 à Cotonou: prévalence et facteurs associés

Introduction : Le diabète de type 2 s'inscrit le plus souvent dans le syndrome métabolique qui est fréquemment associé à l'hyperuricémie. Objectif : Déterminer la prévalence et les facteurs de risque de l'hyperuricémie chez les diabétiques de type 2 à Cotonou.Méthodes : Il s'agit d'une étude transversale, descriptive et analytique qui a consisté à analyser les dossiers des patients diabétiques de type 2 suivis à la Banque d'insuline d'Akpakpa à Cotonou. Cette étude s'est déroulée sur 5 mois (de Mai à Octobre 2014).Résultats : Notre population d'étude est constituée de 157 patients diabétiques de type 2. L'âge moyen de cette population d'étude était de 54,46 ans ± 10,61 avec des extrêmes de 31 et 82 ans. Les femmes étaient majoritaires (55,4%) soit une sex-ratio de 0,80. L'obésité était retrouvée chez 37,6%, 36,3% avaient un surpoids et 26,1% avaient un indice de masse corporelle (IMC) normal. Sur les 157 patients de notre étude, 45 avaient une hyperuricémie soit une prévalence de 28,7%. L'âge (p=0,029) et l'obésité (p=0,004) ont été identifiés comme facteurs de risque de l'hyperuricémie chez nos patients diabétiques. Concernant les complications du diabète, c'est la néphropathie qui est bien corrélée avec la présence de l'hyperuricémie (p=0,026), la prévalence de la néphropathie étant de 32,3% chez les diabétiques ayant une hyperuricémie contre 12,5% chez les diabétiques n'en ayant pas.Conclusion : Le dosage de l'uricémie doit être systématique chez les diabétiques

Constraints in the neurosurgical management of pituitary tumours in an African developing country: a 5-year observational study from Benin Republic.

INTRODUCTION: Benin Republic, a very low-income-sub- Saharan African developing country, has a severely resource-constrained health system. There is hardly any data available on the pattern of pituitary tumour in this country METHODS: A single surgeon, hospital-based retrospective analysis of the pattern, presentation and clinical / surgical course of7a prospective cohort of pituitary tumours seen over a 5-year period is presented RESULTS: There were 38 cases, 20 (52.6%) female; 27% of all brain tumours seen. They were macroadenomas in 97. 4%, and greater than 4cm in 63.2%. They occurred mainly (86.8%) in people aged 15 to 59 years. Delayed neurosurgical presentation, mean 5.16years (range 1-23years) was the rule in 94.7%%; and, visual and endocrinological dysfunction the two most prominent symptomatology. Due to severe logistic constraints, neuroimaging evaluation was possible with cranial CT only in about 90% of the cases. Also only 9 cases (23.7%) did eventually receive the planned neurosurgical operative treatment, in 5 cases of which even this surgical treatment Was only facilitated by some foreign neurosurgical missions. CONCLUSIONS: Pituitary adenomas represent a sizeable proportion of brain tumours in Benin Republic. National health care resources in this low income African country for their optimal clinical / radiological evaluation, and surgical treatment, are grossly inadequate; indeed, almost non-existent.

Dyslipidémie athérogène chez le diabétique de type 2 à Cotonou

Introduction : Les anomalies lipidiques sont fréquentes chez les diabétiques, en particulier les diabétiques de type 2.Objectif : Cette étude avait pour objectif de déterminer la prévalence et les facteurs associés à la dyslipidémie athérogène (DA) chez les diabétiques de type 2 à la Banque d'insuline de Cotonou Méthodes : Il s'agit d'une étude rétrospective descriptive et analytique qui s'est déroulée sur 5 mois (de Mai à Octobre 2014). Résultats : L'effectif total des patients diabétiques de type 2 retenus était de 156 (56% femmes). L'âge moyen était de 54,14 ± 10,5 ans avec des extrêmes de 31 ans et 80 ans. La prévalence d'obésité (37%), d'excès pondéral (36%), d'hypertension artérielle (69%) étaient importantes. Celle du tabagisme était faible (2%). La prévalence de la dyslipidémie athérogène était de 5,1%. Mais séparément, les prévalences de l'hypocholestérolémie HDL et de l'hypertriglycéridémie étaient respectivement de 39% et 12%. C'est la prévalence de l'hypercholestérolémie LDL qui est la plus élevée (71%). Parmi les facteurs associés recherchés dans notre étude, seule l'obésité a été retrouvée comme favorisant la survenue de la DA (p=0,02).Conclusion : Les anomalies lipidiques étaient fréquentes chez les diabétiques de type 2, mais la prévalence de la DA dans notre étude paraissait moins élevée

Prévalence de l'obésité abdominale en consultation médicale au CNHU-HKM de Cotonou

Introduction : L'obésité abdominale traduit l'accumulation de graisse viscérale. Elle favorise la survenue de plusieurs facteurs de risque cardio-vasculaires. L'objectif de ce travail était de déterminer la prévalence de l'obésité abdominale chez les patients admis en consultation médicale au CNHU/HKM de Cotonou. Patients et méthodes : Il s'agissait d'une étude transversale descriptive et analytique qui s'était déroulée du 15 juin 2011 au 16 septembre 2011. Elle a porté sur 1000 sujets obtenus par recrutement de tous les patients venus consulter au cours de la période d'étude. La technique de collecte a été une enquête par questionnaire. Les données collectées ont été saisies à l'aide du logiciel Epi-Data 3.1 et analysées avec le logiciel Epi-Info 3.3.2. Résultats : Les sujets étaient âgés de 15 ans et plus avec un âge moyen de 48,1 ans ± 14,5 ans. La prédominance était féminine 55,6% versus 44,4%. La prévalence de l'obésité abdominale était de 34,8%.Conclusion : Cette étude a montré le taux élevé de l'obésité abdominale en consultation externe au CNHU/HKM de Cotonou

Prevalence of hypertension and associated risk factors in Benin.

BACKGROUND: Hypertension is one of the main risk factors of cardiovascular diseases. There has been a lack of data on this risk factor in the general population in Benin. The aim of this study was to determine the prevalence of hypertension and identify the associated risk factors in Benin. METHODS: A cross-sectional study was conducted from July to August 2008 in Benin's 12 departments. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. The sample included 6853 subjects 25-64 years of age, randomly selected by five-stage random sampling. Blood pressure was measured using standard procedures. Data was processed and analyzed using EPI DATA and STATA 9.2 software. Prevalence levels were compared using Pearson's chi(2) and means with the Student t-test. Univariate and multivariate regression analysis, taking the sampling method into account, was used to identify risk factors. RESULTS: The sample comprised 49.5% females, the 25- to 34-year-old age group was the largest, and the mean age was 42.7±12.4 years. The prevalence of hypertension was 27.9% [95% CI: 26.3-29.5%], 77.5% of the subjects were unaware of their high blood pressure, and 81.6% had not taken their drugs two weeks before the survey. Prevalence of known hypertension was 6.9%, prevalence of treated hypertension 4.8%, and prevalence of controlled hypertension 1.9%. Age and obesity were significantly associated with hypertension. Department and profession were not associated with hypertension. CONCLUSION: This study showed a high prevalence of hypertension in the general population in Benin. Better management of this risk factor will contribute to reducing morbidity and mortality due to cardiovascular diseases.

[Morbidity of diabetic foot in Internal Medicine CNHU HKM, Cotonou]. / Morbidite du pied diabetique en medecine interne au CNHU HKM de Cotonou.

The diabetes and its complications appear increasingly frequent in our medical practice. We fixed ourselves for objectives to determine the frequency of the foot diabetic in Internal Medicine at Cotonou, to count the factors etiopathogenic responsible for the lesions and to describe the clinical aspects of the lesions. We carried out a retrospective study on the 420 diabetics hospitalized of January 1, 1995 to December 31, 1999. The frequency of the foot diabetic was 16.66%, the average age of the patients 60 years and the sex ratio 2.04. The diabetes of the type 2 was most frequent (71.4%). The traumatisms were the supporting factors most often found (32.86%). The lesions were in majority (38.57%) at the stage V of the classification of Wagner. On the therapeutic level, the amputations were frequent (20%) especially the amputations of legs. The installation of medical team of education for the assumption of responsibility of the diabetes and the prevention of the complications appears essential.

Antioxidant status in alcohol-related diabetes mellitus in Beninese subjects.

In the present study, we investigated the antioxidant status in diabetes mellitus, related or not to alcohol consumption. A total of 38 type 1, 48 type 2 and 42 alcohol-related diabetic patients were selected. Total antioxidant status was assessed through the oxygen radical absorbance capacity of the plasma and the determination of enzymatic and non-enzymatic antioxidant molecules. Serum triglycerides, total cholesterol and HDL-cholesterol concentrations were determined and the lipid peroxydation was evaluated by measuring thiobarbituric acid reactive substances (TBARS) assay. Plasma total antioxidant capacity was more decreased in alcohol-related diabetes than that in type 1 and type 2 diabetes, regardless of the complications (retinopathy and renal failure). Plasma vitamin E concentrations were significantly decreased whereas those of vitamin C increased in all of the diabetic patients compared to the controls, irrespective to the complications. In addition, superoxide dismutase and glutathione peroxidase activities were reduced in all the patients (type 1, type 2 and alcohol-related), irrespective to the complications. Glutathione reductase activity was diminished in type 1 and alcohol-related, but not in type 2, diabetic patients. Glutathione (GSH) concentrations significantly decreased in all diabetic patients with a significant decrease in alcohol-related diabetic patients. Excessive alcohol consumption appears as an oxidative aggravating factor in diabetes mellitus. Besides, alcohol-related diabetes highly resembles to type 1 diabetes as far as the antioxidant parameters are concerned.

Effets de la chloroquine sur la thyroide de rat

Depuis les observations de Marine vers les annees 1950; le goitre colloide est considere comme etant le resultat de l'accumulation de colloide apres l'arret de la stimulation de la glande prealablement hy-perplasique. Nous avons injecte ou administre par voie orale; 1mg de chloroquine a des rats Wistar pendant 1 ou 3 jours. D'autres rats ont d'abord recu le 6 - Propyl - 2 Thiouracil (0;25) dans leur ali-mentation avant l'administration de la chloroquine. Les rats ont ete peses ainsi que leur thyroide. Les coupes histologiques ont ete traitees au PAS. Nous avons observe une augmentation des poids moyen absolu et relatif; un goitre colloide et parfois des depots de substance fibrinoide. Ces observa-tions font suggerer un blocage de l'endocytose par la chloroquine. L'usage de la chloroquine au long cours pourrait etre implique dans la pathogenie du goitre dans les regions d'endemie palustre

[Epidemiology of chronic obstructive arterial disease of the lower limbs and diabetic patients at the University Hospital of Cotonou (Benin)]. / Epidémiologie de l'artériopathie chronique oblitérante des membres inférieurs chez le diabétique au CHU de Cotonou (Bénin).

The aims of this study were to determine the prevalence of chronic obstructive arterial disease of the lower limbs and to identify the factors which contribute to its occurrence in a population of adult African francophone diabetics. This was a prospective study which included all consenting diabetics systematically over a 6 month period at the out patient clinic or during hospital admission. Patients with incomplete data were excluded. An ankle systolic pressure index of less than 0.9 was required for the diagnosis of obstructive arterial disease. Demographic parameters, the characteristics of the diabetes, the quality of blood sugar control, the presence of classical cardiovascular risk factors and the results of their treatment, the nature and distribution of the arterial lesions on ultrasonography were all studied. A univariate analysis and a multivariate analysis of their correspondences were undertaken to determine the correlation coefficients. The prevalence of arterial disease of the lower limbs in the 102 diabetics retained for the study (average age 53 years) was 33.3%. The arterial disease was distal in 47% of cases and diffuse in 26.5% of cases. The arterial wall was calcified in 19.6% of cases. In univariate analysis only age was correlated with arterial disease (p = 0.04), the duration of diabetes tended to be related (p = 0.07). In multi-factorial analysis of Correspondences with other factors, hypertension, hyperlipidaemia and multiple cardiovascular risk factors seemed to be correlated with arterial disease of the lower limbs. Therefore, arterial disease of the lower limbs is very common and an early complication of diabetic patients in Benin. Predisposing factors were age and, probably, duration of diabetes, hypertension, hyperlipidaemia and multiple cardiovascular risk factors.

Post-partum recurrent sarcoidosis associated with type 1 diabetes mellitus.

Immunologic abnormalities observed in sarcoidosis may suggest a link between this affection and autoimmune endocrine diseases. Indeed a high frequency of autoimmune thyroïd diseases is observed in sarcoidosis. However association of type 1 insulin-dependent diabetes mellitus with sarcoidosis is rare. We report the case of a type 1 diabetic woman in whom clinical and biological signs of sarcoidosis appeared after her first pregnancy with a relapse in the post-partum period of a second pregnancy. Diagnosis of sarcoidosis was established on characteristic cutaneous, articular and pulmonary manifestations associated with elevated plasma levels of angiotensin converting enzyme. From this case, association between type 1 diabetes mellitus and sarcoidosis has been discussed as well as reciprocal relationship between sarcoidosis and pregnancy. Since familial history of sarcoidosis was present in this case, familial aspects of sarcoidosis have also been reviewed.

[Influence of maternal weight on pregnancy outcome in Cotonou (Benin)]. / Influence du poids maternel sur l'évolution de la grossesse à Cotonou (Bénin).

To evaluate prevalence of obesity in pregnant women in Cotonou and to study the influence of obesity on pregnancy outcome, we analysed retrospectively obstetrical reports of 323 women delivered at the university clinic of gynecology and obstetrics during the year 1999. Prevalence of obesity was 18% among pregnant women and 30.6% of them were overweight. Medical complications of pregnancy were more frequent in obese women than in women with normal weight since obese women showed higher frequency of proteinuria (241% versus 10,5%, p<0.05) and high blood pressure (25.9% versus 4.5%, p<0.001). Diabetes mellitus was only present in obese women with a frequency of 5,2%. Compared with normal weight women, the obese ones showed a tendency to higher frequency of cesarean delivery (34.5% versus 21%), this difference being not statistically significant. Although there was a slightly higher number of reanimated infants in obese women, the difference was not significant. Six percent hypotrophic infants were observed in obese mothers versus 13.1% in mothers with normal weight (non significant) but it can be noticed that lean mothers showed statistically higher frequency of hypotrophic infants than normal weight mothers (33.3% versus 13.1%, p<0.01). This study shows that obesity in women represents, even in developing country, an obstetrical risk factor leading to high frequency of complications during pregnancy and needs the development of preventive actions.

[Diabetic nephropathy: an epidemiological study based on proteinuria in a population of black African diabetics in Cotonou, Benin]. / Néphropathie diabétique: une étude épidémiologique fondée sur la protéinurie dans une population de diabétiques noirs africains à Cotonou, Benin.

We evaluated proteinuria to determine the frequency of diabetic nephropathy and to study epidemiological aspects of this disease. We measured 24-hour urinary protein excretion in 152 diabetic patients. We recorded the age and sex of each patient, the duration of diabetes and blood glucose concentration. Proteinuria was diagnosed in 28% of the diabetic patients. The frequency of proteinuria was higher in men (33%) than in women (19%). The highest frequency (37.5%) was observed in subjects aged 70 years or over. In these patients, the higher frequency of proteinuria was associated with a longer duration of diabetes. However, proteinuria was detected in 28% of patients with diabetes diagnosed less than one year previously, suggesting a long period of undiagnosed diabetes in these subjects. Finally, proteinuria was more frequent in patients treated with insulin (42%) than in those treated orally (25%). Thus, diabetic nephropathy is a frequent complication in black diabetic patients in Cotonou. As hemodialysis and kidney transplantation are very expensive and access to these treatments is limited in developing countries, preventive measures based on optimizing patient management and the early diagnosis of diabetes and its complications are required.

[Hypothyroidism: clinical and etiological aspects in Cotonou (Republic of Benin)]. / Les hypothyroïdies: aspects cliniques et étiologiques à Cotonou (Bénign).

To evaluate the frequency of clinical manifestations and to study the etiological aspects of hypothyroidism in hypothyroid patients in Cotonou, we carried out a retrospective analysis of the medical reports on hypothyroid patients followed in our clinical practice. A total of 33 patients was thus studied, comprising 8 men (24%) and 25 women (76%) with mean age of 45,8 years for men and 40,4 years for women. The more frequent clinical manifestations observed were: face edema (45%), weight gain (45%), paresthesia (42%), fatigue (39%), lethargy (30%) and bradycardia (24%). Constipation (12%), sensation of cold (9%), depilation (6%) and dry skin (6%) were less frequently observed. Myalgia, hoarseness and menstrual irregularities were present in 15% of the cases respectively. Regarding the etiology, 82% of the cases were primary hypothyroidism and only 18% were of central origin. Thyroidectomy was the leading cause in our hypothyroid patients, representing 70% of all cases and 85% of primary hypothyroidism. Radioiodine treatment and autoimmune thyroiditis were equally found in 6% of the cases. Central hypothyroidism was related to a pituitary adenoma in four cases (12%) and to Sheehan syndrome in two cases (6%). As it can be expected, hypercholesterolemia was present in 82% of the patients but creatine phosphokinase elevation was more frequent (94% of the patients). Compared to the data reported in the literature, the frequency of the symptoms and signs of hypothyroidism seems to be underevaluated in our study and the frequency of autoimmune thyroiditis as a cause of hypothyroidism is low.

[Malt lymphoma of the thyroid and Graves'disease]. / Lymphome thyroïdien de type MALT et maladie de Basedow.

Maltoma of the thyroid associated to Graves'disease is not such a frequently described association. We report a case of Maltoma of the thyroid gland in a patient with Grave's disease. The diagnosis was established by histological examination after total thyroidectomy. Slow enlargement of the thyroid gland despite a clinically successful antithyroid drug therapy could be considered as an advocating clinical manifestation. Associated anti-neoplastic chemotherapy and cervical irradiation resulted in good outcome with six years follow-up. A review is presented on treatment and prognosis of these tumors.