[Coxiella burnetii endocarditis on a mechanical valvular prosthesis. Apropos of 2 cases]. / Endocardite à Coxiella burnetii sur prothèse valvulaire mécanique. A propos de deux cas.

The authors report two cases of prosthetic valve endocarditis due to Coxiella burnetii. The histories were chronic and complex suggesting an auto-immune disease: prolonged recurrent fever despite antibiotic therapy with a biological inflammatory syndrome whilst blood cultures remained negative. The first patient presented with prosthetic valve dehiscence and acute glomerulonephritis. The second patient had coagulation defects with prosthetic valve thrombosis, mesenteric adenopathy and congestive cardiac failure without prosthetic valve dysfunction. In suspected endocarditis with negative blood cultures, serological tests should be extended to intracellular pathogens difficult to identify and justifying specific and prolonged bactericidal therapy (fluoroquinolones, cyclines, rifampincine). Long-term serological surveillance is essential even when the outcome could have led to the termination of antibiotic therapy. Usually, antibiotic therapy provides a bacteriological cure, but treatment has to be continued for at least 3 years, and, in some patients, all their lives. Valve replacement is reserved for haemodynamic complications of the pathology which determine the ultimate prognosis.

[Neurologic diseases in Niger]. / Les maladies neurologiques au Niger.

The authors report the results of a study realized at National Hospital of Niamey (Republic of Niger) from october 1981 to may 1986. Among 4820 patients living in Western Niger, 410 (8.5%) had neurological disorders. Out of 16 recognized syndromes 6 constitute 75.2%: comas, paraplegias, cranial nerves palsies, convulsions, hemiplegias and sciaticas. An etiological diagnosis is made in 269 patients. From 15 diseases 4 totalize 73.5%: there are medullar compressions, infections of the central nervous system (bacterial meningitis, cerebral malaria), cerebral vascular disturbances and metabolic encephalopathies. POTT's disease is the most common cause of medullar compression with paraplegia and arterial hypertension is a very important etiologic factor of cerebral vascular attack (42.2 and 44.4% respectively). Parkinsonian syndrome and multiple sclerosis seem rare. The diagnosis of cerebral tumor is very uncommon but this is in relation to the absence of autopsy and of recent investigation (scanner). No case of tuberculous meningitis is noted and this can't be explained by the authors in a major tuberculous endemic area.

[Idiopathic annular submitral aneurysm. Contribution of echography apropos of 5 cases]. / Anévrysmes annulaires sous-mitraux idiopathiques. Apport de l'échographie à propos de 5 cas.

The authors report 5 cases of annular subvalvular left ventricular idiopathic aneurysm observed within less than 4 years (April 1984 to October 1987) at the hospital of Niamey, Niger. All 5 patients were examined by echocardiography, an exploratory technique which is new for this type of disease. The condition is rare and has been described mostly in black people living in African countries. At the hospital of Niamey, annular subvalvular left ventricular aneurysm was found in 0.04 p. 100 of in-patients and accounted for 0.34 p. 100 of all cardiovascular diseases. The patients were young adults (mean age 20 years), and at the time of diagnosis all were in stage III or IV heart failure. An apical systolic murmur was regularly present; it was due to the mitral regurgitation resulting from the traction exerted by the aneurysm. The prognosis was unfavourable. There were 3 deaths, 2 of which were directly ascribable to the aneurysm and due to thromboembolism (1 case) and arrhythmia (1 case) which are recognized complications of that disease. The diagnosis, always suspected on the finding, on frontal radiographs, of a protruding left cardiac border, was hitherto confirmed by angiography; the authors did not perform angiography and confirmed the diagnosis by echocardiography. Annular subvalvular left ventricular aneurysms are lesions of obscure origin. In our patients, none of the inflammatory, infective or traumatic causes suggested in the literature could be found. Cardiomyopathy associated with the aneurysm was suspected in all patients and confirmed in 3 of them.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postpartum cardiomyopathy in the Sudanese-Sahelian area. Clinical and epidemiologic studies of 66 cases]. / La myocardiopathie post-partum en région soudano-sahélienne. Etudes clinique et épidémiologique de 66 cas.

The authors report 66 cases of peri- and postpartum cardiomyopathy. The patients' age ranged from 16 to 42 years (mean +/- SD 30 +/- 7 years). All were black women native of the western part of the Republic of Niger, Sahelian in the north, Sudanese in the south. At first examination, all had signs of congestive cardiac failure. In 67 p. 100 of the cases these signs appeared during the first six postpartum weeks. Clinical, radioscopic and echocardiographic features were always those of dilated cardiomyopathy, even when arterial pressure was high. Hypertension was present at first examination in 50.8 p. 100 of the cases, but it remained stable under treatment in 13 p. 100. These data suggest an acute postpartum hypertension. The following risk factors of the disease were identified: rural living, absence of school attendance, low family income, multiparity, identical pathology after a previous pregnancy, postpartum "quarantine" period, ritual ablutions with very hot water, large amounts of sodium in the diet, hypertension, breast-feeding and postpartum oestrogen secretion decrease. Seasonal variations were noted, with doubling of new cases during the hot and humid season. The hypothesis of a latent gravidic myocarditis is discussed: the accumulation of risk factors during the postpartum period might trigger off the clinical disease. Forty seven patients were followed up for a mean period of 15 months. Seven died, 21 (31.8 p. 100) were in complete remission and 19 in partial remission. In case of relapse, complete remission was less frequent and appeared more slowly under treatment. Persistent cardiomegaly under treatment was of poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Postpartum myocardiopathy. Clinical and echographic evaluations of the response to treatment. 30 cases observed in the Sudan-sahelian area]. / La myocardiopathie post-partum. Evaluations clinique et échographique de la réponse au traitement. Trente cas observés en région soudano-sahélienne.

Thirty cases of postpartum cardiomyopathy observed in a savannah-sahelian region of Africa (Niamey, Republic of Niger) are reported. The dilated cardiomyopathy was diagnosed by comparing clinical signs with electrocardiographic, radioscopic and echocardiographic findings. A simplified therapeutic regimen was used in all cases: rest during 2 months, sodium restriction, diuretic and digoxin therapy (1 tablet of each drug every other day). Patients were followed up for a mean period of 13 months. The course of the disease was evaluated at regular intervals by echocardiography which provided accurate information on left ventricular function. At the time of diagnosis all patients had congestive heart failure. Complete remission was defined as the absence of all signs and a normal social life. Twelve patients answered this definition with a mean follow-up of 13 months. Nine patients (mean follow-up 24 months) were in incomplete remission; a large left ventricular aneurysm had developed in 2 of them. In 6 other patients the follow-up was too short (1 to 8 months) for a prognosis to be formulated. In postpartum cardiomyopathy 3 factors are indicative of a poor prognosis: 1) absence of free interval between delivery and first signs of heart failure; 2) history of cardiomyopathy after previous deliveries; 3) poor response to treatment with persistent cardiomegaly. On the other hand, the severity of the initial cardiomegaly and impairment of ventricular contractility, and the presence of permanent hypertension or pericardial effusion have no significant influence on the response to treatment. Irreversible contraception is justified in great multiparous women. In primiparous and oligoparous women a temporary contraception is necessary, a new pregnancy being conceivable only after complete remission and under close supervision.

[Tuberculoma of the heart. Contribution of echography. Apropos of a case]. / Tuberculome du coeur. Apport de l'échographie. A propos d'un cas.

An 18-year old woman was admitted to hospital with signs of right heart failure and atrial tachycardia. Ultrasounds showed a tumoral mass in the tricuspid valve. Post-mortem examination revealed that the mass was a tuberculoma obstructing the tricuspid orifice. The exceptional character of this case is emphasized: lesions of the heart have been found in less than 0.3 p. 100 of tuberculous patients autopsied. The different anatomical aspects of tuberculosis of the heart are mentioned, and it is suggested that echocardiography should be performed systematically in all patients with severe, disseminated tuberculosis. Tuberculoma of the heart should figure on the list of intraparietal and intraluminal masses visualized at echocardiography.

[Hepatic amebiasis at Niamey Hospital (Nigeria)]. / L'amibiase hépatique à l'hôpital de Niamey (Niger).

The authors report the results of a prospective study on hepatic amebiasis realized in national hospital of Niamey (Republic of Niger). Hepatic amebiasis is uncommon in Niger as in other hot and dry countries of Africa whereas it is common in hot and damp areas of the continent. These results point out the hypothesis of a hepatotropic strain of Entamoeba histolytica uncommon in Sahelia area whereas the amebiasis infestation is frequent.

[A survey on gastric diseases in black Africans in Dakar (Senegal) (author's transl)]. / Enquete sur les gastropathies des africains de race noire à Dakar (Senegal).

The authors report on a survey about 1.188 Senegaleses affected by gastric disease. The diagnosis was established by either endoscopy or, less often, by a surgical control. The findings were ulcer (43,09 p. 100) with duodenal localisation in most cases (67 p. 100), non malignant tumor (0,84 p. 100), malignant tumor (1,85 p. 100) and most often (53,95 p. 100) non ulcerous and non tumorous gastropathies. Noticed clinical features are not much different from the ones observed in Caucasian patients. Sex ratio gives male preponderance and there is an etiologic role of age: superficial gastritis and duodenal ulcer prevail from 20 to 40, chronic gastritis from 20 to 50 and gastric ulcer after 35. Smoking tobacco, misuse and overdose of aspirin and antiphlogistic drugs seem to be facilitating factors which were recorded in 50 p. 100 of non ulcerous gastropathies, 40 p. 100 of gastric ulcers and 27 p. 100 of duodenal ulcers. Neither ethnic origin, nor blood group, nor diet have shown any etiologic influence. Most patients with an ulcer have 3 periods of pain every year and one among three needs a surgical intervention.

[Normal values of gastric acid secretion in Senegalese (author's transl)]. / La valeur de la sécrétion gastrique acide normale chez le Sénégalais.

From a sample of 70 selected after gastric biopsies and who presented no gastroduodenal illness was proposed a table of reference of values of gastric acid secretion in Senegalese in their base state and after stimulation with a subcutaneous injection of 6 microgrammes per kilo of pentagastrine. The method of calculation is taken entirely from the one proposed by Bernier and colleagues (1973). The flow (or hourly volume) found in the sample are established in comparison with the thin mass and more precisely with the exchangeable potassium that was obtained in relation to the weight, age and sex. The comparison with European's secretion shows differences statistically significant for stimulated secretion. The hourly volume (average and standard deviation) are calculated for all subject in relation to the weight, age and sex.

[Late signs of vascular complications of closed trauma of the shoulder (author's transl)]. / Manifestations tardives des complications vasculaires des traumatismes fermés de l'épaule.

The authors report four cases of vascular complications of closed injuries of the shoulder, which appeared later, some time after the initial accident. There was one false aneurysm of the axillary artery at the forty sixth day after a fracture of the upper humeral diaphysis with elongation of the brachial plexus; one case of acute ischemia of the upper limb 3 years after a dislocation of the shoulder; one case of thrombosis with gangrene of the hand twelve years after a fracture-dislocation of the head of the humerus and one case of chronic ischemia of the forearm with severe changes in the vessels below one year after a fracture of the clavicle which had caused an aneurysm of the subclavian artery. The clinical, pathological and physiopathological study showed the enormous possibilities of the collateral circulation in the axilla. An arterial lesion may thus remain undiagnosed during the initial trauma. The authors emphasise the importance of the initial examination with a search for disappearance of the peripheral pulses. In the light of these four cases, it seems necessary to explore as a routine any arterial lesion complicating a shoulder injury.