[Disseminated histoplasmosis treated by boluses of fluconazole]. / Histoplasmose disséminée traitée par bolus de fluconazole.

We report a case in which an HIV-infected man was cured of disseminated histoplasmosis (Histoplasma capsulatum var duboisii) after treatment by high-dose fluconazole (1,600 mg taken four times daily) for 2 months, combined with active antiretroviral therapy. The choice of fluconazole at this dosage was motivated by its availability as a generic and thus inexpensive medication, the patient's precarious status, and his critical clinical condition. At the end of the second month of treatment, the patient chose to stop the fluconazole, which he could no longer afford, while continuing the antiretroviral treatment, which was free. The clinical and laboratory improvement observed from the first week has continued to progress for more than 8 months after fluconazole treatment stopped. This single case needs - and deserves - to be confirmed in a series of patients. Nonetheless it makes it possible to envision fluconazole as a low-cost and efficacious antifungal agent for the treatment of disseminated histoplasmosis in AIDS patients in sub-Saharan Africa.

[Unrecognized juvenile dermatomyositis complicated by calcinosis universalis: a case report from Cameroon]. / Dermatomyosite juvénile méconnue compliquée d'une calcinose universelle : un cas camerounais.

Juvenile dermatomyositis is a rare autoimmune disease that causes inflammation of the skin and muscles. Calcinosis may complicate its course, especially when the diagnosis is late or the corticosteroid therapy inadequate. In those cases, significant joint disability may occur. Few cases are reported in sub-Saharan Africa, probably because it is rarely recognized in these areas. We report the first Cameroonian case, occurring in a 9-year-old girl. Although she sought treatment early in the disease course, the dermatomyositis was diagnosed quite late, after the onset of calcinosis universalis and severe disability. Early diagnosis of the disease and effective treatment are essential to prevent calcinosis universalis from complicating this disease in children.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

[Fatal miliary tuberculosis in an HIV-infected Cameroon woman: disseminated histoplasmosis due to Histoplasma capsulatum capsulatum]. / Miliaire pulmonaire létale chez une femme camerounaise infectée par le VIH.

The purpose of this report is to describe the first Cameroonian case of disseminated histoplasmosis due to Histoplasma capsulatum capsulatum in association with HIV infection. The patient was a 34-year-old HIV1 infected woman. Diagnosis of histoplamosis was made in post-mortem. The similarity of the clinical symptoms with disseminated tuberculosis makes diagnosis of mycosis difficult. Active and effective care of histoplasmosis is urgently necessary for the HIV infected persons.

Rheumatic diseases in patients attending a clinic at a referral hospital in Yaounde, Cameroon.

BACKGROUND: The spectrum of rheumatic diseases in sub-Saharan Africa remains poorly defined. OBJECTIVES: To determine the spectrum of rheumatic diseases in Yaounde. DESIGN: Descriptive cross-sectional study. SETTING: Rheumatology clinic at the Yaounde General Hospital, Cameroon. SUBJECTS: Twelve thousand four hundred and ninety four patients were referred to the outpatient department of the Internal Medicine service of the General Hospital of Yaounde over a 12-month period. Of these cases, 536 (9.4%) were diagnosed as belonging to the general class of rheumatic conditions. There were 334 (62.31%) females and 202 (37.69%) males. The mean age was 52.72 +/- 5.3 years. RESULTS: The 536 cases were further classified as follows: degenerative disease of the spine 196 (36.5%), osteoarthritis of the limbs 110 (20.5%), regional musculo-skeletal disorders 83 (15.5%), arthritis associated with infections 50 (9.3%), chronic inflammatory and connective tissue diseases 44 (8.2%), crystalline arthropathies 32 (5.9%) and miscellaneous (unclassified) rheumatic conditions 21 (4.1%). CONCLUSION: From these results, we concluded that degenerative disease of the spine and limbs are the most common forms of rheumatic disease in this region. Gout is the most commnon acute inflammatory arthropathy and rheumatoid arthritis the most prevalent arthropathy due to chronic inflammation.

[Venous thromboembolism in Cameroon (report of 18 cases)]. / La maladie thrombo-embolique veineuse au Cameroun (a propos de 18 cas).

The purpose of this report was to describe clinical and ultrasound findings associated with venous thromboembolism of the lower extremities and pulmonary embolism observed in our department with special emphasis on the utility of venous ultrasound in the diagnosis of venous thromboembolism. Between January 1, 1998 and December 31, 1999, a total of 47 venous ultrasound procedures were carried out according to the standard technique using a Logic 400 MD system (General Electric). Deep venous thrombosis was diagnosed in 18 cases (38.3%). There were 10 men and 8 women with a mean age of 46 years (range, 24 to 71 years). Thrombosis involved the internal saphenous, popliteal, or sural vein in 12 cases, the common or deep femoral vein in 4, and the external iliac vein in 2. The most common risk factors observed in our series were surgery, predisposing conditions, history of venous thrombosis and morbid obesity (66.8% of case). Prolonged periods of bed confinement and neoplasm (lower extremity Kaposi's disease) were more uncommon (22.2%). Pulmonary embolism occurred during the observation period in six cases (33.3%) including 3 (50%) that were fatal. Based on these findings it can be concluded that although its incidence is relatively low in black African patients at risk, thromboembolic disease is often fatal and requires routine preventive treatment using heparin.

[Prolactinomas in Yaounde: analytical study of 36 consecutive cases followed in the internal medicine department of the Yaounde Hospital from 1990 to 1996]. / Les adénomes à prolactine à Yaoundé: étude analytique de 36 cas consécutifs suivis dans le service de médecine interne de l'Hôpital de Yaoundé de 1990 à 1996.

We analysed the epidemiological, clinical, biological, morphological and therapeutic characteristics of 36 cases of pituitary prolactinomas in Yaoundé, Cameroun. Diagnosis was made on the basis of neuro-ophthalmological, gynaecological and sexual symptoms associated with quantity determinations of prolactinemia, total testosterone and blood oestrogen, folliculo stimulating hormone and luteining hormone. Expected levels of prolactinemia are above 150 micrograms/l. Cerebral tomodensitometry and, where possible, magnetic resonance imaging were used. Among the 24 patients on whom a tomodensitometry was performed, 4 male patients presented macroprolactinomas; the remaining 20 patients--mostly female--had microprolactinomas. Macroprolactinomas were found in male patients only, leading to an acute ophthalmological emergency for 2 of them who were operated in Paris-France. All the patients were put on bromocriptine; this molecule has antisecretory and antiproliferative properties, which are very useful in Africa, since surgery is very expensive. Cases of resistance to the molecule exist and new dopaminergic agonists are not yet being used in Cameroon.

Les aspects cliniques de la retinopathie diabetique a Yaounde

Les auteurs rapportent les aspects cliniques de la retinopathie diabetique dans une population de 284 diabetiques camerounais suivis de janvier a decembre 1990. La frequence de la retinopathie diabetique est de 37;32 pour cent. Cette retinopathie diabetique apparait chez 9;16 pour cent de femmes et 28;17 pour cent d'hommes et l'age moyen des porteurs de retinopathie diabetique est de 54 ans. La duree moyenne du diabete pour qu'apparaisse la retinopathie diabetique est de 5 ans. La retiniopathie mixte associant chez un meme patient la retinopathie oedemateuse et la retinopathie ischematique predomine. Le taux de cecite est de 5 pour cent

Profil lipidique general d'un groupe de malades insuffisants renaux chroniques camerounais

Dans un groupe de 52 malades insuffisants renaux chroniques; nous avons mesure les lipoproteines de haute densite (HDL); les lipoproteines de basse densite (LDL) et les triglycerides (TG); le cholesterol total (CT) ainsi que le quotient CLDL/CHLD qui mesure le risque atherogene. Les valeurs moyennes montrent que l'hyperlipidemie est constante dans l'insuffisance renale chronique (IRC) a Yaounde et 61 pour cent des malades du groupe etudie sont a risque atherogene

[Male sterility through hormonal insufficiency in Cameroon]. / Les stérilités masculines par insuffisance hormonale au Cameroun.

At the Gyneco-obstetric service of the Yaounde CHU, we have studied 361 cases of couple sterility. In 38%, the man was responsible. Among these patients, less than 50% had a complete hormonal checkup. The hormonal cause of sterility was confirmed in 63 patients by static tests using the radio-immunologic method. These hormonal abnormalities were most the result of a primary testicular insufficiency (23.8%) and seminifer tube abnormalities (38.5%).