[Peritoneal tuberculosis and HIV infection. Reflection apropos of 22 cases at the National Hospital of Bobo Dioulasso]. / Tuberculose péritonéale et infection par le VIH. Réflexion à propos de 22 cas à l'Hôpital national de Bobo Dioulasso.

Peritonitis tuberculosis is still a frequently encountered pathology in our hospital. Since the AIDS pandemic, cases of peritonitis tuberculosis present increasingly atypical characteristics, largely diverging from classical descriptions. The authors report on 22 cases of peritonitis tuberculosis associated with HIV infection. The study was carried out from June 1997 to December 1999 in the National Hospital Centre Souro SANOU of the Bobo Dioulasso internal office. It concerned 10 women and 12 men of a mean age of 37.9 years. The sex-ratio was 1.2 in favour of men. Diagnosis was established by laparoscopy. Peritonitis tuberculosis associated with HIV accounted for 78.5% of peritonitis tuberculosis cases. The clinical picture was dominated by isolated ascite (100%) associated with an oscillating high fever in 68.2% of cases. Negative results for IDR seemed to reflect poor prognosis. Response to treatment was slow but acceptable. The general prognosis was poor with a mortality rate of 18%.

[Perihepatitis and HIV/AIDS infection. Apropos of 13 cases at the National Hospital of Bobo-Dioulasso]. / Périhépatite et infection par le VIH/sida. A propos de 13 cas à l'Hôpital national de Bobo-Dioulasso.

Perihepatitis or Fitz-Hugh syndrome, peritonitis located in the right hypochondriasis (RH), is a relatively rare affectation. However, the HIV-AIDS pandemic has brought about the emergence and re-emergence of disease-states either uncommon or formerly on the decline as well as the appearance of opportunistic illness. We report the results of a retrospective study conducted in the National Hospital of Bobo-Dioulasso (Burkina-Faso) between 1 June 1997 and 31 December 1999 in an effort to contribute to a wider vision of diseases associated with HIV-AIDS. We based our study on 130 laparoscopies carried out for unexplained pain linked to RH (with or without fever), as well as abdominal-pelvian or diffuse abdominal pain. Thirteen cases (11 women, 2 men) of perihepatitis were diagnosed. The mean age for women and men was respectively 31.4 and 39.5. HIV serology was systematically carried out for all patients and, in case of perihepatitis, cultures were taken. All patients were infected with HIV and some presented signs of AIDS according to the WHO classification. In clinical terms, a shalking pain for RH was noted for 5 patients, abdominal sensitivity in 8 cases as well as gynaecological anomalies: cul-de-sac moving pain (4 cases), leuchorrea (3 cases) and mucosic vulvovaginitis (1 case). Paraclinical tests revealed a slight hepatic cytolysis for only 3 patients (1.5 N). 6 patients tested positive for Chlamydia trachomatis; the 7 others could not be tested, but this aetiology was assumed for evaluating the efficacy of the treatment under study. The high frequency of perihepatitis in these patients, all of whom were suffering from HIV-AIDS, and its presence in the 2 male cases, suggest that immunodepression is conducive to the appearance of this disease.

[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)]. / Sérologie toxoplasmique chez les patients infectés par le VIH et suspects de toxoplasmose cérébrale au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]. / Manifestations neurologiques associées à l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.

Neurocysticercosis: a major aetiological factor of late-onset epilepsy in Madagascar.

To assess the impact of cysticercosis on public health in Madagascar, we compared patients > 15 years with late-onset epilepsy to non-epileptic controls in a matched case-control study. The association between epilepsy and cysticercosis was studied by enzyme-linked immunoelectrotransfer blot (EITB) assay for antibodies specific to Taenia solium. The EITB assay was performed on 104 pairs of sera specimens and on 95 pairs of cerebrospinal fluid (CSF) specimens. Depending on whether we consider the results obtained from sera or from CSF, we obtain for the population attributable risk percent of cysticercosis in late-onset epilepsy two slightly different estimates: 22.3% and 17.6%. Therefore cysticercosis is a major aetiological factor of late-onset epilepsy in Madagascar. In the control group, the frequency of positive results, especially in CSF specimens (7.4%), confirms the existence of asymptomatic cases of neurocysticercosis.

[Prevalence of Helicobacter pylori infection in Tananarive, Madagascar]. / Prévalence de l'infection à Helicobacter pylori à Tananarive, Madagascar.

During a 8-month period, Helicobacter pylori infection has been studied in 140 patients who presented upper gastrointestinal symptoms. Helicobacter pylori was searched in antral biopsy specimens using standard bacteriological methods (Gram-staining, urea-test, culture) and histological staining techniques (hematoxylin-eosin-saffron, undifferentiated Giemsa). The global prevalence of H. pylori infection was 59%. The prevalence rates did not seem to differ with age and sex but H. pylori infection was significantly more frequent in patients with an active duodenal ulceration (30 of 41) compared with those with a normal endoscopy (21 of 47) (p < 0.02).

[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. / Madagascar : la fibroscopie oeso-gastro-duodénale. Analyse descriptive de 12000 examens et problèmes rencontrés sous les tropiques.

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

[660 cases of histologic extra-pulmonary tuberculosis at the Pasteur Institute in Madagascar]. / A propos de 660 cas de tuberculoses histologiques extra-pulmonaires étudiés a l'Institute Pasteur de Madagascar.

A 33 months retrospective study (from September 1992 to May 1995) of 8525 patients indicated that the incidence of histologic extrapulmonary tuberculosis (EPT) was 7,7%. The 8341 malagasy native patients presented an incidence of 7.8%. Male are more frequently infected than female. Most samples came from Antananarivo, with a prevalence reaching 12,5% while it was only 2,9% in the provinces. Most pathologic EPT were pleural tuberculosis (55,6%) and ganglial tuberculosis (34%). Peritoneal tuberculosis were much less frequent. According to literature data in Madagascar, the incidence of histologic EPT is obviously increasing.

[Peritoneal tuberculosis in Madagascar, 55 cases at the Soavinandriana Hospital Center in Antananaviro]. / La tuberculose péritoneale á Madagascar, á propos de 55 observations recueillies au Centre Hospitalier de Soavinandriana a Antananarivo.

This retrospective study conducted in Antananarivo for a 42 months period, from September 1991 to March 1994, allowed to record 55 peritoneal tuberculosis, all of them in malagasy patients. The sex ratio was 0,83 and the mean age 36 years old. Ascites puncture was done each time there was an effusion (44 cases). For all cases. For all cases, the diagnosis based on laparoscopy allowed an investigation of the liver and the peritoneum, and 10 peritoneum biopsies could be done. The tubercular bacillus has been isolated in 2 ascites fluids out of 8 incubations, and in 5 biopsies of peritoneal granulation out of 8. For 8 cases, another tubercular localization has been discovered: 5 pleurisis, 2 evolutive tuberculosis and 1 pericardial effusion. All the patients have been put under antitubercular treatment and have regained health. Peritoneal tuberculosis has become rare in the West but is still a frequent pathology mostly in young women, in Africa and up in Madagascar.

[Madagascar: from Isoavinandriana to Soavinandriana or the remarkable history of the Girard and Robic Hospital]. / Madagascar: d'Isoavinandriana à Soavinandriana ou la belle histoire de l'Hôpital Girard et Robic.

The history of the Soavinandriana Hospital is remarkable for several reasons. The oldest hospital on the island, this institution is the product of the combined efforts of English Christian missionaries, French colonists, and native Madagascans. Its history has always been closely linked to political events in Madagascar and the successive names often reflect Franco-Malagasy relations. The hospital which was long the crown jewel of the "colonial" health corps still provides a framework for harmonious cooperation between French and Malagasy military physicians. The institution has always been on the forefront of medicine in Madagascar and, despite current problems, is still the best-equipped health facility on the island. Thanks to the quality of care and the dedication and competence of its staff, the hospital has succeeded in maintaining patient attendance from all classes of society. The hospital which in its over 100-year history has witnessed two momentous occasions with the visits of the last Queen and the first President of the Republic now stands on the threshold of a renaissance and could become a model for successful Franco-Malagasy cooperation.

[Tumor-like focal nodular hyperplasia. Apropos of 3 cases observed at the Dakar Central Hospital from 1986 to 1989]. / Hyperplasie nodulaire focale à forme tumorale. A propos de 3 cas observés à l'Hôpital Principal de Dakar de 1986 à 1989.

Authors report three observations of Focal Nodular Hyperplasia, Tumor-like on two: senegalese female patients, 16 years and 37 years old, and a young senegalese man, 24 Years old. The mean age is about 25.5 years and oestro progestative intake has bean noted once. Diagnosis of Focal Nodular Hyperplasia was difficult and has been done twice after surgical intervention for chronic cholecystitis and blood peritonitis. The only complication reported, has been a rupture of nodular, causing the death of a patient. This benign tumor that never degenerates, does not need any particular treatment unless a stopping of oral contraception.

HIV-2 and HIV-1 AIDS cases in Senegal: clinical patterns and immunological perturbations.

The serological and immunological parameters, disease patterns, and social characteristics of 39 human immunodeficiency virus type 2 (HIV-2) seropositive CDCIV cases seen in Dakar, Senegal were studied. These data were compared with those obtained from 48 HIV-1 seropositive CDC stage IV patients. Social characteristics of populations infected with HIV-1 or HIV-2 were clearly different. A patient sex ratio of three men to one woman was found for both viruses. In addition, the immune status of nonsymptomatic HIV-1 and HIV-2 seropositive people was evaluated. The correlation between abnormalities of the immune system and clinical status was similar for the two infections. Clinical symptoms of both diseases were the same, but this cross-sectional study could not address the questions of differences between the two infections in latency and development of disease or specific manifestations of HIV-2 infection. This study suggests that HIV-2 infection may contribute to the present AIDS epidemic in West Africa.

[Epidemiology of cancer of the digestive tract in Senegal. Review of 18,000 endoscopies performed at the Principal Hospital of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. Apport de 18.000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 alimentary tract cancers were discovered in 219 black males and 95 black females at the occasion of 18.000 endoscopies (high or low) performed during the 5 past years at the Principal Hospital (Dakar-Senegal). Mean age of the patients was 50, gastric cancer (170 cases) was the most frequent localization, then rectocolonic one (71 cases) and oesophageal one (61 cases). The more frequent utilization of endoscopy and may be a modification of diet in urban milieu might explain such a high frequency of discovery of alimentary tract cancers in Dakar.

[Crohn's disease. Apropos of 2 recent cases collected at the Dakar Central Hospital]. / Maladie de Crohn. A propos de deux observations récentes recueillies à l'Hôpital Principal de Dakar.

This report covers two cases of Crohn's Disease, one in a 27 year old Senegalese woman, the other in a 38 year old Senegalese man, both presenting abdominal pain, diarrhoea and loss of weight over several months. The ulcerated lesions were staged on the colon, respecting the rectum, and reached the ileum in one patient and the esophagus in the other. Following X-rays, endoscopy and consideration of the history, Crohn's Disease was diagnosed. Treatment with corticoids produced rapid improvement with the ulcers healing after one month. The unusualness of Crohn's Disease in Black Africans adds interest to these two observations.

[Epidemiology of digestive tube cancers in Senegal. Apropos of 18,000 endoscopies carried out at the Hospital Principal of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. A propos de 18,000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 bowel cancers were discovered in 219 men and 95 women of negroid race in the course of 18,000 upper and lower endoscopies taken over the past 5 years at Dakar's Main Hospital. The average age of the sick persons is 50 years. Gastric cancer (170 cases) is the most frequent, followed by recto-colic cancer (71 cases) and oesophagian cancer (61 cases). The use of endoscopy and perhaps dietetic changes in the urban area, explain the large number of bowel cancers discovered in Dakar.

[Mucous diaphragm of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the General Hospital of Dakar. Relationship with the Kelly-Paterson or the Plummer-Vinson syndrome]. / Diaphragme muqueux de l'oesophage cervical a propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Kelly-Paterson ou de Plummer-Vinson.

At the occasion of 15,000 high endoscopies performed during the past 5 years at the general Hospital of Dakar (Senegal) 38 mucous diaphragms of cervical esophagus were discovered. 36 patients are Black Senegalese; 29 females and 9 males with a mean age of 37. Dysphagia was present 29 times and anemia 22 times. Endoscopies diagnosis is easy, putting into light a mucous diaphragm at the level or immediately below Killian mouth. 18 of these cases have been classified as Kelly-Paterson syndrome. Performed in 30 patients, the treatment consists in breaking down the mucous diaphragm with an endoscope. It is difficult to keep on endoscopic monitoring, although it is essential because the risk of cancerisation.

[The value of laparoscopy. Results of 600 studies performed in an internal medicine department at the General Hospital of Dakar]. / Intérét de la laparoscopie. Résultats de 600 examens effectués dans un service de Médecine interne à l'Hôpital Principal de Dakar.

600 laparoscopic examinations were performed in an Internal Medicine Department of the general Hospital Dakar (Senegal) from 1984 to 1989 in 402 males and 198 females aged from 7 to 82 years. This examination of simple and quick procedure well tolerated under simple premedication, should be performed only after diffusion of the pneumoperitoneum, per- foration being the major risk. Even if liver cell carcinoma and cirrhosis represent more than an half of the examined cases (52%) due to their high frequency, exploration of peritoneal pathology is the best indication for laparoscopy. Thanks to laparoscopy, 68 tuberculosis, 28 peritoneal carcinomatosis and 11 infectious peri-hepatitis were diagnosed. It remains a major examination perfectly adapted to studies of the so-frequent hepato-peritoneal pathology in Black Africa]

[Campylobacter pylori and the gastric mucosa. Apropos of the detection of Campylobacter pylori in 12 patients with gastric mucosa lesions]. / Campylobacter pylori et muqueuse gastrique. A propos de la mise en évidence de Campylobacter pylori chez 12 patients porteurs de lésions muqueuses gastriques.

The authors report the results of systematic research on Campylobacter pylori during high endoscopy. Of the 60 patients examined, 12 were found to have the germ in their antral, gastric mucosa. All these patients had a history of chronic gastritis. They recall the role of this germ in creating chronic gastritis, and evoke the hypothesis that the mucosa becomes fragile facilitating the appearance of an ulcer.

[Gelatinous disease of the peritoneum of appendiceal origin. Apropos of 2 Senegalese cases]. / Maladie gélatineuse du péritoine d'origine appendiculaire. A propos de deux observations sénégalaises.

The authors report two cases of Peritoneum Gelatinous Sickness of appendicular origin, occurring in male adults aged 65 and 57. Laparoscopy practised on an extended abdomen showing non-homogeneous dullness confirmed the diagnosis in both cases. The laparotomy highlighted the gelatinous substance and led to appendicectomy aimed at the mucocele. They take this opportunity to discuss the unusualness of this affliction in Africa, and recall the clinical and etiological means and the diagnostical difficulties that this disease evokes.

[Mucoid webs of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the Hôpital Principal of Dakar. Relationship to Plummer-Vinson syndrome]. / Diaphragmes muqueux de l'oesophage cervical. A propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Plummer-Vinson.

Thirty-eight cervical esophageal mucous diaphragms were discovered in the course of 15,000 high endoscopies carried out over the past 5 years at Dakar General Hospital. Thirty-six of the sufferers were Black Senegalese. The 29 women and 9 men had an average age of 37 years. Dysphagia was diagnosed 29 times, and anemia 22 times. Endoscopic diagnosis readily shows the mucous diaphragm at the level of, or immediately below, KILLIAN's mouth. PLUMMER-VINSON's syndrome affected 16 of these patients. Treatment consists in collapsing the mucous diaphragm by putting the endoscope through it: this happened to 30 of the patients. Endoscopic surveillance is indispensable because of the risk of cancer, but is difficult to perform.