Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

Mixing Ability of Intercropped Wheat Varieties: Stability Across Environments and Tester Legume Species.

Cereal-legume intercrops are developed mainly in low input or organic farming systems because of the overyielding and numerous ecosystem services they provide. For this management, little advice is available for varietal choice and there are almost no specific breeding programs. Our study aimed to evaluate the mixing ability of a panel of bread wheat genotypes in intercropping and to assess the impact of environment and legume tester choice on this ability. We used partial land equivalent ratios (LERs) to assess the mixing ability of a genotype defined as the combination of its ability to maintain its own yield in intercropping (producer effect, LERw) and to let the mixed species produce (associate effect, LERl). Eight wheat genotypes and 5 legume testers (3 pea and 2 faba bean varieties) were grown in sole crop and in all possible binary intercrops in nine contrasting environments. A mixed model was used to evaluate the effects of wheat genotypes, legume testers, environments, and all the interactions among these 3 factors on LERw and LERl. The chosen wheat genotypes presented contrasting mixing ability, either in terms of producer effect (LERw) or associate effect (LERl). A strong negative correlation was observed between these two components of genotype mixing ability, with an increase in producer effect being generally associated with similar decrease in associate effect, except for three genotypes. The impact of environment on the producer and associate effects was limited and similar between genotypes. Legume tester had a significant effect on both LERw and LERl, making the choice of tester a major issue to reveal the producer or associate effects of wheat genotype. Although the 5 testers showed no significant differences in wheat genotype order for both producer or associate effects, they showed different competitiveness and ability to discriminate genotypes: faba bean was very competitive, resulting in low LERt and low capacity to discriminate wheat genotypes for their mixing ability. On the contrary, pea was less competitive, resulting in higher LERt and better capacity to discriminate wheat genotypes. In particular, the Hr varieties (Geronimo and Spencer) discriminated best the wheat genotypes. Consequences on the implementation of breeding programs for wheat varieties adapted to intercropping are discussed.

[Pathophysiological and diagnostic aspects of Guillain-Barré syndrome]. / Syndrome de Guillain-Barré : physiopathologie et aspects diagnostiques.

Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathy. It usually onset with a rapidly progressive ascending bilateral weakness with sensory disturbances, and patients may require intensive treatment and close monitoring as about 30% have a respiratory muscle weakness and about 10% have autonomic dysfunction. The diagnosis of GBS is based on clinical history and examination. Complementary examinations are performed to rule out a differential diagnosis and to secondarily confirm the diagnosis. GBS is usually preceded by an infectious event in ≈ 2/3 of cases. Infection leads to an immune response directed against carbohydrate antigens located on the infectious agent and the formation of anti-ganglioside antibodies. By molecular mimicry, these antibodies can target structurally similar carbohydrates found on host's nerves. Their binding results in nerve conduction failure or/and demyelination which can lead to axonal loss. Some anti-ganglioside antibodies are associated with particular variants of GBS: the Miller-Fisher syndrome, facial diplegia and paresthesias, the pharyngo-cervico-brachial variant, the paraparetic variant, and the Bickerstaff brainstem encephalitis. Their semiological differences might be explained by a distinct expression of gangliosides among nerves. The aim of this review is to present pathophysiological aspects and the diagnostic approach of GBS and its variants.

[Endoscopic features of esophageal cancer in Dakar, Senegal: study of 76 observations]. / Aspects endoscopiques du cancer de l'oesophage à Dakar (Sénégal): étude de 76 observations.

OBJECTIVE: In response to the lack of cancer register and paucity of publications on esophageal cancer in Senegal, this retrospective descriptive single-center study was undertaken to determine epidemiological, clinical, endoscopic and histological features of the disease at a digestive endoscopy center in Dakar. PATIENTS AND METHOD: Reports describing upper digestive tract endoscopy procedures performed at the Aristide Le Dantec Teaching Hospital in Dakar between January 2006 and December 2009 were reviewed. Cases involving histologically confirmed esophageal cancer were compiled and patient data including age, sex, and indication for endoscopy as well as endoscopic and histological findings were analyzed. RESULTS: A total of 78 reports were collected including 76 patients with suitable data for analysis. Esophageal cancer accounted for 0.97% of upper digestive tract endoscopy procedures performed. Mean patient age was 49 years and the sex-ratio was 1.9. The main indication for endoscopy was dysphagia (92.1%). The most frequent endoscopic finding involved budding lesions with (42%) or without (29%) ulceration. The most common location was the middle third of the esophagus (50%). The most frequent histological type was squamous cell carcinoma (92.1%). CONCLUSION: Esophageal cancer observed at the endoscopy center of the Aristide Le Dantec Teaching Hospital in Dakar mainly affects young male adults. Lesions are generally located in the middle third of the esophagus and corresponded to squamous cell cancer. There is a need to establish a cancer register and to conduct multicentric studies to gain insight into risk factors for esophageal cancer in Senegal.

Alertness in young healthy subjects: an fMRI study of brain region interactivity enhanced by a warning signal.

An effective connectivity study was carried out on 16 young, healthy subjects performing an alertness task. The objective of this study was to develop and to evaluate a putative network model of alertness by adapting structural equation modeling to fMRI data. This study was designed to evaluate the directed interactivity of an attentional network during intrinsic and phasic alerting tasks. On the basis of theoretical hypotheses, clinical observations, behavioral data and neuroimaging studies, it was hypothesized that neural circuits in the right hemisphere including the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex, inferior parietal cortex and the thalamus were involved. The results of this study support the existence of a common network of activated areas with significant path coefficient differences between intrinsic and phasic alertness. Functional interactivity was significantly reinforced during the phasic alertness task and appeared to preferentially involve activity in the DLPFC region, whereas the path coefficients of the model were well-balanced during intrinsic alertness. This study highlights the predominant role of the DLPFC region in maintenance of a state of alertness and in temporal preparation during an alertness task.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]. / Apport de la coloscopie dans le diagnostic des rectorragies à Dakar (Sénégal).

INTRODUCTION: Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal. PATIENTS AND METHODS: This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed. RESULTS: A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%). CONCLUSION: Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

Differences in effective connectivity between dyslexic children and normal readers during a pseudoword reading task: an fMRI study.

PURPOSE: This fMRI study investigated phonological and lexicosemantic processing in dyslexic and in chronological age- and reading level-matched children in a pseudoword reading task. MATERIALS AND METHODS: The effective connectivity network was compared between the three groups using a structural model including the supramarginal cortex (BA 40; BA: Brodmann area), fusiform cortex (BA 37) and inferior frontal cortex (BA 44/45) areas of the left hemisphere. RESULTS: The results revealed differences in connectivity patterns. In dyslexic patients, in contrast with chronological age- and reading level-matched groups, no causal relationship was demonstrated between BA 40 and BA 44/45. However, a significant causal relationship was demonstrated between BA 37 and BA 44/45 both in dyslexic children and in the reading level-matched group. CONCLUSIONS: These findings were interpreted as evidence for a phonological deficit in developmental dyslexia.

[Clinical interest of fMRI and functional exploration methods of brain activity and interactivity: physical and neurophysiological considerations]. / Intérêt clinique de l'IRMf et des méthodes d'exploration fonctionnelle de l'activité et de l'interactivité cérébrales : considérations physiques et neurophysiologiques.

After having provided a brief reminder of the principle of the blood oxygen level-dependent (BOLD) contrast effect, the physiological bases of brain activity and the concepts of functional integration and effective connectivity, we describe the most recent approaches, which permit to explore brain activity and putative networks of interconnected active areas in order to examine the normal brain physiology and its dysfunctions. We present various methods and studies of brain activity analysis clinically applicable, and we detail the concepts of functional and effective connectivity, which allow to study the cerebral plasticity which occurs at the child's during the maturation (e.g., dyslexia), at the adult during the ageing (e.g., Alzheimer disease), or still in schizophrenia or Parkinson disease. The study of specific circuits in networks has to allow defining in a more realistic way the dynamic of the central nervous system, which underlies various cerebral functions, both in physiological and pathological conditions. This connectivity approach should improve the diagnostic and facilitate the development of new therapeutic strategies.

[Frequency of hematological and immunological manifestations of lupus in Dakar]. / Frequence des manifestations hematologiques et immunilogiques de la maladie lipique a Dakar.

INTRODUCTION: The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immun pathology characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The discovery circumstances of diagnosis are variable and polymorphic. The hematologic signs and the immunological disorders constitute the diagnosis criteria of the lupic disease. METHODOLOGY: It is a multicentric and retrospective study undertaken study from January 1, 1997 to September 30, 2006. Patients were followed up in the Internal Medicine of Dakar. We have studied the hematological and immunological aspects of the SEL and have evaluated the prevalence of lupic disease. RESULTS: 142 patients with lupic disease were included with 125 women and 17 men; the ratio--sex was 0.13. The mean age was 34 years with extremes of 6 and 72 years. Our patients had hematological and immunological manifestations in 32.4% and 76.8% of the cases. The immunological tests showed the presence of antinuclear antibodies in 97.9% of the cases, native antibody anti-DNA in 45.7% of the cases, the anti-ECT in 8.95% (with the anti-RNP in 78.3 % of the cases, anti-Sm in 56.5% and of anti-SSA in 87% of the cases). Antibodies anti-DNAand anti-ECT were associated the hematologic demonstrations respectively in 92% and 95% of the cases (p 0.08). CONCLUSION: The hematologic and immunoligical signs of lupus disease are frequent and constitute diagnostic criteria of the disease.

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]. / Les pneumopathies interstitielles diffuses non specifiques au cours des connectivites: à propos de 7 observations à Dakar.

INTRODUCTION: The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases. CASES: We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy. CONCLUSION: Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

[Functional exploration of the brain by fMRI]. / Exploration fonctionnelle cérébrale par IRMf Approche théorique de l'analyse spectrale.

Functional magnetic resonance imaging (fMRI) permits to obtain physiological information about MRI signal, which is modulated by electrical, biochemical, and physiological properties of the cerebral tissue. It is possible to characterize the brain interactions from an fMRI signal. Particularly, the use of a spectral analysis at a given frequency allows access to the time series chronology, which occurs within various activated areas of the brain. Thus, spectral parameters such as coherency and phase shift may be calculated from presupposed stationary stochastic signals and of an estimate of the cross-spectral power density function. Coherency describes a correlation structure in frequency domain between signals and thus allows obtaining an accurate estimate of the phase relation (time delay), which connects the signals between them. We describe in the last part of the article a calculation method integrating spectral information obtained previously and which makes it possible to evaluate the intensity of the existing interaction between two distinct cerebral areas.

[Contribution of the spectral analysis to the brain connectivity study by fMRI]. / Apport de l'analyse spectrale à l'étude de la connectivité cérébrale en IRMf Dissociation fonctionnelle de l'aire motrice supplémentaire.

AIM: To validate, through functional magnetic resonance imaging (fMRI) from spectral analysis of time series during a visuomotor task, a model of functional connectivity mainly constituted by the pre-supplementary motor area (pre-SMA), the supplementary motor area proper (SMA-proper) and the primary motor cortex (M1). MATERIALS AND METHODS: The paradigm that was tried out in young subjects (n=5) consisted of a preparation task of motor movement. We firstly proceeded with an estimate in the frequency domain of coherency coefficients and values of phase shift between these three areas. Secondly, the estimated coherency coefficients were integrated to a model of functional connectivity. Two interaction coefficients were calculated, one for the related M1 and pre-SMA regions, the other one for the related M1 and SMA-proper regions. RESULTS AND CONCLUSION: Our results demonstrate hemodynamic activity that definitely occurred earlier in the pre-SMA area during the preparatory period of the task. In the same way, a more important interaction was found between M1 and pre-SMA areas, which corroborates the assumption of the prevalent role played by these two areas in the case of a preparation task of a motor movement. Thus, this study has allowed highlighting a functional dissociation between the two portions of the SMA.

[Current aspects of systemic lupus erythematosus in Dakar. About 74 cases]. / Aspects actuels du lupus erythemateux systemique a Dakar. A propos de 74 observations.

INTRODUCTION: previously reported studies on systemic lupus erythematosus in Senegal were more then ten years old and reported few cases of patients. Our objectives were to update epidemiological, clinical, laboratory and evolutive aspects of systemic lupus erythematosus throughout a study of 74 patients. PATIENTS AND METHODS: we conducted a retrospective study in the internal medicine and the dermatology units of the university teaching hospital Aristide Le Dantec from January 1993 to December 2002. All patients with systemic lupus erythematosus according to the ACR criteria were included. Those who didn't meet ACR criteria were excluded. RESULTS: we included 74 patients; their mean age was 32 years and the sex ratio 0.1 (male to female). At the entry general symptoms were constants, and cutaneous signs were found in 96% of cases, joints signs in 58.1% and renal sign in 56.8%. Haematological and immunologic abnormalities were nearly constant. All the patients received corticosteroids and in 35.71% they had in addition immunosuppressive drugs. Shorts term evolution was satisfactory. At the medium term 27.02% of the patients were lost and 10.81% of them died. CONCLUSION: currents aspects of systemic lupus erythematosus in Dakar are improved by the early diagnosis when the disease is pauci-symptomatic and by the use immunosuppressive drugs in association with corticosteroids.

[Pulmonary hypertension revealing systemic diseases: two Senegalese case reports]. / Hypertension arterielle pulmonaire revelant des connectivites: a propos de deux observations Senegalaises.

INTRODUCTION: Pulmonary hypertension (PH) is a complication of autoimmune diseases which worsen the prognosis. In Senegal, a few cases of PH have been previously reported in patients with systemic sclerosis. CASE REPORTS: We report two cases of patients with PH that revealed autoimmune diseases (Sharp' syndrome and Sjögren syndrome). Epidemiological, clinical, evolutive and laboratory data were analyzed. Evolution of disease was favourable for one patient and fatal for the other. CONCLUSION: These two cases show necessity of early diagnosis of systemic diseases in our countries. PH should be screened in each patient with autoimmune disease before installation of irreversible pulmonary arterial lesions that respond to treatment. New therapy used in idiopathic PH are not yet accessible for our patients.

Use of Phase-Contrast MRA to Assess Intracranial Venous Sinus Resistance to Drainage in Healthy Individuals.

BACKGROUND AND PURPOSE: Resistance to blood flow in the cerebral drainage system may affect cerebral hemodynamics. The objective of the present study was to use phase-contrast MRA to quantify resistance to drainage of blood across branches of the venous sinus tree and to determine whether the resistance to drainage values correlated with internal jugular vein outflows. MATERIALS AND METHODS: We performed whole-head phase-contrast MRA and 2D phase-contrast MR imaging in 31 healthy volunteers. Vascular segmentation was applied to the angiograms, and the internal jugular vein velocities were quantified from the flow images. Resistance to drainage across branches of the venous sinus tree was calculated from the segmented angiograms, by using the Poiseuille equation for laminar flow. Correlations between the values of resistance to drainage and internal jugular vein outflow measurements were assessed by using the Spearman ρ. RESULTS: The overall mean resistance to drainage of the venous sinus tree was 24 ± 7 Pa s/cm3. The mean resistance to drainage of the right side of the venous sinus tree was 42% lower than that of the left side (P < .001). There were negative correlations between the values of resistance to drainage and internal jugular vein outflows on both the left side of the venous sinus tree (R = -0.551, P = .002) and the right side (R = -0.662, P < .001). CONCLUSIONS: Phase-contrast MRA is a noninvasive means of calculating the resistance to drainage of blood across the venous sinus tree. Our approach for resistance to drainage quantification may be of value in understanding alterations in the cerebral venous sinus drainage system.

[Polyarticular gout in young adults: a curable rheumatic disease]. / La goutre polyarticulaire de l'adulte jeune: un rhumatisme curable.

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.

[Senegalese case of thromboangeitis obliterans or Buerger's disease]. / Premiere observation Senegalaise de thromboangeite obliterante ou maladie de Buerger.

INTRODUCTION: Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case. CASE REPORT AND DISCUSSION: A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning. CONCLUSION: TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.

Biermer anemia: Hematologic characteristics of 66 patients in a Clinical Hematology Unit at Senegal.

Hematological manifestations can lead to diagnosis of pernicious anemia, also known as Biermer disease and Biermer anemia. This disease has been little studied among black Africans. Our aim is to describe its diagnostic and therapeutic aspects and outcome in our practice. This descriptive study retrospectively examined the records of 66 patients with pernicious anemia seen at the Clinical Hematology Unit of Le Dantec Hospital in Senegal from January 1, 2000, to June 30, 2014. Symptoms were anemic syndrome (40 cases), hemolytic anemia (13), anemic heart failure (7), isolated pallor of the mucous membranes (5), and venous thrombosis (2). Their mean hemoglobin on diagnosis was 6.52 g/dL [1.3-15.2 g/dL], macrocytosis (52), normocytosis (14), hypochromia (4), thrombocytopenia (39), and leukopenia (28 cases). Cytopenia was associated with pancytopenia (25) and bicytopenia (18). Cytologic abnormalities were documented in 42 cases: megaloblastic erythrosis (37 cases) and hypersegmented neutrophils (24 cases). After vitamin B12 therapy - intramuscular (52) or oral (14) -, a reticulocyte crisis was noted on the 8th day and followed by correction of the blood count. Macrocytic anemia, frequently associated with thrombocytopenia and/or leukopenia, is the main hematologic sign evoking pernicious anemia. Venous thrombosis is a rare circumstance of diagnosis that must not be ignored. Intramuscular or oral vitamin B12 is recognized to be effective in these cases and reverses hematological manifestations.

[Benefits of multidisciplinary care for excised women]. / Intérêt de la prise en charge pluridisciplinaire des femmes excisées.

AIM: To present the results of multidisciplinary care model for excised women. PATIENTS AND METHODS: Qualitative retrospective study on multidisciplinary care between 2007 and 2012 within Excised Women Care Unit. Patients are seen by three specialists: a gynecologist obstetrician, a psychotrauma therapist and anthropologist, a psycho-sexologist. The Unit welcomes any excised woman, whatever are her demands. Women wishing for a clitoridian surgery meet systematically the three specialists. The study covers a population of 270 women, most of them aged between 18 and 40years. RESULTS: The presented results are related to women having asked for clitoridian surgery. Two outstanding results come out from multidisciplinary care: few women finally go for surgery, and a high rate of patients wishing for surgery present a sexual trauma other than female genital mutilation/cutting. CONCLUSION: The importance of the psychotraumatic and interpersonal dimension (marital - familial) in the problems presented by the patients indicates that the "repair" of excision cannot be reached by the sole surgery and requires a medical, psychological and sexological management.