[Prevalence and etiologic factors of non-carious cervical lesions. A study in a Senegalese population]

The non carious cervical lesion (NCCL) is a loss of tooth tissue at the neck of affected teeth that is unrelated to tooth decay. They are commonly encountered in clinical practice and present in a variety of forms. The purpose of this paper is to determine the prevalence of the NCCL in a Senegalese population. From 655 patients, 112 with cervical lesions were identified i.e. a global prevalence of 17.10%. The prevalence rate for abrasion was reported to be 77.70%, 12.50% for abfraction and 9.80% for erosion. Etiological factors were studied for abrasion and erosion. 54% of the patients with abrasion used their toothbrush horizontally. For erosion, only external factors were identified: consumption of acidic drinks (9 patients) or alcohol (1 patient) and professional environment (1 patient). Dentists should consider these lesions in their daily practice.

[Active rheumatic heart disease: findings from an 17-case series in the University Hospital Center of Dakar, Senegal]

This report is based on retrospective review of the charts of 18 patients with pre-existing active rheumatic heart disease compiled over a period of two years (January 2000 to December 2001). The purpose of this study was to determine the incidence of acute degenerative joint disease, to describe the clinical features and natural course of the disease, and to highlight the main points in the fight against degenerative joint disease and rheumatic heart disease. The prevalence of active rheumatic disease was 3.7%. Mean patient age was 15.5 years (range: 8 to 25 years). Female sex was predominant with 13 girls and 4 boys (sex ratio: 3.25). The most common clinical symptoms were migratory polyarthritis involving large joints in 14 cases (82.3%) and left heart insufficiency in 13 (76.4%). Additional clinical findings included oscillating fever in 8 cases (47.05%), tooth decay in 11 (73.3%), and poor buccodental hygiene in 14 (93.3%). Blood tests to evaluate inflammation demonstrated high values in all patients with mean ASLO titer of 950 UI/l, mean serum fibrin level of 7.8 g/l, and mean C-reactive protein level of 28.5 mg/l. The erythrocyte sedimentation rate was high in 15 cases (88.2%). In addition to showing heart valve disease, electrocardiography demonstrated first-degree atrioventricular block in 1 case. Chest x-ray revealed cardiomegaly in 15 cases (88.2%). Doppler ultrasonography of the heart showed isolated rheumatoid disease in 11 cases (64.7%). All patients responded favourably to treatment with corticosteroids and penicillin. The incidence of recurrence of active disease was high (70.5%) thus supporting use of high loading doses. Rheumatic heart disease is a public health problem in Africa and requires appropriate preventive measures.

Hypoglycaemic and antidiabetic activity of acetonic extract of Vernonia colorata leaves in normoglycaemic and alloxan-induced diabetic rats

The aqueous extract of Vernonia colorata (Willd.) Drake (Composeae) leaves is used by African traditional medicine practitioners as a remedy for the treatment of diabetes. Our previous studies have shown the hypoglycaemic activity of the aqueous extract of Vernonia colorata leaves (300 mg/kg, per os) in normoglycaemic rats. The aim of the present study was to investigate the hypoglycaemic and antidiabetic activity of acetonic and hexanic extracts of the leaves of Vernonia colorata in order to further discriminate the type of extract which provides a better antidiabetic activity. Experiments were performed in normoglycaemic and alloxan-induced diabetic rats. The acetonic extract of the leaves of Vernonia colorata (AELVC) (100 mg/kg, per os) induced a significant decrease of blood glucose in normoglycaemic rats. The glycaemia varied from 4.72+/-0.11 to 3.72+/-0.22 mmol/l (p<0.05, n=5) 3 h after AELVC administration per os. In contrast, the hexanic extract of the leaves of Vernonia colorata (HELVC) increased significantly the glycaemia in normoglycaemic rats. Like glibenclamide, AELVC has an antihyperglycaemic effect in oral glucose tolerance test (OGTT) and alloxan-induced diabetic rats. These results have shown that: (i) AELVC and HELVC have an opposite effect on basal blood glucose in normoglycaemic rats, suggesting that the mechanisms of action of both above-mentioned extracts are different; (ii) AELVC has also an antidiabetic activity in hyperglycaemic rat models.

[Risk behavior associated with the manipulation of dental amalgam in Senegal]

Dental amalgam is a combination of mercury, silver, tin and copper used in the treatment of the dental decays. Amalgam is used in dentistry since many years. Actually a large discussion held according to environmental pollution and risk of intoxication for the patient and the dentist himself. The aim of our survey concerning 103 dentists was to determine the quantity of mercury used in a year, to see the risks linked with the equipment and the manipulation of amalgam and to study the incoming of the trashes of amalgam. Our results showed that among the dentists: 44.66% used 250 to 500 g of mercury by year, 14.56% used their hands for insertion of amalgam in the cavities, 10.68% used their hands for condensation of amalgam in the cavities, 87.38% throw their amalgam on the trash.

[Evaluation in vitro of the antibacterial effectiveness of 2.5% sodium hypochlorite on endocanal bacteria related to the time contact within root canal]

INTRODUCTION

The aim of this study was to evaluate the antibacterial effectiveness of 2.5% sodium hypochlorite on endocanal bacteria related to the time contact Within root canal.

MATERIALS AND METHODS

110 teeth were prepared and inoculated with Enterococcus feacalis. All teeth were irrigated with a same volume and exposed a period ranging 1 to 10 min. Canals were sampled before and after time contact.

RESULTS

All time reduced the number of bacterial cells within the root canal (p > 0.05). There was no significant difference after the time contact of 3 min (p > 0.05). Lack of effectiveness might be caused by irrigant to reach microorganism in dentinal tubules.

[Physical performance and thermoregulatory study of subjects with sickle cell trait during a sub-maximal exercise]

The sickle cell trait is a genetic abnormality of red blood cells. It is due to the mutation of a parental gene, which rest Its to the substitution of glutamic acid by valin on beta globin chain of haemoglobin. The possibility for sickle cell trait carriers (SCT) to present any disturbance during predominantly anaerobic and aerobic exercises is unclear. Ten (10) subjects with sickle cell trait and 10 subjects control were studied during exercise test on cycloergometer. They were all students of the National Institute of Popular Education and Sport of Dakar. The mean of environmental temperature was 26 degrees C and humidity was 60 to 80%. After haematological analysis, a submaximal muscular exercise for one hour with 75% of maximal heart rate was done. We have determined heart rate, blood pressure, rectal and skin temperature during exercise. Haematological parameters shown any significant difference between the two groups. No significant difference was found in cardiocirculatory variables during maximal exercise in cycloergometer between control group and sickle cell trait group. The two groups have done submaximal exercise during 1 hour without particular difficulty. We have not observed a significant difference between the two groups in cardiovascular variables, rectal and skin temperature during exercise, and after 3 minutes of rest. These results show that subjects with SCT have physical capacity comparable with control subjects during a sub maximal exercise for 1 hour. We can assure that subjects with SCT in our country may participate in sports competition, as well as normal subjects (HbAA).

[Prevalence of non carious dental lesions in the department of Dakar]

Non carious dental lesions are destructions of dental external surfaces originating from non bacterial cause in opposition to dental caries. We distinguish 5 types of non carious dental lesions: attrition, abrasion, abfraction, erosion and demastication. These lesions may be pathological or physiological. Data dealing with them are not very numerous in the literature. Their study shows a real interest in conservative dentistry because of problems both aesthetic and functional they set We carried out an epidemiological trial in the department of Dakar with as aim providing data on the prevalence of these lesions. Our results have disclosed the following rates of prevalence: 60% of attrition, 25,55% of abrasion, 7,22% of abfraction, 5,55% of demastication and 1,68% of erosion. The results indicate once more the importance of the need for clinical evaluation of those dental lesions.

[Hepatitis B infection in infantile population of Sénégal]

Hepatitis B is endemic in Senegal. According to many data, the prevalence of this infection in adult population is up 85%. Young children are victims of the intensive circulation of this virus. Indeed, the risk of becoming chronic carrier which can further lead to Hepatocellular Carcinoma, is related to the age at which the infection had been contracted. In this study, we investigated the prevalence of HBV markers in children less than 5 years living in two regions of Senegal: Dakar and Thies. Using specific Elisa methods, HBV markers were determined in 2962 sera of newborns and children: AgHBs, antiHBc, antiHBs for all children; AgHBe and IgM antiHBc for AgHBs carriers. HBV markers were detected in 59.38% of sera; in 39.26% of the samples only one marker was detected: AgHBs (3.18%), antiHBc (36.08%), antiHBs (0.49%). In 20.12% of samples, markers were associated. So, the global prevalence of the infection is 59.38% with the predominance of chronic forms compared to acute one. The rate of chronic carriage is independent of the sex but is influenced by age and geographic area. The post- infection immunization rate is 7.11%. In Senegal Hepatitis B is contracted at the early childhood. The high prevalence of this infection in children under five years emphasize the need for a spread vaccination in this age bracket, since we well know that the risk for them to become chronic carriers is high.

[Electrocardiographic recording of long duration (Holter) of 24 hours during idiopathic cardiomyopathy of the peripartum]

The idiopathic myocardiopathy of the peripartum (IMPP) is a frequent disease in the Soudano-Sahelian zone of Africa whose evolution is loaded with many complications hemodynamic, thrombo-embolic and rhythmic. The prevalence and the meaning of the rhythm disorders are unknown. The aims of this prospective study are to measure and to describe the prevalence of the anomalies observed in Holter ECG of 24 hours. It's about a description cross-sectional study realized at the Cardiology Department (CHU Dakar) and 19 patients with IMPP were included, from October 2000 to July 2002. A recording ECG of 24 hours (Holter) was realized on all the patients. The average age was 29.4+/-6.9 years with a low socio-economic level (100%). The diagnosis of IMPP done before childbirth in 4 cases (21%) and the post partum on 15 patients (78.9%). The dyspnea was constant, the chest pain in 12 cases (63.1%) and palpitations in 8 cases (42%). The average rate of hemoglobin was of 10.85+/-2.05 g/dL. The standard electrocardiogram recorded a sinusal tachycardia (68.4%), a cavitary hypertrophy (78.8%), and disorders of the repolarization (47.3%). The cardiac echo-Doppler noted a cavitary dilatation (84.2%), a constant alteration of the left ventricular systolic function with a fraction of average ejection of 29.7+/-10.3%. The anatomy of the valves was normal. The recording Holter ECG of 24 hours recorded a sinusal tachycardia in 17 cases (89.4%), ventricular extrasystoles on 7 patients (36.8%), 4 cases of ventricular tachycardia non-sustained and double ventricular extrasystole on 1 patient, auricular extrasystoles in 4 cases (21%) and 1 case of auriculo-ventricular block of the first degree. The study of heart rate variability founded a mean value of 106 ms.

[Tricuspid valve stenosis. A prospective study of 35 cases]

Authors report the results of prospective and longitudinal study. The aims of this study were to evaluate among 35 patients, prevalence, diagnosis and treatment aspects of tricuspid stenosis (TS), as well as evolution and pronostical factors. The prevalence of TS was about 4.2%. The main clinical signs were: dyspnoea (94.2%), jugular veinus pulses (42.8%), superior cave syndrom (68.8%), diastolic rumble (74.3%). ECG showed sinus rhythm (51.4%), a right atrial hypertrophy (48.5%). Echocardiography showed tricuspid leaflets thickened (82.8%), a right atrial hypertrophy (48.5%), a mean gradient between right atrial and right ventricle: 8.6 +/- 3.14 mmHg (65.7%) and mean tricuspid area about 1.41 +/- 0.83 cm2 (continuous equation); about 1.74 +/- 1.29 cm2 (Hatle formula) and 1.11 0.84 cm2 (simplified Hatle formula). Aetiology was only rheumatic fever. After a follow-up of 8.53 +/- 6.06 months, the mortality rate was 28.5%. Complications were irreducible heart failure (24 cases), liver failure (2 cases) and stroke (3 cases). Factors associated with mortality were: severity of tricuspid stenosis and pulmonary hypertension, importance of dyspnea and heart failure (p < 0.041).

[Apical foramen position on mesio buccal root of the maxillary first molar. Study in Senegalese population]

The maxillary first molar is submitted to frequent endodontic treatment and more over, it presents the highest failure rates, often in relation with his mesio-buccal root. Several studies about failures factors showed implication of root canal anatomy often in relation with the frequency of second canal. However, other failures factors, as the foramen situation, which is very important in endodontic practice, could increase the failure rate. The aim of this study was to determine the foramen situation in Senegalese people. The results showed 63.85% of excentric foramina (83 out of 130). 86% of excentric foramina were located at 1.5mm radiology apex.

[Antidiabetic activity of the leaves of Vemonia colorata (Wilid.) Drake (Composees) in alloxan-induced diabetic rats]

Vemonia colorata is distributed through Africa (Benin, Cameroon, Senegal, Togo etc...). Its leaves are commonly used by african tradipractitioners for treating diabetes. However, the antidiabetic activity of the leaves of V. colorata had never been investigated in experimental conditions. The present study aimed to test the aqueous extract of the leaves of V. colorata for its effects in normoglycaemic and alloxan-induced diabetic rats in comparison to glibenclamide antidiabetic activity. Such glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) induced a significant hypoglycaemic effect in normoglycaemic rats. The blood glucose varied from 0.77 +/- 0.01 to 0.58 +/- 0.01 g/l (p < 0.05, n = 5). It also reduced significantly the fasting glucose level of the hyperglycaemic rats induced with oral administration of glucose (4 g/kg). In alloxan-induced diabetic rats, glibenclamide (0.2 mg/kg, per os) lowered significantly the blood glucose from 2.40 +/- 0.30 to 0.70 +/- 0.40 g/l (p < 0.05, n = 5). As well as glibenclamide, the aqueous extract of V. colorata (300 mg/kg, per os) decreased the blood glucose in alloxanic rats from 2.80 +/- 0.10 to 1.00 +/- 0.20 g/l (p < 0.05, n = 5). The aqueous extract of the leaves of V. colorata possesses both hypoglycaemic and antidiabetic effect in normoglycaemic and alloxan-induced diabetic rats. This may indicate the ethnopharmacological basis of the use of V. colorata leaves in traditional medicine for treating diabetes.

[The athlete's heart: an echocardiographic case-control study on Senegalese athletes]

The aim of this work is to study the echocardiographic parameters of male trained athletes. It is about a case-control study comparing 3 groups: basketball players, cyclists and not sports healthy subjects. All the subjects benefited from an echocardiography (time motion, two-dimensional and pulse Doppler). The mean age is of 23.5 years for the cyclists group, 24 years for the basketball players and of 26.2 years for the control group. Compared with the control group, the left ventricular telediastolic dimensions, left ventricular mass index and the pulmonary flow velocity are higher in athletes group. The basketball players have a higher left ventricular diameter and parameter of systolic function than cyclists group. The septal diameter is higher in the cyclists group. This study finds some differencies in Senegalese athletes in the characteristics of the standard athletic heart syndrome.

[Left atrial myxoma. Report of 2 cases operated in Senegal]

Cardiac tumours are rare and are dominated by left atrial myxoma. The authors report 2 cases of left atrial myxoma operated in the Cardiology department of Dakar (Senegal). Clinical signs were heart failure, cardiac sounds mimicking mitral valve disease and alteration of general state. The electrocardiogram showed sinus rhythm in 1 case and atrial flutter in the second case. The chest-x-ray show cardiac enlargement. Diagnosis was suggested by echocardiography and confirmed by anatomy. Evolution was favourable in one case and the other patient died.

[Role of transesophageal echocardiography in the diagnosis of aortic dissection. Report of 5 cases]

Aortic dissection is medical and surgical emergency. About 5 cases, the authors emphasized the role of transesophageal echocardiography in the diagnosis of aortic dissection. For all patients we realized a clinical examination, electrocardiogram, chest X ray, thoracic and transesophageal echocardiography and laboratory studies. Echocardiography were performed by an apparatus Hewlett Packard sonos 1000 with colour doppler and multiplanar transesophageal. Transesophageal echocardiography made the diagnosis by showing dilatation of aorta, intimal flap, false channel; this exam also allow to classify the aortic dissection.

[Management of children with sickle cell disease in Africa: experience in a cohort of children at the Royal Albert Hospital in Dakar]

Management of major sickle hemoglobinopathies in industrialized countries has improved significantly over the last few years thanks to strict application of the preventive and curative measures developed as a result of a better understanding of the underlying pathophysiological mechanisms. However patients in Africa have benefited little from progress in the field due to the lack of human and physical resources in sharp contrast with the high prevalence of the disease. The purpose of this study was to analyze problems involved in management of childhood sickle cell disease in Africa based on our experience in a cohort of 556 cases treated over a period of 12 years. The main problems were the same as those encountered in other black African nations, i.e., delayed diagnosis due to a lack of routine neonatal diagnostic screening, difficulty implementing anti-infectious prophylaxis due not only to the high cost of recommended vaccinations not covered by the Expanded Program on Immunization but also to poor compliance with antiobioprophylaxis, and insufficient transfusion facilities hindering application of long-term transfusion protocols when indicated. In addition the high prevalence of digestive-tract parasitosis and malaria raise the need to combine standard preventive measures with routine parasiticidal treatment and malarial prophylaxis adapted to each geographical area. The high frequency of associated iron deficiency requires systematic laboratory testing to identify and treat resulting manifestations during follow-up. An important prerequisite for widespread implementation of appropriate preventive and curative measures in Africa is recognition of sickle cell disease as a priority in public health care policy.

[Effect and mechanism of action of Tinospora bakis roots on biliary secretion using in vivo models]

The aim of this study is to determine the choleretic properties of lyophilized aqueous extract of Tinospora bakis roots. For thus, we have used healthy and cholestatic Wistar rats. After administration of the extract (4 mg/100 g of weight) biliary flow, biliary acids flow, biliary glutathione and glucose concentrations were measured by specific methods. Comparative results between treated rats and non treated rats show: For healthy rats: a significant increase of biliary flow, biliary acids flow in the group of treated rats versus non treated healthy rats. There were no significant difference in the glutathione and glucose concentrations. For cholestatic rats: we noted also significant increase of biliary flow, biliary acids flow and glutathione concentration in the treated rats group. These results suggest that Tinospora bakis has a choleretic effect in vivo which depends on biliary acids and/or glutathione concentration.

[Management problems of malignant hemopathies among children in Senegal]

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

[Subvalvular left ventricular aneurysm. Report of 2 cases]

The authors report both Senegalese's cases of subvalvular left ventricular aneurysm (SVLVA). The aim of the study was to describe the clinical and paraclinical aspects of this disease. Mitral regurgitation an heart failure were constant. Beyond cardiomegaly observed in both patients, one of them presented vaulting of the left ventricle. In the two cases, electrocardisgram showed sinus rhythm, and biology an inflammatory syndrome. One patient had also tuberculosis. Transthoracic echocardiography showed an aneurysm situated in a mitral subvalvular position, thrombosed in one case. Medical treatment with furosemid and digoxin has been administrated. One patient received also drugs against tuberculosis. Surgery of aneurysm had not been possible. During the evolution, we have observed persistence of heart failure in one patient. The other one died, probably after a cerebral embolism. Autopsy confirmed the echocardiographic aspects and integrity of myocardium and coronary arteries.

[Major thrombocytosis associated with severe anemia in children. Diagnosis of 9 cases]

Major thrombocytosis associated with severe anemia is uncommon in pediatrics. We report 9 consecutive cases observed in Albert Royer Children Hospital of Dakar. They were 7 boys and 2 girls 4 to 15 years old (mean age = 10 years). Six patients had a history of geophagia and 3 presented recent emission of worms by the stools. Anemia was clinically well tolerated in all cases. In initial blood count platelet levels varied from 800 10(3) to 1180 10(3)/mm3 (mean = 1032 10(3)/mm3), while hemoglobin level varied from 3.4 to 7.4 g/dl (mean = 4.9 g/dl). Anemia was microcytic, hypochromic and associated with low serum iron level in all patients. We considered the diagnosis of reactive thrombocytosis induced by iron deficient anemia in all cases. Platelet count and red cell indices were progressively normalised with iron treatment and no complication of thrombocytosis was observed. Considering published data, iron deficiency is one of the most frequent causes of reactive thrombocytosis in children. The physiopathologic mechanism, still unknown, could involve cytokines of thrombopoiesis. Reactive thrombocytosis induced by iron deficiency or other factors have usually a benign course and need no specific treatment other than that of the etiology.

[Post myocardial infarction septal rupture. Report of 2 cases]

The authors report 2 cases of post myocardial infarction septal-rupture. There were one woman and one man aged respectively of 52 and 69 years. Risk factors were diabetes associated in one case with hypertension, and in the other case with tobacco addict. Both patients presented a ventricular septal defect murmur, and cardiac failure. Myocardial infarction (MI) was inaugural, semi-recent, and concemed interventricular septum or circumference of myocardium. Cardiac enzymes were high. Echocardiography showed a left ventricular apical aneurysm, and septal rupture. An abnormal blood flow pattern from left to right ventricle was visualized at Döppler. Medical treatment of Ml and cardiac failure were administrated. Surgery had not been possible. Both patients died respectively after 36 days and 4 days by cardiogenic shock.

[Peripartum idiopathic myocardiopathy: prospective echocardiographic study]

Still frequent in Africa, the idiopathic peripartum cardiomyopathy (PPC) is the subject of only few prospective studies. The aim of this prospective work was to assess the echocardiographic abnormalities of the PPC and to determine on 26 patients the evolution and the prognostic factors of this disease. Six women had mild to moderate pericardial effusion. The abnormalities of the wall motion, constantly found, were diffuse in 20 cases (77.1%) and localized or prevalent on the interventricular septum or the left ventricular posterior wall in the other cases. The cardiac chambers were dilated in 24 cases (92.3%). Left ventricular hypertrophy was noted among 16 patients (61.5%); it was eccentric in 15 cases. The left ventricular systolic dysfunction was constant. The other abnormalities were: the abnormal left ventricular relaxation (one case), low mitral and aortic flow (12 cases), the mitral (21 cases) and tricuspid regurgitation (five cases). One noted a septal hypertrophy and an isolated dilatation of the right ventricle. The mean follow-up was 7.3 +/- 1 month (1-18 months). Two patients died at the 4th and 8th month. Among the 24 survivors, 11 had normalized were: the gestity (p = 0.01), the parity (p = 0.01), the cardiothoracic ratio (p = 0.04), the left ventricular volumes (p = 0.02), and the parameters of left ventricular function. The echocardiography of patients with PPC usually shows a pattern of dilated and hypokinetic cardiomyopathy, but many variations are possible. Most of the patients keep echocardiographic abnormalities after mean term follow-up.