[Contribution of the musculocutaneous flap of pectoralis major in head and neck oncology: 26 observations in Senegal]

INTRODUCTION

The pectoralis major musculocutaneous flap constitutes a significant advance in cervicofacial carcinology. At our institution, it has allowed most surgical problems to be resolved in a single-stage procedure. The objective of this study was to report our experience with this flap.

PATIENTS AND METHODS

This retrospective study includes 26 cases observed over a 10-year period (January 1994-December 2003). The parameters studied were clinical and paraclinical. All patients included in this study received a pectoralis major musculocutaneous flap. Patients treated using another type of flap were not included.

RESULTS

Mean patient age was 51 years (range, 20 to 74). The sex ratio was 12 (24 men and 2 women). At the time of admission, 73% of patients showed marked impairment of general condition. In 21 patients (81%), the effect of the pectoralis major musculocutaneous flap was observed immediately after surgery unlike pharyngostome (19%) in which the flap is used in a second stage procedure. With a mean follow-up of 7 years, failure has been observed in 4 cases (15%).

CONCLUSION

The pectoralis major musculocutaneous flap is an excellent tool for cervicofacial reconstruction after carcinological exeresis. It reduces the duration of hospitalization. Acquiring proper flap harvesting technique is an important factor in improving outcome.

[Lung cancer in Dakar, Senegal]

A prospective, multicenter was conducted in all specialized centers in the city of Dakar. The objective was to describe the epidemiology to assess the management of lung cancer. 45 patients were included. The sex ratio M/F = 8. The average age of patients was 57.5 years. Smoking was found in 84.4% of cases. The average time for consultation after the onset of symptoms was 6 months. The average time to diagnosis was 2 months. Two out of three patients (66%) had seen beyond the stage III B. Improved diagnostic performance for early diagnosis of cancer is needed. Emphasis should be on prevention through tobacco control.

[Cryptococcal meningitis in children: description of 3 cases]

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

Genetic diversity of polymorphic vaccine candidate antigens (apical membrane antigen-1, merozoite surface protein-3, and erythrocyte binding antigen-175) in Plasmodium falciparum isolates from western and central Africa

The malaria vaccine candidate antigens erythrocyte binding antigen 175 (EBA-175), merozoite surface protein 3 (MSP-3), and apical membrane antigen (AMA-1) from Plasmodium falciparum isolates from countries in central and west Africa were assessed for allelic diversity. Samples were collected on filter paper from 600 P. falciparum-infected symptomatic patients in Cameroon, Republic of Congo, Burkina Faso, Ghana, and Senegal and screened for class-specific amplification fragments. Genetic diversity, assessed by mean heterozygosity, was comparable among countries. We detected a clinical increase in eba 175 F-allele frequency from west to east across the study region. No statistical difference in msp-3 allele distribution between countries was observed. The ama-1 3D7 alleles were present at a lower frequency in central Africa than in West Africa. We also detected little to no genetic differentiation among sampling locations. This finding indicates that, at least at the level of resolution offered by restriction fragment length polymorphism analysis, these antigens showed remarkable genetic homogeneity throughout the region sampled, perhaps caused by balancing selection to maintain a diverse array of antigen haplotyes.

[Disseminated histoplasmosis due to Histoplasma capsulatum var. duboisii in Senegal. A case in HIV-infected patient]

INTRODUCTION

Histoplasmosis, a disease due to Histoplasma capsulatum, is an invasive opportunistic fungal infection, endemic in Africa. So, the occurrence of african histoplasmosis associated with HIV infection has been rarely reported despite the high prevalence of both pathogens in this area. We report the first case of disseminated african histoplasmosis in an HIV-infected Senegalese patient.

OBSERVATION

A patient, 50-year-old has been admitted for umbilicate, necrotic and disseminated papulonodular lesions with oral infection, fever and reduction of total body mass. HIV1 test was positive, and CD4 count was 4/mm(3). Direct examination of ulcerated lesions shown extracellular, large, doubly contoured yeasts. After culture, we obtain brownish colonies, septate hyphae, echinulated chlamydospores characteristic of Histoplasma. Cutaneous biopsy revealed polymorphous granulomatous infiltrate, giant cells containing numerous large, doubly contoured, thick-wall yeast-bodies characteristic of H. capsulatum var. duboisii.

DISCUSSION

The association AIDS and histoplasmosis frequency is probably underestimated because the difficult diagnosis and the ignorance of the medical staff.

[Update on toxoplasmosis prevalence based on serological tests in pregnant women in Dakar, Senegal from 2002 to 2006]

The purpose of this study was to update data on toxoplasmosis antibody prevalence based on antenatal surveillance tests in pregnant women in Dakar, Senegal. The study population consisted of 941 pregnant women referred for diagnosis of toxoplasmosis in the Laboratory of Parasitology and Mycology at Le Dantec University Hospital Center from 2002 to 2006. Two tests using the solid-phase immunoenzymatic method were performed on venous blood samples collected at 3 weeks of interval (S1 and S2). This double testing technique was designed to detect increases in IgM and IgG antibody levels in order to confirm diagnosis of toxoplasmosis by ruling out immune response, acquired immunity or nonspecific antibody fixation. Comparison of S1 and S2 results in the 941 patients indicated a prevalence of 7.7% and 0% respectively for IgM+IgG- cases, 23.3% and 24.3% respectively for IgM+IgG-cases, and 11.3% and 10.2% respectively for IgM+IgG+ cases. The overall prevalence of toxoplasmosis antibodies was 34.5%. These data showing a high prevalence of toxoplasmosis among pregnant women in Dakar underscore the need to improve serological screening and follow up.

Maturation of mosquito spermatozoa during their transit throughout the male and female reproductive systems

The testes, seminal vesicles and spermathecae of 22 species of mosquitoes belonging to the genera Aedes, Anopheles, Culex, Mansonia and Toxorhynchites are investigated under the electron microscope. Modifications of the acrosome and sperm wall occur during the transit of the spermatozoon from the lower region of the testes to the spermathecae throughout the seminal vesicles. The origin and fate of the cell coat and the possible roles of somatic cell layers both in the testes and the seminal vesicles are discussed.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[A prospective longitudinal study of coma in the intensive care unit in an African setting: case of Dakar, Senegal]

Little is known on coma in neurological intensive care unit (NICU) in the setting of developing country in Sub-Saharan Africa. The aim of this study was to determine the morbi-mortality and survival of coma in the NICU of Dakar, Senegal. We carried out a prospective longitudinal study in the NICU of the teaching hospital of Fann in Dakar during a period of 15 months (with 12 months of inclusion) on comatose patients. Were included all patients presenting with a Glasgow score inferior to 9. Standard biological analyses were prescribed for each patient while CT scan was performed if indicated. Daily evaluation was done and complications recorded. Each patient was followed for at least 3 months. Survival was determined by the Kaplan Meier method. 345 patients were admitted in the NICU and 169 were included (48,99 %). The mean age of the patients was 58.04 +/- 17.55 years with a sex ration of 0.92. The mean time from installation of disorders and initial consultation was 47.30 +/- 138.34 hours. Etiologies were vascular disease (71 %), status epilepticus (9.47 %), meningoencephalitis (8.88 %) and metabolic disorders (8.88 %). The mean duration of hospitalization was 8.89 +/- 9.53 days associated with a mortality rate of 82.25 % for the same period. Survival at day 90 was 10.65 %. Mortality was related to infectious condition (28.4 %), renal failure (14.78 %), cardiovascular failure (13.61 %), cerebral engagement (12.43 %), multivisceral failure (11.24 %), pulmonary embolism (1.18 %) and unknown cause (18.34 %). In conclusion, coma is associated with a high mortality rate in our context and suggests that early consultation, a good control of vascular risk factors and better management of infectious condition should reduce this impact.

Squamous carcinoma of the hypopharynx in children in Sénégal: between disarray and enigma

INTRODUCTION

The squamous carcinoma of the hypopharynx constitutes the first reason of hospitalization in our department. Different studies have been realized about it and showed an epidemiological profile characterized by the young age of the patients and the predominance of female.

OBJECTIVES

To specify the place of the children in hypopharynx cancers. To evaluate the epidemiological criteria and the difficulties in the management.

MATERIALS AND METHODS

Retrospective study of 11 years (1995-2005). Collection of the data concerning the epidemiology, clinical and paraclinical findings, the treatment, and the evolution was carried out at the University Department of Otorhinolaryngology in Dakar (Sénégal).

RESULTS

15 charts of children have been collected. They presented in the majority of the cases, an advanced cancer, with 93% of T3T4. The lesion was localized at the retro-cricoid area in 4 cases, the pyriform sinus in 3 cases, the oesophagus junction in 2 cases, and the posterior wall in 1 case. In 5 cases the lesion was spreading to the totality of the hypopharynx. No case of smoking or alcohol has been noted. The anemia has been noted in 86.7% of the cases. A case of papillomatosis of the mouth and lips has been noted. The treatment was for most of cases as symptomatic, like tracheotomy with or without gastrostomy. The evolution was fatal with 11 deaths (73.33%).

DISCUSSION

Our set is the richest set through the world of hypopharyngeal cancers in children. The Plummer-Vinson syndrome noted in 86.7% of the cases and the viral infection by HPV could play a role in the genesis of this cancer.

CONCLUSION

The cancer of the hypopharynx essentially affects the young women in Sénégal without alcohol or tobacco consumption. It does not save the children, with an awful prognosis, however. So, it is imperative to organize a vast campaign of information of the populations on the bad prognosis of this cancer and to lead a large-scale epidemiological investigation, to get a better understanding of this cancer in our country.

[Anesthesia and recovery of infrarenal abdominal aortic aneurysm surgery]

The aim of this study was to evaluate the anaesthetic assumption of responsibility of the surgery of the aneurism of under renal abdominal aorta. It was a retrospective study over two years (April 2005 - April 2007). Seven patients were operated, the mean age was 69,4 years. An operational pre evaluation was carried out among all patients including/understanding an interrogation, a clinical examination and a clinical assessment. All the patients profited from a general anaesthesia with controlled ventilation. Arterial hypertension (5 cases) was the independent factor of risk followed by the nicotinism (2 cases) with a patient at the stage of obstructive chronic broncho-pneumonopathy (BPCO). A patient was allowed in a table of rupture with acute abdominal pain and a cardiovascular collapse. Electrocardioscopic anomalies were noted among three patients with type of: HVD+ HBAG; HVG; HAG. A patient presented a hypertrophy cardiopathy with deterioration of the function of the VG and an important pulmonary arterial hypertension. A tensionnelle fall was found among three patients after induction with the midazolam. The aortic time of clampage varied between 20 and 120 mn with an average of 57, 6 mn. The incidents at the time of the clampage were: a bradycardia, a hypertensive push and a hypotension. No incident was observed at the time of the declampage. The blood losses per operational were estimated on average at 1000 ml and the numbers of transfusion by patient was on average of 4 pockets. The post operative issue was simple among 5 patients. A surgical recovery was necessary in front of a case of thrombosis of prosthesis. An oligoanurie, an acute respiratory insufficiency was found at the patient admitted in a table of rupture. The intermediate duration of stay threw 11 days. The maintenance of a homodynamic stability per and post operational remainder a good strategy to prevent the operational complications post.