Infected urachal cyst in an adult, report of two observations

INTRODUCTION

Urachus is an embryonic remnant that usually involutes before birth. Abnormal persistence of this structure gives embryologic malformation like an urachal cyst. Infection or malignancy degeneration can complicated it.

CASE PRESENTATION

Case 1: We report 20 years old female patient consulted with acute abdominal pain. Clinical examination showed fever and infra-umbilical tender mass. The abdominal Computerized Tomography showed pelvic mass between umbilicus and bladder. The open laparotomy found infra-abdominal semi-solid mass. A complete resection was done and histological exam confirmed infected urachal cyst. Case 2: A 19 years old male patient presented with abdominal pain and fever. Physical examination found tenderness in lower abdomen. Biology revealed leukocytosis, and Ultrasonography found a heterogeneous infra-umbilical mass. Surgical exploration by mini-laparotomy found an abscess urachal cyst that is confirm by histological exam after complete resection.

CLINICAL DISCUSSION

Urachal cyst in adult patient is rare. Clinical symptoms without complications are insignificant. Because of malignancy risk, adult urachal cyst are managed by surgery.

CONCLUSION

Infection cyst is the most common complication of urachal cyst. Complete resection is recommended because of malignancy degeneration risk.

[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]

OBJECTIVES

The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism.

METHODS

This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire.

RESULTS

We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05).

CONCLUSION

This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

The cost of diets according to nutritional quality and sociodemographic characteristics in Belgium

Introduction

Prices of foods may influence purchases and therefore, the overall quality of diets. Our objective was to estimate cost variations according to the nutritional quality of diets and to identify sociodemographic characteristics associated with the cost differences in adults' diets.

Methods

Data from adults (N = 1,158; 18-64 years) included in the 2014-2015 Belgian National Food Consumption Survey were used. Dietary assessment was based on two 24-h dietary recalls and a food frequency questionnaire. The “Mediterranean Diet Score” (MDS) and the “Healthy Diet Indicator” (HDI) were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan panel food price data. Associations were estimated using linear regressions.

Results

The mean diet cost was 5.79€/day (SEM: 0.07). Adjusted for covariates and energy intake, it was significantly higher in the highest (T3) tercile of both scores than in the lowest tercile (T1) (MDS: T1=5.60€/d (0.09) vs. T3=6.03€/d (0.10); HDI: T1=5.42€/d (0.09) vs. T3=6.34€/d (0.10)). Higher intake of fruits, vegetables, fish, dairy products, vegetable oil, fibre and potassium and lower intake of free sugars were associated with higher diet cost. Both diet quality and cost were higher in 35-64-year-old (vs. 18-34 years), active (vs. students) and post-secondary education (vs. secondary education or lower) respondents. The association between quality and cost of diets was weaker in males and among individuals with higher education levels.

Conclusions

Healthier diets are more expensive than less healthy diets in Belgium. These findings contribute to a better understanding of social inequalities in diet in order to support public health policies and actions.

Key messages

Strategies need to be developed to improve the affordability to a healthy diet. In particular, messages promoting healthy diet targeted to the vulnerable populations should better consider the food cost.

Adult ileocecal intussusception induced by adenomatous ileal polyp: case report and literature review

Intussusception is a rare cause of bowel obstruction in adults, and has generally an organic etiology. However, adenomatous polyp of the small bowel is an uncommon etiology. Moreover, there’s a great difference with childhood intussusception in its presentation, etiology and management. We describe herein a case of adult ileocecal intussusception due to an adenomatous ileal polyp with a preoperative diagnosis made on computed tomography. We performed a right hemicolectomy, without attempting to reduce the intussusception, and an end-to-end ileotransverse anastomosis. The pathological examination of the surgical specimen revealed an adenomatous polyp with a high grade dysplasia on the terminal ileum, being the cause of the ileocecal intussusception.

Particle size and endosperm type of dry corn grain altered duodenal flow of B vitamins in lactating dairy cows

The objective of the experiment was to determine if factors such as endosperm type (floury vs. vitreous) and particle size (fine vs. medium) of dry corn grain, known to affect starch digestibility in the rumen, modify apparent ruminal synthesis and duodenal flow of B vitamins in lactating dairy cows. Eight lactating multiparous Holstein cows equipped with rumen and duodenal cannulas were assigned randomly to a treatment sequence according to a 2 × 2 factorial arrangement in duplicate 4 × 4 Latin square design experiment. Duration of each experimental period was 21 d. When expressed per unit of dry matter intake (DMI), floury treatments increased duodenal flow and apparent ruminal synthesis of niacin and folates but tended to increase apparent degradation of thiamin in the rumen. Duodenal flow of thiamin, riboflavin, niacin, folates, and vitamin B₁₂, expressed per unit of DMI, decreased with an increase in particle size. Similarly, apparent degradation of thiamin and riboflavin was greater and apparent synthesis of niacin, folates, and vitamin B₁₂ was reduced when cows were fed coarser dry corn grain particles. Neither endosperm type nor particle size had an effect on duodenal flow and apparent ruminal synthesis of vitamin B₆. Apparent ruminal syntheses, expressed per unit of DMI, of all studied B vitamins but thiamin were negatively correlated with apparent ruminal digestibility of neutral detergent fiber. Duodenal flow of microbial N was positively correlated with apparent ruminal synthesis of riboflavin, niacin, vitamin B₆, and folates. Under the conditions of the present experiment, except for thiamin, the effects of factors increasing starch digestibility of dry corn grain in the rumen on the amounts of B vitamins available for absorption by the dairy cow seem to be mediated through differences on ruminal digestibility of neutral detergent fiber and, to a lesser extent, on duodenal microbial N flow.

[Profil course of SC sickle-cell patients in Dakar: a case-control study with SS sickle cell form]

AIMS

The study aim to describe the epidemiological, clinico-biological and evolutionary aspects of SC sickle cell patients compared to SS sickle cell disease.

PATIENTS AND METHODS

We realized a case-control study of 12 months duration including 98 major sickle cell patients (49 SC and 49 SS sickle cell patients). SS sickle cell patients were randomly selected according to age and sex. Socio-demographic, clinico-biological and evolutionary data were noted for each patient.

RESULTS

Mean age was 24.7 years (5 - 53). Sex ratio was 0.8. Mean number of transfusions was 0.06 of SC patients and 0.34 for SS patients (p=0.0008). Mean number of vaso-occlusive crisis per year was 2.24 of SC patients and 2.37 of SS patients (p=0.3). Mean basic hemoglobin level was 10.8 of SC patients and 7.8 of SS patients (p=0.0000). Priapism was found in 2.04% of SC patients and 4.04% of SS patients (p=0.3) and acute anemia in 2.04% of SC and 24.48% of SS patients (p=0.003); 26.53% of SC patients had a chronic complication compared to 18.36% of SS patients (p=0.0001).

CONCLUSION

This study shows that SC sickle cell patients are less symptomatology compared to SS patients, however they would develop more chronic complications from where the utility for regular follow-up.

Graphene-based acceptor molecules for organic photovoltaic cells: a predictive study identifying high modularity and morphological stability

An idealized donor:acceptor pair is proposed for improved organic photovoltaic lifetimes and efficiencies.

[Evaluation of the efficacy of medical screening of blood donors on preventing blood transfusion-transmitted infectious agents]

BACKGROUND

The aim of this study was to evaluate the efficacy of medical screening to retain blood donors in window period by comparing the seroprevalence of infectious agents (HIV, hepatitis B and C, syphilis) in deferred versus accepted blood donors.

MATERIALS AND METHODS

This prospective and transversal study was performed during 4 months in the National Blood Transfusion Center in Dakar (Senegal). We conducted a convenience sampling comparing the seroprevalence of infectious agents (HIV, HBsAg, HCV and syphilis) in deferred versus accepted blood donors after medical selection.

RESULTS

In total, 8219 blood donors were included. Medical selection had authorized 8048 donors (97.92%) and deferred donors were 171 (2.08%). The prevalence of HIV was higher in the deferred than in accepted blood donors (1.75% vs. 0.05%) (P=0.0003; OR=35.91), as well as for HBsAg (12.87% vs. 7.35%) (P=0.006; OR=1.86). HCV antibodies were present in 0.71% of accepted blood donors and 0.58% in deferred blood donors (P=0.65; OR=0.82). Only accepted donors had brought the infection of syphilis (0.34%) (P=0.56; OR=0).

CONCLUSION

Medical selection is efficient to exclude blood donors at high risk of HIV transmission and to a lesser extent of HBV. However, current medical screening procedures do not allow us to exclude donors asymptomatic carriers of HCV and syphilis.

Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

[Appendicitis schistosomiasis: unusual lesion about two cases in Senegal]

Appendiceal schistosomiasis is a rare disease of only histopathological diagnosis. Appendectomy should be followed by treatment with praziquantel to avoid complications. We report two cases of appendiceal schistosomiasis while discussing the place of this infection in the pathogenesis of appendicitis. Finally we recommend a routine pathological examination of any part of appendectomy for better care for patients.

[Prevalence of child and teenage obesity in schools in Dakar]

Obesity is currently viewed as a serious worldwide public health issue. In this survey, we aim to determine its prevalence among schoolchildren and teenagers in Dakar. The sample of our survey consisted of 2,356 students aged 11-17, including 1,110 boys and 1,246 girls. For each of them, we have calculated their body mass index. Based on the higher value of the norm of that index, referred to the 97th percentile of Rolland-Cachera MF's curves, we have identified obese students according to their age and sex. The prevalence of obesity within our sample is 9.34%, with 2.88% for boys and 6.46% for girls. It is at its peak in the age of 11, though there is no significance (p > 0.05) in its decrease (from age 12 to 17). There are significantly (p < 0.05) more obese students in "catholic private" schools than in "public" schools where schooling is free. Child and teenage obesity is a reality in Dakar schools. Consequently, it is advisable to determine its nationwide prevalence to take on its prevention as well as its cure.

[Predictive factors of chronic complications in adult sickle cell anemia patients in Dakar, Senegal]

PURPOSE

Chronic complications of sickle cell disease (SS) usually involve irreversible organ damage. Several genetic factors have been shown to have predicative value for chronic complications but these data are not always available. The purpose of this study was to assess the value of sociodemographic and clinicobiological features in predicting chronic complications.

METHODS

This study included a total of 229 adult SS patients who underwent quarterly follow-up examinations for at least 10 years (range, 10 - 16). All sociodemographic and clinicobiological data were recorded. Screening for complications was performed at least once every three years. The risk of developing chronic complications was analyzed in function of patient follow-up data.

RESULTS

Mean patient age was 28.6 years (range, 20 - 57) and sex ratio was 1.3. Prevalence of chronic complications was 34.9% (80/229). The most common complication was bone necrosis in 27 cases (11.7%) followed by gallstones in 24 (10.4%). The only sociodemographic factor with predictive value was patient age (p=0.0008). Multivariate analysis identified two clinicobiological factors with predictive value. History of transfusion was associated with a 3-fold higher risk while hemoglobin F level was associated with decreased risk.

CONCLUSION

In this study, age and low hemoglobin F level were the only predictive factors of chronic complications in SS patients.

[Watery diarrhea with fever: consider the possibility of pneumococcal meningitis]

The purpose of this report is to describe two rare cases of pneumococcal meningitis observed in Africa. Both cases were revealed by gastrointestinal symptoms characterized by abdominal pain and watery diarrhea. Due to the potential severity of bacterial meningitis, early diagnosis is required. Since diarrhea with fever is a common occurrence in Africa, differential diagnosis is necessary. Isolated diarrhea can be caused by meningeal syndrome and calls for testing to detect invasive pneumococcal infection.

[Spitting cobras: description of 2 cases in Djibouti]

The purpose of this report is to describe two cases involving ophthalmic exposure to venom from spitting cobras. Based on these cases, readers are reminded that eye injury can be prevented by low-cost treatment consisting of prompt, prolonged saline irrigation. This treatment also reduces pain.

[Centipede bite in a woman with heterozygotous sickle cell disease]

Although centipede bits can cause severe symptoms, they are seldom reported since outcome is generally favorable. The purpose of this report is to describe a case of centipede envenomation causing severe and prolonged symptoms in a woman with sickle cell trait.

[Prevention of the acute tolerence with fentanyl by ketamine]

INTRODUCTION

The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine.

MATERIALS AND METHODS

We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery.

RESULTS

Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1.

CONCLUSION

The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.

[Enhancing the anthelminthic activity roots of Annona sengalensis]

INTRODUCTION

Annona senegalensis is a plant largely used in traditional medicine in Africa. The roots showed an antiparsitic activity. The purpose of this work is to determine through bioassay on Rhabditis pseudoelongata the activity of the roots of Annona senegalensis and characterise if any substances responsible for this activity.

MATERIAL AND METHODS

The vegetable material consists of roots of Annona senegalensis collected in Casamance at 1999. The tests of activity are carried out on Rhabditis pseudoelongata, stock L. Lamy, Institut Pasteur, Paris. Powder of roots (1070 g) was extracted with methanol. From this rough extract, we carried out two extractions with the dichloromethane of which one after passages in alkaline and acid medium. Various extracts were subjected to a chromatography on column of silica gel or from alumina gel; some compounds were isolated by high performance liquid chromatography . The identification of compounds was deed using spectrometric techniques (mass, Ultraviolet, Infrared) and nuclear magnetic resonance. The tests of activity related to three extracts and seven molecules isolated from the roots. The percentage of dead worm is determined after two hours of contact with demineralised water containing the sample to be tested.

RESULTS

The neutral extract chloromethylenic showed an important activity on Rhabditis pseudoelongata. Five acetogenines were insulated starting from this extract chloromethylenic (gigantetronenine, squamocine, glaucanisine, glaucanetine, goniothalamicine) and two alkaloids starting from the alkaline extract chloromethylenic (liriodenine and norolivéroline). The tests on Rhabditis pseudoelongata of these compounds showed an activity of the squamocine with a IC50 of 0.1 microg/ml and IC90 0.3 microg/ ml more powerful than that of the levamisole, reference substance (IC50 of 0.8 microg/ml and IC90 13 microg/ml).

CONCLUSION

The study of the biological activity of the roots of Annona senegalensis made it possible to determine the anthelminthic activity of the extract chloromethylenic from where the squamocine was isolated. The presence of this molecule could explain the anthelminthic activity of this plant.

[Profile of patients admitted for myocardial infarction at the emergency reception facility of Principal Hospital in Dakar, Senegal]

This retrospective study was carried out from January 2005 to December 2006 to ascertain the profile of patients admitted for treatment of myocardial infarction (MI) in a modern emergency reception facility (ERF) in Sub-Saharan Africa. Diagnosis of MI was based on clinical presentation, electrocardiography (persistent ST-segment depression), and laboratory findings (measurement of troponine T and CPK MB). Study data included epidemiological parameters (including risk factors and interval between onset of symptoms and admission), clinical and paraclinical findings, therapeutic modalities (including any prehospital management), complications at the time of admission, and mortality within the first five days. Men accounted for 77% of the 52 consecutive patients hospitalized for MI during the study period. Mean age was 59 years. Risk factors included hypertension in 46% of cases, tobacco use in 40%, and diabetes in 21%. The mean interval for management was approximately 29 hours with only 5 patients receiving care within the first 6 hours. Chest pain was the main reason for coming to the ERF (86%). The location of pain was anterior in 58% of cases and inferior in 37%. Diagnosis was confirmed by laboratory findings in 96% of patients. Ten patients benefited from transportation by ambulance and four patients underwent thrombolysis before hospitalization. Complications at the time of admissions included cardiovascular collapse (n=3), acute pulmonary edema (n=13), and arrhythmia (n=6). Eleven patients (21%) died within the first five days. These findings confirm the need to educate the population in an effort to reduce the interval for management, to develop prehospital medical care, and to increase the availability of coronary artery revascularization modalities to improve the prognosis of MI in the acute phase.

[Antileishmanial activity of five 2- or 3- quinolines by enyne group]

INTRODUCTION

Leishmaniasis is an emergent orphan disease because of its co-infection with HIV AIDS. We report herein the in vitro biological evalution of five news quinolines, 2- or 3- substituted by an enyne group against Leishmania donovani (MHOM/ET/L82/LV9).

PATIENTS AND METHODS

The quinolines has been synthesized by using a cross-coupling reaction between a chloroenyne and an organometallic coumpound in a presence of iron a "green" catalyst. Biological evalution is realized by a colorimetric method with the use of 3-(4,5-dimethylthiazol-2,5-diphényl)-tétrazolium bromide.

RESULTS

Determination of the inhibitory concentrations as well as the minimal inhibitory concentrations has shown that the substitution by an enyne group made it possible to have a more important antileishmanial activity. In addition, we have seen that the -2 or the -3 position of the enyne group had no influence in the antileishmanial activity.

CONCLUSION

Thus, we have shown the real interest of these quinolines which could be favourably compared with pentamidine, which is currently the reference product, and to consider the use of these quinolines in the treament of the leishmaniasis.

[Antileishmanial activity of five 2- or 3- quinolines by enyne group]

INTRODUCTION

Leishmaniasis is an emergent orphan disease because of its co-infection with HIV AIDS. We report herein the in vitro biological evalution of five news quinolines, 2- or 3-substituted by an enyne group against Leishmania donovani (MHOM/ET/L82/LV9).

PATIENTS AND METHODS

The quinolines has been synthesized by using a cross-coupling reaction between a chloroenyne and an organometallic coumpound in a presence of iron a "green" catalyst. Biological evalution is realized by a colorimetric method with the use of 3-(4,5-diméthylthiazol-2,5-diphényl)-tetrazolium bromide.

RESULTS

Determination of the inhibitory concentrations as well as the minimal inhibitory concentrations has shown that the substitution by an enyne group made it possible to have a more important antileishmanial activity. In addition, we have seen that the -2 or the -3 position of the e nyne group h ad no influence in the antileishmanial activity.

CONCLUSION

Thus, we have shown the real interest of these quinolines which could be favourably compared with pentamidine, which is currently the reference p roduct, and to consider the use of these quinolines in the treament of the leishmaniasis.

Hemodynamic aspects and oxygenation variables in severe malaria of adults in Africa

OBJECTIVES

Study of the hemodynamic profile and oxygenation variables in severe malaria to determine whether they are identical to those observed in severe bacterial infections.

DESIGN AND SETTING

Prospective study in an intensive care unit of a West African hospital.

PATIENTS AND PARTICIPANTS

Two groups of adult patients hospitalized for severe malaria according to WHO criteria, a control group (n = 13) with systemic vascular resistance of 800 dyne s(-1) cm(-5) or higher and a hyperkinetic group (n = 16) with a level lower than 800 dyne s(-1) cm(-5). Twenty-nine patients participated in this study (19 semi-immune, 10 nonimmune).

INTERVENTIONS

Before hemodynamic study a loading dose of quinine formiate was administered: 20 mg/ kg intravenously for 4 h. Artificial ventilation was used in the case of persistent hypoxemia.

MEASUREMENTS AND RESULTS

The hemodynamic study with Swan-Ganz catheter was performed after filling with 1,000 ml lactated Ringer's solution. From a clinical and a biological standpoint there was no difference between the two groups except for creatine phosphokinase, which was significantly higher in the hyperkinetic group: 2404 +/- 3654 vs. 1,898 +/- 1,828 IU/l. Hemodynamic and oxygenation variables showed a significant difference in cardiac index (6.1 +/- 1.2 vs. 3.9 +/- 1.21 min(-1) m(-2)), systemic vascular resistance (536 +/- 143 vs. 1098 +/- 170 dyne s(-1) cm(-5)), oxygen delivery (645 +/- 163 vs. 482 +/- 186 ml min(-1) m(-2)), and oxygen extraction (23 +/- 9 % vs. 34 +/- 14 %). Oxygen extraction was negatively correlated with oxygen delivery in the control group but not in the hyperkinetic group. Eight of 10 nonimmune patients (80 %) were in the hyperkinetic group versus 8 of 19 semi-immune patients (42 %; p < 0.05). Nine patients in the hyperkinetic group (69 %) and seven of the control group (46 %) died (NS).

CONCLUSIONS

In contrast to severe bacterial infections, severe malaria does not always induce hyperkinetic-type hemodynamic changes. Such changes are observed mostly in nonimmune subjects.

[Chloroquine poisoning with respiratory distress and fatal outcome]

Chloroquine poisoning can cause life threatening cardiovascular disturbances. We report three cases of suicide with chloroquine causing acute respiratory insufficiency from pulmonary oedema with lethal outcome, despite a treatment with diazepam, epinephrine and mechanical ventilation.

[Re-expansion pulmonary edema after excision of an intrathoracic tumor]

We report an acute respiratory insufficiency following the removal of a large intrathoracic fibroma (3.1 kg) in a 6 year-old child, caused by a re-expansion pulmonary oedema (unilateral oedema occurring within one hour after expansion). This oedema improved rapidly and was followed by a well-tolerated pleural effusion. This complication is due to discrepancy between a small lung and a large thoracic cavity, due to the prolonged time course of the tumor growth. These oedemas are caused by rapid lung re-expansion, the volume of the removed tumor and the depth of postoperative pleural suction. The value of positive-end expiratory pressure is discussed.

[Multiple organ failure syndrome after ovarian hyperstimulation]

Ovarian stimulation is used to treat female infertility, especially in Black Africa where infertility is considered as shameful. Ovarian stimulation can lead not only to multiple pregnancies but also to severe systemic complications such as the one described in this report. Ovarian stimulation using human menopausal gonadotropin led to ovarian hyperstimulation and multiple organ failure in a 28-year-old Senegalese woman. Symptomatic treatment using corticosteroids, abdominal paracentesis to relieve ascites, and fluid expansion failed. Bilateral ovariectomy was performed resulting in permanent sterility. Ovarian stimulation requires close monitoring by ultrasound visualization and measurement of 17 beta-estradiol to allow early detection of complications.

Anti-Müllerian hormone (AMH) secretion in prepubertal and adult rams

The aim of the present analysis was to determine whether anti-Müllerian hormone concentrations in prepubertal plasma or adult rete testis fluid are related to the number or function of Sertoli cells in rams or to the presence of the FecB Booroola gene. Twenty rams from two Booroola crosses, differing in their testicular masses were analysed; in each cross, half of the animals were heterozygous carriers of the FecB gene. The data from rams, during prepuberty and at adulthood during the non-sexual season, were analysed by two-way ANOVA and residual correlations. In 4-week-old intact male lambs, the mean anti-Müllerian hormone plasma concentration was 15 ng ml-1, irrespective of cross, genotype or eCG stimulation; it was significantly negatively correlated with FSH (r = -0.51; P = 0.02; n = 19). In adults, anti-Müllerian hormone was not detectable in plasma and was 0.5 ng ml-1 in rete testis fluid, irrespective of cross or genotype. The total number of Sertoli cells per testis was not related to anti-Müllerian hormone concentration in lamb prepubertal plasma or in adult rete testis fluid. The concentration of anti-Müllerian hormone in adult rete testis fluid was significantly and negatively correlated with the daily production of leptotene primary spermatocytes per testis (r = -0.56; P = 0.02; n = 16). The mean oestrogen concentration in the adult testicular vein was 2 pg ml-1 and was correlated negatively with the rete testis fluid concentration of anti-Müllerian hormone (r = -0.60; P = 0.02; n = 15) and correlated positively with the daily production of leptotene primary spermatocytes per testis (r = 0.53; P < 0.05; n = 19). In conclusion, anti-Müllerian hormone secretion was not correlated with the total numbers of Sertoli cells per testis and cannot be used as a predictor of the number of Sertoli cells. Anti-Müllerian hormone secretions were not affected by the presence of FecB gene. However, anti-Müllerian hormone secretion could be considered to be inversely related to the daily production of primary spermatocytes by the testis.

[Transfer hypokalemia induced by norepinephrine infusion]

We report a case of a severe hypokalaemia by intracellular shift of potassium in a sedated and ventilated head trauma patient. The kalaemia which was 3.9 mmol.L-1 at admission in the intensive care unit decreased to 1.3 mmol.L-1 during a perfusion of noradrenaline (0.3 micrograms.kg-1.min-1). Following the decrease of the noradrenaline dose, and administration of potassium, the kalaemia rapidly increased to 5.3 mmol.L-1 carrying a risk of arrhythmia. Therefore, kalaemia and ECG should be closely monitored when the noradrenaline doses are reduced. The causes of transcellular shift of potassium are reviewed.

[Severe acute asthma in adults in black Africa]

A prospective study has been conducted in an intensive care unit of West Africa in order to determine the clinical and laboratory features of severe acute asthma in black Africans. The study concerned 55 episodes of severe acute asthma, with PaCO2 above 45 mmHg, in 42 patients (26 men and 16 women, mean age 35 +/- 3 years). A triggering factor was found in only 36 percent of the cases. None of the patients were using beta-adrenergic stimulants as maintenance therapy. The mean duration of asthmatic attacks prior to hospitalization was 49 +/- 7 hours. Three patients had cardiorespiratory arrest on admission. Mechanical ventilation was necessary on 12 occasions (initially in 4 and secondarily in 8). Four patients died. It would appear from this study that severe acute asthma in black Africans is characterized by a prolonged onset and by a frequent need for mechanical ventilation, suggesting a physiopathological mechanism different from that described in industrialized countries.

Treatment of severe tetanus by intrathecal injections of baclofen without artificial ventilation

A study was conducted to evaluate repeated intrathecal injections of baclofen, without artificial ventilation, in the treatment of severe tetanus. Ten patients, 5 men and 5 women, with a mean age of 34 +/- 7 years, were included in the study. The dose of baclofen injected was 1000 micrograms between the ages of 16 and 55 years, 800 micrograms over the age of 55 years and 500 micrograms under the age of 16 years. The efficacy was assessed on the basis of the resolution of contractures and paroxysms and the initial dose was reinjected prior to the reappearance of these symptoms. Treatment was discontinued in the case of central nervous system depression or inefficacy. The first injection was effective in 9 cases for 24-48 h. The haemodynamic safety was always good. Five patients developed central depression with coma and respiratory depression, requiring artificial ventilation in 3 cases and reversed by flumazenil in 2 cases. Five patients were treated exclusively with baclofen with 4 cures. Five patients had to be ventilated with only one cure. This study confirms earlier studies concerning the efficacy of intrathecal baclofen in tetanus. However, the frequency of episodes of respiratory depression prevents the recommendation of repeated injections when respiratory intensive care facilities are not available.

[Effects of diazepam on mortality from acute chloroquine poisoning]

A retrospective study was carried out, over a twelve-year period, of all cases of acute chloroquine poisoning where more than 2 g of chloroquine had been taken. It included 386 patients; of these, 60 who had taken drugs other than chloroquine, and 17 who had ingested less than 1 g of the drug, were excluded. The remaining 309 patients were allocated to two groups: a "control group", consisting of the patients admitted between January 1973 and April 1980 (n = 146), and a "diazepam group", made up of those admitted from May 1980 to December 1989 (n = 163). The patients in the latter group had had the same symptomatic treatment as those in the control group, and had been routinely given a 0.5 mg.kg-1 bolus of diazepam on admission followed by 0.1 mg.kg-1.day-1 for every 100 mg of chloroquine supposed to have been ingested. Both groups were divided into three subgroups, those patients with cardiorespiratory arrest, and those with, and those without, symptoms on admission. No statistically significant difference was found between either the control and diazepam groups or between subgroups, concerning the distribution of age, sex, amount of chloroquine supposed to have been ingested, delay in hospital admission and death rate. However, there was a higher death rate in the asymptomatic subgroup not treated with diazepam than in the diazepam group. Therefore, the routine use of diazepam for the treatment of acute chloroquine poisoning does not seem to be justified in symptomatic cases and in those with inaugural cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cerebral malaria in non-immune subjects. Current aspects in African endemic areas]

The current clinical and therapeutic aspects of cerebral malaria in non-immune adult subjects living in endemic areas of Africa were evaluated in 10 men (mean age: 40 +/- 11.4 years). On admission, 8 patients had fever, 3 were truly comatose with a Glasgow score of 7 or more. All had negative central venous pressure and only one was in a state of hyperkinetic shock. Respiratory symptoms were present in 8 cases, and jaundice was observed in 8 cases. Three patients has a haemoglobin level lower than 8 g/100 ml, and 8 had thrombocytopenia. Blood creatinine levels above 240 mumol/l and blood bilirubin levels above 50 mumol/l were found in 6 and 8 patients respectively. Plasma creatine phosphokinase was above 500 IU/l in 7 cases, and PaO2 was below 70 mmHg in 7 cases. All patients received quinine, combined with doxycycline in 6 cases. Infectious complications occurred in 5 patients, with 2 septic shocks. Two patients developed acute pulmonary oedema. Five patients died. This study shows that cerebral malaria in non-immune subjects living in endemic areas produces multivisceral deficiency similar to that observed in imported malaria. Its prognosis can be improved by loading doses of quinine and by a better prevention of nosocomial infections.