Molecular Signatures in Ductal Carcinoma In Situ (DCIS): A Systematic Review and Meta-Analysis

CONTEXT

Adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is debated as benefits are inconstant. Molecular signatures for DCIS have been developed to stratify the risk of local recurrence (LR) and therefore guide the decision of RT.

OBJECTIVE

To evaluate, in women with DCIS treated by BCS, the impact of adjuvant RT on LR according to the molecular signature risk stratification.

METHODOLOGY

We conducted a systematic review and meta-analysis of five articles including women with DCIS treated by BCS and with a molecular assay performed to stratify the risk, comparing the effect of BCS and RT versus BCS alone on LR including ipsilateral invasive (InvBE) and total breast events (TotBE).

RESULTS

The meta-analysis included 3478 women and evaluated two molecular signatures: Oncotype Dx DCIS (prognostic of LR), and DCISionRT (prognostic of LR and predictive of RT benefit). For DCISionRT, in the high-risk group, the pooled hazard ratio of BCS + RT versus BCS was 0.39 (95%CI 0.20-0.77) for InvBE and 0.34 (95%CI 0.22-0.52) for TotBE. In the low-risk group, the pooled hazard ratio of BCS + RT versus BCS was significant for TotBE at 0.62 (95%CI 0.39-0.99); however, it was not significant for InvBE (HR = 0.58 (95%CI 0.25-1.32)), Discussion: Molecular signatures are able to discriminate high- and low-risk women, high-risk ones having a significant benefit of RT in the reduction of invasive and in situ local recurrences, while in low-risk ones RT did not have a benefit for preventing invasive breast recurrence. The risk prediction of molecular signatures is independent of other risk stratification tools developed in DCIS, and have a tendency toward RT de-escalation. Further studies are needed to assess the impact on mortality.

[Surgical site infections at surgery service B of Point "G" hospital]

BACKGROUND

Surgical site infections (SSI) complicate most operations in developing countries. A variety of germs is responsible for it. The purpose of this study was to determine the incidence of surgical site infections and the bacteriological profile.

PATIENTS AND METHODS

We conducted a prospective study for descriptive purposes. The included patients were treated between August 2016 and July 2017 in the Surgery B department of the University Hospital Center Point G. The study population consisted of all patients operated on and hospitalized for at least 72 hours. Patients who had an infection of the operative site were retained. The incidence of ISOs, the different bacterial strains and their susceptibility to antibiotics were studied. Data was analyzed on SPSS 12.0.

RESULTS

The incidence of surgical site infections was 4.7%. The median age of the patients was 29.5 ± 4.34, the sex ratio was 1.66. The average time to onset of infections was 7.33 days. Of the samples taken, 4 bacterial strains were identified: Escherichia coli, Staphylococcus aureus, Acinobacter baumanii and Enterobacter spp. Isolated strains of Escherichia coli and Staphylococcus aureus were sensitive to Cefotaxim, Amikacin, Nitrofurantoin, but resistant to Ceftriaxon, Amoxicillin + Clavulanic acid. The species of Acinobacter baumanii and Enterococcus spp. Were sensitive to Colistin, but resistant to Ceftriaxone, Amoxicillin + clavulanic acid.

CONCLUSION

Escherichia coli and Staphylococcus aureus are the main germs of the generally antibiotic-resistant ISOs commonly used in the service.

[Diagnosis and treatment of acute surgical abdomen in Koutiala]

PURPOSE

To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center.

PATIENTS AND METHOD

This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications.

RESULTS

One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%.

CONCLUSION

Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques.

[Non-traumatic digestive perforation in Koutiala: epidemiological and therapeutic aspects]

PURPOSE

the aim of this study was to evaluate the clinical and therapeutic aspects of non-traumatic digestive perforations at the Koutiala Reference Health Center.

PATIENTS AND METHODS

This was a prospective and descriptive study from August 1, 2017 to December 31, 2018. Patients admitted and operated on for non-traumatic digestive perforation were included. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and operative follow-up.

RESULT

Sixty-one patients were registered. Non-traumatic digestive perforations accounted for 78.2% of cases of acute peritonitis (n = 78). Men were in the majority with 73.8%. The average age was 34.5 years old. The symptomatology was represented by abdominal pain in all patients, vomiting in 56 patients and fever in 42 patients. The mean duration of evolution of the symptomatology was 5.5 days. On physical examination, the most common signs were abdominal contracture with 81.9%, disappearance of prehepatic maturation (52.4%) and pain in rectal examination (95.1%). Radiological pneumoperitoneum was found in 39 patients. The serodiagnosis of Widal was positive in 15 cases. The etiologies were dominated by perforation of infectious origin with 77.0% (46). The perforation was ileal in 28 patients, appendicular in 18 patients and gastroduodenal in 11 patients. Excision-suturing of the perforation was done in 30 patients, resection anastomosis in 8 patients and appendectomy in 18 patients. Morbidity and mortality were respectively 14.7% and 6.5%.

CONCLUSION

Non-traumatic digestive perforations are the first cause of peritonitis in our department. The ileal seat is the most common and is most often secondary to typhoid fever. Morbidity and mortality remain high and this result is a reflection of late diagnosis which is the main factor of severity of digestive perforations.

[Brachial Plexus: Dissection At The Laboratory Of Anatomy Of Bamako]

INTRODUCTION

The brachial plexus consists of the ventral twigs of the last four cervical nerves and the first thoracic nerve. It ensures the motor and sensitive innervations of the thoracic limb.

AIM

Our goal was to describe the brachial plexus of the cervical region to the middle third of the arm.

METHODOLOGY

We conducted a prospective study at the anatomy Laboratory of the Faculty of Medicine and Dentistry in Bamako from September 2016 to October 2017. We dissected the brachial plexus (PB) of 13 fresh adult corpses on both sides. The inclusion criteria were: Fresh adult corpses with cervical regions and brachial without scarring. The injected or scar-carrying corpses were not included in the cervical and brachial regions.

RESULTS

Twenty-six brachial plexus of which 18 bp in men and 8 bp in women were dissected. The average age of the subjects was 42 years (extreme: 18 and 70 years). We noted nerve block variations in 3.8%, fascicular in 3.8% and late terminal in 73.1%. The involvement of the anterior branch of the fourth spinal nerve (C4) was found in 46.2%.

CONCLUSION

The brachial plexus is the seat of many anatomical variations whose knowledge is indispensable to treat its lesions.

[Epidemiology of bacterial infection materno-fetal at Abidjan- Ivory Cost: prospective study of eighty (80) cases]

The aim of our study was to describe the risk factors, clinical symptoms and bacteria isolated during fetal-maternal bacterial infections in hospitals.

MATERIALS AND METHODS

This was a prospective, descriptive study conducted from August 2, 2007 to October 3, 2007 at the neonatology department and the delivery room of the Yopougon teaching hospital . All newborn babies presenting a risk factor of infection have been included in this study. A bacteriological evaluation including containing central, peripheral and gastric fluid samples was performed. Bacteriological tests (NFS, CRP, PCT) were also performed on those newborn babies.

RESULTS

Eighty newborn babies were included. The maternal risk factors were dominated by prolonged breaking of membranes 62.5%. In the newborn bad APGAR score 56.3% and prematurity 18.8%, were noted. The main clinical symptoms were neurological, , respiratory and digestive 52.5%, 44.4% 37.5%, respectively. The main pathogens isolated were 65.5% Staphylococcus coagulase negative, 13.8% Staphylococcus aureus, 6.9% Pseudomonas aeruginosa, 3,4% Klebsiella pneumoniae, and 3.4% Acinetobacter Sp.

CONCLUSION

The clinical symptoms of the fetal-maternal bacterial infections are polymorphic. Germs found in our study differ from those usually found in the fetal-maternal bacterial infections in Europe.

[Investigation of the collateral branches of the external carotid artery in a population from West Africa. About 60 cadaver dissections]

OBJECTIVE

The goal of this survey was to study the level of emergence of the external carotid artery and the origin of its collateral branches about a dissection of 30 cadavers subjects of West Africa.

MATERIAL AND METHOD

We dissected to the laboratory of Abidjan anatomy 30 cool adults' cadavers corresponding to 28 men and two women. At these 30 cadavers, we dissected 60 external carotids. We studied the level of bifurcation of the carotid artery in relation to hyoid bone and thyroid cartilage and the level of the emergence of the collaterals branches of the external carotid artery according to classic description.

RESULTS

The origin of the external carotid artery was variable: in 46 cases (75%), the origin was between the hyoid bone and the thyroid cartilage; in 10 cases (15%), this origin was below the thyroid cartilage and in four cases (13%), this origin was over to the hyoid bone. In 46.5% of cases, we find five collaterals branches of the external carotid artery. According to classic description, we find some variations of the emergence of collateral arteries: the facial artery is not below the lingual artery in 28 cases (46.5%); the ascending pharyngeal artery do not emerge at the same level of lingual artery in 46 cases (76.5%) and in 44 cases (73%), the occipital artery do not emerge of the same level of the facial artery.

CONCLUSION

Levels of collateral branch emergence in population of West Africa is variable. It is important to know that for practice cervical surgery safety.

[Contribution to subscapularis nerve supply. 18 dissections]

INTRODUCTION

Dividing the subscapularis muscle along its fibers axis allows approaching the glenohumeral joint. The more medial its division, the more possible injury of its nerve supply.

AIM

The aim of our study was to assess the subscapularis nerve supply through cartography of the entry points of subscapularis nerves from simple landmarks, reproducible by triangulation.

MATERIAL AND METHODS

On 18 formalin-preserved shoulders, after dissection of the subscapularis nerves, distances were measured between entry points of subscapularis nerves and the following landmarks: center of the minor tubercle (tm), upper and lower poles of the glenoid cavity (cgs and cgi), apex of the coracoid process (pc).

RESULTS

There were in average 3.33 subscapularis nerves (2-4). These different nerves split most often before entering subscapularis muscle; there were in average 5.05 entry points (3-6). Distances between entry points and clinical landmarks were as follows: cgs, 3.9-6.45 cm; cgi, 3.7-5.54 cm; tm, 5.9-7.15 cm; pc, 4.9-7.66 cm. Reporting these measurements onto a frame allowed to show that all these points were located in average medially to the scapular notch and at more than 3 cm from the anterior border of the glenoid cavity.

CONCLUSION

If the transverse division does not extend farther than 3 cm from the anterior border of the glenoid cavity and from the medial border of the root of the coracoid process, there should not be any injury of the subscapularis nerves.

[Oro-facial manifestations during AIDS/HIV infection. Apropos of 60 cases seen at the Ambulatory Treatment Center in Ouagadougou and at the Yalgado University Hospital Center]

The opportinistics complaints of the AIDS occur all along the episode of the infection and depend on the individual's body immunity and on the existence or no of an anti-retroviral treatment. The buccal appearences on the face are relatively frequent. They are dominated by the buccal mycosis, the lymphatic ganglion's complaints, the inflammation of gums and buccal mucous, and the tooth decay in our context. Some authors suggest a classification that can make easy their study and treatment. Complaints like the herpes simplex infection, the herpes zoster infection, are usually found during the symptomatic stage non AIDS, whereas others like KAPOSI's disease are typical to AIDS disease. The availlability of an anti-retroviral treatment and a specialized one strenghten the efficiency of the reimbursement and improve the prognosis.

[Portal vein: variations of its branches (about 32 dissections)]

PURPOSE

The aim of this study is to precise the variations of portal vein branches and also to elucidate anatomic basis of partial hepatectomy.

MATERIAL AND METHODS

Thirty-two post-mortem specimens, with ages ranged from one day to sixty-five years in both two sexes, were dissected. Latex and Rhodopas were used for visualizing and drawing the portal vein course and its branches.

RESULTS

Nine types of different variations of portal vein branches were observed. Most of cases were similar to those previously reported in literature. But four types must be especially noted, because they were not available in literature.

DISCUSSION

this study updates the anatomy of portal vein and its tributaries, and also finds out four types of distribution which must be known by surgeons with regards to partial hepatectomy.

End-to-side neurorrhaphy for defects of palmar sensory digital nerves

Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscopic magnification. At final follow-up, the static two-point discrimination test (2 pd) scored at an average of 9.1 mm (range, 6-12 mm) on the repaired nerve, compared to an average of 4.6 mm (range, 4-6 mm) on the contralateral uninjured control side. Moving 2 pd scored at an average of 7 mm (range, 4-9 mm) on the repaired nerve compared to an average of 2.6 mm (range, 2-4 mm) on the control side. This short series showed that ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits.

Traitement de l’ulcère de Buruli par excision-greffe : à propos de 118 observations

INTRODUCTION

Buruli ulcer is the most common mycobacteria disease after leprosy and tuberculosis. The purpose of our study is to make our contribution to the surgical treatment of Buruli ulcer and to asses our results.

METHOD

One hundred eighteen patients presenting progressive Buruli ulcers were operated on. The surgical procedure included excisions for necrotic lesions and grafts for clean wounds. The results were estimated on the time of hospitalization and appearance of complications.

RESULTS

Seventy-three patients (62%) were subjected to excision followed by thin skin grafts and 35 patients (30%) were subjected to grafts only. The number of excision times varies from 1 to 7 per patient and from 1 to 4 for the skin grafts. All our patients heal within a period of 120 days with extremes going from 14 to 265 days. We deplored 26 complications (22%): eight new focus, seven infectious complications, six recurrences, five stiffnesses and ankyloses.

CONCLUSION

The treatment of Buruli ulcer by excision and grafts is efficient but does not prevent recurrences and new focus from happening and for their prevention, it is necessary to discover pharmaceutical molecules that are efficient on Mycobacterium ulcerans.

[Renal artery vascularization in the African black. Report of 44 dissections]

Studies on the anatomy of the renal arteries in Black Africans being scarce, the authors have made their contribution to the knowledge of the renal arteries. They have provided a comparison between the anatomy of the renal arteries studied in the literature in relation to a white patient and black patient. It is a prospective study based on the change in the number of the renal arteries of 44 Black Africans' maccabees quite fresh, not yet embalmed that have been dissected in order, as received in the anatomy laboratory of Abidjan. That work has allowed to notice some results that are more or less similar to those revealed in the literature, i.e. in 80% of the cases, the kidney is irrigated by an artery, and in 20% of the cases, we have more than one artery for one kidney. No kidney is vascularized by more than two arteries. These results underline how important it is to have good anatomical knowledge of this region in renal surgery. This is possible thanks to medical imagery and arteriography which helps in preventing operative accidents and in preserving the kidney.

Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve

While the divisions of the facial nerve in the face are well known, the innervation of the orbicularis oculi by the different distal branches of the facial nerve is poorly described. To determine which branches of the facial nerve play a role in this innervation, the facial nerve was dissected in 30 fresh cadavers. The innervation of this muscle was in the form of two plexuses, a superior one, most often (93%) formed by the union of the temporal and superior zygomatic branches, and an inferior one, usually formed (63%) by the union of the inferior zygomatic and superior buccal branches. This new mode of innervation explains how, without damage to both plexuses, innervation of orbicularis oculi by the facial nerve remains functional. It also explains the often unsatisfactory results of treatment of primary blepharospasm, and the unusual character of palsies of this muscle in cervicofacial lifts.

[Facial localizations of Buruli ulcers: two cases]

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.

[Plastic surgery treatment of Buruli ulcer sequelaes. A retrospective study of 16 patients]

INTRODUCTION

Thirteen percents of the patients suffering from Buruli ulcer in Ivory Coast show sequels at a result of their spontaneous healing. The purpose of our study is to report and estimate the first series of the sequel treatment of Buruli ulcer, with standard reconstructive procedures used in plastic surgery.

METHOD

Sixteen patients totalizing 18 sequels were classified into 2 groups:13 patients showed functional sequels in connection with cicaticial retractions about level with joints;3 patients showed aesthetic sequels with no repercussion on the functional aspect. The surgical treatment included for the functional sequels, the excision of the retractile scar, the restoration of the underlying structures followed by the coverage of the defect with skin grafts or muscle or musculo cutaneous flaps and for aesthetic sequels, the excision of the scar tissues and the coverage with full-thickness skin grafts.

RESULTS

The results were considered good because the patients found an acceptable physical activity again that enable some of them to resume a professional activity and others a school activity. Motherless, a certain number of complications are to be deplored:1 case of distal necrosis of a skin flap autonomized which required excision and conducted healing but without repercussions on the functional result;1 residual edema about level with the fingers at the time of the covering of a hand with a groin flap;1 haematoma at the donar site of a full-thickness skin graft.

CONCLUSION

Distance flaps are more advisable for hand sequels in Buruli ulcer considering the regional character of the disease and the necessity to preserve the main vascular axes about level with the hand. On the lower limb, autonomized skin flaps enable provide important tissue and preserve the major vascular axes of the lower limb.

[Multifocal forms of Buruli ulcer: clinical aspects and management difficulties in 11 cases]

OBJECTIVE

A certain number of authors have in literature pointed out multifocal forms of Buruli ulcer but no study was ever dedicated to them. The purpose of this study is to be more specific about the clinical aspects and to show how difficult it is for those multifocal forms of Buruli ulcer to be operated on.

METHOD

The 11 patients who were accepted for the study were subjected to an interrogation, a thorough clinical examination, research of BAAR in ulcers and operative pieces with a direct examination after Ziehl-Neelsen colouring. Each of these patients underwent a surgical treatment under general anaesthesia or spinal anaesthesia depending on the seat of the lesions under cover of pre and post operative therapy by antibiotics.

RESULTS

Initial lesions preferentially were located at limbs level; new foci appeared within an average period of 3 months, ranging from 1 to 15 months in some cases. All body parts could be the seats of secondary foci. Depending on the patients, the number of foci varied from 3 to 7. Furthermore, amputation has been necessary for the complete healing of four patients. The average operation was 2.4 by patient ranged from 2 to 5. We observed the healing of all the patients within an average hospitalisation time of 6.3 months running sometimes from 4 to 13 months. In addition to amputations, 4 patients presented after-effects as articular stiffness, retractions of the hand's dorsal face and knee's retraction.

CONCLUSION

Those multifocal forms can, with good reason, be considered as malignant form of Buruli ulcer.

[Pain during peritoneum pinching, a pathognomonic sign of peritoneal disease. Clinical research. Semiological value]

Pain induced by pinching the peritoneum betrays a pathology of that membrane. It is absent when the peritoneum is perfectly healthy. Pain is elicited by a special palpation technique. Clinically and statistically, the presence of this pain is pathognomonic, but it does not inform on the aetiology. In the present study the most frequent causes of positive abdominal peritoneal pinching test were peritoneal tuberculosis, followed by portal hypertension with or without liver cirrhosis.

[Stopping persistent hiccups in the adult by endoscopic maneuver]

Thirty-four patients with persistent hiccups (median duration 10 days) were treated by gentle endoscopic massage of the region of the cardia. Hiccups stopped in all cases. Its early recurrence in one patient only required a second massage, which was also effective. This simple technique is recommended for the treatment of persistent hiccups.

Parasitologic and clinical human response to immunoglobulin administration in falciparum malaria

The protective effect of African IgG antibodies against Plasmodium falciparum malaria was investigated by passive transfer in Thai patients. Sera from 333 African adults were collected in the Cote d'Ivoire and subjected to extensive screening. One hundred fifty-three samples were discarded for safety reasons, and IgG was extracted from those remaining under conditions allowing their use by the intravenous (iv) route. Eight Thai patients with P. falciparum parasitemia were treated by iv inoculation of the IgG: six with a 100 mg/kg dose given over three days, one with a single 20 mg/kg dose, and one with a single 200 mg/kg dose. To ensure a safety margin of at least 48 hours, subjects were chosen among patients having a recrudescent parasitemia following quinine treatment failure at the RI level. At that stage, symptoms were mild or absent and parasitemia was low but increasing (range 4, 200-9,000/microliters). The IgG pool exerted a profound, stage-specific, but non-sterilizing effect on each of the strains tested, and proved to be safe. Asexual parasitemia decreased by a mean 728-fold (range 46-1,086), while gametocytes were unaffected. Clearance of parasites and symptoms was as fast or faster than with drugs, and was consistent in the eight patients treated, suggesting that target antigens were equally expressed in geographically remote isolates. In peripheral blood smears, no mature forms were seen at any time during the followup, which does not support the hypothesis that reversal of cytoadherence occurred. After the disappearance of the transferred antibodies, recrudescent parasites from three patients were found to be susceptible to the same extent (mean decrease of 1,310-fold) to the same IgG preparation, indicating that selection of parasites able to escape the effect of antibodies had not occurred. No adverse side-effects were detected during the followup, which lasted one year.

HIV-1 and HIV-2 infection associated with AIDS in Abidjan, Côte d'Ivoire

In September 1987, a seroprevalence study of HIV-1 and HIV-2 infection was conducted among 956 people from different groups in Abidjan, Côte d'Ivoire. Groups examined were hospitalized patients (Internal Medicine and Infectious Disease Departments, Centre Hospitalier Universitaire de Treichville, Abidjan), outpatients at tuberculosis treatment centers, blood donors, women attending an antenatal clinic, and patients attending sexually transmitted disease (STD) clinics. Total HIV infection prevalence ranged from 10% in STD clinic patients and pregnant women to 45% in hospitalized patients on an infectious diseases service. Within groups, HIV-1 infection was 2-6.5 times more prevalent than infection with HIV-2. One-quarter of HIV-seropositive people were serologically reactive to both HIV-1 and HIV-2 on enzyme-linked immunosorbent assay and Western blot. Clinical conditions previously observed in patients with HIV-1 infection were observed in people infected with HIV-2 only, as well as in those with HIV-1 infection and dual serologic reactivity. An isolate of HIV-2 was obtained on culture from a person with wasting disease and chronic fever. The results of this study suggest that infection with HIV-1 and HIV-2 is epidemic in Côte d'Ivoire, and that HIV-2 may be associated with AIDS.

Blood transfusions and HIV infections (HIV1, HIV2/LAV2) in Ivory Coast

Sera from 500 blood donors, 67 multiply-transfused children with sickle-cell anaemia and 320 healthy children who had not been transfused were tested for HIV1 and HIV2 antibodies. Amongst blood donors, 49 (9.8%) exhibited antibodies to retroviruses: 12 (2.4%) to HIV1, 17 (3.4%) to HIV2 and 20 (4%) to both HIV1 and HIV2. Fifteen (22.4%) of the 67 multiply-transfused children had retroviral antibodies: five (7.4%) to HIV1 four (6%) to HIV2 and six (9%) to both HIV1 and HIV2. In contrast, among 320 non-transfused children only two (0.62%) exhibited HIV1 infection. These results suggest that children with sickle-cell anaemia who have been repeatedly transfused, constitute a high risk group for HIV1 and HIV2 infections in Ivory Coast.

[Significance of the presence of Australia antigen in liver diseases seen in a department of internal medicine in Abidjan]

The exact responsibility of the hepatitis B virus in hepatic diseases seen in Ivory Coast is difficult to specify for several reasons, particularly technical ones. Nevertheless, we have tried to determine the prevalence of the HB virus in hospital practice and in patients hospitalized for liver diseases (viral hepatitis, cirrhosis, primary liver cancer). Comparison of the results to the prevalence of the virus in the ivorian population and statistical processing has led us to moderate the influence of HB virus in the different hepatic disorders. In primary liver cancer, the role of aflatoxine whose carcinogenic potential is now well established has not been disproved.