The spiked helmet sign in a patient with erysipelas: an alarming electrocardiogram sign (a case report)

Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient's sepsis and electrolyte disturbance, she had a favorable outcome.

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

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

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

BACKGROUND AND PURPOSE

Resistance to blood flow in the cerebral drainage system may affect cerebral hemodynamics. The objective of the present study was to use phase-contrast MRA to quantify resistance to drainage of blood across branches of the venous sinus tree and to determine whether the resistance to drainage values correlated with internal jugular vein outflows.

MATERIALS AND METHODS

We performed whole-head phase-contrast MRA and 2D phase-contrast MR imaging in 31 healthy volunteers. Vascular segmentation was applied to the angiograms, and the internal jugular vein velocities were quantified from the flow images. Resistance to drainage across branches of the venous sinus tree was calculated from the segmented angiograms, by using the Poiseuille equation for laminar flow. Correlations between the values of resistance to drainage and internal jugular vein outflow measurements were assessed by using the Spearman ρ.

RESULTS

The overall mean resistance to drainage of the venous sinus tree was 24 ± 7 Pa s/cm³. The mean resistance to drainage of the right side of the venous sinus tree was 42% lower than that of the left side (P < .001). There were negative correlations between the values of resistance to drainage and internal jugular vein outflows on both the left side of the venous sinus tree (R = -0.551, P = .002) and the right side (R = -0.662, P < .001).

CONCLUSIONS

Phase-contrast MRA is a noninvasive means of calculating the resistance to drainage of blood across the venous sinus tree. Our approach for resistance to drainage quantification may be of value in understanding alterations in the cerebral venous sinus drainage system.

[Unusual aspect of pernicious anemia during association of beta-thalassemia: a new case report and literature review]

Pernicious anemia appears classically by macrocytosis. We report a case of a late discovered Biermer disease, on a 42-year-old young black woman. The reason was an unusual aspect of this disease in a context of betathalassemia. The patient presented chronic anemia which evolved during about ten year. Biology showed a normocytosis and signs of hemolysis according to beta-thalassemia. This was confirmed by an electrophoresis showing 9.1 % of fraction F some haemoglobin. Since this date, the patient was treated by folic acid alone with periodic transfusions of red blood cell. She presented eight years after the beginning of her disease, neurological deterioration. Diagnosis of pernicious anemia was finally established up on histological gastritis, low level of the blood rate of vitamin B12, macrocytosis, and presence of intrinsic anti-factor and parietal anti-cells antibodies.

X-ray analysis of mesoporous silica thin films templated by Brij58 surfactant

The structural optimization of highly mesoporous silica thin film templated with Brij58 is reported in this paper. The best conditions for obtaining well organized films are studied as a function of the concentration of surfactant, the relative humidity (RH) and the aging time of the solutions used in the dip-coating process. We first show on the basis of the results obtained by small angle x-ray scattering (SAXS) experiments on the binary system Brij58/water that the structure of the films determined by grazing incidence (GI) SAXS experiments can be explained according to a specific equation involving the initial masses of the sol constituents. Then the structural properties of the films are investigated by x-ray reflectivity (XRR) and GISAXS before and after removing the surfactant. The mesoporosities and morphology of the films are determined by analyzing the reflectivity curves of the highly ordered silica thin films in the cubic phase.

In situmonitoring by synchrotron radiation of the formation of ZnO nanoparticles by aqueous chemical growth

Synchrotron radiation experiments were carried out during thein situgrowth of ZnO nanoparticles by the aqueous chemical growth technique. The first results of this exploratoryin situgrazing-incidence diffraction (GID) experiment are reported, with emphasis on the difficulties encountered. In particular, it is shown that, whenin situGID experiments are carried out in a 25 mm-long cell, scattering by the solvent dominates. This impedes the observation of the formation of ZnO nanoparticles during the early stages of the growth process. Nevertheless, it is clearly shown that the wurzite hexagonal structure is present in the solution. At a specific concentration, it is shown how the peak intensities and widths of the Bragg peaks evolve as a function of time.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]

INTRODUCTION

Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal.

PATIENTS AND METHODS

This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed.

RESULTS

A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%).

CONCLUSION

Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Clinical interest of fMRI and functional exploration methods of brain activity and interactivity: physical and neurophysiological considerations]

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

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

PURPOSE

This fMRI study investigated phonological and lexicosemantic processing in dyslexic and in chronological age- and reading level-matched children in a pseudoword reading task.

MATERIALS AND METHODS

The effective connectivity network was compared between the three groups using a structural model including the supramarginal cortex (BA 40; BA: Brodmann area), fusiform cortex (BA 37) and inferior frontal cortex (BA 44/45) areas of the left hemisphere.

RESULTS

The results revealed differences in connectivity patterns. In dyslexic patients, in contrast with chronological age- and reading level-matched groups, no causal relationship was demonstrated between BA 40 and BA 44/45. However, a significant causal relationship was demonstrated between BA 37 and BA 44/45 both in dyslexic children and in the reading level-matched group.

CONCLUSIONS

These findings were interpreted as evidence for a phonological deficit in developmental dyslexia.

Assessment of brain interactivity in the motor cortex from the concept of functional connectivity and spectral analysis of fMRI data

Functional magnetic resonance imaging (fMRI) was used to assess the contributions of movement preparation and execution of a visuomotor task in a cerebral motor network. The functional connectivity of the voxel time series between brain regions in the frequency space was investigated by performing spectral analysis of fMRI time series. The regional interactivities between the two portions of the supplementary motor area (pre-SMA and SMA-proper) and the primary motor cortex (M1), defined as a seed region, were evaluated. The spectral parameter of coherence was used to describe a correlation structure in the frequency domain between two voxel-based time series and to infer the strength of the functional interaction within our presumed motor network of connections. The results showed meaningful differences of the functional interactions between the two portions of the SMA and the M1 area depending on the task conditions. This approach demonstrated the existence of a functional dissociation between the pre-SMA and SMA-proper subregions. We therefore conclude that spectral analysis is useful for identifying functional interactions of brain regions and might provide a powerful tool to quantify changes in connectivity profiles associated with various components of an experimental task.

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]

INTRODUCTION

The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases.

CASES

We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy.

CONCLUSION

Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

[Frequency of hematological and immunological manifestations of lupus in Dakar]

INTRODUCTION

The systemic erythematosus lupus (SEL) or lupic disease is a systemic auto-immun pathology characterized primarily by the presence of antibodies directed against native antibodies anti-DNA. The discovery circumstances of diagnosis are variable and polymorphic. The hematologic signs and the immunological disorders constitute the diagnosis criteria of the lupic disease.

METHODOLOGY

It is a multicentric and retrospective study undertaken study from January 1, 1997 to September 30, 2006. Patients were followed up in the Internal Medicine of Dakar. We have studied the hematological and immunological aspects of the SEL and have evaluated the prevalence of lupic disease.

RESULTS

142 patients with lupic disease were included with 125 women and 17 men; the ratio--sex was 0.13. The mean age was 34 years with extremes of 6 and 72 years. Our patients had hematological and immunological manifestations in 32.4% and 76.8% of the cases. The immunological tests showed the presence of antinuclear antibodies in 97.9% of the cases, native antibody anti-DNA in 45.7% of the cases, the anti-ECT in 8.95% (with the anti-RNP in 78.3 % of the cases, anti-Sm in 56.5% and of anti-SSA in 87% of the cases). Antibodies anti-DNAand anti-ECT were associated the hematologic demonstrations respectively in 92% and 95% of the cases (p 0.08).

CONCLUSION

The hematologic and immunoligical signs of lupus disease are frequent and constitute diagnostic criteria of the disease.

[Contribution of the spectral analysis to the brain connectivity study by fMRI]

AIM

To validate, through functional magnetic resonance imaging (fMRI) from spectral analysis of time series during a visuomotor task, a model of functional connectivity mainly constituted by the pre-supplementary motor area (pre-SMA), the supplementary motor area proper (SMA-proper) and the primary motor cortex (M1).

MATERIALS AND METHODS

The paradigm that was tried out in young subjects (n=5) consisted of a preparation task of motor movement. We firstly proceeded with an estimate in the frequency domain of coherency coefficients and values of phase shift between these three areas. Secondly, the estimated coherency coefficients were integrated to a model of functional connectivity. Two interaction coefficients were calculated, one for the related M1 and pre-SMA regions, the other one for the related M1 and SMA-proper regions.

RESULTS AND CONCLUSION

Our results demonstrate hemodynamic activity that definitely occurred earlier in the pre-SMA area during the preparatory period of the task. In the same way, a more important interaction was found between M1 and pre-SMA areas, which corroborates the assumption of the prevalent role played by these two areas in the case of a preparation task of a motor movement. Thus, this study has allowed highlighting a functional dissociation between the two portions of the SMA.

[Pulmonary hypertension revealing systemic diseases: two Senegalese case reports]

INTRODUCTION

Pulmonary hypertension (PH) is a complication of autoimmune diseases which worsen the prognosis. In Senegal, a few cases of PH have been previously reported in patients with systemic sclerosis.

CASE REPORTS

We report two cases of patients with PH that revealed autoimmune diseases (Sharp' syndrome and Sjögren syndrome). Epidemiological, clinical, evolutive and laboratory data were analyzed. Evolution of disease was favourable for one patient and fatal for the other.

CONCLUSION

These two cases show necessity of early diagnosis of systemic diseases in our countries. PH should be screened in each patient with autoimmune disease before installation of irreversible pulmonary arterial lesions that respond to treatment. New therapy used in idiopathic PH are not yet accessible for our patients.

[Current aspects of systemic lupus erythematosus in Dakar. About 74 cases]

INTRODUCTION

previously reported studies on systemic lupus erythematosus in Senegal were more then ten years old and reported few cases of patients. Our objectives were to update epidemiological, clinical, laboratory and evolutive aspects of systemic lupus erythematosus throughout a study of 74 patients.

PATIENTS AND METHODS

we conducted a retrospective study in the internal medicine and the dermatology units of the university teaching hospital Aristide Le Dantec from January 1993 to December 2002. All patients with systemic lupus erythematosus according to the ACR criteria were included. Those who didn't meet ACR criteria were excluded.

RESULTS

we included 74 patients; their mean age was 32 years and the sex ratio 0.1 (male to female). At the entry general symptoms were constants, and cutaneous signs were found in 96% of cases, joints signs in 58.1% and renal sign in 56.8%. Haematological and immunologic abnormalities were nearly constant. All the patients received corticosteroids and in 35.71% they had in addition immunosuppressive drugs. Shorts term evolution was satisfactory. At the medium term 27.02% of the patients were lost and 10.81% of them died.

CONCLUSION

currents aspects of systemic lupus erythematosus in Dakar are improved by the early diagnosis when the disease is pauci-symptomatic and by the use immunosuppressive drugs in association with corticosteroids.

[Polyarticular gout in young adults: a curable rheumatic disease]

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

[Senegalese case of thromboangeitis obliterans or Buerger's disease]

INTRODUCTION

Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case.

CASE REPORT AND DISCUSSION

A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning.

CONCLUSION

TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.

Bacterial density and community structure associated with aggregate size fractions of soil-feeding termite mounds

The building and foraging activities of termites are known to modify soil characteristics such as the heterogeneity. In tropical savannas the impact of the activity of soil-feeding termites ( Cubitermes niokoloensis) has been shown to affect the properties of the soil at the aggregate level by creating new soil microenvironments (aggregate size fractions) [13]. These changes were investigated in greater depth by looking at the microbial density (AODC) and the genetic structure (automated rRNA intergenic spacer analysis: ARISA) of the communities in the different aggregate size fractions (i.e., coarse sand, fine sand, coarse silt, fine silt, and dispersible clays) separated from compartments (internal and external wall) of three Cubitermes niokoloensis mounds. The bacterial density of the mounds was significantly higher (1.5 to 3 times) than that of the surrounding soil. Within the aggregate size fractions, the termite building activity resulted in a significant increase in bacterial density within the coarser fractions (>20 mum). Multivariate analysis of the ARISA profiles revealed that the bacterial genetic structures of unfractionated soil and soil aggregate size fractions of the three mounds was noticeably different from the savanna soil used as a reference. Moreover, the microbial community associated with the different microenvironments in the three termite mounds revealed three distinct clusters formed by the aggregate size fractions of each mound. Except for the 2-20 mum fraction, these results suggest that the mound microbial genetic structure is more dependent upon microbial pool affiliation (the termite mound) than on the soil location (aggregate size fraction). The causes of the specificity of the microbial community structure of termite mound aggregate size fractions are discussed.

[HIV associated nephropathy syndrome: a case report in Dakar]

HIV associated nephropathy syndrome ( HIVAN Syndrome ) is a recently identified entity and no study has been done in Senegal. So we report this observation. A 40 years old black patient was admitted for renal oedema syndrome and immunosuppressive signs. The biological investigations noticed a non-pur nephrotic syndrome and severe renal failure. Ultrasonography showed quite normal kidney sizes with hyper echogenicity and dediferenciation. HIV research was positive with 45 CD4 lymphocytes / mm3. This patient had no known causes of nephrotic syndrome ( diabetis, lupus ,amyloidosis.). So the diagnosis of HIVAN syndrome was determined with the clinical features and the bad outcome. We emphasize on the necessity to think about HIVAN in every black patient presenting a quickly progressive non-pur nephrotic syndrome. We expect prospectives studies to describe the clinical signs and the frequency of HIVAN syndrome in Senegal.

[Non iatrogenic primary hypothyrodism in adults at Le Dantec Hospital : clinical features, diagnosis and treatment. Review of 19 cases]

The authors report 19 cases of non iatrogenic primary hypothyroidism in adults at Le Dantec Hospital of Dakar. Those cases had been found during a period of 6 years and half in the internal medicine service. The aim was to study clinical features, diagnosis and outcome of patients after treatment. The mean age of patients was 42.2 years with a sex-ratio of 0.33 M/F. The diagnosis delay was around 6,1 years. All patients presented clinical signs of hypometabolism: physical asthenia (63.15%), frilosity (26.3%), bradycardia (47.3%), constipation (36.8%). The cutaneomucal syndrom was composed by myxoedema (73.6%), macroglossia (26.3%), raucousness of voice (26.3%), alopecia (57.9%). Muscle weakness was found in 2 cases and genital troubles in 3 cases. Five patients presented goiter and 9 others had spontaneous thyroid atrophy. All patients presented a high level of TSH associated with decreased level of T4. Anemia was found in 7 cases and hypercholesterolemia in 13 cases. Treatment was based on substitutive hormonotherapy with L-Thyroxin (75 to 250 microg/day). Evolution was favorable after 10 month mean duration of processing. More alertness is necessary on behalf of the practitioners in front of any sign suggesting hypometabolism to reduce the diagnostic delay and prevent complete form of hypothyroidism that might be complicated, by cardiac involvement in particular.

Characterization of Vibrio fluvialis-like strains implicated in limp lobster disease

Studies were undertaken to characterize and determine the pathogenic mechanisms involved in a newly described systemic disease in Homarus americanus (American lobster) caused by a Vibrio fluvialis-like microorganism. Nineteen isolates were obtained from eight of nine lobsters sampled. Biochemically, the isolates resembled V. fluvialis, and the isolates grew optimally at 20 degrees C; none could grow at temperatures above 23 degrees C. The type strain (1AMA) displayed a thermal reduction time (D value) of 5.77 min at 37 degrees C. All of the isolates required at least 1% NaCl for growth. Collectively, the data suggest that these isolates may embody a new biotype. Pulsed-field gel electrophoresis (PFGE) analysis of the isolates revealed five closely related subgroups. Some isolates produced a sheep hemagglutinin that was neither an outer membrane protein nor a metalloprotease. Several isolates possessed capsules. The isolates were highly susceptible to a variety of antibiotics tested. However, six isolates were resistant to erythromycin. Seventeen isolates harbored plasmids. Lobster challenge studies revealed that the 50% lethal dose of a plasmid-positive strain was 100-fold lower than that of a plasmid-negative strain, suggesting that the plasmid may enhance the pathogenicity of these microorganisms in lobsters. Microorganisms that were recovered from experimentally infected lobsters exhibited biochemical and PFGE profiles that were indistinguishable from those of the challenge strain. Tissue affinity studies demonstrated that the challenge microorganisms accumulated in heart and midgut tissues as well as in the hemolymph. Culture supernatants and polymyxin B lysates of the strains caused elongation of CHO cells in tissue culture, suggesting the presence of a hitherto unknown enterotoxin. Both plasmid-positive and plasmid-negative strains caused significant dose-related intestinal fluid accumulations in suckling mice. Absence of viable organisms in the intestinal contents of mice suggests that these microorganisms cause diarrhea in mice by intoxication rather than by an infectious process. Further, these results support the thermal reduction data at 37 degrees C and suggest that the mechanism(s) that led to fluid accumulation in mice differs from the disease process observed in lobsters by requiring neither the persistence of viable microorganisms nor the presence of plasmids. In summary, results of lobster studies satisfy Koch's postulates at the organismal and molecular levels; the findings support the hypothesis that these V. fluvialis-like organisms were responsible for the originally described systemic disease, which is now called limp lobster disease.

[Behçet's disease in Dakar (Senegal): epidemiological and clinical features]

We report epidemiological and clinical characteristics of 17 consecutives patients with Behçet disease during 26 years in Dakar(Sénégal). All the patients were black, with a mean age of 27.5 years (11- 42 years) and the disease was more common between 20 and 30 years. The sex ratio was 2.4 (12 men -5 women). The majority live in cost area (64.7). Clinical features frequencies were as follow muco-cutaneous (94.11%), ocular (58.82%) neurological (47.05%) articular (47.05) psychiatric (41.17%) vascular (35.29%) digestives (11.76%). Epidemiological characteristics of Behçet disease in Sénégal are common however, the important frequency of neuropsychiatrics manifestations is remarkable.

[Diabetic ketoacidosis at an internal medicine service]

Ketoacidosis as usual inaugural manifestation and the high frequency of infectious precipating events have been reported in our department on 1986. These same aspects were found in other African series. In this retrospective study of 34 patients presenting an ketoacidosis and managed from, July 1st 2001 to December 31st 2001, we have evaluated the precipating events, and analysed the evolution in comparison with our previous study. Age range was 15 to 74 years with a mean of 43.9. Sex ratio was 2.4. Ketoacidosis inaugurated the disease in 41.17% of cases. Diabetic type 2 was the most frequent one, with an evolution mean duration of 8.1 years. The presenting picture of admission was varied. In addition to the disturbance of consciousness, dehydratation and compensatory hyperventilation were common. With 82.3% in our series versus 43.22% in previous one, infection remain the main precipating cause in our internal medicine department and in tropical area. The disease course was favorable under therapy in 32 patients (94.1%) versus 64.32% on 1986. This might be explained by the lack of hypoglycemic episodes in this present series. The average hospitalisation duration was 20 days. This fact point out the importance of diabetic patients education and screening programs.

[Systemic scleroderma: 92 cases in Dakar]

We performed a retrospective study in order to characterize epidemiological data and signs of systemic scleroderma in Sénégal. All patients with the diagnosis according the ACR's criteria of scleroderma were recruited. We included 92 patients, the mean age was 33 years and sex ratio male to female was 0.19 (15 men and 77 women). There were 8 children in our series (8.9%). The initial complaints were cutaneous manifestations (64%) and Raynaud's syndrome (16.3%). Clinical manifestations at admission were muco-cutaneous (100%), osteo-articular and muscular (59%) and Raynaud's syndrome (57%). Focal hypopigmentation was common (70%). Anti-nuclear antibodies were present in 67.4% of patients. Skin biopsy was contributive in all patients in which it was performed (79 cases). Electrocardiogram was abnormal in 55%, non specific inflammatory syndrome was present in 44% and pulmonary function was abnormal in 52%. Our data suggest that systemic scleroderma is more common in younger people in black population. Disorders of pigmentation are common and Raynaud's syndrome is uncommon.

The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Collaborative Stroke Audit and Research

OBJECTIVE

It is uncertain whether self-propulsion in a wheelchair should be encouraged or discouraged in the early stages of stroke rehabilitation.

DESIGN

A two-centre pilot study to assess the feasibility of performing a multicentre randomized controlled trial on this subject.

SETTING

Clatterbridge and Aintree Stroke Rehabilitation Units, Merseyside, UK.

SUBJECTS

Forty early stroke patients (mean age 67 years) in whom it was uncertain whether self-propulsion in a wheelchair should be encouraged were studied.

INTERVENTION

A central randomization service at Newcastle University was used to determine the policy about wheelchair provision and use for each patient. They were allocated to either an 'encouraged to self-propel' or a 'discouraged from self-propulsion group'. OUTCOME MEASURES USED: Independent outcome assessment was performed by postal questionnaire and telephone interview using the Barthel ADL Scale, Nottingham Extended ADL Scales and the shortened General Health Questionnaire (GHQ-12) at 3 and 12 months. Patient's length of stay and their Ashworth tone score were also measured either at three months or when they were discharged from hospital.

RESULTS

After considerable preparation time it was possible to conduct a trial on self-propulsion in early stroke rehabilitation in the two-pilot centres. No major differences were found between the pilot groups for any of the outcome measures.

CONCLUSIONS

A multicentre randomized controlled trial to assess this question is feasible but further work is being conducted before proceeding, to satisfy the concerns expressed to our group regarding the appropriateness of the intervention and the outcome measures.

Conjugated estrogens reduce endothelial prostacyclin production and fail to reduce postbypass blood loss

Intravenous conjugated estrogens correct bleeding times and reduce bleeding in uremia, gastrointestinal telangiectasias, and liver disease. One study found a similar benefit in patients undergoing open heart surgery. The mechanism by which conjugated estrogens improve bleeding times is unknown. We report on the effect of estrogens on endothelial prostacyclin production and bleeding in coronary bypass surgery. In a randomized, double-blind trial, 16 male patients undergoing elective coronary artery bypass surgery received four daily infusions of conjugated estrogens (0.6 mg/kg/day) or placebo, preoperatively. Groups were similar with respect to age, preoperative hemostatic profiles, and pump time. Conjugated estrogens significantly reduced greater saphenous vein endothelial prostacyclin production in the estrogen group compared to control subjects. Postoperative blood loss was not reduced, with a trend toward increased blood loss in the treatment group. We have shown that conjugated estrogens reduce endothelial prostacyclin production and fail to reduce blood loss in coronary bypass surgery.