Une ascite chyleuse au décours d’une exérèse d’une tumeur vulvaire : un piège

Chylous ascites is a rare condition, linked to lymphatic duct obstruction. We report a case of chylous ascites in a young woman operated for a vulvar tumour. Following surgery, the patient presented ascites, inguinal adenopathies and subcutaneous nodular formations. An abdominal ultrasound scan revealed the ascites and deep adenopathies. Such cases suggest the diffusion of a malignant process aided by surgical aggression. CAS The diagnosis of lymphatic node tuberculosis was confirmed by the histology which showed a granuloma with caseous necrosis. Tuberculosis treatment resulted in good progress. We recommend that in cases of chylous ascites in a tropical country, testing for tuberculosis is carried out in view of the effectiveness of the specific treatment.     

Female genital mutilation and noninvasive cervical abnormalities and invasive cervical cancer in Senegal,West Africa: A retrospective study

Female genital mutilation or cutting (FGM/C) is a traditional practice that affects a significant portion of women in sub-Saharan Africa, Egypt, areas of the Middle East and some countries in Asia. While clinical and epidemiological studies have established a close association between inflammation and carcinogenesis, particularly in epithelial cancers, the relationship between FGM/C and cervical cancer is not well known. We performed a secondary analysis using combined data from six research studies conducted in and around Dakar, Senegal from 1994 to 2012. Study subjects included both asymptomatic women who presented to outpatient clinics but were screened for cervical cancer, and women with cancer symptoms who were referred for cervical cancer treatment. We used unconditional logistic regression to estimate adjusted pooled odds ratios (ORs) and 95% confidence intervals (CI) for associations between FGM/C and (1) Invasive cervical cancer (ICC) and (2) noninvasive cervical abnormalities. After adjusting for confounding, women with ICC were 2.50 times more likely to have undergone FGM/C than women without cervical abnormalities (95% CI, 1.28–4.91). Restricting to HPV-positive women increased the strength of the association (OR = 4.23; 95% CI 1.73–10.32). No significant associations between FGM/C and noninvasive cervical abnormalities were observed, except in commercial sex workers with FGM/C (OR = 2.01; 95% CI 1.19–3.40). The potential increased risk for ICC suggested by our study warrants further examination. Study results may impact cancer prevention efforts in populations where FGM/C is practiced and draw awareness to the additional health risks associated with FGM/C.     

Kinetics of maternally-derived serogroup A,C, Y and W-specific meningococcal immunoglobulin G in Malian women and infants

A prospective, randomised, controlled observer-blind trial measuring the efficacy and immunogenicity of trivalent influenza vaccine (TIV) and the immunogenicity of quadrivalent meningococcal conjugate vaccine (MCV) in pregnant women and their infants up to 6?months of age was conducted in Mali. Here we reported the immunogenicity of MCV, which was used as a comparator vaccine to TIV, in this population. Third-trimester pregnant Malian women were randomized to receive TIV or MCV. Blood samples were collected from women prior to vaccination, 28?days post-vaccination, at delivery and 3 and 6?months post-delivery and from infants at birth and 3 and 6?months of age. Meningococcal-specific serogroup (Men) A, C, Y and W-specific antibodies were measured by enzyme linked immunosorbent assay in a randomly selected subset of 50 mother-infant pairs where the mother had received MCV. At birth, 94.0% (47/50) of infants had MenA specific IgG levels?≥?2?µg/mL decreasing to 72.9% and 30.4% at 3 and 6?months of age. For MenC, 81.3% (39/48) of infants had MenC specific IgG levels?≥?2?µg/mL at birth decreasing to 29.4% and 17.8% at 3 and 6?months of age. For MenY, 89.6% (43/48) of infants had MenY specific IgG levels?≥?2?µg/mL at birth decreasing to 64.6% and 62.5% at 3 and 6?months of age. For MenW, 89.6% (43/48) of infants had MenW specific IgG levels?≥?2?μg/ml at birth decreasing to 62.5% and 41.7% at 3 and 6?months of age.Maternal immunization with MCV conveyed protective levels of IgG at birth through to 3?months of age in the majority of infants.     

Évaluation de l’effet cardioprotecteur de l’extrait aqueux de Mareya micrantha (Euphorbiaceae) chez le lapin

We investigated the cardioprotective effect of Mareya micrantha (Euphorbiaceae) from the dosage of 3 biochemical markers. It is a plant traditionally used as laxative, antibacterial and for abortion affections in Côte d’Ivoire and in other countries in West Africa. Increasing doses of aqueous crude extract of Mareya micrantha were injected to various rabbits of different batches. Then we evaluated the variation of the serum activities of glutamo-oxaloacetic transaminase (GOT), lactate-deshydrogenase (LDH) and creatinephosphokinase (CPK). The statistic analysis of results shows a reduction of serum activities of CPK and LDH (P < 0.05) but it indicates an insignificant variation of the serum activity of GOT (P > 0.05). In conclusion, we can say the extract of Mareya micrantha with the dose of 100 mg/kg of body weight during 4 weeks is well tolerated by heart and it also may have heart protector effect in rabbits.     

Bronchial fistula postpneumonectomy: predictive factors

OBJECTIVE: To determine predictive factors of bronchial fistula following pneumonectomy. PATIENTS AND METHODS: In 14 years (1989-2003), we collect 58 cases of bronchial fistula following 725 consecutive pneumonectomy in the service of thoracic surgery of the Sainte Marguerite Hospital in Marseilles. There were 53 cases (91.4%) of cancers and 5 cases (8.6%) of various pathology. The average age of the patients was of 61 +/- 10 years (range 24 to 80 years). The sex ratio M/F was 8.7. The software of regression SPSS (version11.5) was used to identify the factors risk of a bronchial fistula after a univariate and multivariate analysis. RESULTS: The prevalence of the bronchial fistula after a pneumonectomy was 8%.The preoperative factors which increased to a significant degree the incidence of the bronchial dent to the univariate analysis were the chronic smoking (P < 0.001), the existence of COPD (P = 0.001) and of a previous thoracic surgery (P = 0.01). Operational data like a right- side pulmonary resection (P < 0.001), the type of bronchial stup carried out (P = 0.03) as and an extended pneumonectomy to the auricule (P = 0.03) were significant risk factors. With the logistic regression the significant risk factors were the chronic smoking (P = 0.002), the existence of COPD (P = 0.003), a previous pulmonary surgery (P = 0.03) and the right - side of the pneumonectomy (P < 0.001). The indication of the pneumonectomy was retained neither by the univariate analysis, nor by the logistic regression significant risk factors. CONCLUSION: The predictive factors of a bronchial fistula after a pneumonectomy are dominated by respiratory co-morbidities. To prevent this complication, we insist on the stop of the tobacco, a better respiratory preparation and the acquisition of a protocol adapted of the bronchial stub after a pneumonectomy particularly on the right side.     

Long-term effectiveness and safety of didanosine combined with lamivudine and efavirenz or nevirapine in antiretroviral-naive patients: a 9-year cohort study in Senegal

Objective The use of didanosine (ddI) in first‐line antiretroviral therapy has been recently promoted for resource‐limited settings. We therefore compared the long‐term effectiveness and safety of the regimen combining ddI, lamivudine, and efavirenz or nevirapine with that of the WHO‐recommended regimen of zidovudine (ZDV), lamivudine, and efavirenz or nevirapine in antiretroviral‐naïve patients in Senegal. Methods Observational cohort study of patients enrolled between January 2000 and April 2002 in the Senegalese antiretroviral drug access initiative. Multivariate analyses were performed to compare, between the ddI and ZDV groups, the proportion of patients with a viral load <500 copies/ml during follow‐up; the increase in the CD4 cell count; survival; treatment changes and severe adverse events. Results Of 151 patients, 71 received the ddI‐based treatment and 80 received the ZDV‐based treatment. Throughout follow‐up, 80–95% of patients had a viral load below 500 copies/ml in both the ddI and ZDV groups (P = 0.5). The CD4 cell count increased after treatment initiation from 176 to 497 cells/mm³ in the ddI group and from 176 to 567 cells/mm³ in the ZDV group (P > 0.3). The rate of death tended to be higher in the ddI group (P = 0.06). ddI was less commonly discontinued than ZDV (P = 0.03). Conclusion The combination of ddI, lamivudine, and efavirenz or nevirapine resulted in sustained viral suppression and immunological recovery.     

The triterpenoid CDDO-Me promotes hematopoietic progenitor expansion and myelopoiesis in mice

The synthetic triterpenoid CDDO-Me has been shown to directly inhibit the growth of myeloid leukemias and lends itself to a wide array of therapeutic indications, including inflammatory conditions, because of its inhibition of NF-κB. We have previously demonstrated protection from acute graft-versus-host disease after CDDO-Me administration in an allogeneic bone marrow transplantation model. In the current study, we observed that CDDO-Me promoted myelopoiesis in both naive and transplanted mice. This effect was dose dependent, as high doses of CDDO-Me inhibited myeloid growth in vitro. All lineages (granulocyte macrophage colony-forming unit, BFU-E) were promoted by CDDO-Me. We then compared the effects with granulocyte colony-stimulating factor, a known inducer of myeloid expansion and mobilization from the bone marrow. Whereas both drugs induced terminal myeloid expansion in the spleen, peripheral blood, and bone marrow, granulocyte colony-stimulating factor only induced granulocyte macrophage colony-forming unit precursors in the spleen, while CDDO-Me increased these precursors in the spleen and bone marrow. After sublethal total-body irradiation, mice pretreated with CDDO-Me further displayed an accelerated recovery of myeloid progenitors and total nucleated cells in the spleen. A similar expansion of myeloid and myeloid progenitors was noted with CDDO-Me treatment after syngeneic bone marrow transplantation. Combined, these data suggest that CDDO-Me may be of use posttransplantation to accelerate myeloid recovery in addition to the prevention of graft-versus-host disease.