Pulmonary embolism mimicking acute anterior myocardial infarction: diagnostic trap

Pulmonary embolism remains the major malingerer of acute chest disease. The clinical and electrocardiographic manifestations may deviate to a diagnosis of myocardial infarction. We report a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism. Coronary angiography performed after the second hospitalization was normal.     

Dépistage de l’ischémie myocardique par l’échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal

Introduction

Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal.

Methodology

We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases.

Results

Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8 ± 11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria (p = 0.0001), inactivity (p = 0.0001), dyslipidemia (p = 0.0002), arterial hypertension (p = 0.001), smoking (0.003) and male sex (p = 0.004).

Conclusion

In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.     

Fatal evolution of a huge right atrial free‐floating thrombus

Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management.     

Periodontal infection in pregnant women and low birth weight babies]

Among several factors in preterm low birth weight, we can find pre-conceptional causes and others depending on pregnant women's behaviour. In 1996 a scientific team composed by periodontists, gynaecologists and epidemiologists found that 18% of preterm low birth weight in 250,000 babies are due to periodontal infection. In our survey we used 113 pregnant women in gynaecological clinic in university hospital. By using Community Periodontal Index Treatment Needs (CPITN) in pregnant woman and by weighting babies as soon as accouchement done. In spite of percentage of preterm low birth weight, we registered 33.9% babies of normal birth weight with mother's CPITN under 1.     

La tuberculose péritonéale: étude rétrospective de 61 cas à l’hôpital Principal de Dakar

Aims

To describe the characteristic features (epidemiological, clinical, paraclinical, therapeutic and evolutive) of peritoneal tuberculosis in Senegal.

Patients and methods

Retrospective study, which included all cases of peritoneal tuberculosis identified at Principal hospital in Dakar between the 1 January 1996 and 30 June 2006.

Results

Sixty-one cases of peritoneal tuberculosis were included in ten years and six months. The mean age of patients was 36 years, and the sex ratio was 0.9. Ascites associated with fever was the most common symptom. The ascitic fluid was exudative in 92.4% and lymphocytic in 90.5%. Peritoneal tuberculosis was isolated in 70.5% of cases and associated with pleural effusion in 21%, lung involvement in 13% and liver involvement in 3.2%. The HIV was positive in 4.5% of patients who were tested. The definite diagnosis was based on laparoscopy associated with peritoneal biopsy showing granulomatous lesions in 70% of cases. The outcome was favourable in all cases after antituberculous therapy.

Conclusion

Peritoneal tuberculosis occurs in young adult with a discrete female predominance in this series. It must be suspected in the presence of any lymphocytic and exudative ascites associated with fever. The definite diagnosis is based on laparoscopy with peritoneal biopsy. The outcome is generally favourable with antituberculous treatment.