The place of radiography in endodontic treatment carried out in general practice in Dakar]

An investigation conducted over dental surgeons of 52 dental offices in Dakar and it's near suburb (40 from private sector and 12 from public and quasi-public) has shown that the use of retro-alveolar radiography during endodontic treatment was not systematic, due to the price of retro-alveolar film, waste of time and relative facility of the endodontic treatment of monoradicular teeth. The preparatory negative is favored (32.70%) particularly by private dental surgeons, who use two retro-alveolar films for endodontic treatment: pre and post operative radiography (30%). The immediate post operator control is executed only in case of post-operator pains by public and quasi-public dental surgeons (16.67%) with one retro-alveolar film on average for the endodontic treatment; at term any radiographic control is done. Three retro-alveolar films per endodontic treatment were exceptionally used (9.61%) and offset incidences (15%) are not much used as well as support-films (angulators). The retro-alveolar radiography is still a reliable guide for a clinical success in endodontic treatment with a minimum of three retro-alveolar films and offset incidences.     

Injuries of permanent incisors: epidemiology and management in a public health clinic in Dakar]

This prospective study done in a dental care center in a near suburb of Dakar during a period between January 1999 and December 2000, bas shown that permanent incisors traumatism's frequency is about 10.30% (61 teeth) which come within common values of the literature; and a sex ratio of 2.25. These traumatisms concern central maxillary incisors (75.41%) on patients less than 20 years old; falls, violence and road accidents are the major etiology. The consulting time limit is quite disadvantaged to preserve pulp vitality and dental re-implant in case of recent traumatisms. 53.33% of old dental traumatisms are observed to patients between 20 and 40 years old. And overall 80.76% of endodontic treatments realised in this case were not finished. The control of pain and anxiety would ease the emergency treatment. The information's of patients about significance of the consulting time limit, their motivation on differed dental treatments and/or endodontic treatments, as well the post traumatic watch would improve the management and the prognostic by setting of a referenced dental care units.     

Merkel cell carcinoma of the gingival mucosa in a black young adult

Merkel cell carcinoma (MCC) is a rare and aggressive primary neuroendocrine neoplasm of the skin with a poor prognosis. It occurs mainly in the skin of white elderly patients. Its occurrence in intraoral mucosal sites is rare. We report a rare case of MCC that arose in the gingival mucosa of young black adult.     

Les lésions intestinales au cours des traumatismes fermés de l’abdomen : diagnostic et prise en charge en milieu défavorisé

Purpose

To report our experience of treatment for bowel injuries following blunt abdominal trauma in a rural area.

Patients and methods

This retrospective study involved nine cases of bowel injury after blunt abdominal trauma, operated in the emergency department at the Regional Hospital of Thies from January 2009 to July 2011. We analyzed the circumstances of trauma, clinical aspects, investigations, the treatment and the postoperative course.

Results

There were 8 men and 1 woman with a mean age of 27 years (14 years–65 years). The traffic accidents were the cause in 5 cases followed by sports accidents (2 cases) and a fall from a height (2 cases). Signs of peritonitis and hemoperitoneum were found respectively in 5 and 2 cases. The clinical picture consisted of a localized defense in 2 cases. Plain abdominal X-ray showed a pneumoperitoneum in 4 cases. Ultrasound found a single intraperitoneal effusion in 2 cases and was normal in 1 case. CT-scan had diagnosed a jejunal rupture in a patient and had found a pneumoperitoneum that was missed at the plain abdominal X-ray in another patient. Four patients had undergone laparotomy less than 24 hours after injury and five after 48 hours. Perforation was found in the small intestine in 8 cases, in the sigmoid in 1 case. Treatment consisted in intestinal suture (5 cases) and resection-anastomosis (2 cases). Ileostomy was performed in a patient with septic shock. Sigmoid perforation was treated by sigmoidectomy followed by colostomy. Two deaths were noted due to severe sepsis.

Conclusion

Intestinal lesions secondary to blunt abdominal trauma are difficult to diagnose. They require an early surgical treatment because it determines the prognosis.     

Les hépatites auto-immunes au Sénégal : étude rétrospective à l’Hôpital Principal de Dakar

Abstract

Autoimmune hepatitis (AIH) is a disease rarely reported in Subsaharian Africa. The aim of our study was to describe the diagnostic aspects, therapeutic and outcome of HAI at Hôpital Principal de Dakar.

Patients and Methods

This is a retrospective study from January 2001 to December 2008. All cases with a diagnosis of AIH were included. Patients with incomplete data were not included.

Results

Twelve patients were included (sex-ratio = 0.5, mean age = 33 years [15-52 years]). The most frequent clinical manifestations were jaundice (n=7) and impaired general condition (n=7). Liver function tests showed cytolysis and high bilirubin levels in all patients. Polyclonal hypergammaglobulinemia was found in 11 patients. Antinuclear antibodies and anti-smooth muscle antibodies were positive in 8 and 11 patients, respectively. Anti-mitochondrial antibodies and anti-LKM1 antibodies were negative in all cases. HBsAg and hepatitis C virus (HCV) were negative. Abdominal ultrasound showed: features of portal hypertension (n=5) and morphological changes suggestive of cirrhosis (n=5). Liver biopsy performed in 5 patients showed in all cases periportal lymphoplasmocytic infiltrates and periportal necrosis and fibrosis (F1: 4 cases, F2: 1 case). Type 1 AIH was diagnosed in all patients and 7 with cirrhosis at diagnosis. Another autoimmune disease was associated with AIH in 5 patients. Treatment included prednisone and azathioprine in 7 patients; prednisone alone in 2 cases and 3 patients did not received any medication. The mean follow-up was 48.8 months [9-96 months]. The outcome was favorable in 8 patients. Relapse after drug withdrawal was observed in 4 among them. In 4 cases, including 2 with immunosuppressive therapy, death occurred in a picture of decompensated cirrhosis.

Conclusion

AIH are rare and are dominated by type 1 in our hospital. The clinical presentation is characterized by young age of patients and the presence of features of cirrhosis at diagnosis. Evolution with corticosteroids treatment with or without azathioprine was favorable.     

The cAMP-dependent protein kinase A and brain-derived neurotrophic factor expression in lymphoblast cells of bipolar affective disorder

BACKGROUND: Abnormalities in cAMP signaling and altered expression of downstream targets such as brain-derived neurotrophic factor (BDNF) have been postulated in patients with bipolar disorder (BD). METHODS: The PKA activity and levels of (3)H-cAMP binding to PKA R regulatory subunits were measured in lymphoblasts from 10 BD and 10 control subjects. In addition, the possibility that BDNF expression could be altered in these cells has been explored. RESULTS: Results indicate that PKA activity significantly increased (t-test; P<0.01), whereas the (3)H-cAMP binding to PKA R subunits decreased in cells from BD (t-test; P<0.02). The presence of 10 microM Sp-cAMP in culture 24 h before cell harvesting induced an increase in enzyme activity and a decrease in (3)H-cAMP binding sites (t-test; P<0.01), with a significant difference between BD and controls (t-test; P<0.01). This presence of Sp-cAMP also results in increased BDNF expression (t-test, P<0.01), but neither in resting cells, nor in stimulated cells, was any difference observed in BDNF expression between BD and controls (t-test, NS). Limitations: This study was conducted on a peripheral model cell, whose importance of BDNF is unknown. CONCLUSIONS: These data suggest that the upregulation of cAMP signaling observed in BD patients results in the normalization of the BDNF expression. Studies on signal transduction, gene expression and pathologies have implications for development of novel treatments.