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Pericarditis in Cardiology at a Regional Hospital

World Journal of Cardiovascular Dis.ases 2024年第9期14卷 581-587页

作者： Coulibaly souleymane Traoré Djénébou Konaté Mas.ama B. A. Hamidou Oumar Guindo Ais.ata Yves Roland Koumaré sidibé samba sako Mariam sanogo Alpha kodio aniés.a Mahamadou Yaya Kéita Diakité Mamadou Menta Ichaka Department of Cardiology CHU Point G Bamako Mali Department of Internal Medicine CHU Point G Bamako Mali Mali Hospital Medical Department Bamako Mali Department of Cardiology Gabriel Tour University Hospital Bamako Mali Department of Cardiology Nianankoro Fomba Hospital Sgou Mali

Introduction: Pericarditis is.an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its prevalence was 6.3% in Gabon in 2020 and 7.2% in Mali in 2022. In Europe, an Italian study estimates the incidence of acute pericarditis.at 27.7 cases per 100,000 people per year. In another study conducted in Finland over a period of 9 years, the incidence of pericarditis requiring hospitalisation was 3.32 cases per 100,000 people per year. The aim of our study was to describe the clinical and paraclinical characteristics of pericarditis observed in the cardiology department of the regional hospital in Mali. Methodology: This was.a single centre cross-sectional study from 30 January 2018 to 30 June 2020 in the cardiology department of the ségou regional hospital. All consenting patients, regardless of age or sex hospitalised in the department for pericarditis confirmed on cardiac ultrasound were included. Data were collected using an individual patient follow-up form recording sociodemographic, clinical, biological, electrocardiographic and echocardiographic data, as well as the course of the dis.ase. Results: Out of 879 patients hospitalized, the hospital frequency was 7.28%. Females predominated, with a sex ratio of 0.42. More than half the patients were aged 45 or younger (59.4%). The mean age of patients was 41.8 ± 18.1 years. Cardiovascular risk factors were dominated by hypertension and smoking (46.9% and 12.5% respectively). The reasons for consultation were dyspnoea (84.3%), chest pain (54.7%), cough (71.9%) and fever (34.4%). Physical signs included muffled heart sounds (76.6%), tachycardia (70.3%), pericardial friction (17.2%) and signs of peripheral s.asis in 53.1% of cases. We observed elevated C-reactive protein (CRP) in 57.8% of cases, hypercreatininaemia in 37.5% and positive HIV serology in 3.1%. The major radiographic signs were cardiomegal

关键词： Pericarditis Epidemiology Clinic Nianankoro Fomba Hospital ségou

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Migration of a Progestin Implant into a Pulmonary Artery: Observation of a Case at the Reference Health Center of Commune III of the District of Bamako in Mali

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Open Journal of Obstetrics.and Gynecology 2024年第9期14卷 1431-1436页

作者： Hamady sissoko souma kodio Hamidou Albachar Cheickna sylla salif Diarra sidy Moctar Diakité Mohamed Traoré souleymane Traoré Ibrahim Fomba Ouncoumba Diarra Nana Bah Dris.a Diarra Mahamoudou Coulibaly Bocary sidi Koné Hawa samaké Ahmadou Coulibaly Mamadou Traoré seydou Z. Dao sitapha Dembélé samou Diarra Konimba Koné Alou samaké sanogo s.aka Amara Reference Health Centre of Commune III of the District of Bamako Bamako Mali Department of Gynecology and Obstetrics Gabriel Toure University Hospital Center in Bamako Bamako Mali Department of Gynecology and Obstetrics Kalaban Coro Reference Health Centre Bamako Mali Mohamed VI Perinatal Clinic Bamako Mali Reference Health Centre of Commune V of the District of Bamako Bamako Mali Point-G Obstetrics.and Gynecology Department of University Hospital Center Bamako Mali Reference Health Centre of Commune II of the District of Bamako Bamako Mali H Department of Gynecology and Obstetrics of the Fousseyni Daou Hospital in Kayes Kayes Mali Reference Health Centre of Commune VI of the District of Bamako Bamako Mali

It was.a 36-year-old patient, 5th Pregnancy, 5th Delivery, 4 live children, and I deceased, had a consultation in the department for the removal of implants. Questioning revealed that she had had the implant three years.ago without medical follow-up. It was in view of the difficulties in extracting the capsule that the chest X-ray and CT s.an carried out concluded that the implant had migrated into a branch of the left pulmonary artery. Therapeutic abstention has been the attitude of cardiovascular surgeons.

关键词： Migration Implant Pulmonary Artery Bamako

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Venous Thromboembolic Dis.ase in a Regional Hospital in Mali

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World Journal of Cardiovascular Dis.ases 2023年第12期13卷 837-844页

作者： Coulibaly souleymane Taoré Djénébou sidibé samba sako Mariam Guindo Ais.ata sanogo Alpha kodio aniés.a Dao Ais.ata B. A. Hamidou Oumar Diakité Mamadou Konaté Mas.ama Menta Ichaka Cardiology Department CHU Point G Bamako Mali Department of Internal Medicine CHU Point G Bamako Mali Cardiology Department Nianankoro Fomba Hospital in ségou Ségou Mali Cardiology Department CHU Gabriel Touré Bamako Mali Mali Hospital Medicine service Bamako Mali

Introduction: Venous thromboembolism (VTE) is.a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was.a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifes.ations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores;51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis.and early recovery in a hospital environment, remains the effective means of combating this condition.

关键词： Venous Thrombosis Pulmonary Embolism Nianankoro Fomba Hospital ségou

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sjögren’s syndrome Revealed by Obstructive Renal Failure: A Case Report and Review of the Literature

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Open Journal of Nephrology 2022年第4期12卷 375-381页

作者： Mamadou Badou sanogo Aboubacar sidiki Fofana Atabième kodio sidy Toure Magara samake seydou sy Alkaya Toure Hamadoun Yattara saharé Fongoro Nephrology and Hemodialysis Department The Point “G” University Hospital Bamako Mali Nephrology Unit The Fousseyni Daou Hospital Kayes Mali Rheumatology Department The Point “G” University Hospital Bamako Mali National Center for scientific and Technological Res.arch Bamako Mali Faculty of Medicine and Odontostomatology The University of Science Techniques and Technologies of Bamako Bamako Mali

Introduction: Primary sjögren’s syndrome (ss) is the most common connective tissue dis.ase after rheumatoid arthritis.and affects mostly women between 30 and 40 years of age with an estimated prevalence between 0.1% and 0.6%. This observation illustrates.an incidental finding of a case of ss in a young female patient in a context of obstructive renal failure (ARF) due to uterine fibroids. Observation: This was.a 31-year-old woman hospitalized for anuric AKI (Acute Kidney Injury) with a creatinine level of 1247 μmol/l. Her history included sickle cell dis.ase A/C and an unoperated uterine fibroid diagnosed 3 years.ago. Approximately 2 months before her admission, her symptomatology was made of dizziness, physical asthenia, vomiting, poly-arthralgia, morning rash, pollakiuria and oral dryness. Abdominal examination showed a painless transverse mass in the pelvis. Biological examination showed a CRP (C-reactive protein) level of 488 mg/l. The cytobacteriological examination of the urine was normal and the proteinuria was 1.35 g/24 hours. The CT s.an showed kidneys measuring 110 mm on the right and 113 mm on the left associated with bilateral pyelo-caliceal dilatation on a large polymyomatous uterus of interstitial and submucosal type. Immunologically, the anti-nuclear factor, the rheumatoid factor and the anti-s.a antibodies were positive. The resumption of the interrogation within the framework of the res.arch of the subjective dry syndrome to find a notion of intermittent xerophthalmia 4 months.ago. The schirmer test was positive in the left eye. The initial management consisted of a polymyomectomy after 3 sessions of hemodialysis. Background treatment combining prednisone 5 mg/day and methotrexate 20 mg/week was s.arted in parallel with the use of artificial tears. The evolution after twelve (12) months of treatment was favorable with a complete disappearance of the signs dry syndrome and full recovery of renal function. Conclusion: ss can have an insidious evolutio

关键词： Obstructive Renal Failure Fibroid sjögren’s syndrome

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Prevalence of severe Anemia (Hb ≤ 5 g/dl) in Non-Dialyzed Chronic Renal Failure Patients in the Nephrology and Hemodialysis Department of Point G University Hospital

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Open Journal of Nephrology 2021年第2期11卷 252-264页

作者： seydou sy Magara samaké Aboubacar sidiki Fofana Awa Diallo Moctar Coulibaly Djibril sy Atabième kodio saharé Fongoro Mahamane Kalil Maïga Nephrology Department of Point G University Hospital Bamako Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of the Fousseyni Daou Hospital Kayes Mali Nephrology Unit of Mali Gavardo Hospital Bamako Mali Department of Internal Medicine Point G University Hospital Bamako Mali

Introduction: Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m2 for at least three (3) months. Anemia is one of its most common complications. Anemia increases the r... 详细信息

strong>Introduction:strong> Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73msup>2sup> for at least three (3) months. Anemia is one of its most common complications. Anemia increases the risk factor for cardiovascular mortality by 18% per gram of hemoglobin loss. strong>Objectives:strong> To determine the prevalence and characteristics of this severe anemia, to determine the indications for transfusion, the complications related to this.anemia, the evolution and the prognosis of these patients. strong>Materials.and Methods:strong> This was.a descriptive study with retrospective data collection over 18 months (January 1, 2017 to June 30, 2018) that included hospitalized CRF patients. Were included, non-dialyzed chronic renal failure patients with Hb ≤ 5 g/dl hospitalized during the said period. Not included were chronic renal failure patients with an Hb level ≥ 5 g/dl, those followed up and/or hospitalized outside the study period. strong>Results:strong> Among 1176 patients, 26 had severe anemia (Hb level ≤ 5 g/dl) on CRF, a prevalence of 2.21%. The mean age was 40 years ± 32.62 with extremes of 15 and 67 years. seventeen women and 9 men. The etiology of chronic renal failure (CRF) was hypertensive vascular nephropathy in 50% of cases. CRF was end-s.age in 18 patients (69.2%). The mean hemoglobin level was 4.10 g/dl ± 0.64 with extremes of 2 and 5 g/dl. The anemia was microcytic hypochromic in 50% and aregenerative (96.2%). The main symptoms were asthenia in 20 cases (76.9%), dizziness in 20 cases (76.9%), exertional dyspnea in 19 cases (73.1%). signs of cardiac decompensation (n = 12) were jugular turgor 10 cases (38.5%), hepato-jugular reflux 06 cases (23.1%), mitral insufficiency murmur 06 cases (23.1%). The main complication was left ventricular hypertrophy 17 cases (77.3%). There was no correlation between anemia and sex (p = 0.291), age (p = 0.778), malaria (p = 0.158), etiology of CRF (p = 0.26)

关键词： severe Anemia Chronic Renal Failure Blood Transfusion Mali

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Profile of Urinary Tract Infections in the Elderly in the Internal Medicine Department of the University Hospital Center of Point G, Bamako, Mali

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Open Journal of Nephrology 2021年第2期11卷 217-229页

作者： Dris.a sangaré Magara samaké Nanko Doumbia Aboubacar sidiki Fofana sékou Mamadou Cissé seydou sy Atabième kodio Moctar Coulibaly sah dit Baba Coulibaly Djibril sy Kaya Assétou soucko Mamadou Dembélé saharé Fongoro Department of Medicine and Medical specialty The Fousseyni Daou Hospital Kayes Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of Fousseyni Daou Hospital Kayes Mali Medicine Department of Mali Hospital Bamako Mali Nephrology Department of the University Hospital Center of Point G Bamako Mali Nephrology Unit of Mali Gavardo Hospital Bamako Mali Nephrology Unit of somino Dolo Hospital Mopti Mali Internal Medicine Department of the University Hospital Center of Point G Bamako Mali

Introduction: Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly... 详细信息

strong>Introduction:strong> Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly has been conducted, hence the interest in this innovative work. strong>Objectives:strong> To determine the prevalence and clinical and paraclinical aspects of urinary tract infections in the elderly. strong>Materials.and Methods:strong> This was.a prospective descriptive and cross-sectional study from september 1, 2013 to August 31, 2014, i.e. duration of 12 months. All patients.aged 65 years.and over, hospitalized or ambulatory in the internal medicine department with a documented urinary tract infection were included. strong>Results:strong> We collected and examined 194 patients. The cytobacteriological study of urine (CBsU) was positive in 28 patients, i.e. a prevalence of 14.43%. The male sex represented 59.8% of the cases, the sex ratio was equal to 1.46. The age groups between 65 - 69 and 70 - 74 years were the most affected, respectively 28.57% and 39.28%. The main clinical signs were: asthenia, anorexia, dependence, fever, urinary burning, dysuria. Hospitalization was.associated with urinary tract infection with P = 0.01. The group of enterobacteria were incriminated in 75% of cases. Escherichia coli, Klebsiella pneumoniae and Pseudomonas.aeruginosa represented 39.28%, 14.28% and 10.71% of cases. Urinary tract infections were represented by pyelonephritis, acute pros.atitis, orchi-epididymitis.and simple cystitis. strong>Conclusion:strong> Urinary tract infection is frequent in the elderly, its clinical presentation is polymorphic and enterobacteria are the most incriminated group of bacteria.

关键词： Urinary Tract Infection Elderly subject Internal Medicine Point G Hospital Mali

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Endoscopic Management of Migrated Intra Uterine Device in sub-saharan Health setting Area. Our Experience about seventeen Cases

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surgical science 2018年第1期9卷 17-23页

作者： Traoré Youssouf Kanté Ibrahim sima Mamadou Ongoiba Ibrahima Coulibaly Ahmadou Dicko Birama Bocoum Amadou kodio souma Théra Tiounkani Téguété Ibrahima Traoré Mamadou Department of Gynecology and Obstetrics of Gabriel Touré Teaching Hospital Bamako Mali Department of Gynecology and Obstetrics of Point “G” Teaching Hospital Bamako Mali Department of Forensic Medicine of Bamako University Bamako Mali

Intra uterine device migration is.a relatively rare event. The migration of the IUD in the surrounded viscera can be managed by endoscopy approach. Objectives: We reported our experience to determine the epidemiologic characteristics of patients that presented migrated IUD, to report clinical aspects.and describe the laparoscopic management. Method: We conducted a descriptive and prospective survey from January 1st, 2014 to October 31, 2016. That survey took place in the department of gynecology and obstetrics of Point G Teaching hospital, Bamako, Mali. Population study concerned patients with intra uterine device complications. s.atistic tests used have been X2 or Fisher test according their application conditions. P Results: seventeen patients were included. Mean age of patients is 29 years with extremes of 13 years.and 44 years. The main reference incitement of patients were perforation of the uterus.and pelvis pain (27.8% for each), misplaced IUD (22.3%). Complications observed were intra uterine device migrated in to the bladder (1 case), in the abdomen (10 cases), in the ovary (2 cases) and in the uterine tuba (1 case). Three perforations were done without migration in to surrounded viscera. We used endoscopic surgery among all of them. But in one case we switched endoscopy method in to laparotomy because of important intra peritoneal bleeding to end the management of the patient. No death occurred and mean duration of the s.ay of hospitalization was 2 days. Conclusion: IUD migration is.a s.arce event. All the surrounded viscera can be the site of its migration. The management of that complication is us.ally done by endoscopy method.

关键词： IUD Migration Bladder Pain Endoscopy surgery Mali

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Centropontine Myelinolysis.after Conservative Correction of Hyponatremia: A Case Report and Review of Contributing Factors

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Open Journal of Nephrology 2022年第2期12卷 187-194页

作者： Aboubacar sidiki Fofana Magara samaké sah dit Baba Coulibaly seydou sy Atabième kodio Moctar Coulibaly Christophe Bouaka Ghas.an Alchahin Hermione Deudjeu Youmbissie Hamadoun Yattara Nouhoum Coulibaly saharé Fongoro Nephrology Unit Fousseyni Daou Hospital in Kayes Kayes Mali National Center for scientific and Technological Res.arch (CNRsT) Bamako Mali Nephrology Unit Somino Dolo Hospital in Mopti Mopti Mali Nephrology and Hemodialysis Department University Teaching Hospital of Point-G Bamako Mali Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali Nephrology Unit Mali Gavardo Hospital Bamako Mali Nephrology and Hemodialysis Department Martigues Hospital Martigues France Medical Imaging Department Martigues Hospital Martigues France

Introduction: Centropontine myelinolysis (CPM) is.a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as.a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests.an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.

关键词： Centropontine Myelinolysis Hyponatremia Alcoholism

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First Consultation in Nephrology: Case of the Point G University Hospital (Bamako-Mali)

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Open Journal of Nephrology 2021年第3期11卷 412-421页

作者： Hamadoun Yattara Nouhoum Coulibaly Djeneba Diallo Mamadou sanogo seydou sy Pamela samiza Mous.apha Tanagra Alakay Touré Magara samaké sah Dit Baba Coulibaly Aboubacar sidiki Fofana Atabieme kodio saharé Fongoro Nephrology and Hemodialysis Department of the Point G University Hospital Bamako Mali Nephrology Department of the Regional Hospital of Kayes Kayes Mali

Unders.anding the first consultation of people with kidney dis.ase seems to us to be essential to unders.and the attitude of the referring physician and the nephrologist. The aim was to find out to whom a patient with kidney dis.ase should be referred in the first ins.ance and for what reason? Hence the evaluation of the prevalence of the first consultation in the nephrology department of the Point G University Hospital in Bamako was made. strong>Patients.and Method:strong> This was.a prospective descriptive study which took place from July 2017 to June 2018 in the nephrology department of the Point G University Hospital. The study included all patients who came to the nephrology department for the first time during this period. strong>Results:strong> Between July 2017 and June 2018 at the nephrology and haemodialysis service of the G point University Hospital, we retained 643 out of 1031 patients who came for their first consultation, i.e. 62.36%. There were many patients.aged between 41 and 50 years. The average age was 42.6 ± 5.03 years with extremes of 30 and 82 years. The sex ratio (M/F) was in favor of males, 1.14. The majority of patients were referred/evacuated from the referral health centres (57.6%). The majority of patients were referred/evacuated by general practitioners (70.5%). Cardiologists were the main specialists to refer/evacuate patients (21.2%). The main reasons for consultation that led to the first diagnostic hypotheses were: arterial hypertension for vascular nephropathy, glomerular syndrome for glomerular nephropathy, acute uraemia syndrome for acute renal failure, hydronephrosis for obstructive uropathy and finally diabetes for diabetic nephropathy. strong>Conclusion:strong> The first consultation in nephrology remains.an important step in the management of renal dis.ase, especially when the referral is.an emergency. The percentage of referrals is dominated by general practitioners.

关键词： Renal Failure First Consultation Nephrology CHU du Point G

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Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

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Open Journal of Nephrology 2020年第2期10卷 135-143页

作者： saharé Fongoro Hamadoun Yattara seydou sy Magara samaké Djénèba Diallo Moctar Coulibaly Fatoumata Modjéré Doumbia Djibril samaké Mous.apha Tangara Alkaya Touré Atabième kodio Nouhoum Coulibaly Nephrology and Haemodialysis Department of the University Hospital Centre of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the Fousseyni Daou Hospital in Kayes Kayes Mali Nephrology Unit of the Mali Gavardo Hospital in sébénikoro Bamako Mali ORL Unit Reference Health Center of the Municipality V Bamako Bamako Mali

Introduction: secondary hyperparathyroidism is.a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeost... 详细信息

strong>Introduction:strong> secondary hyperparathyroidism is.a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeos.asis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. strong>Objective:strong> To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTs), report the post-operative course and early and late complications. Patients.and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. strong>Results:strong> We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney dis.ase was of vascular origin (HTA). No cases of diabetic nephropathy were identified. symptoms were in order of frequency: bone pain (60%), paresthes.a (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplas.a in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis t

关键词： Chronic Renal Failure secondary Hyperparathyroidism Dialysis Parathyroidectomy

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