Interest of SAAG in Etiological Diagnosis of Ascites in African Black

Purpose: To show the interest of the serum-ascites concentration gradient in albumin (SAAG) in the etiological diagnosis of ascites in African black. Materiel and Methods: This was a monocentric observational and analytical study performed on patients over 15 years old and hospitalized in the Hepato-Gastroenterology department of Cocody from January 1st, 2010 to March 31st, 2017 for ascites. The cytology and chemistry of the ascites fluid and the protidogram were performed. The main outcome measure was the prediction of portal hypertension (PHT) or non-portal hypertension related causes of ascites from SAAG. Results: The hospital prevalence of ascites was 11%. There were 82 women (46.9%) and 93 men (53.1%) with a sex ratio (M/F) of 1.1. SAAG was low in 68.6% of cases and high in 31.4% of cases. The most common etiologies were post-viral cirrhosis (74%), HCC (16.60%) and peritoneal tuberculosis (13.7%) respectively. In the case of high SAAG, 91% of ascites related to PHT were observed, but also 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%. All patients with peritoneal tuberculosis had a SAAG low of less than 1.1 g/dl significantly (p = 0.002). SAAG had a diagnostic performance of 89% in peritoneal tuberculosis at the cutoff value of ?1.24 g/dl (AUROC = 0.91, Se = 96%, Sp = 86%) while in post viral hepatitis cirrhosis at a threshold of 0.58 g/dl the diagnostic performance was 60% (AUROC = 0.69, Se = 53%, Sp = 79%). Conclusion: The simple technical SAAG, allowing to distinguish the ascites linked to the PHT and the ascites not bound to the PHT, can be used like a method of diagnosis of the etiologies of the ascites especially in the peritoneal tuberculosis in the African countries low income.

Duodenal Metastases of Malignant Melanoma: One Case Report

The duodenal metastases of a malignant melanoma are rare. We report a case at a 86-year-old, hypertense patient, without tumoral history, who was hospitalized in our department for a change of the general state and an anaemia ferriprive without found home (foyer) of display. In the clinical examination, we had found anemia syndrome, nodules under cutaneous about 2 cm in diameter at the level of the thorax, of the belly, the members and of the lower lip partners in a painless left adenopathy axillary about 3 cm in diameter and an absence of méléna in the rectal touch. The gastroscopy had highlighted polypoides ulcéro-bourgeonnantes hurts with a blackish pigmentation by places at the level of the bulb and of the second duodenum. In the histology of biopsie fragments, we noted a fuso-cellular proliferation and epithelioid with deposits of melanin. The positivity of antibodies anti-protein S100 and anti HMB45 in the immunohistochemical study allowed confirming the diagnosis. The gastroduodenal hurts, persons suffering from a liver complaint and lungworts in the scanner testify of a terminal metastatic scattering. The death arose two months later, in a picture of circulatory collapse further to a high digestive bleeding of big abundance.

Endoscopic profile of caustic burns of the university hospital center of Cocody Abidjan / Côte d’Ivoire

Background:To determine the clinical and endoscopic demographic characteristics of the ingestion of acidic products in the digestive endoscopy unit of the Cocody University Hospital.Methods:This was a retrospective,descriptive and analytical study on endoscopic reports,which took place for five years,from January 1,2014,to December 31,2018.All patients were admitted to the digestive endoscopy unit with the indication of ingestion of caustic products.The parameters studied:are demographic,clinical,and endoscopic.The statistical tests used were Pearson’s CHI 2 and Fisher’s exact tests.The significance threshold was set at 5%.Results:83 patients were included for an endoscopic prevalence of 1.33%.The mean age was 20.77±16.58 years,with extremes ranging from 1 to 63 years.They were divided into 34 men and 49 women for a sex ratio of 0.69.Accidental circumstances were observed in 73.49%of cases,followed by attempted autolysis(26.51%).Bleach was the most offending caustic(75.90%),followed by hydrochloric acid(14.46%).FOGD was normal in 53.01%and revealed stage I(41.54%)digestive lesions,followed by stage II(35.39%)and stage III(21.53%).The lesions were preferentially gastric(36.11%),esogastroduodenal(27.78%),and esogastric(22.23%).Based on severity,54.55%of esophageal lesions were stage IIA,53.12%were stage I gastric lesions,and 54.55%were stage IIA duodenal lesions.One case of gastric perforation was noted(1.54%).In univariate analysis,we found a statistically significant link between the age group of 1–14 years and the accidental intake of caustics(P<0.001)on the one hand and the other hand between the age group of 26 years and over and taking for autolysis(P=0.02).Likewise,bleaching was responsible for less severe lesions(P=0.006).Conclusions:The seriousness of the ingestion of caustic products requires early,specialized and multidisciplinary management to improve the short,medium,and long-term prognosis of patients.