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The Rain Came

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I.Generalite 1.Definition hypertrophie pathologique de plus de 1 cm d’un ganglion lymphatique. 2.Physiopathologie L'hypertrophie ganglionnaire fait suite à : -­‐une prolifération lymphocytaire réactionnelle due à une stimulation antigénique locale (infectieuse ou tumorale) ou générale (infectieuse ou dysimmunitaire) -­‐une prolifération tumorale primitive du tissu lymphoïde (lymphome hodgkinien ou pas) -­‐une accumulation de cellules pathologiques filtrées par le ganglion (bactéries ou cellules tumorales). En cas infection locale, adenite est satellite. en cas infection generale, hypertrophie ganglionnaire est generalisee. 3.Etiologie -­‐infection: plus frequent -­‐cancer et hemopathie malignes: deuxieme grande cause. -­‐malade dysimmunitaire ou des etiologie medicamenteuse.

II.Adenopathie localisee -­‐adenopathie localisee est faite d’un ou plusieurs ganglion pathologie hypertrophie situe dans un secteur limite d’une aire ganglionnaire. 1.Demarche diagnostique -­‐Clinique -­‐interrogatoire: -­‐port d’entrée dans le territoire de drainage: plaie, piqure, morsure, griffade cutane ou muqueuse, vaccination de BCG, voyage de pays tropical, contact sexuel, contact animal

-­‐aspect Clinique de adenopathie: sign inflammatoire local: rougeur, chaleur, douleur a la pression, empatement avec periadenite. 2.Examen complementaires:

diagnostic etiologie peut etre approche par certains examens: -­‐NFS, CRP: hyperlymphocytose, syndrome mononucleosique, lymphoblastose, polynucleose. -­‐IDR: tuberculose -­‐serologie: VIH…. 2 examen est premiere importance: -­‐la pontion: tres sensible, examen direct de bacterie et culture. -­‐la biopsie 3.Etiologie -­‐adenite pyogene -­‐Clinique: douleureuses,fievre, oederm ou cellulite periganglionnaire. -­‐polynucleose neutrophile, VS et CRP et elevee -­‐germ plus frequent: streptococcique et staphylococcique -­‐en cas adenite suppure: ponction evacuatrice -­‐chez enfant: enterobacterie et BGN -­‐adenite mycobacterie -­‐mycobacterie typique -­‐mycobacterie tuberculosis est responsible d’adenite encore frequentes et observe a tout age. localization cervical a plus frequent: atteines axillaire et inguinal. -­‐Clinique: adenopathie sont fermes au debut, peu ou pas douleureuse, sign de inflammatoire. -­‐sign generaux sont absent ou rares. -­‐IDR est fortement positive chez sujet immunocompetent. -­‐mycobacterie atypique -­‐M.scrofulaceum ou M kansasii est plus frequent. -­‐infection a HIV: M.avium intracellulare -­‐BCG-­‐ite -­‐adenopathie axillaire, accompagne du site injection d’une papule erythmateuse extensive, voire ulceree, suppuration. -­‐autre cause -­‐syphilis -­‐chancre mou -­‐lymphogranulomatose venerienne -­‐herpes 4.diagnostique differentielle On affirme dans un premier temps la nature ganlionnaire de la tumefaction, ce qui permet d’eliminer: -­‐localization cervicale posterieure: un lipome ou kyste sabace -­‐localization cervicales laterals: une tumeur, inflammation de gland parotidienne ou sous maxillaire, anevrisme carotidien, tumeur glomique du corpuscule carotidien -­‐en region cervical anterieure: tumefaction de thyroidienne, developpe de gland salivaire sublinguale. -­‐localization axillaire: une hidrosadenite -­‐region inguinale: hernie, lipome pre hernie, abces de la gaine du psoas, phlebite de la crosse de la saphene. III.Polyadenopathie polyadenopathie est atteinte de plusieurs territoires ganglionnaires. 1.diagnostic -­‐interrogatoire -­‐contage sexuel( syphilis, infection VIH)

-­‐une toxicomanie par voie veineuse -­‐contact avec un rubeoleux -­‐voyage en pays tropical -­‐medicament -­‐Clinique -­‐fievre, sueurs, eruption cutane, AEG -­‐Examen complementaire -­‐NFS: leucemie, hyperlymphocytose, hypereosinophile, syndrome inflammatoire -­‐Radiographie du poumon, echo ou TDM de abdomen: recherché de ganglion profound -­‐IDR a tuberculin. -­‐serologie: Virus de Epstein barr, VIH, CMV, rebeole, toxoplasmose -­‐biopsie chirurgical. 2.Etiologie -­‐Polyadenopathie infectieuses -­‐Virale -­‐Mononucleose infectieuse:EBV, rubeole ( plus frequent) -­‐en cas associer avec toux: pnuemopathie est possible -­‐bacterie -­‐mycobacterie: TB ou atypique -­‐maladie de whipple: rare. -­‐polyadenopathie non infectieuses -­‐hemopathie malignes -­‐chez enfant: leucose: confirme par NFS et myelograme -­‐chez adult: lymphoma de Hodgkin . confirmer par biopsie -­‐chez sujet age: lymphoma malin non hodgkiniens, leucemie lymphoide chronique. confirmer par biopie -­‐maladie inflammatoire -­‐polyarthrite juvenile, lupus erythemateux disemine -­‐syndrome de Kawasaki.

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...Many of her stories are set against the scenic background of Lake Victoria and the traditions of the Luo people. One theme that features prominently within Ogot's work is the importance of traditional Luo folklore, mythologies, and oral traditions. This theme is at the forefront in "The Rain Came", a tale which was related to Ogot in her youth by her grandmother, whereby a chief's daughter must be sacrificed to bring rain.[16] Furthermore, much of Ogot’s short stories juxtapose traditional and modern themes and notions, demonstrating the conflicts and convergences that exist between the old ways of thought and the new. In The Promised Land, the main character, Ochola, falls under a mysterious illness which cannot be cured through medical intervention. Eventually, he turns to a medicine man to be healed. Ogot explains such thought processes as exemplary of the blending of traditional and modern understandings, “Many of the stories I have told are based on day-to-day life… And in the final analysis, when the Church fails and the hospital fails, these people will always slip into something they trust, something within their own cultural background. It may appear to us mere superstition, but those who do believe in it do get healed. In day-to-day life in some communities in Kenya, both the modern and the traditional cures coexist.” [17] Another theme that often appears throughout Ogot’s works is that of womanhood and the female role. Throughout her stories, Ogot demonstrates an interest...

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