[Humanitarian surgical missions]. / Missions chirurgicales humanitaires.

Humanitarian surgical missions are one of the most promoted aspects of french humanitarian action in the third world through the media. This action, previously limited, is now well-organised and its actors have become real professionals. The working conditions of this kind of surgery, are characterised by its lack of means and insecurity. Logistic, technical and ethic constraints have led to propose specific training suitable for these special conditions.

Open wound drainage versus wound excision in treating the modern assault rifle wound.

Military dogma of the past 20 years preaches that excision of all injured tissue around the path of a penetrating projectile is essential in wound treatment. To find out whether excising injured muscle surrounding a bullet path benefits healing over and above the benefit provided by a simple release of tension by incision, two groups of 90 kg swine were shot in the hind leg with a replica of the AK-74 assault rifle projectile. One group was treated by excision of injured tissue around the projectile path; in the other group no tissue was excised. Both groups were given parenteral penicillin for 5 days, and simple gauze dressings were used to cover the wounds. No difference in healing time occurred; the wounds in both groups had closed, and no epithelial defect remained by 20 to 22 days. These results indicate that the simple extremity wound caused by the modern-generation assault rifle, provided with adequate open drainage and systemic penicillin, heals as rapidly when the body defense mechanisms handle the disrupted tissue as when an attempt is made to excise it surgically.

[Esophageal cancer in the tropical environment]. / Le cancer de l'oesophage en milieu tropical.

UNLABELLED: The esophageal cancer is unevenly distributed within the Tropical regions: while its prevalence rate is high in East and South Africa and in the Far-East, this rate is much lower in West Africa. In most cases, the practitioner will face very evolutive forms, generally out of range of any therapy. In developing countries, efforts must be directed towards three goals: -- EPIDEMIOLOGY: Detection of the predisposing factors such as traumatisms, the use of bethel, kath, tobacco, and, above all, alcohol (beer consumption is steadily increasing in African countries). -- DIAGNOSIS: Development of the endoscopy of the digestive tract. -- SURGERY: Its remains the only therapeutic solution; but it is costly, time consuming and major surgery.

[Primary liver cancer in the tropical environment. Classical and current data]. / Le cancer primitif du foie en milieu tropical. Données classiques et récentes.

In most cases, primary liver carcinoma in tropical areas remains an hepatoma. The high incidence of this malignant tumor of the liver in some regions, and especially in black Africa, is still unexplained. As compared with the form found either in the European or in the North-African, this hepatoma shows special features since it occurs in younger people (35 years), follows a bursting-out course and is precipitously associated not to an alcoholic cirrhosis but to a post-hepatitic one. An humoral syndrome leading to a presomptive diagnosis consists of hypoglycemia, hypercholesterolemia, hyperlipemia, and high blood level of alcaline phosphatases. In 85% of the cases, these tumors secrete an alpha fetoprotein determined by radioimmunoassay. A major etiologic factor is the oncogenous activity of hepatitis virus B which could be either an induction factor or a "co-factor" which would initiate, facilitate or increase the activity of the carcinogen. In this respect, aflatoxin has to be regarded as a "co-factor" too. The best treatment, when it is possible, is an exeresis carried out through a partial hepatectomy. If such a surgical intervention is unadvisable, chemotherapy is the only possibility. Immunization against viral hepatitis has raised hope for the prophylaxis of hepatoma. But it will not be possible to evaluate it before the year 2.000.

[Birth control overseas]. / La régulation de la fécondité outre-mer.

After reminding the changes of ovarian cycle during sexual life, the authors propose some indications on the reversible means that can be used for birth control in the developing countries where they practice. As practicing is very peculiar to these countries and in order to enable married couples to decide freely upon different advisable possibilities, the authors underline the importance to develop all the educational ways and means on this topic.

[Alternation, or the best approach to contraception]. / L'alternance ou la bonne politique en contraception.

PIP: This article outlines the indications and contraindications of different contraceptive methods based on knowledge of the female reproductive cycle and variations by age and reproductive history. Methods should be chosen after clinical examination and interview to determine the wishes of the couple. The female reproductive cycle is reviewed through definitions and discussion of the endometrium, the ovaries and their endocrine and exocrine functions, the pituitary, and the hypothalamus, with indications where appropriate of their role in the action of specific contraceptive methods. Variations in the cycle at puberty, from adolescence to 35 years, at premenopause, postpartum and postabortion, and as a result of pathological conditions are described. The general characteristics, use instructions, effectiveness, and advantages and disadvantages of different contraceptive methods are then described, including the physiological methods (rhythm, temperature, and Billings); mechanical barriers and cervical chemical methods (condoms, diaphragms, spermicidal tablets); monophasic, sequential, and diphasic pills and progestin only pills; morning after pill; trimonthly injections of progesterone, and IUDs. Indications and contraindications for different age groups are outlined. IUDs are contraindicated for adolescents, low dose pills may be used at least 2 years after puberty if cycles are regular, and local spermicides may be the best choice for those with sporadic sexual activity. In general all methods may be utilized by women under 35 but different pill formulations are appropriate for different conditions and IUDs should be avoided in cases of local infection or retroverted uterus. For women over 35 sequential progestins are recommended to compensate for luteal insufficiency. Discontinuous progestins are recommended for premenopausal women because they simultaneously treat luteal insufficiency, mastopathies, and endometrial hypertrophies. For postpartum use minidose combined pills, injections of Depo-Provera, or local spermicides are recommended. A table of indications for various methods is included.^ieng

[Surgical indications in urogenital schistosomiasis in West Africa (author's transl)]. / Les indications chirurgicales dans la bilharziose urogénitale en Afrique de l'ouest.

Surgical indications in urogenital schistosomiasis are discussed after 12 years of experience in Senegal hospitals. Stenosis or achalasia of lower ureter might cause ureterohydronephrosis which appears to be the main sequella. The local hospitals conditions and the difficulties met with in the long-range surveillance of the patients both require a prudent approach. The replacement plastics with intestine is the logic and ideal solution, but other and simpler techniques are available and may be selected according to the localization and to the value of renal functions.

[Anatomopathological aspects of schistosomiasis. A study of 286 pathological specimens. (author's transl)]. / Aspects anatomo-pathologiques des bilharzioses (à propos de 286 pièces histopathologiques).

Schistosomiasis pathology demonstrates the successive stages of the specific inflammation and accounts for the large variety of its macroscopic and histological features. This paper reviews 286 bilharzial lesions studied between 1956 and 1979 at the ""Institut de Médecine tropicale du Service de santé des Armées". - First, the histopathological caracteristics of the disease are considered. Some lesions are caused by schistosomules and adult worms, but the proeminent role is devoted to egg: the bilharzial granuloma get developped around it, and is the elementary and specific lesion, after three successive phases: exsudative nodule, productive granuloma and scleral nudule. Some recent researches about histogenesis of this granuloma have pointed out the role, in the immune response, of cell mediated cytotoxicity. - The the pathological aspects due to each of the four parasitic species are described: S. haematobium is predominant (249 cases). 34,2 percent of the examined lesions are of vesical and/or ureteral nature. Vesical changes are increased because their chronic evolution and are frequently modified by secondary infections: lesions of uretere, giving stricture, frequently induce severe complications in the upper part of the urinary tract. The different parts of female genital tract (61 specimens) may be affected, with cervix and fallopian tubes more often hit. Testis and epididymis frequently show tumoral features, mainly in young patients. Appendicitis (41 cases) may have various pathological aspects. S. mansoni infections (34 cases) specially affect liver and côlon. Three degrees of inflammation are described in liver where Symmers fibrosis is characteristic. Inflammatory lesions as well as tumors are observed in côlon, rectum and anus. Lesions caused by S. japonicum have been detected in three specimens (liver and appendix). A brief description about S. intercalatum lesions is presented. - The study gives some information regarding the geographical origin of the patients, their age and the polymorphorus features of the lesions. Diagnosis of tumors requests special staining techniques. Completing the parasitologic and immunologic methods, anatomopathology may help diagnosis of bilharziasis. It should be included in any multidisciplinary and long term eradication programme.

[Necrotizing amoebic colitis (a propos of 12 cases observed in Dakar)]. / Les amibiases coliques nécrosantes (à propos de 12 cas observés à Dakar).

Twelve cases of necrotizing amoebic colitis recorded in Dakar Hospital Principal are studied. The authors draw basis rules for an early surgical indication giving opportunity to detect not too extensive lesions and implement intensive care which may prove effective. Prognosis is still unfavourable with a death rate of two thirds.

[A left pseudo-pleurisy syndrome manifesting as a liver abscess complicating malignant localized amebic colitis]. / Syndrome pseudo-pleurétique gauch révélateur d'un abcès du foie complaiquant une amibiase colique maligne localisée.

The authors report on a case of localised bipolar malignant colic amebiasis in a 34 year old man, as a complication of undiagnosed benin colic amebiasis; the initial signs consisted of left basi-thoracic symptoms for which a sub phrenic abcess secondary to rupture of two abcesses of the left lobe of the liver was responsible. The surgical intervention consisted of a right hemicolectomy without anastomosis with a double derivation by ileostomy colostomy and drainage of the abcesses. The evolution was rapidly fatal by an irreversible state of shock.