[Safety and efficacy of peribulbar anesthesia in cataract surgery]. / Tolerance et efficacite de l'anesthesie peribulbaire dans la chirurgie de la cataracte.

INTRODUCTION: Peribulbar anesthesia (PBA) involves the injection of local anesthetic of volume around the globe and outside the fasciomuscular cone, which will then diffuse from the peribulbar space to the retrobulbar space. The goal was to evaluate the safety and efficacy of PBA in cataract surgery in Secondary Ophthalmology Center. PATIENTS AND METHOD: this was a cross-sectional study over two months. Our population consisted of all patients admitted to the anesthesia room, scheduled for cataract surgery and the PBA had been completed. The data was analyzed using Epi Info software version 7.2. The correlations were carried out using Khi2 with a threshold of significance (p <0.05). RESULTS: A total of 285 patients were included and sex-ratio H/F = 0,72. Average age of 62 +/- 12 years. Lidocaïne 2% and Bupivacaine 0.5% was used in combination at equal volume. The anesthesia was tolerated in 99,3% of patients. We observed 77,19% total analgesia and 13,33% chaemosis. CONCLUSION: Peribulbar anesthesia allows the easy realization of cataract surgery with great safety and efficiency.

INTRODUCTION: l'anesthésie péribulbaire (APB) consiste à l'injection d'anesthésique local autour du globe et en dehors du cône fasciomusculaire. Le produit diffuse ensuite de l'espace péribulbaire vers l'espace rétrobulbaire. L'objectif était d'évaluer la tolérance et l'efficacité de l'APB dans la chirurgie de la cataracte dans un centre d'ophtalmologie secondaire. PATIENTS ET MÉTHODE: il s'agissait d'une étude transversale sur deux mois. Notre population était constituée par tous les patients admis en salle d'anesthésie et programmés pour la chirurgie de la cataracte chez qui l'APB avait été réalisée. Les données ont été analysées à l'aide du logiciel Epi Info version 7.2. Les corrélations ont été réalisées à l'aide de Khi2 avec un seuil de significativité (p< 0,05). RÉSULTATS: Au total, 285 patients ont été inclus, avec un sex-ratio H/F de 0,72. L'âge moyen était de 62 ans avec un écart type de 12ans. La lidocaïne 2% et labupivacaïne 0,5% étaient utilisées en association à volume égal. L'anesthésie a été tolérée chez 99,3% des patients. Nous avons observé77,19%d'analgésie totale, 13,33% de chémosis conjonctival. CONCLUSION: L'anesthésie péribulbaire permet la réalisation facile de la chirurgie de la cataracte avec une bonne tolérance et une meilleure efficacité.

Meningitis seasonal pattern in Africa and detection of epidemics: a retrospective study in Niger, 1990-98.

Control of epidemic meningitis is still an unresolved problem in Africa. WHO has promoted the use of surveillance and response following alerts based on weekly threshold levels. In order to avoid any waste of resources related to false-positive alerts, it was decided not to choose too sensitive thresholds. This policy, however, leads to delayed response. The seasonal pattern of epidemics provides a solution to this dilemma. We carried out a retrospective survey of district-level surveillance data in Niger from June 1990 to June 1998. We identified an early and late meningitis season. Following this pattern, we studied the performance of the WHO-recommended threshold as compared to alternative thresholds for identifying early, late and non-epidemic district-years (DYs). (ADY was defined as a 52-week period starting in the last week of June, at the district level). We studied 296 DYs, comprising 50 early epidemic, 38 late epidemic, and 208 non-epidemic DYs. Early epidemics were more often large and accounted for almost 75% of total cases. When applied no later than the first week of March, a highly sensitive alternative threshold resulted in initiation of an alert, with a median of 3 weeks earlier than the standard threshold, with no false-positive alerts, i.e., a specificity of 1.

Preventive immunisation could reduce the risk of meningococcal epidemics in the African meningitis belt.

Control of meningitis epidemics is based on early case detection followed by mass campaigns of immunisation. However, this strategy showed severe inadequacies during recent outbreaks in Africa. In Niamey, Niger, meningococcal vaccinations began in 1978 and detailed bacteriological and epidemiological surveillance of meningitis started in 1981. When vaccine coverage rates were higher than 50%, the prevalences of Neisseria meningitidis A meningitis were low in Niamey, although there was a concurrent epidemic in rural Niger. A massive outbreak of meningitis in Niamey in 1994-1995 followed a 6-year period during which the mean rate of vaccine coverage remained < 25%. The data indicate that, in the meningitis belt, preventive immunization should avoid a great number of deaths and be less expensive than mass immunisation campaigns performed after epidemics have begun.

[Seroprevalence of HCV in the general population of Niger and in patients with chronic liver diseases: comparison of different second generation tests and PCR]. / Séroprévalence du VHC au Niger dans la population générale et chez des malades atteints d'hépatopathies chroniques: comparaison de différents tests de seconde génération et de la PCR.

The aim of our study in Niger was to compare the seroprevalence of hepatitis C in a rural "normal" population and in a group of patients presenting at the hospital with signs of chronic liver disease: to estimate this seroprevalence, we used 4 second generation ELISA screening and 3 confirmatory tests (LIA, RIBA and PCR); genotyping was performed on PCR positive sera, using Inno-LIPA HCV. We could not find a statistically significant difference (Fisher's exact test) between the two groups of healthy and sick people (2.5 versus 5.4% for seroprevalence and 2.5 versus 3.2% for viremia). Our study didn't find any relationship between hepatitis C infection, blood transfusion or surgery; other major ways of transmission of hepatitis C have to be considered. The predominant genotype detected was 2a.

Hepatic vein involvement in hepatocellular carcinoma.

A retrospective review of the dynamic computed tomography (CT) and ultrasound scans from examinations of 134 patients with hepatocellular carcinoma was undertaken with emphasis on evaluation of hepatic vein involvement. Hepatic veins were involved in 8 patients (5.9%). Portal vein obstruction was associated in 7 of these cases. Sonography demonstrated hepatic vein involvement in 6 cases was considered within normal limits in 1 and failed to display hepatic veins in another. Dynamic CT was superior in depicting venous obstruction in all the cases by different signs including (a) hypodensity and enlargement of the vessel, (b) perivenous arterial hypervascularization surrounding the hypodense intraluminal region, and (c) hemokinetic changes in relation to the outflow obstruction. The frequency and significance of these CT signs are discussed and correlated in 2 patients with magnetic resonance imaging (MRI) data.