[Noma]. / Le Noma.

Noma is a necrotizing ulcerative stomatitis known since Antiquity. It occurs mostly in poor countries, the Sahel countries being the most affected. Each year, several hundred thousand cases are reported. Noma affects especially malnourished children who are less than 6 years old and rarely adults with acquired immunodeficiency (HIV, cancer). Ulcerative lesion is occurring rapidly due to the production of endotoxins by bacteria from oral commensal, telluric and animal origin. Necrotic debridement leads to huge defects: loss of soft tissue (skin, nerves, vessels, eye), bone (maxilla, mandible) and teeth. Death occurs rapidly in a few weeks in 80 % of the cases. In case of survival, the consequences are functional, aesthetic, psychological and social. The goal of the treatment in the acute phase is the patient's survival and the fight against limited mouth opening. The management of the phase of sequela is an anaesthetic, surgical and physiotherapy challenge. Its purpose is the social reintegration of the patient.

[Peroperative bronchospasm during surgery of hydatid cysts]. / Bronchospasme peropératoire au cours de la chirurgie des kystes hydatiques.

A case is reported of isolated bronchospasm occurring during the removal of two hydatid cysts in the same patient at the same time. This 44 year old man already had had a hydatid cyst removed one year previously; no complication had occurred at the time. The patient had a past history of asthma, easily treated by salbutamol spray. All went well until the first cyst was manipulated: the ventilating pressures rose, and wheezing rhonchi appeared in both lung fields. This bronchospasm was resistant to an increase in anaesthetic depth, to salbutamol, terbutaline, steroids and 3% halothane for 15 min. It however disappeared completely as soon as the cyst was removed. There were no other signs of an anaphylactic reaction. The same thing occurred during the removal of the second cyst. Postoperative investigations showed the patient to be sensitized to house dust and mites. His asthma is confirmed. Allergologic tests showed no reaction with the anaesthetic drugs used, but a hypersensitivity to the echinococcal antigens. The bronchospasm was probably due to the increased bronchial sensitivity of this patient.