[Seroprevalence of HBs Ag and of anti-HCV antibodies among HIV infected people in N'Djamena, Chad]. / Séroprévalence de l'Ag HBs et de l'anticorps Anti VHC chez les personnes infectées par le VIH1 à N'Djamena, Tchad.

This is a prospective study conducted as part of a voluntary testing for HBV, HCV and HIV. The aim of the study is to determine the seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people and a control group of HIV negative people. HIV prevalence among newly diagnosed volunteers is 9.1%. The overall seroprevalence of HBs Ag and anti-HCV antibodies is respectively 13.5% and 2.0%. The seroprevalence of HBs Ag and anti-HCVantibodies in the control group (HIV-negative) is respectively 12.2% and 2%. The seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people (old and new) is respectively 16.1% and 1%.This study, the first one conducted in Chad, has allowed us to know the seroprevalence of HBs Ag and anti-HCV antibodies among HIV infected people.

[Practice of spinal anesthesia in a developing country: usefulness of vascular preloading with a 7.5% hypertonic saline solution]. / Pratique de la rachianesthésie dans un pays en voie de développement: intérêt du remplissage vasculaire par un soluté salé hypertonique à 7,5%.

OBJECTIVE: To assess the efficacy of hypertonic saline for prevention of arterial hypotension in patients undergoing spinal anaesthesia in Niger. STUDY DESIGN: Prospective, randomized, double-blinded study. PATIENTS: Fifty adults undergoing scheduled surgery under spinal anaesthesia, allocated either to a hypertonic saline group (HSG) or a isotonic saline group (ISG). METHODS: Over the 15 min prior to anaesthesia, 100 mL of 7.5% saline were infused in patients of HSG, and 100 mL of 0.9% saline in those of ISG respectively. Spinal anaesthesia was performed at the L3-L4 or L4-L5 interspace using either lidocaine 5%, or bupivacaine 0.5% or a mixture of both supplemented with fentanyl. Arterial pressure (AP) and heart rate (HR) were measured the day before surgery, prior to and after spinal anaesthesia, thereafter every 5 min over 30 min and every 10 min thereafter until completion of surgery. Hypotension (30% decrease of systolic AP control value was treated with 500 mL of Ringer lactate solution and in case of failure with ephedrine (5-30 mg i.v.). An isolated bradycardia (HR < 60 b.min-1) was treated with atropine (0.5-1 mg i.v.). RESULTS: Hypotension occurred in two out of 24 patients of the HSG and eight out of 24 of the ISG (P < 0.05). The mean infused volumes of Ringer lactate solution were 387 +/- 218 mL vs 623 +/- 318 mL respectively (P < 0.05). Ephedrine and/or atropine were not required in HSG, however in 7 out of the 24 patients of the ISG. Adverse clinical effects did not occur. CONCLUSION: Hypertonic saline prevents efficiently the occurrence of hypotension during spinal anaesthesia. Considering its ease of preparation, the lack of adverse effects, in patients not suffering arterial hypertension or congestive heart failure, and low cost, hypertonic saline is well adapted for use in a developing country, if isotonic solutions are not available.

[Urethral reconstruction by pedicled labial flap in the treatment of extensive urethral lesions after obstetrical injury. Apropos of 34 cases]. / Reconstruction urétrale par lambeau labial pédiculé dans le traitement des lésions urétrales étendues d'origine obstétricale. A propos de 34 cas.

Reported here is our experience with a new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. From January 1992 to January 1996, 31 cases of urethral damage in African female patients, with an average age of 18-years-old were treated by pedicled labial urethroplasty. This procedure was done by using a pedicled flap obtained from the major labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were used: the patch to lengthen sufficiency (13 cases), or the tubularized flap following complete reconstruction of the urethra (21 cases). Good quality urine continence was obtained by using the suburethral Martius' sling procedure. In 6 cases, we combined the treatment with a colposuspension procedure. The average follow-up is 14 months (ranging from 6 to 37 months). Recovery of normal micturition with absence of urinary leak was obtained in 21/30 cases (70%). While 5 moderate failures occurred, 4 cases were considered complete failures. In view of the high success rate, the authors consider that the one-stage procedure by the use of a pedicled labial flap is a choice treatment and highly suitable procedure for the management of extensive urethral cervical damage after obstetrical injury.

Transepidermal water loss modifications in rats and humans treated with cyclosporin.

Modifications of transepidermal water loss (TEWL) of rat and human skin induced by oral administration of cyclosporin (CS) were investigated. The integrity of the cutaneous barrier was evaluated using TEWL measurement which is a relatively simple and noninvasive means of assessing the functional state of the cutaneous barrier. After 12 weeks, the TEWL of treated rats decreased significantly and this difference was still present after the 16 weeks of treatment. In humans, there was a statistically significant decrease of TEWL on both forearm and thigh in CS-treated patients compared to non-CS-treated patients and controls (p less than 0.05). These results suggest that CS causes skin modifications, particularly concerning its barrier status. The nature of these skin modifications still remains to be determined.