Noradrenaline content and adrenergic receptors in kidney and heart of the prehypertensive and hypertensive Lyon rat strain

Sympathetic activity modulates the blood pressure in part by activation of cardiac and renal adrenergic receptors. Thus an alteration of tissue noradrenaline content and/or adrenergic receptors in heart and kidney might be involved in the pathogenesis of hypertension. In order to verify this possibility, we studied tissue noradrenaline content and alpha and beta adrenergic receptors in the heart and kidney of Lyon hypertensive (LH), normotensive (LN), and low-pressure (LL) rats. Density and affinity of receptors were determined using the specific radioligands [3H]-prazosin (alpha 1), [3H]-rauwolscine (alpha 2), and [3H]-dihydroalprenolol (beta) in prehypertensive (5-week-old) and hypertensive (21-week-old) rats. In the prehypertensive period, no differences concerning renal and cardiac noradrenaline content and adrenergic receptor densities and affinities were observed. In the hypertensive period, an age-related decrease of renal alpha 1 and beta receptors was observed in LN and LL (P less than 0.01) but not in LH rats. Consequently, at this time, density of renal alpha 1 and beta receptors was higher in LH than in LN and LL (P less than 0.01). In contrast, the density and affinity of renal alpha 2 and cardiac alpha 1 and beta receptors and tissue noradrenaline content were similar in the three rat strains. Because renal alpha 1 and beta receptors mediate various functions involved in the control of blood pressure such as tubular sodium reabsorption, renin secretion, and glomerular filtration, the different density of these receptors in LH rats might be involved in the development or maintenance of hypertension.     

Limits to the practice of craniofacial oncology in Black Africa: the example of cancer of the larynx]

Cervico-facial carcinology is currently one of the major concerns of oto-rhino-laryngologists. The authors have chosen laryngeal cancers to determine the limits of the practice of such cervico-facial carcinology in the topics. Over a 10-year period, 61 patients with a suspected malignant laryngeal disease were examined at the E.N.T. Clinic of the University Hospital in Dakar. Histological confirmation was found in only 38 patients, and a curative treatment was undertaken with 27 patients. No significant differentiation could be found from the results as far as sex, age and histology were concerned. On the other hand, the TNM breakdown of our 36 carcinomas revealed that in 78% of the cases large tumours (T3, T4) were involved. In the vast majority of these cases (18/27), treatment was purely surgical, with a total laryngectomy in 90% of the cases. Pharyngostomas accounted for the majority of the early postoperative complications (6/14). Over 10 years of practice, 70% of our patients have died or have been lost from sight. These poor results are due to numerous factors, including late consultation, the lack of specialists and the insufficiency of technical facilities. To improve results, the authors recommended the setting-up of proper cancer institutes.     

The impact of alternative cost recovery schemes on access and equity in Niger

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax+fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax+fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax+fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.