Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections)

The variations in the emergence and distribution of the ilioinguinal nerve are the cause of the failures of the ilioinguinal block and the difficulties at interpreting the ilioinguinal nerve syndrome. In order to identify its variations and set reliable anatomical landmarks for performing the ilioinguinal block, we dissected 100 inguinal regions of 51 adult corpses. The nerve was absent in seven cases and double in one case. The ilioinguinal nerve emerged from the internal oblique muscle, passing at 1 ± 0.8 cm of the inguinal ligament and 3.33 ± 2 cm of the ventral cranial iliac spine. It appeared behind the inguinal ligament and/or the ventral cranial iliac spine in 19 cases and presented a common trunk with the iliohypogastric nerve in 13 cases. In 47 cases, the nerve appeared in the form of a single trunk. Sixteen modes of division and eight types of predominantly anterior scrotal topographic distribution could be noted. These results show the high variability of the emergence and the sensory distribution of the ilioinguinal nerve. They enable us to propose techniques for ilioinguinal block performance using more accurate anatomical landmarks formed by the inguinal ligament and the ventral cranial iliac spine and a better diagnostic approach of ilioinguinal neuropathies.     

Prevalence of nosocomial infections in a university hospital (Dakar, Senegal)

Nosocomial infections constitute today a great public health problem that is still ignored or poorly mastered in our health institutions. METHOD: A prevalence study initiated by the CLIN (committee for the prevention of nosocomial infections) was recently conducted at the Fann teaching hospital. A questionnaire was prepared and submitted to all patients that were hospitalized on the day of the study; the questionnaire allowed gathering a lot of information on exposure factors and clinical and microbiological arguments in favor of nosocomial infections. RESULTS: One hundred and seventy-five patients (59.9% of all available beds) participated in the study. Nosocomial infections were found mostly among people between 20 and 44 years of age and predominantly in women. Fifty-eight percent of those cases were found in the neurology unit. The infections were mostly urinary (40%) and pulmonary (25%). The germs responsible were multiresistant bacteria: Enterobacter cloacae secreting broad-spectrum betalactamase, methicillinresistant Staphylococcus aureus, and Pseudomonas aeruginosa. The infected patients were usually under antibiotic treatment (80%) with various protocols, mainly monotherapy. The antibiotics used were betalactams, fluoroquinolones, and nitroimidazoles.     

Nontyphoidal Salmonella bacteremia cases in AIDS patients in a Dakar University Hospital (Senegal)

OBJECTIVES: This study had for aim to describe epidemiological, clinical and bacteriological aspects of nontyphoidal Salmonella bacteremia in patients with AIDS in the Dakar University Hospital Infectious Diseases Clinic. METHOD: This study was made on data recorded between 1January1996 and 31December2005. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Screening for strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Sixty-two cases of nontyphoidal Salmonella bacteremia were recorded in AIDS patients as follows: Salmonellaenteritidis bacteremia (32 cases), Salmonellatyphimurium bacteremia (11 cases), and Salmonella spp bacteremia (11 cases). The strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin plus clavulanic acid in at least 92% of the cases. Only 79% of them were susceptible to cotrimoxazole. The lethality rate was 55%. DISCUSSION: This lethality rate of nontyphoidal Salmonella bacteremia is high in AIDS patients. Therefore, the priority should be put on prevention and, in patients with AIDS, on food hygiene measures, antiretroviral treatment and efficient chemoprophylaxis. This should prove efficient to reduce incidence of nontyphoidal Salmonella bacteremia.     

Effects of varying moisture on egg production and longevity of Lutzomyia longipalpis (Diptera: Psychodidae)

The sand fly Lutzomyia longipalpis (Lutz & Neiva) (Diptera: Psychodidae), is the vector of the Neotropical parasite Leishmania chagasi. Designing methods to control the spread of this pathogen involves maintaining large laboratory colonies of these flies. However, transmission studies have been hampered particularly in regard to significant fluctuations in colony productivity. In the process of optimizing our sand fly rearing protocol, we increased moisture levels in the environment of the adult blood-fed female and found that egg development increased, whereas sand fly longevity decreased. Interestingly, continuous moisture from the fourth day after a bloodmeal significantly increased the longevity of the fly, but it did not significantly decrease the number of eggs developed. These results will help guide investigators aiming to manipulate the longevity and productivity of sand fly colonies.     

猪苓汤合四物汤对大鼠利尿作用研究

用水负荷雄性大鼠探讨猪苓汤合四物汤（ＺＬＳＷ）的利尿作用。ＺＬＳＷ０．６ｇ／ｋｇ，１．３ｇ／ｋｇ，呋喃苯氨酸（ＦＳ）０．０１ｇ／ｋｇｉｇ５ｈ后均能增加水负荷大鼠的尿量，分别与ＮＳ组比较有显著或非常显著的差异（Ｐ＜０．０５，Ｐ＜Ｏ．０１）。ＺＬＳＷ０．６ｇ／ｋｇ，１．３ｇ／ｋｇ，２．５ｇ／ｋｇ组均能增加Ｋ＋的排泄，分别与ＮＳ组比较有非常显著的差异（均Ｐ＜０．０１）。但对Ｎａ~＋没显示有排泄作用。结果表明，ＺＬＳＷ小、中剂量有利尿作用，三种剂量的ＺＬＳＷ均有排Ｋ~＋作用。     

Efficacy and tolerance of antiretroviral therapy in HIV-2 infected patients in Dakar: preliminary study

OBJECTIVE: The authors had for aim to evaluate the clinical and immunological response as well as the tolerance to antiretroviral therapy in HIV-2 infected patients. DESIGN: A retrospective chart review was made from August 1998 to August 2004. RESULTS: 188 patients were on protease inhibitor based regimen. 153 (81.38%) were HIV-1 and 35 (18.62%) HIV-2 infected patients. The mean weight gain was significantly higher in the HIV-2 group at months 9 and 12 (P=0.02 et P=0.01 respectively), whereas CD4 cells count gain was higher in the HIV-1 group at month 6 (P=0.004). New AIDS defining criteria are less likely to occur in HIV-2 infected patients on HAART than in HIV-1 (P=0.004). Lipodystrophy syndrome was present only in HIV-1 infected patients. CONCLUSION: Antiretroviral therapy in HIV-2 infected patients shows similar clinical and immunological efficacy than in HIV-1 infected ones and is also well tolerated.     

Technology insight: Enteral stenting and new technology

Self-expandable metal stents (SEMS) have gained acceptance for use in the gastrointestinal tract in order to relieve malignant luminal obstruction. In the upper gastrointestinal tract SEMS are used as an alternative to surgical bypass for palliation of malignant gastric-outlet obstruction. In the colon, SEMS are used to avoid colostomy during palliation and as a bridge to surgery for left-sided colonic obstruction. Enteral SEMS appear to be cost effective. This article reviews the latest in stent technology as well as the outcomes following their placement.     

Subacute sclerosing panencephalitis. Study of 32 cases observed in Conakry, Guinea

Thirty two cases of subacute sclerosing panencephalitis were reported. Diagnosis was based on epidemiological, clinical and electroencephalographic data; myoclonies and alterations of intellectual functions were the most frequent symptoms.     

Comparative analysis ofp53 protein immunoreactivity in prostatic,lung and breast carcinomas

Summary In this study we analysed the expression ofp53 protein in a total of 143 carcinomas immunohistochemically. These consisted of 34 prostatic adenocarcinomas, 59 lung and 50 breast carcinomas. In 28 cases, an average of 2–3 additional sections from different tumour areas were analysed. Forty-nine of the 143 carcinomas (34%) showed typical nuclear immunoreactivity by immunohistochemical staining with thep53 antibody CM-1. Two of the 34 prostatic carcinomas (6%) werep53 positive while 25 of the 59 lung carcinomas (43%) and 22 of the 50 breast carcinomas (44%) showed positivity forp53. By grade: 49% of grade III tumours, 36% of grade II and 5% of grade I tumours werep53 positive. There were significantly morep53-positive cases in grade II–III tumours than in grade I tumours (P= 0.001) when all tumours were taken into account. Further, there were significantly morep53-positive cases in grade III than in grade I–II tumours (P=0.001). In lung tumours there were significantly morep53-positive cases in grade II–III tumours than in grade I tumours (P=0.018). Similarly, there were significantly morep53-positive tumours in grade III breast tumours than in grade I–II tumours (P=0.003). The low incidence ofp53 positivity in prostate carcinomas suggests that mutations of thep53 gene are not as frequent in the neoplastic transformation of these tumours as in lung or breast carcinomas. The association ofp53 positivity with tumours of higher grade suggests thatp53 mutations lead to tumours of a more aggressive type. The analysis of tumours by multiple sections indicates thatp53 positivity is not evenly distributed in tumour tissue. Therefore, analysis of additional tumour areas may reveal positivity some cases, which is not evident if only one section is studied.