[Pharmacovigilance among dentists: a survey of practitioners in Dakar, Senegal]

AIM

Since 1968, the World Health Organization has used an international pharmacovigilance programme to monitor and examine the effects of drugs. The purpose of this study was to assess the knowledge and attitudes of dentists toward pharmacovigilance.

METHODS

The paper presents the results of a cross-sectional descriptive study of 103 dentists in Senegal, based on an exhaustive selection process. Data were collected on the dentists' sociodemographic characteristics and their knowledge and attitudes toward pharmacovigilance.

RESULTS

Over 50% of the sample were general practitioners. The average number of years of professional experience was 9 years. Painkillers (41.9%) were the most widely prescribed drugs, followed by antibiotics, which were particularly involved in the onset of adverse effects (41.8%). Adverse effects were observed by just 3.8% of the sample. Almost 90% of the participants were not aware of the existing pharmacovigilance system.

CONCLUSION

The results suggest that pharmacovigilance training and education sessions for dentists are needed to improve their knowledge of pharmacovigilance and to foster positive attitudes toward adverse effects.

Low-level environmental exposure to lead and renal adverse effects: a cross-sectional study in the population of children bordering the Mbeubeuss landfill near Dakar, Senegal

This study deals with the health effects within a child population, neighbouring a landfill. After detecting metals in soil and air samples collected in the surroundings of the landfill and in a control site, we have studied: (i) levels of lead (Pb) and exposure biomarkers in blood and urine, (ii) oxidative stress biomarkers and (iii) renal injury by applying a set of early effect biomarkers. Levels of Pb were higher in the exposed site (i.e. 1129 mg/kg and 640 ng/m(3) in soil and air samples, respectively) versus those in the control site (i.e. 14.3 mg/kg and 9.3 ng/m(3) in soil and air samples, respectively). Pb impregnation and levels of delta-aminolevulinic acid in urine were influenced by the living site that shows the prevailingly alarming situation in the Mbeubeuss landfill. Malondialdehyde changes indicated Pb-induced excessive production of reactive oxygen species. Lactate dehydrogenase activities and proteinuria were found to be higher in the children living in the exposed site. These evidences may reveal the usefulness of these two effect biomarkers to monitor the kidney injury entailed by relatively low-environmental exposure to Pb. Overall, these results show that the Mbeubeuss landfill constitutes a real source of environmental and health risk, be it living or working on site, of the surrounding population, predominantly for children.

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients 'on behalf of the Group of Surgeons from the French Unicancer Federation'

BACKGROUND

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.

PATIENTS AND METHODS

We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.

RESULTS

Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].

CONCLUSION

ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Osteogenesis imperfecta in a pediatric surgical center in dakar, senegal: clinical and radiological aspects

INTRODUCTION

Osteogenesis imperfecta presents with a set of constitutional disorders of varying severity, genetically determined and characterized by an abnormal production of collagen and matrix of the bone leading to bone fragility responsible for multiple fractures and many skeletal deformities. The aim of our study was to analyze the clinical and radiological aspects of the pathology.

PATIENTS AND METHODS

This was a retrospective study of 10 cases of children with osteogenesis imperfecta who consulted the Pediatric Surgery Unit of the University Center Aristide Le Dantec Hospital over a period of 6 years. The parameters analyzed were the reasons for consultation, physical examination findings and findings on standard radiographs. After collecting all the data, children were divided according to the classification of Silence and Glorieux.

RESULTS

Pain was the reason for consultation in eight children. The saber blade deformity of the legs was found in nine children. Physical examination found tenderness in 80% of cases. Blue sclera was found in one child. The teeth were normal in eight patients. Standard radiographs showed an osteopenic skeleton with multiple fractures (3.7 fractures on the average) associated with vicious callus formation and deformity. According to the classification of Silence and Glorieux, six children were type VI, two children type IV, a child type III and one type I.

CONCLUSION

Osteogenesis imperfecta is a rare disease. In our environment, the diagnosis is made late - a stage associated with deformity. Of these, the occurrence of sabber deformity of the lower limbs is the most common. Radiological aspects are dominated by vicious callus formation, deformed bones and osteopenia. Moderate forms are predominant. Parents need to be educated about the risk of repeat fractures and the need to present deformed children to hospital early.

Potential use of densified polymer-pastefill mixture as waste containment barrier materials

Mining activities generate a large amount of solid waste, such as waste rock and tailings. The surface disposal of such waste can create several environmental and geotechnical problems. Public perception and strict government regulations with regards to the disposal of such waste compel the mining industry to develop new strategies which are environmentally sound and cost effective. In this scenario, recycling of such waste into mining or civil engineering construction materials have become a great challenge for the mining and civil engineering community. Hence, in this study, taking advantage of the inherent low hydraulic conductivity of paste tailings (pastefill), small amounts (0.05, 0.1, 0.2, 0.5%) of a super absorbent polymer (SAP) are added to the latter after moisturizing the tailings. The resulting densified polymer-pastefill (PP) materials are compacted and submitted to permeability tests at room temperature and performance tests under cyclic freeze-thaw and wet-dry conditions to evaluate their suitability as a barrier for waste containment facilities. Valuable results are obtained. It is found that the hydraulic conductivity of the proposed barrier material (PP) decreases as the amount of SAP increases. Hydraulic conductivity values as low as 1 × 10(-7) and 6 × 10(-9)cm/s are obtained for PPs which contain 0.1-0.5% SAP, respectively. The PP material also shows relatively good resistance to cyclic freeze-thaw and wet-dry stresses. The results show that negligible to acceptable changes in hydraulic conductivity occur after five freeze-thaw and six wet-dry cycles. None of the changes reach one order of magnitude. As a final step, a cost analysis is undertaken to evaluate the economical benefits that could be drawn from such a proposed barrier material. When compared to a conventional compacted sand-bentonite barrier with 12% bentonite concentration, it is found that the benefit realized could be estimated to 98, 96 and 90% when using PP material that contains 0.10, 0.20 and 0.5% of SAP. From this study, it can be concluded that PP materials show encouraging performance properties for barrier design.

Exploring the influence of operational parameters on the reactivity of elemental iron materials

In an attempt to characterize material intrinsic reactivity, iron dissolution from elemental iron materials (Fe(0)) was investigated under various experimental conditions in batch tests. Dissolution experiments were performed in a dilute solution of ethylenediaminetetraacetate (Na(2)-EDTA - 2mM). The dissolution kinetics of 18 Fe(0) materials were investigated. The effects of individual operational parameters were assessed using selected materials. The effects of available reactive sites [Fe(0) particle size (<or=2.0mm) and metal loading (2-64 g L(-1))], mixing type (air bubbling, shaking), shaking intensity (0-250 min(-1)), and Fe(0) pre-treatment (ascorbate, HCl and EDTA washing) were investigated. The data were analysed using the initial dissolution rate (k(EDTA)). The results show increased iron dissolution with increasing reactive sites (decreasing particle size or increasing metal loading), and increasing mixing speed. Air bubbling and material pre-treatment also lead to increased iron dissolution. The main output of this work is that available results are hardly comparable as they were achieved under very different experimental conditions. A unified experimental procedure for the investigation of processes in Fe(0)/H(2)O systems is suitable. Alternatively, a parameter (tau(EDTA)) is introduced which could routinely used to characterize Fe(0) reactivity under given experimental conditions.

Outcome of HER2-Positive (HER2+) Metastatic Breast Cancer Patients (MBC) Treated with Trastuzumab (T): An Institutional Based Review

Background: HER2+ status is associated with poor prognosis, high incidence of visceral and brain metastasis. However the addition of trastuzumab to chemotherapy (CT) significantly improves survival in early and advanced breast cancer. The purpose of this retrospective study was to explore the pattern of outcome in a cohort of MBC patients treated with T-based chemotherapy in a single institution. T was approved in Europe in 2000 and in 2001 all pts had access to T according HER2+ status. Methods: Women with de novo or recurrent breast cancer treated with trastuzumab at Institut Curie between 2001 and 2006 with HER2+ status (IHC 3+ or FISH +) were identified from the Institut Curie database. Disease was classified in two groups: patients who received T upfront and those who received T after one or several CT regimens. Overall survival (OS) was defined as the time from the date of the first metastasis to the date of death or last follow-up and was estimated using the Kaplan-Meier product method. Results: The final analysis included 244 patients. Median age was 53.4 yrs (29-80). Median time from primary and first metastasis was 22 mths (0-238). Visceral metastasis were present in 153 pts (63%) and 125 pts (51%) presented multiple sites. One hundred pts (42%) developed brain metastasis during the course of disease. One hundred and sixty five pts (68%) received T as first line, 79 pts (32%) after a median of one line of CT (median 1, range 1-5). One hundred and twenty four pts (52%) received more than 3 regimens. The median overall survival was 53 mths (4-113), similar in both groups. However there is a major bias: pts with very aggressive disease not treated upfront with T not have not been offered delayed T and don't appear in the analyzed population. Patients who developed brain metastasis had a median survival of 41 mths (11-90). Complete characteristics of pts will be presented. Conclusions: The introduction of T has altered the natural history of HER2+disease. Even outside a clinical trial, our results show that the addition of T to CT improves the prognosis of MBC patients with HER2+ disease. Prolongation of T after progression with other CT appears beneficial, even in pts with a high disease burden. The high incidence of brain metastases remains an issue in such a population.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5107.

[Quality control of antibiotics used in Senegal]

To slow the spread of bacterial resistance and promote safety in the use of medicines, development of quality control tools is indispensable. The purpose of this study was to evaluate the quality of several antibiotic agents used in Senegal and to assess the utility of the mini laboratory as a quality control tool. The mini laboratory and all materials necessary for this study were provided by the German Pharma Health Fund. A total of 34 antibiotic samples were submitted to a battery of tests including physical and visual inspection, disintegration, and thin layer chromatography designed for identification and semiquantitative evaluation. Non-conformities detected by physical and visual inspection were found mainly in products from the illicit sector (80%) but some non-conformities were also found in products from licit private sector (20%). Based on thin layer chromatography findings, non-conformities in product identity and dosage involved mainly erythromycin (45%) followed by amoxicillin and ciprofloxacin (22% each). Again this type of non-conformity was most frequent in products from the illicit sector (45%) but it was also observed in products from the private and public sectors (33% and 22% respectively). These findings show that follow-up is necessary to ensure the quality of medicines, especially antibiotics. In this study the mini laboratory was a highly useful quality control tool.

Reflex mechanisms for bladder inhibition

Continence of urine requires ability of the bladder to maintain a low intravesical pressure at increasing filling, in order to preserve a positive urethral-bladder pressure gradient. During micturition the conditions are reversed: the bladder has to generate pressures exceeding the urethral pressure, which also presupposes that the urethra opens and remains open as long as is required for all urine to be expelled. These events are made possible by a complicated pattern of central and peripheral neural responses, affecting the bladder-urethral unit. The pioneer work of determining the reflex mechanisms involved in the regulation of the lower urinary tract was done at the beginning of this century. Recently, further studies have been made and by means of electrophysiological investigations previous data have been confirmed. In this communication some important observations are reviewed and one example is given of how bladder inhibitory reflexes are utilized in therapy.

[Risk factors for neonatal mortality. The pediatric surgery service, Aristide Le Dantec University Hospital, Dakar]

OBJECTIVES

To determine neonatal mortality factors at the paediatric surgeon service in Aristide Le Dantec University Hospital in Dakar.

PATIENTS AND METHODS

It is a retrospective study of 245 cases collected between January 1997 and December 2006 at the paediatric surgeon service, the surgery emergency and intensive care unit of Aristide Le Dantec University Hospital. We studied the age, sex, geographical origins, consultation time, weight at birth, evacuation means to the reference medical structure, consultation motives, clinical diagnosis, associated malformations, treatment methods, surgery follow ups and death causes.

RESULTS

The neonatal death rate at the paediatric surgery service was 36.7 %. Our patients' average age was eight days. A masculine predominance was observed with a 1.57 sex ratio. The average admission time was 08 days. Sixty-five per cent (65%) of our patients came from suburbs. Thirty-eight per cent were transported by an ambulance from a health centre. Fifty-three per cent (53%) weighed less than 2,500 grams at birth. The occlusive syndrome was the commonest reason for consultation (38.5 %). The most frequently observed pathology was the ano-rectal malformations. Associated malformations were observed in 12% of the cases. The majority of the patients (52%) died before the surgical operation after an average duration of 5 days. The commonest causes of death are the digestive malformations (66%).

CONCLUSION

Male newborn babies, aged less than 8 days are the most vulnerable age group. The lack of hospital transportation means, the weak weight at birth, the caring time and the digestive pathologies are other factors of wrong diagnosis. A multidisciplinary collaboration, the improvement of the technical capacity and of the available emergency therapeutic means and the creation of an intensive paediatric care unit would certainly contribute to lower the mortality rate.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Toxicological study of emissions resulting from a diesel and a gazoline engine using an organotypic culture of lung slice]

INTRODUCTION

Many studies were carried out in vivo and/or in vitro for better understanding toxic effects of exhausts or particles emitted by Diesel vehicles. Few studies were interested in Gazoline engines when progress of metrology made it possible to highlight the presence of small particles with a strong capacity of penetration within pulmonary tissue. The aim of this study is to compare the toxic impact of the emissions of Diesel and Gasoline engines of recent technology.

MATERIALS AND METHODS

Biological material was constituted by an organotypic rat lung precision slice. It was exposed to a continuous flow exhausts thanks to a preparation and dilutions system of these emissions placed on the line of exhaust. A measurement of the biological markers involved in the process of the lung tissue reaction to the air-contaminants was carried out.

RESULTS

With Diesel exhausts, the results showed a stability of the rate of ATP and an increase in enzymatic activities of the antioxydant system (GPx and catalase). Gazoline emissions, as for them, were responsible for a cytotoxic attack of the pulmonary tissue defined by a reduction in the rate of ATP as well as a deterioration of the system of detoxication with reduction in the antioxydant enzymatic activities.

CONCLUSION

These results show that toxicological profiles obtained with this system of exposure depends on the engine technology used, highlighting thus the specific response of the model in relation with the type of atmospheres which it is exposed.

[Study of the contents in fat, in protein and in vitamin D of powdered milk varieties sold in Dakar]

INTRODUCTION

The powdered milk is a much appreciated food in Senegal. However no particular control is realized by authorities on the various marks of milk imported before their marketing. In the concern to protect the health of the consumers, but especially in front of the very big variety of the sources of supply in this product we determined the contents in fat, in protein and in vitamin D main variety show of marketed powdered milk Dakar.

MATERIAL AND METHODS

Chemical methods were operated to determine the fat contents and in proteins. The liquid chromatography in high performance was used to identify and measure the vitamin D.

RESULTS

The obtained results profits showed that all the studied samples of milk had contents in fat included between 25 and 31 g %, those in proteins were included between 23 and 25 g %. As regards the dosage of the vitamin D, a single sample had content weaker than that mentioned on the packaging by the manufacturer.

CONCLUSION

The results of this study allowed to notice most of the variety varieties of powdered milk marketed in Dakar were in accordance with the standards established for this food and are consequently good quality.

Mutagenicity of benzyl chloride in the Salmonella/microsome mutagenesis assay depends on exposure conditions

Benzyl chloride (BCl) is a clear yellowish, volatile liquid that is widely used as an intermediate for the production of benzyl alcohol and benzyl compounds used in perfumery, dyes and pharmaceuticals. In previous studies BCl has shown weak and inconsistent mutagenicity in the Salmonella/microsome mutagenesis assay (Ames test). The aim of the present study was to investigate the potential mutagenic activity of BCl using modifications of the standard Ames test in order to adapt the method to the volatile nature of the test compound. Tests were performed using (a) the standard plate-incorporation method, (b) incubation of the treated plates in closed containers, (c) a vaporization-diffusion method to expose Ames test plates to volatilised BCl and (d) the pre-incubation method. Using the standard plate-incorporation method, BCl showed no (in the absence of metabolic activation) or very weak (in the presence of metabolic activation) mutagenic activity in Salmonella typhimurium tester strain TA 100. The use of the pre-incubation method did not improve detection of mutagenic activity of BCl. The use of closed containers significantly increased the response, but the most marked response was obtained by testing BCl in volatilised form in the vaporization-diffusion method. Using the latter approach there appeared to be less toxicity of the BCl treatments to the tester bacteria. Our findings suggest that BCl may show greater mutagenic activity in the gaseous phase. This work underlines the importance of using appropriate methods for the evaluation of volatile compounds. The modifications described here are easy to realize in practice and should prove useful for the investigation of other volatile materials or atmospheric contaminants.

EAU Guidelines on Chronic Pelvic Pain

OBJECTIVES

On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of chronic pelvic pain patients were established.

METHOD

Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts.

RESULTS

The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain.

CONCLUSION

A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.

The impact of a general practice co-operative on accident and emergency services, patient satisfaction and GP satisfaction

BACKGROUND

The advent of general practice co-operatives represented a fundamental change in the delivery and organization of out-of-hours services. Concerns have been voiced that co-operatives might impact adversely on workload in accident and emergency (A&E) departments.

OBJECTIVE

The purpose of this study was to assess the impact of establishing a general practice co-operative on use of A&E services, patient satisfaction and GP satisfaction.

METHODS

A controlled before and after study of a GP co-operative in Sheffield, UK was carried out. A postal questionnaire was sent to 26 911 people, 13 442 before and 13 469 after the opening of the co-operative, to determine service use, in particular A&E attendance, in the previous 4 weeks. Patient satisfaction was assessed through structured interviews with 653 patients. GP satisfaction was assessed using a postal survey of all 98 Sheffield practices 2 years after the opening of the co-operative.

RESULTS

There was no change in the use of A&E services, odds ratio = 1.08 (95% confidence interval 0.60-1.94). There was no change in patient satisfaction overall, mean difference 0.02 (-0.32 to 0.36). Sixty-seven per cent of doctors in member practices were much more satisfied with out-of-hours duty compared with 10% in non-member practices (P < 0.001).

CONCLUSIONS

General practice co-operatives have been successful in achieving their policy objectives, improving GP morale without jeopardizing patient satisfaction or impacting adversely on A&E services.

Sacral nerve stimulation for refractory urge symptoms in elderly patients

OBJECTIVE

The presence of an overactive detrusor (OD) is becoming more prevalent in the elderly and may severely influence the social life and activities of daily living in the senior, otherwise healthy, person. There is a marked age-dependent increase in OD above the age of 65 years, which is mainly attributed to dysfunction, with loss of voluntary control, of the micturition reflex and decreased perception of bladder fullness.

MATERIAL AND METHODS

Herein, we evaluate the outcome of sacral nerve stimulation in five patients aged >65 years derived from a large, multinational, randomized, prospective study.

RESULTS

The effect on symptoms was excellent in two subjects. There was a moderate improvement in another subject and a variable but eventually small effect in the remaining two patients. The results appeared to be more favourable in younger patients.

CONCLUSION

Our findings suggest that the outcome of sacral nerve stimulation is more unpredictable in the elderly, a fact that should be considered when counselling the patient. However, it should be remembered that, even for the older, active person, urge incontinence may have a severe impact on quality of life and that the majority of patients treated with an implant will benefit from this treatment.

[Quality of butter sold in Dakar (Sénégal)]

Among foods that are introduced in Senegal, butter takes a significant place particularly at home where it is frequently eaten. Nevertheless, Senegalese authorities don't carry out any quality control under those different types (mark) of butter. In consequence, to find butter without quality or characteristics of authentic butter may be high. The aim of this work is to analyse quality of main varieties of butter in Dakar market. Chemical methods were used to determine the characteristic of butter samples and gas chromatography was made to authentify their fatty acid profile. Our results have shown that most of analysed sample respected the standards of quality. In fact the composition of fatty acid and characteristic factors of authentic butter were certified by this study.

Light and electronic observations on Henneguya ghaffari (Myxosporea, Bivalvulida) infecting the gills and intestine of Nile perch Lates niloticus (Pisces: Teleostei) from Chad and Senegal

Henneguya ghaffari Ali, 1999, described for the first time in Egypt, has been found on gills and intestine of Nile perch Lates niloticus L. from Chad and Senegal (Africa). It formed plasmodia which induced lesions of infected tissues. In fresh state, the spore body was ovoid and its size was 11.07 +/- 0.7 (range 11 to 13) x 7.7 +/- 0.4 (range 7 to 8) microm. The length of the caudal appendages was 44.2 +/- 1.7 (42 to 48) microm. The polar capsules were pyriform, of equal size, with the polar filament showing 4 coils, and measuring 3.17 +/- 0.1 (range 3 to 4) x 2.2 +/- 0.1 (range 1 to 2) microm. The total length of the spore was 55.73 +/- 1.7 (range 53 to 61) microm. At ultrastructural level, our results confirm that in Henneguya species, the sporoplasm is binucleate and the pansporaoblast is disporous.

The treatment of sphincter incontinence with periurethral silicone implants (macroplastique)

OBJECTIVE

Patients with genuine stress urinary incontinence (GSI) refractory to conservative measures often undergo a colposuspension when the reason for urine leakage is hypermobility of the bladder neck. Patients who suffer from an insufficiency of the intramural sphincter are instead often suitable for pubovaginal sling procedures, implantation of an artificial sphincter or peri/intraurethral injection of some expansion substance. Here, we present our experience of periurethral injection of silicone microimplants (Macroplastique).

METHOD

We studied 8 men and 22 women with urodynamically stable detrusor, and validated GSI on a standardized quantification test. Under direct endoscopic control Macroplastique was injected. Follow-up was performed by a questionnaire and a new standardized quantification test.

RESULTS

Nineteen of the 22 patients with follow-up in excess of 2 years reported a considerable amelioration and their subjective impressions were also validated by the postoperative standardized quantification test (preoperative 147 g, postoperative 9 g; p < 0.001). No side effects were reported except for mild dysuria for practically all the patients, in all cases transient. A few patients also reported a short initial sensation of incomplete bladder emptying.

CONCLUSION

Considering the difficulty in treating sphincter insufficiency, particularly iatrogenic, the results in this study appear to justify the attempt of injection therapy. It may very well be performed as an outpatient procedure and, moreover, side effects are rare. If silicone microimplants are used there is no obstacle to proceed with artificial sphincter implantation, should the patient's symptoms remain unaffected by the injection procedure.

[Complement and serum immunoglobulins in homozygous and heterozygous sickle cell anemia in Senegal]

Sickle cell disease is an hereditary hemoglobinopathy syndrome which provokes deglobulization crisis and infectious complications. These infectious diseases may be due to a permanent activation of the immune system. The aim of our study was to explore alternative pathway by measuring C3 complement and the classical pathway by C4 complement. The level of immunoglobulins IgA, IgG and IgM was also measured in the subjects sera. Thirty homozygous sickle cell anemia (SS), 25 heterozygous (AS) and 34 controls subjects (AA) were recruited in the Hôpital d'Enfants Albert Royer (HEAR), Fann hospital and Centre National de Transfusion Sanguine (CNTS). Radial Immunodiffusion (RID) technics using specific antisera for C3c, C4c, IgA, IgG and IgM were used in our study. Homozygous SS proved an increase level of IgA (50%, p < 0.003) and IgG (47%, p < 0.003), unlike of IgM level. The C3c complement decrease significantly in (27%) of homozygous SS patients (p < 0.0005) unlike of C4c level. This low level of C3 and IgG in sickle cell homozygous patients can explain the higher susceptibility to infection in these patients. Normal level of C4 and low level of C3 show activation of alternative pathway. Heterozygous AS showed a normal level of C4, C3 and immunoglobulins. Our results suggests a direct involvement of the complement system in sickle cell disease and the depletion of C3 registered was a possible cause of increased susceptibility to infections in patients with homozygous sickle cell anemia.

[Aflatoxins in food: tests of decontamination of peanut cakes by ionizing treatment]

The efficacy of ionising treatment for decontaminating peanut cakes was tested. The influence of cakes water content and the effect of ionisation dose rate were studied. The results obtained after a reverse phase liquid chromatographic determination of B1, B2, G1 and G2 aflatoxins have revealed an important contamination of the peanut cakes (up to 1000 ppb of total aflatoxin's contents). After ionising treatment at 25 kGy, the aflatoxins degradation in peanut cake's was less important in dried samples (about 5-10% at 0.55 water activity: aw) than in the humid ones (40-60% degradation at 0.95 water activity). At this dose, any indicative difference of the degradation rate of aflatoxins, with regard to the ionising process was observed. The efficacy of ionising treatment for decontaminating peanut cakes could probably be improved, however the economic interest of such process as alternative of the treatment with ammonia is questionable.

[Pesticide bioaccumulation: measurement and levels of organochlorine residues in products of vegetable origin]

Because of their lipophilic properties and their persistence, organochlorine pesticides residues can be accumulated in human body by consuming regularly plants products. This study consisted of the monitoring of the contamination level of pesticides residues from various plants products, in order to assess the long- term intoxication risk to which Senegalese consumer is exposed ant identify throughout these plants some indicators of atmospheric pollution. The chromatographic analysis of medicinal plants, fruits and vegetables extracts showed that they could be contaminated by organochlorine residues. About ten of these pesticides residues were found confirming that the analysed plants were really contaminated. The residues level in medicinal plants (from 0.1 to 45 micrograms/kg) were widely below the maximum allowed concentrations and were also lower than those in fruits and vegetables (from 0.1 microgram/kg to 460 micrograms/kg). Heptachlorine residues contents of tomatoes and citrus fruits were higher than FAO/WHO norms, so that, a regular monitoring of the plants products is recommended for better protection of consumers.

Can urodynamic assessment of outflow obstruction predict outcome from watchful waiting?--A four-year follow-up study

OBJECTIVE

One of the most common "treatment" alternatives in suspected outflow obstruction due to bladder outlet obstruction (BOO) is watchful waiting (WW). The aim of this study was to see whether there were any differences in outcome between patients with slight, moderate or severe obstruction due to BOO as classified by transrectal ultrasound (TRUS) and urodynamics.

MATERIAL AND METHODS

Thirty-seven men with lower urinary tract symptoms (LUTS) and suspected BOO were included. All of the patients were investigated by a routine investigation schedule, including TRUS and urodynamics with pressure-flow measurement (pQS) at baseline. Patients with cancer in the urinary tract, prostatitis, history of detrusor hyperreflexia (peripheral or central diseases or trauma to the nervous system affecting the bladder) and serious systemic diseases were excluded. Patients were examined at baseline, then checked again after 1 year and 4 years. Patients who did not want to continue with WW were listed as treatment failures.

RESULTS

At baseline, 43.2% of the patients were urodynamically severely obstructed and 32.3% were moderately obstructed. Thirty-five per cent of the patients were found to have previously unknown detrusor hyperactivity/overactivity. The prevalence of detrusor hyperactivity/overactivity increased with BOO. After 1 year, IPSS had decreased at unchanged Qmax and postresidual volume. These findings persisted at 4 years. The failure rate increased in the more obstructed patients and was significantly higher with more severe obstruction. Complications were found in 13.5%, with no significant differences between patients with minor BOO [Detrusor Adjusted Mean PURR Factor (DAMPF) scale <42], moderate BOO (DAMPF 42-65) and severe BOO (DAMPF >65).

CONCLUSIONS

In patients with severe BOO, the LUTS and failure rate increase over time. The percentage of patients with detrusor hyperactivity/overactivity was higher in the severely obstructed group. By including full urodynamics when investigating patients with BOO, it seems possible to predict the failure rate according to the patients' obstruction grade. This gives an opportunity to treat the patient with minimal invasion, and to give the individual patient a more precise prognosis if WW is preferred.

Invasive urodynamic studies are well tolerated by the patients and associated with a low risk of urinary tract infection

OBJECTIVE

An essential part of investigation of the lower urinary tract is pressure/flow studies (pQS). In fact, pQS is the only way of diagnosing bladder outlet obstruction. There is controversy regarding whether or not prophylactic antibiotic treatment is necessary. This prospective study was carried out in order to determine the frequency of infections and/or distress after pQS performed without the use of antibiotic prophylaxis.

MATERIAL AND METHODS

One hundred and twenty-three patients were included in the present study, all males. They were requested to answer a questionnaire I week after pQS. Questions were asked concerning symptoms of voiding disorders, dysuria, hematuria, incidence of fever and the patient's acceptance of the investigation after the pQS procedure. Urine was obtained for culture immediately before the investigation and 3 and 7 days after the pQS.

RESULTS

Forty-six per cent of the patients experienced some degree of transient dysuria after pQS. and 18.5% experienced voiding problems of varying nature. Five per cent of the patients had hematuria and 2.5% reported fever. Fifty per cent of the patients experienced some degree of discomfort during the pQS investigation, and 4.1% had positive culture and symptoms of UTI requiring antibiotic treatment.

CONCLUSIONS

PQS is well accepted by the patients and the regular use of propylactic antibiotics is not indicated. We recommend, though, that patients at risk for serious complications from infections (e.g. those with prosthetic heart valves) should receive prophylactic antibiotics.

[A home nutritional rehabilitation trial for severly malnourished children]

A nutritional rehabilitation trial for severely malnourished children aged 6 to 36 months (weight/height index using Z-score of less than -3 as the reference mean) was conducted in the poor suburban areas of Dakar, Senegal. Its purpose was to determine the effectiveness of a rehabilitation programme delivered in the home as compared to one provided in a nutritional recovery center (CREN). Ninety-seven children benefited from rehabilitation at home and 51 at the CREN. At the end of two months of rehabilitation and after five months of charting their weight, the average weight gain was better in the group followed at home, but it still remained well under the 50 g/day recommended by WHO. Within the two groups, all of the children stayed underweight, with an average weight/height index Z-score of less than -2.5 in the group followed at home, and a Z-score of less than -2.9 in the other group. The dropouts and the death rates in the two groups were comparable. The presence and availability of the mother as well as health education sessions adapted to each specific case through interpersonal communication seem to be the elements favouring the most effective rehabilitation being in the home.

BPH with coexisting overactive bladder dysfunction--an everyday urological dilemma

The aim of this study was to use a systematic schedule, including urodynamics, to describe the rate of coexisting overactive bladder (OB) in patients with bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). We also identified differences between the patients with pure BOO compared with those with BOO combined with OB (BOO + OB). One hundred and sixty-two men referred to our clinic due to LUTS were included. Patients with a history that might affect their bladder function were excluded. After cystometry and pressure-flow studies, the patients were divided into pure BOO and BOO + OB. Of the 162 men, 55% had pure BOO. BOO + OB was found in 45%. Age, s-PSA, voided volume, and obstruction grade differed significantly between the groups. The patients with BOO + OB were older, had a higher s-PSA, voided smaller volumes, and were more obstructed. We found no differences in TRUS-volume, Q-max, IPS score, or PVR. There was a strong association between OB and BOO, the percentage of OB increasing with increased obstruction. TRUS-volume, Q-max, IPS score, and PVR did not predict whether the patients had a combined BOO + OB or not. These findings indicate that BOO is a progressive disease, which in time causes pronounced obstruction and perhaps in itself contributes to the development of OB.

Lidocaine cystometry in the diagnosis of bladder overactivity

The effect of intravesical lidocaine was studied in a group of patients with symptoms of urinary urgency with or without incontinence. Provocative water cystometry failed to demonstrate signs of unstable detrusor but all patients presented a continuous, steep rise of detrusor pressure at the end phase of filling. Repeat cystometry was performed after the bladder had been treated with 3 g lidocaine intravesically for 20 minutes. In the majority of patients, no change in configuration of the cystometrogram was noted. In a group of patients, a decrease of detrusor pressure occurred and there was also an influence on phasic bladder contractions. In three patients, phasic detrusor contractions developed after lidocaine. Thus, intravesical lidocaine seems to be a useful tool to increase the precision of the urodynamic diagnosis in bladder overactivity.

Clam ileocystoplasty: successful treatment of severe bladder overactivity

OBJECTIVE

When conservative treatment for bladder overactivity fails the "clam" ileocystoplasty has been proposed to restore continence and preserve urethral voiding. This study presents our experience with this technique.

MATERIALS AND METHODS

Thirty patients, 4 men and 26 women, with a mean age of 50.3 years (range 21-71 years) were operated upon. Five patients had an incomplete spinal lesion and detrusor hyperreflexia, 25 subjects had an idiopathic, unstable detrusor. The ileocystoplasty was combined with a colposuspension procedure in 8 patients. In one patient simultaneous repair of an urethro-vaginal fistula was performed using omentum flap interposition. The mean follow-up was 60 months (range 4-127).

RESULTS

To the surgeon, 27 patients (90%) reported satisfaction with bladder control and relief of symptoms at follow-up. When asked by a nurse in a written questionnaire, 18 out of 23 patients (78%) were quite happy with their bladder function postoperatively. No serious complications to surgery were noted. Postoperatively, 11 patients used self-intermittent catheterization and one, by choice, preferred an indwelling catheter. Due to failure, two patients later underwent reoperation with urinary diversion and one further patient required an additional artificial sphincter. Metabolic consequences owing to enteric malabsorption were infrequent and of a mild nature. No malignant change was identified.

CONCLUSION

In patients with refractory overactive bladder, we found the "clam" ileocystoplasty to be an effective technique for symptom reduction and increased quality of life.

Complete transurethral resection of ulcers in classic interstitial cystitis

Interstitial cystitis (IC) is a chronic disease of obscure etiology. It commonly affects females, who present with symptoms of pain on bladder filling and urinary frequency. There are two types of IC: classic and non-ulcer disease, which differ in many respects, including response to different therapies. In this retrospective study we evaluated the hitherto largest series of patients with classic IC treated by transurethral resection (TUR) of visible ulcers. Altogether 259 TURs of Hunner ulcers were performed on 103 patients: 92 experienced amelioration, and in 40% symptom relief lasted more than 3 years. In the remaining patients, although symptom recurrence was common, the majority responded well to subsequent TUR. In conclusion, TUR has a good outcome in patients with classic interstitial cystitis, and we suggest it as first-line treatment in this patient group.

Long-term effectiveness of sacral nerve stimulation for refractory urge incontinence

OBJECTIVES

To evaluate the long-term efficacy of sacral nerve stimulation for refractory urinary urge incontinence.

STUDY DESIGN AND METHODS

Urge incontinent patients qualified for surgical implantation of a neurostimulator system after trial screening with percutaneous test stimulation. Surgical implantation of the InterStim System (Medtronic Inc., Minneapolis, Minn., USA) was performed in cases where a >50% reduction in incontinence symptoms was documented during the 3- to 7-day test stimulation period. The InterStim System consists of an implantable pulse generator, a transforamenally placed quadripolar lead, and an extension that connects these two devices for unilateral stimulation of the S3 or S4 sacral nerve. Efficacy for 96 implanted patients was based on urinary symptom changes as quantified in voiding diaries collected at baseline and annually after surgical implantation.

RESULTS

As compared to baseline, the group of 96 implanted patients demonstrated significant reductions in urge incontinent symptoms at an average of 30.8+/-14.8 (range 12-60) months with respect to the number of urge incontinent episodes per day, severity of leaking, and the number of absorbent pads/diapers replaced per day due to incontinence (all p<0.0001, respectively). Gender, pretreatment variables, and age were not found to be relevant factors that affected these results. 11 of the 96 patients underwent device explant due to lack of efficacy, pain or bowel dysfunction. These data were conservatively included in the efficacy results. No permanent injuries associated with the devices or therapy were reported.

CONCLUSION

Sacral nerve stimulation is an effective treatment for refractory urge incontinence with sustained long-term benefit through an average of 30.8 months.

Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation

PURPOSE

We investigate the efficacy of sacral neurostimulation in patients with idiopathic urinary retention in a prospective, randomized multicenter trial.

MATERIALS AND METHODS

A total of 177 patients with urinary retention refractory to standard therapy were enrolled in the study. Greater than 50% improvement in baseline voiding symptoms during a 3 to 7-day percutaneous test stimulation qualified a patient for surgical implantation of an InterStim parallel system. Of the patients who qualified for implantation 37 were randomly assigned to a treatment and 31 to a control group. Patients in the treatment group underwent early surgical implantation of the sacral nerve stimulation system, while implantation was delayed in the control group for 6 months. Followup evaluations, including voiding diary analysis and temporary deactivation of the stimulator at 6 months, were conducted at 1, 3, 6, 12 and 18 months after implantation in the treatment group, and after 3 and 6 months in the control group.

RESULTS

Compared to the control group, patients implanted with the InterStim system had statistically and clinically significant reductions in the catheter volume per catheterization (p <0.0001). Of the patients treated with implants 69% eliminated catheterization at 6 months and an additional 14% had a 50% or greater reduction in catheter volume per catheterization. Therefore, successful results were achieved in 83% of the implant group with retention compared to 9% of the control group at 6 months. Temporary inactivation of sacral nerve stimulation therapy resulted in a significant increase in residual volumes (p <0.0001) but effectiveness of sacral nerve stimulation was sustained through 18 months after implant.

CONCLUSIONS

Results of this prospective, randomized clinical study demonstrate that sacral nerve stimulation is effective for restoring voiding in patients with retention who are refractory to other forms of treatment.

[Traumatic injuries of newborns after forceps delivery at the Abass Hospital Center Maternity]

The authors report the results of a retrospective study on the effect of traumatic injuries observed among newborns from forceps deliveries in the maternity ward of Abass Ndao hospital between January 1st, 1995 and December 31, 1996. Forceps deliveries represent 5.89 for 1000 of total deliveries and 47 for 1000 of nursery admissions. Traumatic injuries are found in 44.77 % of the newborn by forceps deliveries. They are dominated by the hematoma of scalp in 23 cases and facial nerve injuries in 6 cases. The were about 76.66 percent of primipare among which 30 percent were adolescents. Maternal age, parity, gravity as well as birth weight for forceps deliveries were not significantly different from those without any injuries (p < 0.05). However, traumatic injuries of the newborn were more frequent when the forceps were performed by medical resident. The neonatal mortality is 10.44%. We recommend the teaching of the technique for an improvement of technical competence.