[Treatment of inguinal hernia in a difficult environment: feasibility and efficacy of ilioinguinal and iliohypogastric blocks]. / Cure de hernie inguinale en environnement difficile : faisabilité et efficience du bloc ilio-inguinal et iliohypogastrique.

Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85 h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP.

[Ischemic strokes as a presenting feature of marantic endocarditis despite heparin treatment]. / Accidents cérébraux ischémiques sous héparine révélateurs d'endocardites marastiques.

We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung's adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high.

[Life-threatening bleeding due to craniofacial injury treated by ligature of the external carotid artery]. / Hémorragie massive au cours d'un traumatisme craniofacial traitée par ligature de la carotide externe.

Life-threatening bleeding following craniofacial injury is rare. The rich collateral circulation between external and internal carotid arteries complicates the problem of controlling haemorrhage. We report the case of a 63-year-old man who presented a life-threatening haemorrhage following maxillofacial trauma and a severe head injury with subdural haematoma requiring neurosurgical evacuation. Although we had an interventional radiology unit, facial haemostasis was achieved by an unilateral ligation of the external carotid artery. There were three reasons behind our decision: multiple bleeding excluding selective endovascular embolization, efficiency and speed of the ligation of the external carotid, only one place for this cephalic surgery in two phases (neurosurgery and neck surgery). The role of ligation of the external carotid artery for life-threatening bleeding following facial injury is discussed.