ABSTRACT
To describe the process of establishing a reference center for gestational trophoblastic diseases (GTD) in Senegal and to report its main results so far. We describe the history and establishment of the center, which is based on the experience of the main international centers. The adaptations made to patient follow-up are detailed, while we follow FIGO and WHO diagnostic and management criteria. Finally, we report our main results. Between 2011 and 2017, 878 files were registered at the Center. More than half of the women had no histological confirmation of GTD (60.8 %). The diagnosis was then based on ultrasound images or macroscopic examination of molar vesicles. Spontaneous remission occurred in 64.5 % of the cases, while gestational trophoblastic neoplasia developed in 23.5 %. The FIGO criteria were slightly adapted for hCG monitoring. Methotrexate was the drug of choice in the low-risk group (97.8 %), while the EMACO protocol was financially difficult for nearly half of the high-risk group. The overall remission rate was 83 % and the specific lethality 11.6 %. Our center has demonstrated the efficiency of centralizing the management of GTDs. Difficulty in access to hCG and antimitotic drugs makes management difficult. However, we have introduced alternative solutions that we are working to improve.
Subject(s)
Gestational Trophoblastic Disease , Adolescent , Adult , Female , Gestational Trophoblastic Disease/diagnosis , Gestational Trophoblastic Disease/therapy , Health Facility Administration , Health Resources , Humans , Middle Aged , Pregnancy , Senegal , Young AdultABSTRACT
Foreign body inhalation is a serious emergency which raises both diagnostic and therapeutic problems. Progress achieved in the domain of instrumentation and anaesthesia permit the endoscopic extraction with incontestable comfort and security However, child's anaesthesia often in respiratory distress can prove to be difficult. The aim of this study was to evaluate problems encountered during anaesthesia for endoscopic extraction of foreign bodies in lower respiratory tract and to submit an adequate management strategy. This retrospective study was about 161 cases of lower respiratory tract foreign bodies admitted to the clinic O.R.L. of le Dantec hospital from January 1986 to December 2000. Sixteen patients have had a tracheotomy immediately, before endoscopy. One hundred and fifty six patients have had endoscopy. All endoscopic procedures have been achieved under general anaesthesia with intubation by the bronchoscope. Three patients presented peroperative cardiopulmonary arrest and 8 patients died after endoscopy. The improvement of technical means will permit to reduce morbidity and mortality linked to foreign body inhalation.
Subject(s)
Anesthesia , Bronchi , Bronchoscopy , Foreign Bodies/therapy , Laryngoscopy , Larynx , Trachea , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
Seven roosts of red-billed quelea, Quelea quelea, in the Senegal River Valley and Delta were visited during and after aerial or terrestrial treatments with either Cyanox (cyanophos 500 g a.i. liter-1, five roosts) or Queletox (fenthion 640 g a.i. liter-1, two roosts). The primary goal of the observations was to provide data on environmental effects of cyanophos after mobile ground spraying operations. Twenty-six species of vertebrates (birds, reptile, fish) were found dead or debilitated near the spray sites. Effects on nontarget fauna were most pronounced among owls (cyanophos and fenthion) and blue-naped mousebirds, Urocolius macrourus (fenthion). Among terrestrial invertebrates ants and carabid, and tenebrionid beetles were the most conspicuously affected. Among aquatic invertebrates affected tadpole shrimps, Triops cancriformis, dominated. Extremely high residues were found immediately after spraying on tree leaves in the spillway of a vehicle-mounted Berthoud Super Puma airblast sprayer (up to 1380 mg kg-1) and on birds found dying under these trees (125-11,277 microg bird-1, average 2720 microg bird-1) in two roosts treated with cyanophos. Blue-naped mousebirds were identified as being particularly at risk. Side effects were not dose related. They were most severe after routinely practiced mobile ground spraying applications which led to overdosing. These application methods impose severe environmental hazards, and should be abandoned.