[Practices of caregivers and national recommendations for treatment of malaria in Benin in 2009]. / Recommandations nationales et pratiques en matière de traitement du paludisme au Bénin en 2009.

New treatments against malaria (artemisinin-based combination therapies, ACT) resulted in profound changes in the therapeutic behaviours in Africa. This study aims to evaluate the practices adaptation to the new strategies in Benin in 2009. In three southern areas of the country, 14 private pharmacies, 10 public health centers and 10 private health centers were audited. Between July and October 2009, 36 providers and 93 prescribers were interviewed, 127 dispensations for self-medication were observed, 210 prescriptions were analyzed according to the WHO recommendations, 251 patients with complaints of malaria and 50 healthy women were interviewed and 34 physical inventories were conducted in pharmacies. Knowledge and trainings were inadequate, especially in the private sector and for the providers, as 41.6% of requests for antimalarial drugs were without prescription in private pharmacies. Only 28% of prescribers and 47% of providers knew the national recommendations of 1st line treatment for uncomplicated malaria. 53% of prescribers treated patients by ACT without prior parasitological examination in the case of uncomplicated malaria and no Rapid Diagnostic Test (RDT) was carried out or requested during the dispensation. Pharmaceutical advices were absent in 78.7% of cases and population acknowledged a lack of knowledge about use of the treatment. Private pharmacies were structures where the variability of available antimalarial drugs was the largest, up to 70 different specialities and where unit prices were highest, up to 7.7 times those charged in public health centers. In the field, the difficulties of application of recommendations, given at the scientific or political level, show the necessity of accompanying policy change by prior training activities of all health stakeholders and of adapting the previous regulations to facilitate implementation of the new rules. The number of authorizations issued for the ACT should be limited; authorization to chloroquine and oral formulations of artemisinin monotherapy should be removed. Since the private sector is actually involved in the fight against malaria, one should provide in this sector ACT and rapid diagnostic tests at subsidized prices.

[Paederus dermatitis: A retrospective study of 74 cases occurring in 2008 in Guinea-Conakry]. / Dermatite àPaederus : étude rétrospective de 74 cas survenus en 2008 à Conakry, Guinée.

BACKGROUND: Paederus dermatitis is an unusual form of contact dermatitis caused by pederine, a secretion of insects belonging to the genus Paederus. These insects are found worldwide, although the concentration is higher in tropical and subtropical areas. Diagnosis is based on the presence of typical clinical features (erythematobullous lesions of sudden onset with a stinging, burning sensation on exposed areas of the body) combined with a compatible epidemiological context. In West Africa, more particularly in Guinea-Conakry, paederus dermatitis is common at the end of the rainy season. Our aim is to define the clinical and epidemiological characteristics of this disease. PATIENTS AND METHODS: Herein we report data from a series of cases of paederus dermatitis among French expatriates living in Guinea-Conakry and attending the sociomedical center of the French Embassy at Conakry between October 20 and December 12, 2008. RESULTS: Seventy-four patients with the disease were included in the study (age range: 2-66; sex-ratio: 1:1). Most presented one or two lesions, with 36% of lesions situated on the face and neck region. Three patients presented with oculoconjunctival involvement. Complete remission occurred spontaneously within 8 to 10 days in 90% of patients. Systemic antibiotic therapy was initiated in less than 3% of patients. CONCLUSION: Preventive measures to repel the insects remain vital, in conjunction with curative methods (e.g. immediate cleansing of skin coming into contact with the irritant substance).

[Weather and cholera: epidemic in Douala, Cameroon in 2004]. / Météorologie et cholera: epidémie de Douala en 2004 (Cameroun).

A cholera epidemic was recorded in Douala, Cameroon in 1971. Another 8-month outbreak occurred in January 2004 and spread in rapid succession to all health districts in Douala. The purpose of this study was to assess the association between meteorology and cholera incidence and preventive action in the health districts.

[Human African trypanosomiasis in mangrove epidemiologic area. Presentation, diagnosis and treatment in Guinea, 2005-2007]. / La trypanosomose humaine africaine en faciès épidémiologique de mangrove. Présentation, déterminants et prise en charge dans le contexte de la Guinée (2005 à 2007).

UNLABELLED: Gambiense human African trypanosomiasis is still assumed to be endemic in many part of West Africa, particularly in Guinea coastal area with mangrove swamp. Diagnosis is usually made during active medical screening or by passive initiative. OBJECTIVES: To describe clinical and epidemiological characteristics of Gambiense human African trypanosomiasis in the coastal area of Guinea. METHODS: Exhaustive and retrospective analysis of all patients attending the trypanosomiasis center in the coastal area of Guinea between January 2005 and December 2007 with a diagnosis of human African trypanosomiasis. RESULTS: A total of 196 patients were recruited for the study. Out of them, 55 % of the 73 patients diagnosed during active screening were classified stage 1 (haemolymphatic stage) or early stage 2 (meningoencephalitic stage). Contrarily, 115 of the 120 diagnosed by passive procedure were classified late stage 2, which features more specific signs and neurological symptoms, and leads to coma and death. More than 90 % of all cases presented cervical lymph nodes with identification of trypanosome on direct examination of fluid puncture. Less than one third of the patients were reexamined three months later. DISCUSSION: In the coastal area of Guinea with mangrove swamp, direct examination of lymph node fluid puncture seems to be the most contributive test for the diagnosis of human African trypanosomiasis. Hence, associating clinical examination of cervical lymph nodes area and direct examination of fluid puncture may allow an early diagnosis of Gambiense human African trypanosomiasis and favor the implementation of efficient therapeutic strategies.

[Medical waste incinerator constructed with locally produced materials: experience during the immunization campaign 2002 against measles in Douala, Cameroon]. / Incinérateur de déchets médicaux à base de matériaux locaux: expérience de la campagne 2002 de vaccination anti-rougeole à Douala, Cameroun.

UNLABELLED: Incineration is still the method of choice for disposal of biomedical waste. Combustion at 800+ degrees C eliminates all risk of injury by reducing the waste to ashes and destroying all microorganisms. The purpose of his report is to present a modular double-chambered incinerator in conformity with recommendations for developing countries. The incinerator described here provides the following advantages: suitability for low-cost artisanal construction, excess-air combustion, low risk of accidents and contamination, after-burner for smoke, energy efficiency, easy operation/maintenance, and safety. It is made from locally produced clay bricks reinforced with a steel frame and features two chambers for combustion and post-combustion. It functions on a batch basis with a 2-hour cycle. The immunization campaign against measles that was carried out in 5 districts of Douala in December 2002 produced 800,000 self-disabling syringes with needles. These by-products were immediately discarded in cardboard safety boxes (5-liter capacity, 1 kg) that were taken to the incinerator and burned at the rate of two batches per day. RESULTS: The construction cost of the incinerator was 3,500,000 FCFA (5,300 euros). A total of 5,816 boxes were incinerated, i.e., 29,080 litres, 872,400 syringes, 6,281 kg. Incineration required 126 batches over a period of 11 weeks. The ashes (240 litres, i.e. 0.8% of the total incinerated volume) were virtually free from solid residue. Fuel consumption was negligible. Smoke was never excessive, thick or odorous. Temperatures measured during preliminary trials were always above 800 degrees C. According to the WHO, toxic emissions are negligible if incineration is carried out at temperatures higher than 700 degrees C for less than 2 hours a day. Further study will be necessary to confirm this preliminary experience with regard to temperature control and smoke/ash composition and to test the incinerator in various climatic and operating conditions.

[Impact of parental attitudes on infant vaccinal coverage in Benin]. / Influence de certaines caractéristiques parentales sur la couverture vaccinale des nourrissons au Bénin.

Few studies have addressed the impact of parental attitudes on vaccinal coverage in early childhood. The purpose of this descriptive-analytical transverse study was to assess this problem in a cohort of parents with a 12- to 23-month-old child randomly identified by cluster analysis in five communities in the Oueme department. Data were collected using a questionnaire and tabulation sheet. Statistical analysis was performed by logistic regression using the stepwise digression method. Most of the 438 parents in the study cohort (74.2%) were between 21 and 35 years of age. More than half had not attended school and less than 20% were unemployed. The proportion refusing vaccination for their children was 35% among parents who had to walk more than 30 minutes back and forth to the health care facility and 38% among parents who had poor knowledge about vaccination. The refusal rate was 1.4 times higher for parents with no education than for parents who had attended school (P=0.005). Poor parental knowledge about vaccination was significantly correlated with refusal of vaccination (p<0.001). This study suggests that communication strategies aimed at enhancing parental knowledge and understanding about vaccination should be promoted at health care facilities as well as through other channels, e.g., news media and public events such as social and religious gatherings.

[Two cases of fulminant hepatitis during a curative treatment with an artesunate-amodiaquine combination]. / Deux hépatites fulminantes survenues au cours d'un traitement curatif par l'association artésunate-amodiaquine.

Two previously healthy young women presented with a lethal hepatitis a few days after the onset of an artesunate-amodiaquine combination at the recommended doses for a bout of fever. Nothing proved the fever was due to malaria, the toxic cause of hepatitis, or to the drugs used. Imputability was based on chronology (fever, drug combination, sudden onset of severe fatigue, hepatitis lethal in a few days) and on the absence of any other evident cause for hepatitis. Severe hepatitis under prolonged amodiaquine treatment has been reported since 1985, the risk is estimated at 1/15500 treatments and the symptoms usually appear within 10 to 160 days. The current international recommendations are to promptly treat uncomplicated malaria access, with an artemisinin-based combination therapy, especially with artesunate-amodiaquine. The risk of iterative amodiaquine use could be the same as prolonged treatments, given that the suspected toxicity mechanisms are metabolite accumulation or an immunoallergic phenomenon. All adverse effects must be reported.

Diffuseur artisanal de chlore pour desinfecter les puits lors de l'epidemie de cholera de Douala (2004)

La chloration des puits est recommandee en cas d'epidemie de cholera. Mais les techniques de chloration sont mal codifiees; leur efficacite n'a pas ete prouvee; et l'on ne sait pas a quel rythme doit se faire la chloration. L'objectif etait de tester un dispositif artisanal de chloration continue; mesurer les taux de chlore residuel libre obtenus; et en suivre l'evolution; pour prevoir le delai de renouvellement. Dans 2 quartiers de Douala; 18 puits (9/quartier) ont fait l'objet de la mesure quotidienne pendant deux semaines du volume d'eau; du pH et du chlore residuel; apres installation d'un diffuseur artisanal a base de sable et d'hypochlorite de calcium dans un sachet plastique perfore; renouvele apres annulation des taux de chlore. La concentration maximumde chlore residuel libre a ete atteinte apres 1 jour (31 chlorations sur 36) ou 2 jours (5 sur 36). Elle est demeuree superieure au niveau minimum de 0;2mg/l pendant au moins 48 heures dans 33 des 36 chlorations. A J4; la moitie des puits avaient une concentration de chlore inferieure a 0;2 mg/l. La concentration de chlore etait plus elevee dans les puits familiaux que dans les puits communautaires .Malgre des difficultes de faisabilite et d'acceptabilite; le diffuseur propose a permis d'assurer la diffusion de chlore a des taux efficaces et non toxiques pendant 3 jours. Des systemes de diffusion plus prolongee et moins couteux devraient pouvoir etre proposes; dans le cadre d'actions integrees de lutte contre une epidemie de chlolera

Incinerateur de dechets medicaux a base de materiaux locaux : experience de la campagne 2002 de vaccination anti-rougeole a Douala; Cameroun

Methode de choix pour detruire les dechets biomedicaux; l'incineration consiste a les reduire en cendres par une combustion a 800oC; detruisant les micro-organismes;supprimant les risques de blessure. L'incinerateur presente; de type modulaire double chambre preconise en pays en developpement; repond aux principes de : fabrication artisanale peu couteuse; combustion en exces d'air; reduction des risques d'accident ou de contamination; postcombustion des fumees; economie d'energie; manipulation et entretien faciles; securite d'utilisation. L'incinerateur; en briques d'argile de fabrication locale; solidarise par des cornieres d'acier; comporte deux chambres pour la combustion et la post-combustion. Un reservoir de carburant et un ventilateur permettent d'activer la combustion. Lemodele fonctionne par fournees en cycles de 2 heures. La campagne de vaccination anti-rougeole (decembre 2002) devait produire pour 5 districts deDouala 800000 seringues autobloquantes avec aiguilles. Immediatement jetes dans des boites de securite de carton (contenance 5 litres; 1 Kg); ces dechets etaient achemines jusqu'a l'incinerateur puis incineres en 2 fournees quotidiennes. Resultats. La construction de l'incinerateur a coute 3500000FCFA (5300 _). 5816 boites ont ete incinerees; soit 29080 litres; 872 400 seringues; 6 281 Kg de dechets. Leur incineration a necessite 126 fournees realisees en 11 semaines. Les cendres (240 litres; soit 0;8du volume incinere) ne contenaient pratiquement aucun residu solide. La consommation de gazole a ete negligeable. Les fumees n'ont jamais ete abondantes; opaques; ou malodorantes. Les temperatures mesurees lors d'essais prealables depassaient toujours 800oC. Selon l'OMS; les emissions toxiques sont negligeables au-dela de 700oC si l'incinerateur fonctionnemoins de 2 heures quotidiennes. L'experience devra etre completee par des travaux sur le controle des temperatures; la determination de la composition des cendres et fumees; des essais en differentes conditions climatiques et d'utilisation

Influence de certaines caracteristiques parentales sur la couverture vaccinale des nourrissons au Benin

Les obstacles a la couverture vaccinale de la premiere enfance lies aux comportements des parents ont ete peu etudies. Nous les avons recherches au Benin grace a une etude transversale descriptive analytique des personnes ayant a charge un enfant de 12 a 23 mois revolus et choisies aleatoirement par la technique de grappes dans cinq communes du departement de l'Oueme. Les informations ont ete recueillies a l'aide d'un questionnaire et d'une fiche de depouillement. Une regression logistique a ete realisee selon la methode degressive pas a pas. Parmi 438 parents; 74;2etaient ages de 21 a 35 ans; plus de la moitie n'avait pas ete scolarisee et moins de 20etaient sans emploi. Les proportions de parents n'adherant pas a la vaccination etaient de 35quand la distance a pied par rapport a la formation sanitaire etait de plus de 30 minutes de marche (aller-retour); et de 38lorsque le niveau de connaissance etait faible. La proportion de parents non adherents a la vaccination etait 1;4 fois plus elevee chez ceux n'ayant pas ete scolarises que chez ceux ayant ete scolarises (p=0;05). Le faible niveau de connaissance des parents sur la vaccination etait significativement associe a la non adhesion des parents a la vaccination (p0;001). Cette etude suggere qu'il faudrait privilegier les strategies visant a elever le niveau d'information et de connaissances des parents et des communautes sur le theme de la vaccination; au sein du service de sante; et dans tous les autres secteurs de la communication : medias et organisations sociales et religieuses

[Handmade devices for continuous delivery of hypochlorite for well disinfection during the cholera outbreak in Douala, Cameroon (2004)]. / Diffuseur artisanal de chlore pour désinfecter les puits lors de l'épidémie de choléra de Douala (2004).

Well disinfection is generally recommended as an emergency response measure during cholera outbreaks. However few studies have been carried out to document chlorination techniques, prove the efficacy of chlorination, or determine how often disinfection should be performed. The purpose of this study was to test a handmade device for continuous chlorination, to measure the initial concentration of free residual chlorine, and monitor chlorine concentration to determine when renewal is necessary. Eighteen wells in 2 neighbors of Douala, Cameroon, i.e., 9 wells/neighborhood, were tested. Testing included daily measurement of water volume, pH, and residual chlorine for a period of two weeks after installing the handmade device composed of river sand and hypochlorite in a pre-perforated plastic bag that was renewed after disappearance of free residual chlorine. The maximum concentration of residual chlorine was reached after 1 day in 31 out of 36 chlorinations or 2 days in 5 out of 36. On day 4 the chlorine level was less than 0.2 mg/l in half of the wells. The chlorine concentration was higher in family than community wells. Notwithstanding feasibility and acceptability issues, the device allowed chlorination at effective nontoxic levels for 3 days. These findings open the possibility of developing devices allowing longer diffusion at lower cost for use within the framework of integrated cholera epidemic control programs.

[Pitched battle in Gueme between the Massa of Cameroon and Massa of Chad]. / Bataille rangée à Guémé (Cameroun) entre Massa du Tchad et du Cameroun.

To avenge an act of adultery a pitched battle broke out between the Massa from Cameroon and the Massa from Chad, ending with 82 wounded people on the Cameroonian side, mainly skull, face and upper limbs injuries. Considering the importance of cattle in the social relations in the Massa society particularly in matrimonial exchanges, the battles are often triggered by robbery of cows or bay an act of adultery. Massa are familiar with this type of battle where two long lines of men armed with stones and sticks, confront each other encouraged by the lines of the women. Their accessories (club, battle helmet), their compliance with the rules of the battle (to collect the injured, not to strike a man on the ground or who is injured, end of the fighting at dusk), explain the great number of wounded people, the epidemiology, and the type of injuries. Injured people are usually in care of traditional healers performing distinct techniques using local resources. The role of the women in this type of fighting illustrates their place in the Massa society.

[Consumption of medications during the cholera epidemic in Douala, Cameroon (2004)]. / Consommation de médicaments lors de l'épidémie de choléra de Douala (2004).

To prepare for cholera outbreaks, stockpiles of supplies, rehydration salts/ solutions and appropriate antibiotics must be placed in strategic locations to ensure a prompt and effective response. However specific needs have not been evaluated up to now. The purpose of this report is to give an accurate account of medical supplies that were consumed during the cholera epidemic in Douala in 2004. Consumption of medication for the entire epidemic was measured by crosschecking data from the provincial pharmaceutical supply centre with the order forms, stock sheets and records of hospitals. Cost was calculated based on pricing data from the National Supply Center. For the 5 020 confirmed cases of cholera that were treated in the 14 hospitals in Douala from January to September 2004, consumption consisted of 499,746 doxycycline tablets, 235,881 amoxicilline tablets, 122,781 rehydration salt packets, and 60,217 units of Ringer Lactate (500 ml). The total cost of medications and consumables was 52,229,311 CFAF (approximately 80,000 Euro). Although updated recommendations are not available, comparison with the existing ones shows that the consumption levels observed were 5 times higher for both rehydration and antibiotherapy. The mean cost of treatment in Douala was 13 Euro per reported patient. This cost rose to 15 Euro if antibiotic prophylaxis was prescribed for all contacts. These findings can be useful in planning for future epidemics by allowing recommendations to be updated. We propose the follow supply levels for 50,000 inhabitants with an attack rate of 0.2%: 10,000 doxycycline tablets, 5000 amoxicilline tablets (500 mg), 2500 SRO packs (for 2500 liters) and 600 liters of Ringer Lactate.

[Factors contributing to endemic cholera in Douala, Cameroon]. / Déterminants du choléra a Douala.

Cholera has been endemic in Douala, Cameroon since 1971. A number of environmental factors favourize the survival of the Vibrio in Douala including location at the mouth of Wouri delta on the Atlantic Ocean, sandy clay soil, shallow dirty polluted foul-smelling groundwater, presence of vast expanses of swamp, streams/drainage ditches infested with algae, and high temperatures with low rainfall and drought during certain periods of the year. Most outbreaks have started in Bepanda, a slum area built on a garbage dump in a swampy zone fed by drainage ditches carrying the faecal pollution from neighbouring upstream districts. It is a densely overcrowded area of uncontrolled urbanization generated by the influx of poor city new-comers who live without adequate access to clean water or basic sanitary facilities. The most affected areas are those resulting from recent unregulated urban sprawl in polluted swamp zones or garbage dumps. Since access to the public water system is inadequate with only 65000 persons connected for 3 million inhabitants, dwellers in most areas must take water from the 70000 urban wells (estimated in 2004) that are often not more than 1.5 m deep. Sewage facilities are insufficient to provide complete evacuation of solid and liquid waste. The network of rivers, streams and man-made ditches waste are poorly maintained and often overflow during the rainy season. The contents of latrines are often discharged directly into the environment. Social factors such as the reformation of urban tribes and persistence of traditional attitudes toward waste disposal and water use have not only led to high-risk behaviour but also created barriers to sanitation and hygiene education. With an inadequate sanitation inspection system, a large but purely accessible public health system and a highly disorganized private health sector exists, effective preventive measures are difficult to implement. The combination of these factors probably account for the endemicity of cholera in Douala.

[Antibiotic susceptibility of Vibrio cholerae 01: evolution after prolonged curative and preventive use during the 2004 cholera epidemics in Douala (Cameroon)]. / Evolution de la sensibilité de Vibrio cholerae 01 après utilisation prolongée d'antibiotiques en traitement et en prophylaxie au cours de l'épidémie de choléra de Douala (Cameroun) 2004.

UNLABELLED: Antibiotics were extensively used, both for curative as for prophylactic purposes, to prevent an explosive spread of the 2004 cholera epidemic in Douala. It was thus necessary to control the antibiotic susceptibility of Vibrio cholerae. OBJECTIVE: The authors had for aim to describe the epidemic, the use of antibiotics, and to follow the susceptibility of V. cholerae. DESIGN: The 14 hospitals in the study all used the same diagnostic, treatment, and preventive protocols, as well as in community practice with home visits. All cases were clinically confirmed and reported. Samples were systematically taken at the beginning and at the end of the epidemic, and randomly during the epidemic. Each identified strain was tested by the disk method for antibiotic susceptibility. RESULTS: Between January and September 2004, 5013 patients and 177,353 people in contact with the patients were given a single dose of doxycycline or amoxicillin for 3 days. Sixty-nine deaths were recorded (lethality 1.37%). One hundred (and) eleven strains of V. cholerae were identified in 187 samples. All of them were resistant to sulfamides and colistin, but susceptible to cyclins, betalactams, and fluoroquinolones, without any modification during the 8 months of follow-up. CONCLUSION: Despite the risk of a massive and prolonged use of antibiotics, strictly prescribed and controlled, no resistance developed in the identified strain. Chemoprophylaxis must follow rigorous protocols and be continuously monitored.

Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon.

OBJECTIVES: To evaluate routine use of antimicrobial drugs for treatment and prevention of cholera with special regards to the evolution of the antimicrobial drug resistance patterns of V. cholerae strains. DESIGN: Retrospective population-based descriptive study. SUBJECTS: Four thousand nine hundred and forty one notified cholera cases, their 15,381 patients' guards and their 159,263 household members and close neighbours. RESULTS: A total of 4,941 patients received antibiotic therapy according to the treatment protocols. Prophylactic treatment was administered to 15,381 patients' guards in hospitals and to 159,263 household members and close neighbours during home visits. Over the entire outbreak, the antimicrobial susceptibility patterns of V. cholerae strains isolated remained stable. CONCLUSIONS: The routine use of antimicrobial therapy for cholera cases associated with simultaneous and large scale chemoprophylaxis of close contacts does not seem in our experience to compromise the stability of V. cholerae susceptibility profiles to drugs when applied within a comprehensive package of rigorously monitored community interventions. The role of therapy and chemoprophylaxis in limiting the extent of a cholera epidemic is however difficult to ascertain from our experience. Field trials need to be designed to elucidate this aspect.

[Amniotic infection and neonatal bacterial infection. Search for clinical and bacterial predictive arguments]. / De l'infection amniotique à l'infection bactérienne néonatale. Recherche d'arguments cliniques et bactériologiques prédictifs.

Amniotic fluid infection and its principal sequel bacterial infection of the newborn are major problems in obstetric pathology. The authors hav analysed prospectively 346 obstetrical casenotes over a period of 18 months in order to try to describe and specify the clinical features and to try and work out using bacteriological tests the risk of infecting the neonate by materno-fetal transmission. They compared a control group (27 case histories) and the group at risk (235 cases). 4% of the control group and 18.7% of the "at risk" group were biologically infected (p less than 10(-2)). The following are among the classical clinical criteria to correlate this risk: maternal pyrexia, premature delivery, urinary tract infections and fetal distress; an apparent lessening in active fetal movements is also well correlated to the risk of infection. The bacteriological criteria are: the presence of quantities of altered polymorphonuclear cells in the amniotic fluid--this seems to be more important than others (sensitivity = 70%, specificity = 89%, but positive predictive value = 60% and negative predictive value = 93%). From this study it should be possible to work out antenatally whether the newborn baby will be at high risk of developing an infection in order to consider giving antibiotics to prevent materno-fetal transmission.

[Malignant hyperthermia: halothane kinetics in a study model of muscular contraction. Head space determination and comparison with a mathematical model]. / Hyperthermie maligne: cinétique de l'halothane dans un modèle d'étude de la contraction musculaire. Dosage par Head Space et comparaison avec une modélisation par le calcul.

Testing in vitro are used to locate malignant hyperthemia susceptible subjects. They use muscular contraction in response to anesthetic administration, particularly Halothane. They allow to classify subjects in three classes: susceptible, non susceptible and intermediate. Halothane was dosed by chromatography in the three compartments of a bath for isolated organs with a muscular fiber during steady concentrations were given and after wash out. Partition coefficient were determinated and compared to a calculated model. They are variable with physical conditions of the circuit. This results confirmed published data and give some possibilities to improve such tests to ascertain the subjects susceptibility to Halothane.

[HELLP syndrome. Apropos of a series of 9 cases without disseminated intravascular coagulation]. / Le Hellp syndrome. A propos d'une série de 9 observations sans coagulation intravasculaire disséminée.

The Hellp syndrome defined as the association of micro-angiopathic haemolytic anemia, hepatic cytolysis and thrombocytopenia, correspond to a severe form of gravidic toxemia, combined to manifestations of classic-pre-eclampsia. This retrospective study, conducted over 6 years, concerns 9 cases of Hellp syndrome, including 2 occurring during the immediate post-partum. Only cases where this biological triad was obvious and not associated with manifestations of disseminated intravascular coagulation, were considered in this study. In addition to the usual criteria of gravidic toxemia, the early clinical manifestation occur, in this study, between 28 and 38 weeks of amenorrhea and gastrointestinal manifestations are predominant. The physiopathogenic hypotheses of this syndrome remain variable and management varies depending on the authors. Treatment is that of pre-eclampsia. Medical treatments (steroids, heparin, immunosuppressants,...) are discussed, but severe feto-maternal complications require, most of the time, a surgical approach, depending on the number of pregnancies, the obstetrical conditions, the stage of the pregnancy and the severity of the syndrome.