[Ureteral war injuries. Apropos of 3 African cases]. / Les plaies urétérales de guerre. A propos de trois observations africaines.

The war ureteral gunshot wounds (W.U.G.W.) are, in practice, scarce but not an exception. They are to be suspected in every war abdominal injury. Urethral catheterization, microscopic hematuria research, simple X-Ray and I.V.P. have to be undertaken; but it's never easy in wartime circumstances. Investigation must be carried out during intervention: ureteral exploration in case of retroperitoneal hematoma or wound. Three observations illustrate these main difficulties. Unfortunately diagnosis is often done in post-operative time when a complication arises. The treatment is now well known: adequate debridement, anastomosis or reimplantation and drainage.

[African vesico-vaginal fistulas (author's transl)]. / Les fistules vésico-vaginales africaines.

Obstetrical vesico-vaginal fistulas in Africa are very frequent and are correlated with the insufficiency or even the lack of health structures and sanitary conditions. They follow up a dystocic parturition, and their prevention requires a correct surveillance of pregnancy and parturition. Their pathogenesis consists in a durable compression of the pelvic cavity by the foetal head, inducing ischemia and later on necrosis. Their difficult treatment is based on clinical inspection which makes possible to distinguish several pathological types of fistulas. Surgical tactic will be selected according to the size of the fistula, the conservation or the destruction of the uretra with the vesico-uretral sphincters, the importance of perifistula sclerosis. BRACQUEHAYE'S operation is the basis of the conservatory treatment, associated or not with a technic restoring the urinary continence: either the INGELMAN-SUNDBERG operation of the LE GUYADER rectomyoplasty. When uretra is destroyed, the best palliative intervention is probably the building up of a rectal neobladder. These operations can be performed under conditions often prevailling in Africa. In most cases, they have restored normal social life for the women affected. But setbacks are not rare, and demonstrate the importance of prophylaxis.

[Surgical indications in urogenital schistosomiasis in West Africa (author's transl)]. / Les indications chirurgicales dans la bilharziose urogénitale en Afrique de l'ouest.

Surgical indications in urogenital schistosomiasis are discussed after 12 years of experience in Senegal hospitals. Stenosis or achalasia of lower ureter might cause ureterohydronephrosis which appears to be the main sequella. The local hospitals conditions and the difficulties met with in the long-range surveillance of the patients both require a prudent approach. The replacement plastics with intestine is the logic and ideal solution, but other and simpler techniques are available and may be selected according to the localization and to the value of renal functions.

[Shock in abruptio placentae (author's transl)]. / L'état de choc au cours de l'hématome rétro-placentaire.

In sixty abruptions of the placenta observed during eighteen months, a severe condition of shock was observed in thirty per cent of patients. This shock state is seen during the abruption or after delivery. It's essentially a question of hemorrhagic shock, the importance of hemorrhagy being often underestimated, if the drop of blood pressure and blood losses are only estimated. The measurement of central venous pressure and the research of metabolic acidosis are better indexes of shock. This shock is associated with hypofibrinogenaemia and with other symptoms of disseminated intra-vascular coagulation. Fibrinolysis is rarely observed (3 times). Presence of fibrin degradation products is frequent. Renal complications are observed only in 1/6 of cases, but are frequently severe (one case of renal cortical necrosis). Heparinotherapy does not confirm the hope be suscited and seems to be a frequent source of ehmorrhagic complications in African women. Perfusion of fibrinogen, if useful, can be another source of complications. Rapid transfusion is the more effective treatment of abruption placenta and probably the less dangerous with strict control of the central venous pressure.

[Shock during necrotic amoebic colitis (author's transl)]. / L'état de choc au cours de l'amibiase colique nécrosante.

Two varieties of conditions of shock may be isolated during necrotic amoebic colitis (13 cases). Eight patients present a simple hypovolemic shock secondary to wastage by diarrhea and perilesional oedema with globular, protein, alcaline and potassic deficiency. Its prognosis is relatively good, after vascular infilling and corrections of metabolic disorders. Five other patients present real toxi-infectious shock resulting from widespread tissue necrosis with auto-intoxication associated with septicemic complications. Its prognosis is frankly bad. The treatment is far more difficult. The use of cardiovascular analeptics, such as dopamine, after an infilling failure, is not always sufficient to re-establish the situation. The exeresis of necrotic tissues is an indispensable condition to remove the cause of the shock before septicaemic generalisation.