Residual malaria transmission and the role of Anopheles arabiensis and Anopheles melas in central Senegal.

Understanding the behavior and ecology of local malaria vectors is essential for the effectiveness of the commonly used vector-targeted malaria control tools in areas of low malaria transmission. This study was conducted to determine species composition, biting behavior and infectivity of the major Anopheles vectors of Plasmodium falciparum in low transmission settings in central Senegal. Adult mosquitoes were collected using human landing catches during 2 consecutive nights and Pyrethrum Spray Catches in 30-40 randomly selected rooms, from July 2017 to December 2018 in 3 villages. Anopheline mosquitoes were morphologically identified using conventional keys; their reproductive status assessed by ovary dissections, and a sub-sample of Anopheles gambiae s.l. were identified to species level using polymerase chain reaction (PCR). Plasmodium sporozoite infections were detected using real-time quantitative PCR. During this study 3684 Anopheles were collected of which 97% were An. gambiae s.l., 0.6% were Anopheles funestus, and 2.4% were Anopheles pharoensis. Molecular identification of 1,877 An. gambiae s.l. revealed a predominance of Anopheles arabiensis (68.7%), followed by Anopheles melas (28.8%), and Anopheles coluzzii (2.1%). The overall human-biting rate of An. gambiae s.l. was highest in the inland site of Keur Martin with 4.92 bites per person per night, while it was similar in the deltaic site, Diofior (0.51) and the coastal site, Mbine Coly (0.67). Parity rates were similar in An. arabiensis (45%) and An. melas (42%). Sporozoite infections were detected in both An. arabiensis and An. melas with the respective infection rates of 1.39% (N = 8) and 0.41% (N = 1). Results suggest that low residual malaria in central Senegal is transmitted by An. arabiensis and An. melas. Consequently, both vectors will need to be targeted as part of malaria elimination efforts in this area of Senegal.

Anopheles gambiae s.l. swarms trapping as a complementary tool against residual malaria transmission in eastern Gambia.

Malaria remains a major health problem and vector control is an essential approach to decrease its burden, although it is threatened by insecticide resistance. New approaches for vector control are needed. The females of Anopheles gambiae s.l. mate once in their life and in the swarms formed by males. Trapping swarms of Anopheles gambiae s.l. males is a potential new intervention for vector control, alternative to the use of insecticides, as it would disrupt mating . The proof-of-concept pilot study aiming at investigating swarm trapping as a potential vector control intervention, was carried out in 6 villages as in eastern Gambia. Swarms of Anopheles gambiae s.l. were identified and their size, height, and duration determined during the baseline year. Swarm trapping by local volunteers was implemented the following transmission season in 4 villages while the other 2 villages were taken as controls. Entomological outcomes were monitored by Human Landing Catches and Pyrethrum Spray Catches. A cross-sectional survey to determine malaria prevalence was carried out at the peak of the malaria transmission season for two consecutive years. At baseline, 23 swarming sites of Anopheles gambiae s.l. were identified. Before the intervention, mean indoor resting density per house and malaria prevalence were similar between control and intervention villages. Following the intervention, Anopheles gambiae s.l. indoor resting density was 44% lower in intervention than in control villages (adj IRR: 0.0.56; 95% CI 0.47-0.68); the odds of malaria infections were 68% lower in intervention than in control villages (OR: 0.32; 95% CI 0.11-0.97). Swarm trapping seems to be a promising, community-based vector control intervention that could reduce malaria prevalence by reducing vector density. Such results should be further investigated and confirmed by larger cluster-randomized trials.

[Therapeutic approach to massive thymic hyperplasia associated with respiratory distress syndrome in a newborn infant living in a developing country: a case report]. / Stratégie thérapeutique devant une hyperplasie thymique massive associée à un syndrome de détresse respiratoire chez un nouveau-né dans un pays en voie de développement: à propos d'un cas.

Thymic hyperplasia is an anterior mediastinal mass with a variable clinical presentation. It causes differential diagnostic problems in the pediatric age group and there is no consensus on the therapeutic approach. We here report the case of a 1-month-old infant treated for respiratory distress syndrome. Chest CT scan revealed anterior mediastinal mass, which was excised through median sternotomy. Anatomopathological examination showed thymic hyperplasia. Clinical outcome was satisfactory. This encouraging result suggests that, contrary to what some authors propose, it would be more appropriate to opt for an aggressive therapeutic strategy when managing symptomatic thymic hyperplasia. This is even more justified in a socio-economic context characterised by difficult access to care and follow-up measures limited by patients' means.

Mapping the breeding sites of Anopheles gambiae s. l. in areas of residual malaria transmission in central western Senegal.

Despite the deployment of several effective control interventions in central-western Senegal, residual malaria transmission is still occurring in some hotspots. To better tailor targeted control actions, it is critical to unravel the underlying environmental and geographical factors that cause the persistence infection in hotspot villages. "Hotspots villages" were defined in our study as those reporting more than six indigenous malaria cases during the previous year. A total of ten villages, including seven hotspots and three non-hotspots, were surveyed. All potential mosquito breeding sites identified in and around the ten study villages were regularly monitored between 2013 and 2017. Monitoring comprised the detection of anopheline larvae and the collection of epidemiological, hydrogeological, topographical, and biogeographical data. The number of larval breeding sites described and monitored during the study period ranged from 50 to 62. Breeding sites were more numerous in hotspot sites in each year of monitoring, with 90.3% (56/62) in 2013, 90.9% (50/55) in 2014, 90.3% (56/62) in 2015 and 86% (43/50) in 2017 (Fisher exact test; p = 1). In the non-hotspot areas, the data for the same years were, respectively, 9.7% (6/62), 9.1% (5/55), 9.7% (6/62) and 14% (7/50) (p = 1). The Hotspot villages were characterized mostly by saline or moderately saline hydro-morphic and halomorphic soils allowing water retention and a potential larval breeding sites. By contrast, non-hotspot villages were characterized mainly by a high proportion of extremely permeable sandy-textured soils, which due to their porosity had low water retention. The annual number of confirmed malaria cases was correlated with the frequency and extent of breeding sites. Malaria cases were significantly more frequent in the hamlets located near breeding sites of An. gambiae s.l., gradually decreasing with increasing remoteness. This study shows that the characteristics of larval breeding sites, as measured by their longevity, stability, proximity to human habitation, and their positivity in Anopheles larvae are likely determining factors in the persistence of malaria hotspots in central-western Senegal. The results of this study shed more light on the environmental factors underlying the residual transmission and should make it possible to better target vector control interventions for malaria elimination in west-central Senegal.

Evaluation of the effectiveness of a targeted community-based IRS approach for malaria elimination in an area of low malaria transmission of the central-western Senegal.

The implementation of effective malaria control strategies in the central-western Senegal, such as Indoor Residual Spraying (IRS), long-lasting insecticide-treated nets (LLIN), Seasonal malaria chemoprophylaxis (SMC) and appropriate management of malaria cases, has led to the decline of malaria transmission in the region. However, residual malaria transmission still occurring in some localities, known as hotspots villages, making challenging the achievement of the malaria elimination goal. A pilot study was undertaken between 2013 and 2014 to test the feasibility of a community-based IRS approach for malaria elimination in four targeted health districts of the Central Western Senegal. The residual efficacy of the Actellic® 300CS formulation on the sprayed surface was monitored using WHO cone test. Overall, 615 walls were tested over the two successive years, respectively 240 and 375 in 2013 and 2014 IRS campaigns. The residual efficacy of the IRS with Actellic®300 CS was longer in the second year due to the improvement of community agents spraying skill the second year thanks to the refreshing training and a better supervision by professional agent of the National Hygiene Service. The analysis of the Incidence Rate Ratio under the Poisson model shows no significant difference of IRS effectiveness according to the building type. In conclusion, the quality of training of community agents and good supervision of IRS activities play a key role in the quality and the residual efficacy of IRS campaigns. A good planning and implementation of IRS campaign ensure a high quality and a good effectiveness of spraying with the Actellic®300 CS formulation.

Traditional cooking practices and preferences for stove features among women in rural Senegal: Informing improved cookstove design and interventions.

Nearly half the world's population burns solid fuel for cooking, heating, and lighting. The incomplete combustion of these fuels is associated with detrimental health and environmental effects. The design and distribution of improved cookstoves that increase combustion efficiency and reduce indoor air pollution are a global priority. However, promoting exclusive and sustainable use of the improved stoves has proved challenging. In 2012, we conducted a survey in a community in rural Senegal to describe stove ownership and preferences for different stove technologies. This report aims to describe local stove and fuel use, to identify household preferences related to stove features and function, and to elicit the community perceptions of cleaner-burning stove alternatives with a focus on liquid propane gas. Similar to many resource-limited settings, biomass fuel use was ubiquitous and multiple stoves were used, even when cleaner burning alternatives were available; less than 1% of households that owned a liquid propane stove used it as the primary cooking device. Despite nearly universal use of the traditional open fire (92% of households), women did not prefer this stove when presented with other options. Propane gas, solar, and improved cookstoves were all viewed as more desirable when compared to the traditional open fire, however first-hand experience and knowledge of these stoves was limited. The stove features of greatest value were, in order: large cooking capacity, minimal smoke production, and rapid heating. Despite the low desirability and smoke emisions from the traditional open fire, its pervasive use, even in the presence of alternative stove options, may be related to its ability to satisfy the practical needs of the surveyed cooks, namely large cooking capacity and rapid, intense heat generation. Our data suggest women in this community want alternative stove options that reduce smoke exposure, however currently available stoves, including liquid propane gas, do not address all of the cooks' preferences.

Immunogenicity and safety of MF59-adjuvanted and full-dose unadjuvanted trivalent inactivated influenza vaccines among vaccine-naïve children in a randomized clinical trial in rural Senegal.

INTRODUCTION: Effective, programmatically suitable influenza vaccines are needed for low-resource countries. MATERIALS AND METHODS: This phase II, placebo-controlled, randomized safety and immunogenicity trial (NCT01819155) was conducted in Senegal using the 2012-2013 Northern Hemisphere trivalent influenza vaccine (TIV) formulation. Participants were allocated in a 2:2:1 ratio to receive TIV (full-dose for all age groups), adjuvanted TIV (aTIV), or placebo. Participants were stratified into age groups: 6-11, 12-35, and 36-71 months. All participants were vaccine-naïve and received two doses of study vaccine 4 weeks apart. The two independent primary objectives were to estimate the immunogenicity of TIV and of aTIV as the proportion of children with a hemagglutination inhibition (HI) antibody titer of ≥1:40 to each vaccine strain at 28 days post-dose two. Safety was evaluated by solicited local and systemic reactions, unsolicited adverse events, and serious adverse events. RESULTS: 296 children received TIV, aTIV, or placebo, and 235 were included in the final analysis. After two doses, children aged 6-11, 12-35, and 36-71 months receiving TIV had HI titers ≥1:40 against A/H1N1 (73.1%, 94.1%, and 97.0%), A/H3N2 (96.2%, 100.0%, and 100.0%), and B (80.8%, 97.1%, and 97.0%), respectively. After two doses, 100% children aged 6-11, 12-35, and 36-71 months receiving aTIV had ≥1:40 titers against A/H1N1, A/H3N2, and B. After a single dose, the aTIV response was comparable to or greater than the TIV response for all vaccine strains. TIV and aTIV reactogenicity were similar, except for mild elevation in temperature (37.5-38.4 °C) which occurred more frequently in aTIV than TIV after each vaccine dose. TIV and aTIV had similarly increased pain/tenderness at the injection site compared to placebo. CONCLUSIONS: Both aTIV and full-dose TIV were well-tolerated and immunogenic in children aged 6-71 months. These vaccines may play a role in programmatically suitable strategies to prevent influenza in low-resource settings.

[Indications and results of surgical resection of bubbles arising from pulmonary emphysema]. / Indications et résultats de la chirurgie de résection des bulles d'emphysème pulmonaire.

Surgical resection of bubbles or bullectomy is the gold standard in the treatment of bubbles arising from pulmonary emphysema. It is usually indicated for patients with complicated bubbles or when they are the underlying cause of disabling dyspnea. This study aims to determine the indications for bullectomy and to evaluate surgical outcomes in our Department. We conducted a retrospective, descriptive study of 24 patients (23 men and 1 woman) whose average age was 49 years and who had undergone bullectomy between 2004 and 2013. Collected data were: factors favoring the occurrence of bullous emphysema, the circumstances in which bubble was detected, data from the radiological examinations, data from pulmonary and cardiovascular function testing, data from bullectomy, data from postoperative clinical and functional examination. Morbidity rate was 37.5 %. The main complication was persistent air leak (7 cases). One patient died two days after surgery due to acute respiratory failure. The average follow-up period was 26 months during which we observed improvement of dyspnea in all patients and no complications. Bullectomy is an effective, reliable and safe surgical technique that may improve patients' quality of life for a few years.

Penetrating chest injuries caused by swordfish sword used as a weapon.

We report 5 cases of penetrating chest wounds caused by weapons made from swordfish swords, involving breakage of the sword that later appeared as a thoracic foreign body. The patients had been assaulted 2 days to 17 years earlier. Three of them had a chronic infected wound, one had a penetrating thoracic wound with hemopneumothorax, and one had a foreign body. Computed tomography showed a foreign body in the lung in 4 cases, with aortic penetration in one. The foreign body was removed via thoracotomy in all 4 patients, with aorta repair in one who presented later with a pseudoaneurysm.

An epidemiological study to assess Plasmodium falciparum parasite prevalence and malaria control measures in Burkina Faso and Senegal.

BACKGROUND: Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries. METHODS: This cross-sectional study (NCT01954264) was conducted between October and November, 2013, corresponding to the high malaria transmission season, in four sites with Health and Demographic Surveillance Systems (DSS) [two sites with moderate-to-high malaria endemicity in Burkina Faso (Nouna and Saponé) and two sites with low malaria endemicity in Senegal (Keur Socé and Niakhar)]. Children (N = 2421) were randomly selected from the DSS lists of the study sites and were stratified into two age groups (6 months-4 years and 5-9 years). A blood sample was collected from each child to evaluate parasite prevalence of Plasmodium falciparum and other Plasmodium species and gametocyte density by microscopy, and rapid diagnosis test in the event of fever within 24 h. Case report forms were used to evaluate malaria control measures and other factors. RESULTS: Plasmodium falciparum was identified in 707 (29.2%) children, with a higher prevalence in Burkina Faso than Senegal (57.5 vs 0.9% of children). In Burkina Faso, prevalence was 57.7% in Nouna and 41.9% in Saponé in the 6 months-4 years age group, and 75.4% in Nouna and 70.1% in Saponé in the 5-9 years age group. Infections with other Plasmodium species were rare and only detected in Burkina Faso. While mosquito nets were used by 88.6-97.0 and 64.7-80.2% of children in Burkina Faso and Senegal, other malaria control measures evaluated at individual level were uncommon. In Burkina Faso, exploratory analyses suggested that use of malaria treatment or any other medication within 14 days, and use of insecticide spray within 7 days decreased the prevalence of malaria infection; older age, rural residence, natural floor, grass/palm roof, and unavailability of electricity in the house were factors associated with increased malaria occurrence. CONCLUSIONS: Plasmodium falciparum infection prevalence in children younger than 10 years was 57.5% in Burkina Faso and 0.9% in Senegal, and variability was observed, among others, by age, study site and malaria control measures.

Estimating pediatric asthma prevalence in rural senegal: A cross-sectional survey.

RATIONALE: In Senegal, the prevalence of childhood asthma and utilization of appropriate asthma therapies is unknown. METHODOLOGY: We used the International Study of Asthma and Allergies in Childhood (ISAAC) survey instrument to assess childhood respiratory health in rural Senegal. We interviewed the caregivers of children aged 5 through 8 years of age in the four largest Niakhar villages in August 2012. RESULTS: We interviewed 1,103 primary caregivers for 1,513 children, representing 91% of all age-eligible children in the study area. Overall, 206 (14%) children had wheeze at any time in the past, 130 (9%) had wheeze within the past year, and only 41 (3%) reported a clinical diagnosis of asthma. Among children with wheeze within the past year, 81 (62%) had symptoms of severe asthma. Nocturnal cough was reported in 186 (14%) children who denied any history of wheezing illness. Only four (3%) children with wheeze in the past year had ever received bronchodilator therapy. Children with wheeze in the past year were significantly more likely to seek medical care for respiratory symptoms and to be perceived as less healthy than their peers. Children of lower socioeconomic status were significantly more likely to have wheeze. CONCLUSIONS: Nearly one in ten children in Niakhar, Senegal had symptoms suggestive of asthma; however, few children have a diagnosis of asthma or use appropriate therapies. This study highlights an opportunity to raise community awareness of asthma in rural Senegal and to increase access to appropriate medical therapies. Pediatr Pulmonol. 2017;52:303-309. © 2016 Wiley Periodicals, Inc.

[Anatomical bases of external pudendal artery injuries during surgical treatment of pelvic limb varices]. / Bases anatomiques des lésions de l'artère pudendale externe lors de la chirurgie des varices du membre pelvien.

INTRODUCTION: External pudendal artery is a collateral branch of the common femoral artery which is the primary blood supply to the penis or the clitoris. Its relationship with the venous arch of the great saphenous vein and its afferents in femoral triangle, are very narrow. This often entails injuries during crossectomy and great saphenous vein stripping. These lesions can cause sexual dysfunction. METHODS: This study reports the case of a dissection of 22 inguinal regions in 13 men and 9 women who underwent surgical treatment of the femoral triangle. The distribution and the relationship between the external pudendal artery and the venous arch of the great saphenous vein are studied. RESULTS: Single external pudendal artery is the most common. All external pudendal arteries originate from the common femoral artery. The most common type of relationship is between the sub-crossing of the venous arch of the great saphenous vein and a single external pudendal artery. Moreover, we recorded a pre-crossing, an alternate crossing and some relationship with the common femoral vein and the afferences of the venous arch of the great saphenous vein. Some surgical techniques expose more or less to external pudendal artery injury. CONCLUSION: This study confirms previous data but shows some peculiarities about the relationship between the venous arch of the great saphenous vein and external pudendal artery.

Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer.

The group of inferior tracheobronchial lymph nodes (ITB) is a lymphatic junction through which the lymph from both lungs is carried. Lymphatic activity in this area can be used to assess the lymphatic spreading of lung cancers. Our aim was to quantify lymph drainage from the lung segments towards the ITB group and to determine the direction of the lymph flow into other mediastinal and abdominal lymph nodes. We injected dye directly into the subpleural lymphatic vessels in 100 lung segments of 25 fresh cadaver subjects; the cadavers were then dissected. Thirty-eight segments (38%) drained into the ITB group in 18 subjects. The drainage into the ITB group involved 15.6% of the upper lobe segments, 87.5% of the middle lobe segments, and 70.6% of the lower lobe segments in the right lung. On the left, 6.9% of the upper lobe segments and 83.3% of the lower lobe segments were drained into the ITB group. For three subjects, the dye did not pass beyond the ITB group. The efferent vessels of the ITB group drained towards the right paratracheal and tracheoesophageal chains in 12 subjects and through the left ascending recurrent chain in five subjects. For six subjects, the efferent channels reached the abdominal lymph nodes. A contralateral drainage involved 14 segments (36%). The size and variety of the segments that drain into the ITB group, coupled with the efferent contralateral mediastinal and abdominal pathways, account for the severity of metastasis to this area. Clin. Anat. 29:955-962, 2016. © 2016 Wiley Periodicals, Inc.

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery.

OBJECTIVES: To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC). MATERIALS AND METHOD: We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects. RESULTS: At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes. CONCLUSION: The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

Social Determinants of Routine Immunization Coverage of Children Aged 12 to 23 Months in the Kaolack Region of Senegal / Déterminants sociaux de la couverture vaccinale de routine des enfants de 12 à 23 mois dans la région de Kaolack, Sénégal.

Introduction: The lowest immunization coverages (IC) are recorded in Africa, where health systems fail to take geographical disparities into account. The objective of this study was to identify the social determinants of routine immunization coverage for children aged 12 to 23 months in the Kaolack region.Methodology: A cross-sectional, descriptive and analytical study was conducted in four health districts of Kaolack region from 1 to 30 June 2014. A cluster survey was conducted. Data collection was based on a pretested questionnaire administered to mothers or guardians of children aged 12 to 23 months by trained and supervised interviewers. Bivariate analysis was performed using Epi Info 3.5.4 software.Results: The sample included 849 mothers or guardians between the ages of 15 and 70 years with a mean age of 26.8 years (± 6.9). The majority of these women lived in rural areas (73.3%), were married (96.3%), with no income-generating activities (79.7%), literacy (62.5%) and had at least 4 children (75.1%). 20.1% of them were familiar with the immunization schedule, 87.9% could name at least one adverse event following injection (AEFI), 63.3% knew the EPI target diseases. The majority of women (91.3%) complied with the immunization schedule and attended the facility in case of missed appointments (52.3%). Only 39.1% of them reported AEFI and 59.7% provided home care.Those who lived in rural areas and who had income-generating activities (IGA) knew more about the immunization schedule (p<0.05). Those who lived in rural areas reported more AEFI (p<0.05). Children of mothers educated in French, urban inhabitants with an IGA had better routine immunization coverage (p<0.05).Conclusion: Social determinants such as education, economy and governance contribute to improved routine immunization coverage of children aged 12-23 months.

Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine.

BACKGROUND: The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. METHODS: Because of the public-private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countries, the ethical review process was complex and required strategic, timely, and attentive communication to ensure the smooth review and approval for the clinical studies. Investigators and their site teams fostered strong community relationships prior to, during, and after the studies to ensure the involvement and the ownership of the research by the participating populations. As the clinical work proceeded, investigators and sponsors responded to specific questions of informed consent, pregnancy testing, healthcare, disease prevention, and posttrial access. RESULTS: Key factors that led to success included (1) constant dialogue between partners to explore and answer all ethical questions; (2) alertness and preparedness for emerging ethical questions during the research and in the context of evolving international ethics standards; and (3) care to assure that approaches were acceptable in the diverse community contexts. CONCLUSIONS: Many of the ethical issues encountered during the PsA-TT clinical development are familiar to groups conducting field trials in different cultural settings. The successful approaches used by the MVP clinical team offer useful examples of how these problems were resolved. CLINICAL TRIALS REGISTRATION: ISRCTN17662153 (PsA-TT-001); ISRTCN78147026 (PsA-TT-002); ISRCTN87739946 (PsA-TT-003); ISRCTN46335400 (PsA-TT-003a); ISRCTN82484612 (PsA-TT-004); CTRI/2009/091/000368 (PsA-TT-005); PACTR ATMR2010030001913177 (PsA-TT-006); PACTR201110000328305 (PsA-TT-007).

The azygos lobe: an unusual anatomical observation with pathological and surgical implications.

The azygos lobe is a rare anomaly in broncho-pulmonary segmentation due to an unusual course of the azygos vein. Its radiological aspects are well known but there are few anatomical reports about its bronchial and vascular components. The authors describe the characteristic features in a particular case of the azygos lobe observed in the right lung after studying a fresh specimen and doing a casting of said specimen. This azygos lobe was in a position medial to the right upper lobe and above the hilum. It had the shape of an egg and was 5 cm high, 4 cm wide and 2 cm thick. The azygos fissure was of a vertical form. The lobe was ventilated by the posterior branch of the apical segmental bronchus (B1a). This latter was accompanied by two apical sub-segmental arteries (A1ai, A1aii) and the apical intersubsegmental vein (V1a). The new findings were that: first, the azygos lobe bronchus supplied a part of the right upper lobe; second, the passage of the azygos vein deformed the bronchus of the right upper lobe, and not that of the azygos lobe. This means that it was the right upper lobe, rather than the azygos lobe that was predisposed to the pathology. So, in excising this type of azygos lobe, particular precautions have to be taken to spare the bronchus of the azygos lobe that supplies the right upper lobe.

Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections).

The variations in the emergence and distribution of the ilioinguinal nerve are the cause of the failures of the ilioinguinal block and the difficulties at interpreting the ilioinguinal nerve syndrome. In order to identify its variations and set reliable anatomical landmarks for performing the ilioinguinal block, we dissected 100 inguinal regions of 51 adult corpses. The nerve was absent in seven cases and double in one case. The ilioinguinal nerve emerged from the internal oblique muscle, passing at 1 +/- 0.8 cm of the inguinal ligament and 3.33 +/- 2 cm of the ventral cranial iliac spine. It appeared behind the inguinal ligament and/or the ventral cranial iliac spine in 19 cases and presented a common trunk with the iliohypogastric nerve in 13 cases. In 47 cases, the nerve appeared in the form of a single trunk. Sixteen modes of division and eight types of predominantly anterior scrotal topographic distribution could be noted. These results show the high variability of the emergence and the sensory distribution of the ilioinguinal nerve. They enable us to propose techniques for ilioinguinal block performance using more accurate anatomical landmarks formed by the inguinal ligament and the ventral cranial iliac spine and a better diagnostic approach of ilioinguinal neuropathies.