Médecine tropicale : revue du Corps de santé colonial
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In Africa, the obstetrical risk is related to the difficulty to monitor the pregnancy during which obstetrical emergency may occur and will have to be treated by the practitioner with, sometimes, inadequate facilities. The authors examine the problems concerning successively the expectant mother, the foetus and the placenta. Then, they propose some solutions in the field of anesthesia and intensive care. ⋯ Peridural anesthesia is operative with a great number of situations but it requires some technical training. Then methods to monitor both mother and foetus are exposed. According to the available facilities, ways and means are given to solve problems of anesthesia: labour maternal complications (Mendelson's syndrome, eclampsia, obstetrical complications either mechanical and hemorrhagic) or secondary complications (bacterial or parasitic complications, renal insufficiency); foetal complications either during labour, or at birth, or after delivery.
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1 - More than hundred febrile haemorrhagic jaundice cases with an unexpectedly high number of death happened in the north-west of the Ivory Coast between October 1977 and December 1977. It was the end of the rainy season and in this area, yellow fever is a dreadful eventuality. 2 - Epidemiological and serological survey was immediately carried out. Presence of numerous yellow fever potential vectors was well known and has been noticed in September 1977; there were some left in December 1977. ⋯ Single sera from 52 young rural workers and 402 inhabitants of surrounding villages were examined too. 4 - By the way of clinical, epidemiological, serological evidence, authors concluded 21 cases were certainly yellow fever. Evidence of 2 other cases was demonstrated by specific micropathological features. Furthermore, by serological results, 20 were probably yellow fever, 15 were inconclusive and 476 certainly not. 5 - Authors discussed some specific difficulties of yellow fever retrospective diagnosis in flavivirus endemic area.
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Recent works carried out in west and central Africa resulted in numerous yellow fever virus isolations from sylvatic mosquitoes in the forest-savanna transitional zone. This virus was also obtained from monkeys, whereas studies on sequence and duration of the observed epizootics permitted a previsional approach of the yellow fever mechanisms in the same belt, the epidemiological importance of which was stressed ("emergence zone"). ⋯ It can explain that epizootics may be locally observed several years in succession, despite the fact that yellow fever virus circulation seems to be fundamentally of a dynamic character. Yellow fever virus was recently obtained from ticks and tick-eggs.
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The anesthesic fluid is injected close to the intercostal nerve at the starting point of its course in the corresponding space. Its gives an easy analgesia for thoracic or upper abdominal areas.