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Goal of the Study: Unilateral Menière's disease can be treated by chemical labyrinthectomy. The goal of this work was to report our clinical experience with chemical labyrinthectomy, and to discuss the respective value of labyrinthectomy and of vestibular neurotomy for treating unilateral Menière's disease., Methods: Twelve patients underwent chemical labyrinthectomy using middle ear gentamicin infusion. Before treatment, patients had a pure tone audiogram and a vestibular caloric testing. After treatment, patients had a clinical assessment at 1 and 6 months after treatment (pure-tone audiogram, vestibular caloric testing), and answered a questionnaire at 1 and 2 years following the treatment (number of vertigo attacks, ataxia, tinnitus, subjective assessment of the method by the patient)., Results: At two years post-treatment, the vertigo cure rate was 91.6% (ABC using AAOO criteria), vestibular function was abolished in 70% of cases, ataxia was reported in 42% of patients, 16.6% of patients had hearing deterioration above 20 dB HL (C following AAOO criteria), tinnitus was decreased in 50% of cases. Of 12 patients, 8 were satisfied., Conclusion: Chemical labyrinthectomy cures vertigo in Menière's disease, with similar cure rate than vestibular neurotomy. Minor complications can occur with chemical labyrinthectomy. This method should be used in more patients.

We report the occurrence of a leiomyoma of the suprarenal gland in a 10-year-old girl with ataxia-telangiectasia (A-T). Muscle cell tumors are very uncommon in this gland as they are in A-T. Possible reasons for developing nonhematologic tumors in this syndrome are reviewed. A defect in DNA repair mechanisms probably favors, in young children, the expression of tumors normally expected in the aged.

A sample of 2569 persons (1190 m, 1379 f) from Niamey (population 329,000), Niger, showed a giardiasis prevalence of 28.5%. The prevalence was similar between males and females and highest in the age range 3-29 years.

A comparative study on the extent of urinary tract abnormalities detected by ultrasound was conducted in two villages in an irrigated area of Niger where the pretreatment prevalences were 64.3% and 58.8% respectively. Fewer bladder lesions (20% of abnormalities) and fewer renal lesions (6% of abnormalities) were observed after four consecutive years of follow-up and treatment with praziquantel in the study village as compared to the control village where 54% bladder abnormalities and 36% renal abnormalities were observed. This study suggests that morbidity due to Schistosoma haematobium infection can be reduced by annual treatment over several years in a highly endemic area without other associated interventions.

In two villages of the Aïr (Republic of Niger) the authors have found a Schistosoma haematobium overall prevalence of 24.1% at Timia and 43.5% at El Meki. At El Meki, the distribution of prevalences by age group accords to that which is usually found. The maximum is found in the 5-14 years age group and highest in men than in women. At Timia, the prevalence among young pupils is low, this seems to be due to the application of sanitary education measures. At El Meki, Bulinus truncatus rohlfsi, present in a permanent pool ("guelta") is the intermediate host of schistosomes. The role of this snail in the transmission of urinary schistosomiasis at Timia has not been demonstrated. The role of Bulinus senegalensis, found in both villages has yet to be proved.

In a village of 841 inhabitants, we were able to examine 553 subjects, 357 of whom had urinary egg excretion. The patients were treated with a single dose of 35 mg/kg oltipraz which was given under surveillance together with either whole milk or herrings in oil. The tolerance of the product was very good as only 3% of the patients reported vomiting and 3% paresthesias of the fingers. 66% of the patients examined on day 30 and/or on day 90 were egg-negative and egg excretion was reduced by at least 90% in 22 other subjects, bringing the percentage of good results to 74%. On day 90, the mean egg excretion was reduced by 82.5% in the overall population and by 80.9% in the 5 to 14 year-olds.

In a dry savanna village in Upper-Volta, after mass treatment with metrifonate (four doses of 7,5 mg/kg at three weeks intervals) checking of the population was carried out for the three following years. In children and adolescents, results show a progressive decline in the cure rate (69.0% one year after treatment, 38.1% three years after treatment) and in egg-output reduction (69.9% one year after treatment, 75.4% three years after treatment). In adults, these two parameters still remain high three years after treatment (90.0% for cure rate and 87.3% for egg-output reduction). The authors point out that in a dry savanna village with a sedentary population and a transmission limited to a small collection of water, chemotherapy even employed alone is an appreciable control method to relieve populations.

The effect of praziquantel on urinary tract lesions due to Schistosoma haematobium was assessed by ultrasound in an endemic village in Niger. Ten months after treatment with praziquantel, bladder and renal lesions among the 149 patients were assessed. The parasitological cure rate was 87%. Ultrasonography proved to be an excellent tool to assess pathological changes. It is reliable, quickly performed, well accepted by the community and permits the definition of a "regression-rate" of the pathological lesions. Ten months after treatment, the "regression-rate" of bladder lesions was 68% and of renal lesions was 73%. The presence of bladder lesions had a negative influence on the regression of renal lesions. Nearly all renal lesions, without bladder lesions, regressed within the ten months period of observation. This study permitted the identification of a group of persons whose bladder lesions did not regress and who were possibly more vulnerable to the development of bladder cancer, thus requiring long-term follow-up.

In order to assess the relation between urinary schistosomiasis and urinary tract infections (U.T.T.), a study of two villages in the surroundings of Niamey (Rep. of Niger) was undertaken. In the first village located near a rice plantation irrigation scheme, the global prevalence of S. haematobium infection was 77%. Boys between 5 to 14 years of age were all infected and their mean egg output was 500 eggs/10 ml of urine. In the second village, where water is supplied from wells, schistosomiasis was almost absent. Urinary tract infections were diagnosed upon the cytologic count of the urinary sediment and the urine culture. Comparison between S. haematobium infected and non-infected villages showed that the prevalence of U.T.I. was 3.8 times higher among the females of the infected village. This was also noticed for old men and especially for boys aged 5 to 14 (5.2% U.T.I.) for whom urinary infection is usually uncommon. However the mean blood pressure and the creatininemia showed no difference between the two populations. If schistosomiasis increases the risk of chronic pyelonephritis, that increase could not be accounted for with the measures of these two variables.

Coprologic surveys realized in schoolchildren in a few western areas of the Republic of Niger provided the following results. Concerning protozoa, the prevalence of amebiasis-infestation is strong in all the studies areas, giardiasis is more frequent in dry areas. As for the helminths, Hymenolepsis nana is met everywhere, the prevalence of ancylostomiasis decreases gradually from the south to the north and the endemic area of Schistosoma mansoni is limited to the extreme south of the country. The other helminthiasis are rare.

In order to assess Schistosoma haematobium as an aetiologic factor in sideropenic anaemias, we compared a village with high prevalence of urinary schistosomiasis and a village without urinary schistosomiasis as a control. In the infested village, anaemias (haemoglobin value lower than 12 g/dl) especially affects children between 5 to 14 years old (71%:45/68). Boys being the most infestated group with S. haematobium (prevalence:100%; mean egg output: 496 eggs/10 ml of urine) are also the most anaemic group (82%:23/28). Comparing the two villages shows that urinary schistosomiasis increases the risk of acquiring anaemia by 30% among children aged 5 to 14. Furthermore, the parasitic disease reduces of 1 g/dl the mean haemoglobin level of adult males. On the other hand, S. haematobium is of minor importance as a cause of anaemia among women. The others aetiologies remain preponderant.

A simple method, using urine collectors, was devised to obtain sufficient and reliable samples of urine from infants (0-4 years old) for the quantitative diagnosis of urinary schistosomiasis. The use of urine collectors is readily accepted by rural populations and it avoids possible interchange between young children. Urine collection and examination from as many as 100 infants can be undertaken daily by a small, well-trained survey team. Our present observations on S. haematobium among infants in Niger show surprisingly high (14.06 per cent) prevalence rates and suggest that this age group may play a considerable role in the transmission of the infection in some endemic foci.

This study of S. haematobium infection in communities associated with irrigated schemes shows that prevalence rates are unusually high in adults, especially in men; and distribution disease is probably associated with at least the following three factors: (i) distance of the place of residence from the main transmission sites (ii) the dynamics of transmission in the waterbody and (iii) the human/water contact and contamination patterns. During this chemotherapy trial, at the first survey, only a little more than half (57.47%) of the people recorded in the census was present. Five visits of the survey team were necessary to obtain a compliance rate of 80.51% of the entire population. The indifference of the local people to seek diagnosis and treatment increased with succeeding surveys. It is only, during a subsequent treatment survey, carried out during the season of low agricultural activity and following an official written convocation, that a compliance rate similar to that of the first survey was recorded. If treatment is not given immediately after diagnosis as many as a fifth of positive cases do not appear for treatment. Oltipraz and praziquantel were administered. Their effectiveness could not be truly compared as there was a time lag of six months separating the administration of the treatments. However, based on the results of this trial both drugs gave good results especially in egg output intensity. But, a decrease of this parameter was also observed in non treated people. Seasonal variations of egg output or decrease of transmission could be involved.

An epidemiological survey was made in 4 villages of the recently discovered Schistosoma mansoni focus of Bana (Niger). The total prevalence of intestinal schistosomiasis is 15%. The highest prevalences are noted in the age-group from 20 to 38 years old. The mean egg load is moderate: 11.3 eggs/g of stools. Several hypothesis are discussed to explain the low endemicity of this focus.

Three hundred and seven patients, 130 children and 207 adults, from a hyperendemic village, underwent an ultrasonography of bladder and kidneys. Prevalence of bladder lesions is 79.3% in children and 61.9% in adults, prevalence of hydronephrosis is 36.1% in children and 9.7% in adults. These study confirms the importance of urologic lesions from schistosomiasis in the irrigation schemes of the Niger river. There is no relationship between frequency and importance of lesions and urinary egg count.

PUGH (1978) and TEEDSALE et al. (1980) showed that an associated single dose of metrifonate (12.5 mg/kg) plus niridazole (25 mg/kg) gave good results on Schistosoma haematobium: the egg-reduction percentage ranged between 84.7 and 91.2. In Niger, we compared the effects of this medication to oltipraz in a single dose (30 mg/kg). We selected a dosage of 10 mg/kg of metrifonate and 25 mg/kg of niridazole. This trial was carried out during the minimal transmission period. --109 adults (greater than 15 years) received oltipraz and 159 this combined treatment. They were examined twice: 11/2 month and 6 months after treatment. At the first control, the cure rate was 26.7% for oltipraz and 23.3% for the combined treatment, the egg-reduction was respectively 77.1% and 41.3%. Six months after treatment, the cure rate was 43.5% for oltipraz and 27.7% for the combined treatment and the egg-reduction was 66.5% and 2.0% respectively. Following these results, the authors recommend against the combined treatment in Niger. They note that if, in some particular conditions, this medication can give good results (PUGH, 1978, TEESDALE et al., 1980) it is however necessary to include its test in future control projects. Also, they note the weak result obtained with oltipraz; but, in this case, the heavy endemic level and high egg-loads might explain it, as well as the fact that the 30 mg/kg dosage was probably insufficient.