[Lead poisoning caused by prolonged use of kohl, an underestimated cause in French-speaking countries]. / Intoxication saturnine provoquée par l'usage prolongé de khôl, une cause sous-estimée dans les pays francophones.

Use of kohl (called surma in India and Pakistan) as an eye cosmetic is very common, especially among women, children, and babies, not only in North Africa (Morocco, Algeria, Egypt), but also in the Near East and the Middle East, as well in India and Pakistan. This practice has now become widespread in European countries and North America. The cultural custom is very old and has been in use in Egypt since the Ancient Empire. In a great number of kohls available on the free market, lead sulfide is the main component and the very high lead concentration is a risk, particularly for women and children. We report the observation of a case of lead poisoning in a young Moroccan woman caused by prolonged use of a kohl and provide a review of the published literature. This case study should draw the attention of ophthalmologists in French-speaking areas to a public health problem, largely ignored, although real, considering the high lead concentrations found in the majority of kohls. Actions such as prohibition (importation and sale of eye cosmetics made of lead sulfide) have proved to be inadequate. Appropriate educational campaigns directed toward populations using eye cosmetics will be more effective over the long term.

[Hemoglobinopathy C and splenomegaly in an Ivory Coast patient. Value of splenectomy]. / Hémoglobinopathie C et splénomégalie chez un patient ivoirien. Intérêt de la splénectomie.

We report the case of a young patient native of the Ivory Coast who suffered from homozygous hemoglobin C disease. He presented with the usual findings of this hemoglobinopathy: a moderate hemolytic anemia and a massive, painful and even disabling splenomegaly. Pain completely disappeared following splenectomy. However, postoperative course was complicated by portal venous thrombosis, which was medically treated. No deficiency of natural coagulation inhibitors could be demonstrated, so splenectomy was the only factor predisposing to thrombosis. We consider that in only very few cases of hemoglobin C disease, splenectomy (preceded by prophylactic antipneumococcic vaccine) may be indicated from pain and risk of spontaneous splenic rupture.

[Use of kohl and severe lead poisoning in Brussels]. / Usage de khôl et intoxication saturnine grave à Bruxelles.

The authors report the observation of lead poisoning in a young Moroccan woman, which was caused by prolonged use of a khol made of lead sulphide. Khol is a black eye make-up used since Ancient Egypt. Clinically, this poisoning presented with abdominal crampoid pain, encephalopathy (manifested as anxiety and irritability), a Burtonian gingival border and microcytic sideropenic anaemia. Emergency chelate treatment permitted to improve clinical state and to decrease blood levels (initial blood concentration: 490 micrograms/dl; concentration six weeks after treatment: 49 micrograms/dl). The interest of such a case is recognizing, in French speaking regions, of a public health problem, largely ignored, although real, considering the high lead concentrations found in a majority of kohls available in Brussels and this very old cultural practice among Muslim populations.

[Congenital sideroblastic anemia in an infant]. / Anémie sidéroblastique congénitale chez un nourrisson.

UNLABELLED: Sideroblastic anemia is rare in infants. When it occurs, it is generally hereditary and X-linked. CASE REPORT: A microcytic anemia without iron deficiency was diagnosed in a 2-month old infant with probable acquired cytomegalic infection. Bone marrow examination disclosed ringed sideroblasts without cytomegalic inclusions. Treatment with pyridoxine was tried without effect and no other therapeutic trial was attempted. The child, now aged 5 years, remains well without blood transfusion. CONCLUSION: Hereditary and acquired sideroblastic anemias may occur in infants and children. Whatever their cause might be, the evolution is unpredictable. The only successful treatment for the hereditary variant remains pyridoxine supplementation which brings relief in about one patient out of three. Efficiency and safety of other therapeutic regimens remain to be proven.

[Transient aplasia of the red progenitor cells manifest in a child with double heterozygote Hb SC carriership: the role of human parvovirus B19 (HPV-B19)]. / Aplasie transitoire de la lignée rouge survenant chez un enfant porteur d'une double hétérozygotie HbSC: rôle du parvovirus humain B19 (HPV-B19).

Severe pure red cell anaemia due to B19 parvovirus infection is reported in a child with haemoglobin SC disease. B19 parvovirus infection was demonstrated by specific IgM. Although hypoplastic crisis occurring in SC children is usually less frequent and more benign than in sickle- cell anaemia, it necessitated several blood transfusions in our patient. The child recovered rapidly and was discharged after 12 days. This case again illustrates the role of HPV-B19 in the development of transient red cell aplasia occurring in patients with haemolytic anaemia. However, it is unusual since in the few reported children with HbSC disease and HPV-B19 infection, aregenerative anaemia remained moderate and did not generally require blood transfusions.

[Hemoglobin C (alpha 2 beta 2 6Glu-->lys). Study of 19 heterozygote AC carriers and of 5 cases of double hemoglobinopathy SC]. / Hémoglobine C (alpha 2 beta 2 6Glu-->Lys). Etude de 19 porteurs hétérozygotes AC et de 5 cas de double hémoglobinopathie SC.

This paper describes clinical findings in subjects heterozygous for hemoglobin C and in compound heterozygotes SC. Most of our patients were coming from lands bordering the Guinea Gulf, on the inside of the loop made by the river Niger and from Haiti, which was populated by African slaves coming mainly from the Golden Coast (actually Ghana). Heterozygotes are asymptomatic and do not suffer from anemia. Age at diagnosis is higher than for SCA, although one of our cases was diagnosed at age one. Overwhelming infections or major anemia were not observed. Basal hemolysis remained moderate. HbF levels were not increased as they may be in sickle cell anemia. Splenomegaly was observed in 2/5 patients. Among severe complications we encountered, we must mention one case of foetal death, one tibial infarct, one case of pure red cell aplasia caused by parvovirus B19 infection, and one case of proliferative retinopathy.

Fifty cases of human immunodeficiency virus (HIV) infection: immunoultrastructural study of circulating lymphocytes.

The peripheral lymphocytes of 50 cases of human immunodeficiency virus (HIV) infection (13 of acquired immune deficiency syndrome (AIDS), 17 of AIDS related complex (ARC), and 20 healthy carriers) were studied immunoultrastructurally. The prevalence of "tubuloreticular structures" and "tubular confronting cisternae" increased with the progression of the disease. Numerous tubular confronting cisternae were noted in patients presenting with a high serum acid labile alpha-interferon values. The patients with depressed natural killer cell activity were characterised by circulating immature natural killer cells with abundant multivesicular bodies that were devoid of "parallel tubular arrays". With an immunogold staining technique the location of HIV antigen was detected ultrastructurally, both at the surface of "hand-mirror" natural killer cell lymphocytes and inside vacuolised cells, probably corresponding to infected T4 lymphocytes. These findings indicate the usefulness of electron microscopic techniques in evaluating the pathology and the pathogenetic outcome of AIDS.

Increased levels of myeloid progenitor cells in the blood of patients with metastatic invasion of the marrow.

Granulocyte-macrophage clusters and colony-forming cells (CFU-C) in the peripheral blood have been studied in 26 cancer patients with neoplastic bone marrow involvement. The concentration of CFU-C in the blood of normal individuals and of cancer patients with no bone marrow invasion, ranged from 0 to 99 ml. In contrast, out of 27 cancer patients with marrow invasion, 9 (35%) showed a significant increase of blood CFU-C (100 to 21000/ml) and of those 5 (19%) showed an increase of blood colonies (41 to 9000/ml). There was a strong correlation between increased CFU-C or colony concentration and the presence of myeloid or/and erythroid immature cells in the peripheral blood. On the other hand, there was no apparent correlation between an increased CFU-C level and anaemia or abnormal blood leucocyte count or marrow fibrosis. These observations suggest that bone marrow involvement by neoplastic cells may cause spatial redistribution of the granulocyte macrophage progenitor cells.