Outbreak of enterically-transmitted hepatitis due to hepatitis A and hepatitis E viruses.

BACKGROUND/AIMS: One hundred and eleven patients with acute hepatitis and 61 controls were investigated for hepatitis serological markers in order to determine the viral etiology of cases involved in a waterborne epidemic of hepatitis observed in 1993 in Djibouti, Republic of Djibouti (East Africa). These cases occurred both in indigenous Djiboutians, and in French soldiers and their families in Djibouti. A retrospective study of the viral etiology of acute hepatitis cases observed in French soldiers and relatives living in Djibouti during the 3-year period preceding the epidemic was also undertaken. METHODS: HAV, HBV and HCV infections were investigated using commercial ELISA tests. HEV infections were investigated by testing IgG and IgM-specific antibodies by means of three different ELISA tests using recombinant proteins or synthetic peptides. RESULTS: Hepatitis A was observed in 37 (33%) and hepatitis E in 43 (39%) of the 111 cases of acute hepatitis recorded during this epidemic. Hepatitis B represented only 6% of the indigenous cases and hepatitis C was not observed among the cases investigated. Anti-HEV IgG antibodies were also detected in 19% of the indigenous control group. CONCLUSION: These results suggest that both HAV and HEV were responsible for this waterborne epidemic of acute hepatitis. However, HAV and HEV infections were not equally distributed between French expatriates and Djibouti residents. Whereas HAV infections were mainly observed in French patients, HEV was almost exclusively found in indigenous patients. This study reports for the first time a waterborne outbreak of acute hepatitis simultaneously due to HAV and HEV.

[Occurrence of non-Hodgkin's lymphoma in chronic myeloid leukemia]. / Survenue d'un lymphome non hodgkinien au cours d'une leucémie myéloïde chronique.

The authors report the case of a 42-year old woman who developed chronic myelocytic leukemia with Philadelphia chromosome followed, 21 months later, by malignant follicular lymphoma with small cleaved cells and giant cells. This case is comparable to the other associations of acute or chronic myelocytic and lymphocytic blood diseases previously published. Several pathogenic theories are reviewed. They involve chemotherapy with alkylating drugs (but the diagnosis is sometimes simultaneous), cellular oncogens or, more probably, a clonal abnormality of the stem cell sequentially or concomitantly expressed in the cells of both lineages; unfortunately, in the absence of Philadelphia chromosome this theory has not yet been demonstrated on lymphoma cells.

[Severe and extensive algodystrophies and malignant tumors. Apropos of 4 cases]. / Algodystrophies sévères et extensives et tumeurs malignes. A propos de 4 observations.

The authors report on 4 cases of particularly severe and extensive reflex neurovascular dystrophy, whose clinical course was marked by the onset of a malignant tumor, without any sign of improvement in the reflex neurovascular dystrophy, despite various therapeutic regimens, until the patient's death from malignancy. At this time, the authors compiled a total of 63 case reports (4 of which were reported) and have proposed a classification to differentiate 4 types of disorders in combination according to whether there is a very probable, probable, or possible link or whether the combination is strictly a coincidence. The pathogenic mechanism remains a mystery, when a link is observed; but it never corresponds to criteria to describe a paraneoplastic disorder. Finally, the authors insist on the practical value of detecting this combination, even if due to chance: in order to systematically detect cancer in the presence of any reflex neurovascular dystrophy, and especially to be conscious of a possible reflex neurovascular dystrophy, besides possible metastatic lesions, in the presence of osteoarticular pain present in a patient with cancer. Such a diagnosis, although difficult to realize, has great prognostic and therapeutic interest.

[Neurogenic tumor of the anterior mediastinum. An uncommon diagnosis: neurofibroma of the vagus]. / Tumeur neurogène du médiastin antérieur. Un diagnostic d'exception: le neurofibrome du vague.

Case report of an endothoracic neurofibroma of the left vagus nerve, presenting as an anterior mediastinal mass in a 62 years old man without other signs of Recklinghausen's disease. Rarity of such cases is noted. Previously published sixty one reports are studied. Only four are localised in anterior mediastinum. The authors emphasize absence of specific signs of vagal involvement, importance for diagnosis of surgical extirpation, and mildness of post operative course.