[Epidemiological surveillance of infection by the human immunodeficiency virus (HIV) and of the acquired immunodeficiency syndrome (AIDS) in French Polynesia in 1991]. / Surveillance épidémiologique de l'infection par le virus de l'immunodéficience humaine (VIH) et du syndrome d'immunodéficience acquise (SIDA) en Polynésie Française en 1991.

The authors make out a statement about HIV infection in French Polynesia at the date of 1991 December 31. 96 cases all together of seropositive and AIDS infected people were recorded. These patients are young generally (78 p.c. between 21 and 40 years old) sexually contaminated (72 out of 96) and live in Tahiti island (94 p.c.). Sex-ratio is 2.8 male/1 female. Among them, we noted 55 p.c. of Europeans, 38 p.c. of Polynesians and 7 p.c. of Asiatic people. Epidemiological monitoring of the infection was made easy because of a set of laws and possibilities of detection highly favourable. Progress of the infection is constant, with 20 new cases detected each year with a prevalence of 150 cases of AIDS per 1 million of inhabitants, French Polynesia could be classified as the 5th or 6th region of France as far as the importance of the disease. Clinical, biological and epidemiological taking of charge of patients is detailed as well as the prevention campaign.

PIP: Serological surveillance of HIV infection in accordance with World Health Organization guidelines has taken place in French Polynesia since 1985. 20,000 tests are conducted annually in a population not exceeding 200,000. 30% of tests are among blood donors. An average of 20 new cases of HIV infection are diagnosed each year. A total of 96 cases of HIV infection or AIDS were reported to the public health authorities between 1985 and December 31, 1990. 78% of the 96 persons were aged 21-40 years. The sex ratio was 2.8 men per woman. 55% were in Europeans (53 cases among 24,000 European residents), and 7% were in Asians (7 cases among 10,000 Asians). 94% of the patients were inhabitants of Tahiti. 44 of the 96 patients were male homosexuals or bisexuals, 18 were heterosexuals with multiple partners, 13 received transfusions before 1985, 10 were sex partners of seropositive persons, 9 were former addicts, 1 was the infant of an infected mother, and 1 had no known risk factor. ELISA tests were conducted in 6 different laboratories in the island of Tahiti, with confirmation by Western blot at the laboratory of the Louis Mallarde Territorial Medical Research Institute. Contacts are traced and tested, and seropositive individuals are followed regularly, with consultations at 6 month intervals for seropositive persons. Of the 46 patients present in the territory as of December 1990, 36 were at stage 1, 2 at stage 2, 5 at stage 3, and 3 at stage 4 according to the World Health Organization guidelines. 20 of the other 50 had died and 30 left the territory.

[Leptospirosis in French Polynesia: 120 case reports]. / Les leptospiroses en Polynésie Française: etude de 120 observations.

Because of its clinical polymorphism and the difficulties to made a bacteriological and/or serological diagnosis, leptospirosis is an affection always non-detected. Nevertheless it is daily met affection in French Polynesia. Based on a homogenous series of 120 observations gathered from 1984 to 1990, all of them bacteriologically and/or serologically confirmed, we studied the different clinical and evolutive features of that disease. Fever is present in 91.6 p.c., cephalgia in 79.16 p.c. and myalgia in 70.83 p.c. Admission was necessary once out of four times. The four syndromes we observed in Tahiti are: infections syndrome, meningeal syndrome (30 p.c.) associated to an hyperproteinic grade in the C.S.F. (40 p.c.) and a lymphocytic reaction (60 p.c.). Liver syndrome, with hepatalgia (58.33 p.c.) and pain at the mass motion of liver (65 p.c.), that is an important sign in the local context; jaundice (28.33 p.c.) on the presence of which we must not based a diagnosis of leptospirosis: Biological renal syndrome displayed by transitory renal insufficiency with proteinuria, hematuria and leucocyturia. Neurological complications are mainly of encephalitic manifestations (5.8 p.c.). Hemorrhagic syndrome is expressed in digestive hemorrhage (8.33 p.c.) epistaxis (6.66 p.c.) and hemoptysis (6.66 p.c.). Cardiovascular manifestations are expressed in collapsus in 5.83 of the cases. Pulmonary abnormalities are frequent: cough (26.66 p.c.) and non specific X Ray image (19.16 p.c.). All patients are treated by Penicillin G (10 to 20 millions per day) by parenteral route with enteral alternative for an average of 10 days. Recovery was fast (7 to 10 days). In 65.8 p.c., slower in 15 p.c. (15 to 20 days); failure at first stage was observed in 10 p.c. of the cases, and relapse at medium or long term occurred under treatment in 8 cases (6.66 p.c.). Three dead were deplored (mortality 2.5 p.c.).

[The non-insulin-dependent diabetic (type II) in Tahiti]. / Le diabète non insulinodépendant (type II) à Tahiti.

The authors report on the monitoring in the Diabetology Service of the Territorial Hospital Center of Papeete (French Polynesia) of 51 Polynesians, diabetics non insulin-dependent over periods of 12 to 30 months (average 26.5 months) from July 1988 to December 1991. 31 males and 20 females (sex-ratio 1.5). Mean age: 55.9 (extremes: 22 and 76 old years). Non insulin-dependent diabetes risk factors: heredity (43%), obesity (67%), new-born babies with a weight more than 4 kg (10%). Revealing factors of diabetes: systematic check-up (37%), clinical complications (36%), cardinal signs (20%). Recorded complications are: 1. microangiopathy: nephropathy (25%) including 7 renal insufficiency and 2 patients under dialysis; retinopathy (29%); 2. macroangiopathy: cardiovascular accident 1 case; angor 4 cases; obliterative arteritis of inferior limbs 5 cases; 3. neuropathy 9 cases (17%); 4. high arterial tension 55%; 5. metabolic complications (20%): 4 acidocetosis; 2 hyperosmolar coma; 4 severe hypoglycemia; 6. 16 diabetic feet (32%) among them 8 amputations; 7. 45 infectious complications in 27 patients are reviewed. Review of the complications according to diseases ancientness; before 10 years of evolution, each patient suffered of at least one complication, after 10 years, each patient got an average of 2 complications. Review of diabetic balance: 80% of the patients present a mean glycemia greater than 1.50; 54% present a postprandial glycemia greater than 2 gr. and 34% a A1 C Hb greater than 9%. The possible treatments are reviewed. During this monitoring, mortality was one case; 35 patients were admitted totaling 881 days of hospitalization.

[Hepatic amebiasis in French Polynesia. Study of 42 cases ]. / L'amibiase hépatique en Polynésie Française. Etude de 42 cas.

The authors aimed at describing and analysing retrospectively the clinical, serological, anatomical and evolutive aspects of 42 cases of hepatic amoebiasis treated and followed up in Papeete (French Polynesia) from 1984 to 1990. Painful hepatomegalia with fever, was a revealing sign once out of two. Complications started at initial stage only twice. Amoebic serology (by immunofluorescence or hemagglutination) was always positive, while pathogenic amoeba was absent in 95.2 p.c. of the cases. Hepatic amoebiasis always produces an intra-hepatic collection of pus: to that point of view, superiority of echotomography on other methods of investigation is evident, particularly to diagnose multiple collections (45.25 p.c. in this series). Recovery was always got, in most of the cases by only a medical treatment (39 cases) or in association with a puncture (2 cases). Nitro-imidazol compounds are the preferred treatment. They were efficient in all cases but one, and were always followed by a systematic colic parasiticidal treatment with a contact amoebicide.

[Cerebral vascular accidents in French Polynesia]. / Les accidents vasculaires cérébraux en Polynésie Française.

The authors report on the results of a survey on cardiovascular accidents hospitalized between 01 April 1990 and 31 January 1991 carried out in the Services of Medicine and Cardiology in the Territorial Hospital Center of Papeete. This survey was: 56 cardiovascular accidents: 1/4 (hemorrhagic and 3/4 (42) ischemic. Mean age 59 (extremes 23-86). 36 males (64%); 20 females (36%). 50 Polynesians; 6 Chinese people. Among the risk factors recorded, 38 (68%) were hypertensed patients; 17 (30%) were due to tabagism and 15 (25%) to diabetes; 3 (5%) are known to be carriers of a hypercholesterolemia. 59% of the patients had no case history; 25% the cardiovascular accidents have been observed in patients with cardiopathy; 12.5% are recurrent cardiovascular accidents. Clinically, 5 transient ischemic accidents (12%) out of 42 cardiovascular ischemic accidents. High arterial tension was recognized in 12/14 (86%) of hemorrhagic cardiovascular accidents and in 26/42 (62%) of ischemic cardiovascular accidents. In 42 ischemic cardiovascular accidents, 31 patients suffered from cardiopathy (74%) of which 15 (36%) presented an embolic cardiopathy. Interest of echography and electrocardiogram are discussed. Ultrasonic exam of carotid vessels was found abnormal in almost half of the cases when utilized (12/26). Finally, etiological diagnosis was certain in 17 cases, of presumption in 16 cases, and in 9 cases, it was not possible to precise any cardiovascular etiology. Tomodensitometric tests are discussed. 86% of the ischemic cardiovascular accident were treated with anticoagulants/thrombocyte antiagglutination. 24% of the patients died, 50% recovered incompletely and 26% completely.

[Historical multifocal tuberculosis in an African (apropos of a case report)]. / Tuberculose multifocale historique chez un Africain (à propos d'une observation).

A case of multifocal tuberculosis, similar to historic description of the disease is reported in a clear skinned African. Lungs, bones and joints (vertebreae, sternum, os coxae), liver and esophagus were affected by the disease. The low level of resistance found in the patient could explain this dissemination. Generally, prognosis is not compulsorily bad if the germ is sensitive to an additional chemotherapy which needs to be sufficiently prolonged.

[Hepatic amebiasis in French Polynesia. 16 cases in 2 years]. / L'amibiase hépatique en Polynésie française.

Asymptomatic amebiasis in known for long ago in French Polynesia; the presence of Entamoeba histolytica cyst carriers have been shown by several parasitological investigations. But, until now, no hepatic amebiasis case has been reported in this geographical area. An homogeneous series of 16 cases of hepatic amebiasis is reported here. The diagnosis was made by hepatic ultrasonography and confirmed by immunology (Indirect immunofluorescent tests gave always a positive reaction for a dilution of 1/512 or more). Clinical, biological and radiological signs are well known in tropical pathology. Therapy was always conducted with metronidazol by the authors. From the epidemiological point of view, 14 out of 16 cases come from Tuamotu Archipelago. This epidemiological fact appears important enough to carry out systematically hepatic ultrasonography and amebic++ serology for every patient evacuated from this Archipelago to Tahiti. Hence it must be kept in mind the possibility of hepatic amebiasis not only in people living in French Polynesia but also, for the ones coming from over there but living in France.

[Esophageal cancer in the tropical environment]. / Le cancer de l'oesophage en milieu tropical.

UNLABELLED: The esophageal cancer is unevenly distributed within the Tropical regions: while its prevalence rate is high in East and South Africa and in the Far-East, this rate is much lower in West Africa. In most cases, the practitioner will face very evolutive forms, generally out of range of any therapy. In developing countries, efforts must be directed towards three goals: -- EPIDEMIOLOGY: Detection of the predisposing factors such as traumatisms, the use of bethel, kath, tobacco, and, above all, alcohol (beer consumption is steadily increasing in African countries). -- DIAGNOSIS: Development of the endoscopy of the digestive tract. -- SURGERY: Its remains the only therapeutic solution; but it is costly, time consuming and major surgery.

[Primary liver cancer in the tropical environment. Classical and current data]. / Le cancer primitif du foie en milieu tropical. Données classiques et récentes.

In most cases, primary liver carcinoma in tropical areas remains an hepatoma. The high incidence of this malignant tumor of the liver in some regions, and especially in black Africa, is still unexplained. As compared with the form found either in the European or in the North-African, this hepatoma shows special features since it occurs in younger people (35 years), follows a bursting-out course and is precipitously associated not to an alcoholic cirrhosis but to a post-hepatitic one. An humoral syndrome leading to a presomptive diagnosis consists of hypoglycemia, hypercholesterolemia, hyperlipemia, and high blood level of alcaline phosphatases. In 85% of the cases, these tumors secrete an alpha fetoprotein determined by radioimmunoassay. A major etiologic factor is the oncogenous activity of hepatitis virus B which could be either an induction factor or a "co-factor" which would initiate, facilitate or increase the activity of the carcinogen. In this respect, aflatoxin has to be regarded as a "co-factor" too. The best treatment, when it is possible, is an exeresis carried out through a partial hepatectomy. If such a surgical intervention is unadvisable, chemotherapy is the only possibility. Immunization against viral hepatitis has raised hope for the prophylaxis of hepatoma. But it will not be possible to evaluate it before the year 2.000.

[Treatment of amibiasis with short-term secnidazole therapy]. / Le traitement de l'amibiase par le secnidazole en cure courte.

The authors have treated: a) 48 cases of E. histolytica histolytica intestinal amoebiasis by a single dose of 35 mg/kg of secnidazole with 98 p. 100 of parasitological success; b) 122 cases of E. histolytica minuta with several procedures: a unique dose of 25 mg/kg gives no success in 16.6 p. 100 of the cases, but the same single dose during three days gets only 2 p. 100 of failure; c) 22 cases of hepatic amoebiasis by a daily dose of 25 to 33 mg/kg during 5 days with success in every cases. Tolerance has been excellent. These short cures, facilitated by the long half-life of secnidazole are particularly easy to apply in developing countries.

[Current status of the physiopathology of pernicious malaria attacks]. / Actualité physiopathologique de l'accès pernicieux palustre.

The understanding of the pathophysiology of cerebral malaria has much benefited from the modern techniques of in vitro cultivation of Plasmodium falciparum and from a better knowledge of the biology of the parasite. The demonstration of the existence of "knob-like protrusions" explains some of the processes giving way to changes in the deep capillaries of viscera and particularly of brain. In a synthetic view one can say that this localized vasculopathy is the main factor of the pathologic changes observed in cerebral malaria.

[Present aspects of peritoneal tuberculosis in Africa (study of 77 cases) (author's transl)]. / Les aspects actuels de la tuberculose péritonéale en Afrique: étude de 77 observations.

77 cases of peritoneal tuberculosis recorded in Africa are reported. Ascitic peritonitis is the most frequent clinical form (64 cases). Laparoscopy is the main way, especially in tropical countries, to establish rapidly the diagnosis. Peritoneal white granulations, associated or not to adherences or to a vascular congestion, supported that diagnosis in 68 cases. Laparoscopy allows peritoneal and hepatic biopsies. Systematic peritoneal biopsy was not possible and was performed in 25 patients only with typical tuberculous pathologic lesions in 88 p. 100 of these cases. Hepatic needle biopsy demonstrated the existence of tuberculous follicles in 29.8 p. 100 of the cases and in 12 cases associated lesions such as a macronodular cirrhosis were observed. In spite of a specific treatment 2 patients died of tuberculous dissemination. Control after a long delay was not possible.

[Child amoebic dysentery in New Caledonia (author's transl)]. / L'amibiase dysenterique de l'enfant en Nouvelle-Caledonie.

After giving their diagnostic criteria, the authors report 8 cases of amoebic dysentery observed in children, in New Caledonia. The young patients' age ranges from 2 to 8. Clinical symptoms are the same as in adults but anemia and malnutrition are frequently associated to amoebiasis as well as various intestinal nematodes. Serological test has little value in colic amoebiasis but is useful to rule out an hepatic localization. Treatment is easy and effective with metronidazole.