[Hemiparesia with cutaneous and mucosal ulcerations in a black-skinned man]. / Hémiparésie et ulcérations cutanéo-muqueuses : chez un homme génétiquement pigmenté.

The purpose of this report is to describe the case of a 46-year-old Comorian man in whom presentation with right hemiparesia with buccal and genital ulcerations lead to diagnosis of Behçet's disease. The most remarkable aspect of this case is the patient's ethnic group since Behçet's disease is less frequent in Africans than Caucasians. The most likely explanation for this difference is the absence of genetic susceptibility linked to HLAB51 that is rare in Africans. However lack of awareness of Behçet's disease and changes in environmental triggers in Africa cannot be ruled out.

[Arterial hypertension in sub-Saharan Africa. Update and perspectives]. / Hypertension artérielle en Afrique subsaharienne actualité et perspectives.

Arterial hypertension is a worldwide health problem due to its high incidence and to related cardiovascular and renal risks. More than 25% of adults in the world have hypertension and this percentage is expected to increase in the coming years in all areas including sub-Saharan Africa. There were approximately 80 million patients with hypertension sub-Saharan Africa in 2000 and projections based on current epidemiologic data suggest that this figure will rise to 150 million by 2025. The increase in the incidence of hypertension appears to be closely correlated with aging of the population as well as with the growing number of overweight and obese persons. Association with type II diabetes is particularly deleterious. These trends show regional variations with prevalence being associated with the rate of urbanization and westernization of lifestyle. In Black Africa hypertension presents several etiopathogenic particularities mainly with regard to dependence on sodium sensitivity and lower plasma renin activity. Due to delayed and/or inadequate therapeutic management and to a likely genetic predisposition, organ-related complications are more common and occur earlier in Black Africa. Stroke, heart failure, and renal failure are frequent complications in young patients. From a therapeutic standpoint, the mainstay treatment involves the use of thiazidic diuretics in association with hygiene and dietary measures especially sodium restriction. This article provides an update of recent findings in this domain.

Hypertension arterielle en Afrique subsaharienne - Actualite et perpectives

L'hypertension arterielle (HTA) represente un probleme de sante publique a l'echelle mondiale en raison de sa frequence et des risques de maladies cardiovasculaires et renales qui lui sont attaches. Plus d'un quart de la population mondiale adulte est hypertendue; cette proportion devrait augmenter dans les annees a venir et l'Afrique sub-saharienne ne fait pas exception a cette tendance. Environ 80 millions de patients y souffraient d'HTA en 2000; et selon les projections epidemiologiques ils seront 150 millions en 2025. L'accroissement de l'incidence de l'HTA parait etroitement lie au vieillissement de la population; mais aussi a l'augmentation du nombre de sujets obeses ou en surpoids. L'association au diabete de type 2 est frequente et particulierement deletere. Il existe des variations regionales de ces tendances; avec un niveau de prevalence stimule par le phenomene d'urbanisation et les changements de mode de vie. EnAfrique Noire; l'HTA comporte des particularites etiopathogeniques; notamment son caractere sodium-dependant et une activite renine plutot basse. Les complications au niveau des organes cibles sont frequentes et precoces; temoignant a la fois d'une prise en charge therapeutique tardive et ;deficitaire; et d'une tres probable susceptibilite d'origine genetique. Les accidents vasculaires cerebraux; l'insuffisance cardiaque et l'insuffisance renale compliquent souvent l'evolution et surviennent chez des sujets jeunes. Sur le plan therapeutique; la classique sensibilite aux diuretiques thiazidiques demeure a la base de la prise en charge; en association auxmesures hygienodietetiques et notamment a la reduction des apports sodes. Cette revue fait le point sur les connaissances les plus recentes dans ce domaine

[Thoracic aortic dissection revealed by systemic cholesterol embolism]. / Dissection de l'aorte thoracique révélée par des embolies systémiques de cristaux de cholesterol.

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

Coronal and apical lesions, environmental factors: study in a modern and an archeological population.

Apical periodontitis (AP) are frequent findings in contemporary dental practice in association with dental pathology or dental care. They have also been studied from an anthropological background. The purpose of this study was to compare the prevalence of apical and dental lesions in an archeological Middle Ages sample and a modern population, and to evaluate the influence of environmental factors. Both the archaeological sample group and dental practice subjects were from southern France. The study included full mouth surveys of 252 individuals (2,780 teeth) from a historic necropolis and 223 subjects (5,678 teeth) randomly selected from the Gard area. Tooth wear, caries, and AP were accounted for clinically and radiographically according to specific indexes. Significant differences were found between period and age in the archeological sample as regards the main risk factors for AP. Antemortem teeth loss and dental wear had been reduced, whereas caries rates and AP had increased between archaeological and modern population. The AP ratio was associated with the level of dental care in the modern population. Although significant variations could be observed between archaeological periods, the rupture in E3 (sixteenth and seventeenth centuries) leads to consider the associated population as a premodern. However, it was found that although cultural and alimentary factors seemed to be the main risk factors in an archeological population, dental care seemed to have a strong influence on AP ratio in modern ones.

Dental crowding in a prehistoric population.

The aims of this study were to investigate dental crowding from the Copper Age and examine the extent and patterns of wear. Crowding was estimated in 43 adult mandibles using Little's irregularity index. Dental wear, dental diameters, arch width and the presence of third molars were also studied as possible aetiological factors for crowding. The remains were found at the archaeological site of Roaix, located in the south of France. Radiocarbon dating indicated that the lower layer was from 2150 +/- 140 years BC (date +/- 1 standard deviation) and the upper level from 2090 +/- 140 years. The graves were estimated to contain the remains of 150 adults and 50 children. Forty-three intact mandibles were used for this study. All of the mandibles presented incisor crowding with a majority of minimal and moderate irregularities, but in seven cases there were extreme irregularities and in two canine impaction was observed. These results are in contrast with the literature where it is reported that malocclusions were rare in prehistoric populations. The findings of this study suggest that crowding may be of a genetic origin and might not be caused by excessive tooth size or changes in environmental factors (masticatory activity).

[Plague outbreaks in the Mediterranean area during the 2nd World War, epidemiology and treatments]. / Epidémiologie et prise en charge des épidémies de peste en Méditerranée au cours de la Seconde Guerre Mondiale.

Before the Second World War, the plague was still rife in North Africa but occurred only as sporadic cases or small outbreaks as in Egypt or Morocco. The permanent foci of infected wild rodent were the cause of these rural outbreaks. In 1943 and 1944, plague came back in several Mediterranean towns and ports and was considered as a serious danger for the Allied Forces. These resurgences were related to the World War as well as the overpopulation of the cities, regroupings and population movements, relaxation of prophylactic measures of the plague in sea transport. The Allied Forces medical officers then showed the resistance of Yersinia pestis to penicillin which they had been supplied with recently, the effectiveness of sulphamides but mortality remained high (27%). In parallel, the drastic fight against rodents and fleas (DDT) gave excellent results.

[Indigenous medical assistance in Madagascar (1898-1950)]. / L'assistance médicale indigene à Madagascar (1898-1950).

The foundations of local health services in Madagascar were laid when the island was taken over by the French in 1896. Medical care was a major priority for the first colonial governor named General Galliéni. Local health services expanded greatly from 1896 to 1950 thanks notably to institutions such as the Tananarive Medical School and Pasteur Institute. These services played a crucial role in the fight against smallpox and bubonic plague. However they were also used for political purposes by both colonial and independent governments. In sum the history of local health services in Madagascar can be described as a battle between political power and scientific knowledge. The overall result is positive for some and controversial for others.

Brief communication: Study of noncarious cervical tooth lesions in samples of prehistoric, historic, and modern populations from the South of France.

Noncarious tooth lesions (NCTL) are frequent findings in contemporary dental practices. Unlike other dental and periodontal diseases, NCTL have not been studied in an anthropological context. The purpose of the present study was to compare the prevalence of NCTL in three archaeological samples from the Copper Age and Middle Ages and in subjects examined in three dental practices. Both archaeological samples and dental-practice subjects were from southern France. In the archaeological sample group, no NCTL were detected in 3,927 teeth from 259 individuals. In the dental-practice group, prevalence rates were in agreement with current epidemiological data. Our data also suggest that prevalence of NCTL increases with age and is higher in females. Premolars were the most affected tooth type. Occurrence of NCTL has long been attributed to toothbrushing and to erosion by intrinsic and extrinsic acids. More recently, occlusal stress associated with tooth flexure has been implicated. The reasons underlying the total absence of NCTL in archaeological samples are discussed. The most likely explanations involve differences in lifestyle, diet, and dental condition.

Comparison of occlusion in medieval and present-day populations in southeast France.

Two groups living in southeast France several centuries apart were compared to assess changes in occlusion from medieval times to the present day. The present-day sample included 82 people, and the medieval sample included the skulls of 58 people who lived between the 8th and the 17th centuries. Variations in tooth contacts were examined in accordance with Angle classification. A decrease in Class III occlusion (mesioclusion) was noted from medieval to present-day populations. The rate of Class II occlusion (distoclusion) has increased progressively and has became a general feature in the present-day population (34%). Although the rate of Class I occlusion has generally decreased from proto-historic and medieval times to the present day, it is still the highest percentage (45%) and thus the "normal" reference in European populations. This study highlights distoclusion in human teeth and allowed us to ask questions about functional, genetic, psychological, and environmental factors that cause this malocclusion as opposed to the global harmony that Angle described.

[Buerger's disease and coronary disease]. / Maladie de Buerger et atteinte coronaire.

The authors report the case of a 33 year old man with distal occlusive arterial disease diagnosed as Buerger's disease, with two previous transient ischaemic attacks and coronary disease resulting in myocardial infarction. Coronary angiography showed narrowing of the second segment of the left anterior descending artery, occluded distally and not suitable for revascularisation. The observation of coronary artery disease is very rare in Buerger's disease and data of coronary angiography are very sparse in this context. The occurrence of myocardial infarction and the angiographic appearances of the left anterior descending artery raise the question of coronary involvement of Buerger's disease.

[Salmonella aortic valve endocarditis presenting with rupture of a femoral artery mycotic aneurysm]. / Anévrisme mycotique fémoral rompu, révélateur d'une endocardite aortique à salmonelle.

The incidence of Salmonella enteritidis infections has greatly increased over the last few years. Cardiovascular are amongst the most severe extra-digestive complications. The authors report a case of Salmonella enteritidis presenting with rupture of a femoral artery mycotic aneurysm in a chronic alcoholic patient. Salmonella enteritidis was isolated from blood cultures and the operation specimen after the obligatory limb amputation. The outcome was finally favourable after appropriate antibiotic therapy with a residual, stable grade 3 aortic regurgitation. This rare condition is generally observed in immuno-compromised subjects and carries a high mortality (40 to 70% of cases). The initial infectious signs may be masked, and, in these cases, rupture of an aneurysm is often the mode of presentation. Rapid treatment is essential with, ideally, resection of the aneurysm with reestablishment of arterial continuity and adapted, prolonged antibiotic therapy.

[History of the concept of quarantine]. / Histoire du concept de quarantaine.

Quarantine is a concept developed by society to protect against the outbreak of contagious diseases. From its original application in the favorable context of Medieval Europe, the quarantine concept has been driven by three main currents. The first involves the personification of epidemics. Although this personification had superstitious implications and led to many excesses, it did have the merit of establishing a concrete connection between travel and outbreak of disease. The second fundamental aspect of quarantining is the existence of a social organization capable of providing the necessary infrastructure for isolation. Specialized facilities are needed and laws must be made and enforced by competent officials. The last fundamental aspect of the development of the quarantine concept is the role of science. After a long process involving better medical knowledge and international negotiations, epidemic controls has largely outgrown the early stage involving essentially local control measures. In accordance with the development of these three currents, infected individuals have been branded as curse bearers, possible criminals, and innocent victims of natural contamination. While forced quarantine is no longer practiced, several recent examples of heated debates illustrate that strong emotional feelings are still present in societies threatened by epidemic disease outbreak. Since the major responsibility for disease control now rests in their hands, physicians must take these factors into account for management of possible future epidemic crises.

[Aorto-coronary dysplasia and pseudoxanthoma elastica]. / Dysplasie aorto-coronaire et pseudoxanthome élastique. A propos d'un cas.

The authors report the case of a 50 year old man with pseudowanthoma elastica with a history of myocardial infarction and severe aortic regurgitation. Angiography showed multiple coronary artery aneurysms and aneurysmal dilatation of the aortic annulus. The outcome after triple coronary bypass surgery with aortic valve replacement in a valved Bentall conduit was favourable. Pseudoxanthoma elastica is a rare condition in which the prognosis depends on the degree of vascular involvement. In this context, coronary artery aneurysms and aneurysmal dilatation of the aorta are rare complications.