Hepatic lesions of vascular origin in multicentric Castleman's disease, plasma cell type: report of one case with peliosis hepatis and another with perisinusoidal fibrosis and nodular regenerative hyperplasia.

We report two cases of multicentric Castleman's disease, plasma cell type, associated with three different liver lesions. Peliosis hepatis was observed in one case and perisinusoidal fibrosis with nodular regenerative hyperplasia in the other. These observations give some evidence that Castleman's disease, per se, may be involved in these three presumably interrelated liver vascular lesions. These changes, already described in monoclonal lymphoproliferations such as myeloma and Waldenström's disease, may also be recorded in a disease characterized by a strong polyclonal plasma cell hyperplasia.

Human hydatidosis in Niger.

Thirty-two cases of hydatidosis were collected in two Nigerian hospitals during a 5-year period; 81% of these had extra-hepatic localizations. Human hydatidosis has been considered as exceptional in West Africa but seems to be an underestimated disease in Niger. Studies in slaughtered animals from Niger show a high prevalence of hydatidosis in camels while no infection was found among sheep.

[Neurologic diseases in Niger]. / Les maladies neurologiques au Niger.

The authors report the results of a study realized at National Hospital of Niamey (Republic of Niger) from october 1981 to may 1986. Among 4820 patients living in Western Niger, 410 (8.5%) had neurological disorders. Out of 16 recognized syndromes 6 constitute 75.2%: comas, paraplegias, cranial nerves palsies, convulsions, hemiplegias and sciaticas. An etiological diagnosis is made in 269 patients. From 15 diseases 4 totalize 73.5%: there are medullar compressions, infections of the central nervous system (bacterial meningitis, cerebral malaria), cerebral vascular disturbances and metabolic encephalopathies. POTT's disease is the most common cause of medullar compression with paraplegia and arterial hypertension is a very important etiologic factor of cerebral vascular attack (42.2 and 44.4% respectively). Parkinsonian syndrome and multiple sclerosis seem rare. The diagnosis of cerebral tumor is very uncommon but this is in relation to the absence of autopsy and of recent investigation (scanner). No case of tuberculous meningitis is noted and this can't be explained by the authors in a major tuberculous endemic area.

Mycetoma in the Republic of Niger: clinical features and epidemiology.

Mycetoma is a common disease in the Republic of Niger. In two hospitals 133 cases were observed. The major site of lesions was the foot. Actinomycetomata were seen more often than eumycetomata. Streptomyces somaliensis is prevalent in the north desert zone while Actinomadura pelletieri is common in the southern part of the country. Madurella mycetomatis, the usual etiologic agent of eumycetoma, is seen in both regions. The species incidence and distribution in Niger differs from those of the west and east African endemic areas.

[Hydatid cyst of the thyroid. Apropos of a case in the Republic of Niger]. / Kyste hydatique de la thyroide. A propos d'un cas en République du Niger.

Thyroid echinococcosis has been rarely found, especially in areas where hydatic cysts are rarely encountered. The authors report on a case of thyroid echinococcosis in a patient living in sahelian Africa (Niger), which is classically known as a region of low endemia for hydatic disease.

[A case of hydatid cyst of the mediastinum in the Republic of Niger]. / A propos d'un cas de kyste hydatique du médiastin en République du Niger.

The authors report on an observation made at the Niamey hospital, because of the combined infrequency of both human hydatidosis in western Africa and mediastinal localization of the observed cases.

[Surgical therapy in African mycetoma. Indications a propos of 160 cases]. / Thérapeutique chirurgicale dans les mycétomes africains. Indications á propos de 160 cas personnels.

The authors treated 160 cases of African mycetoma in Mauritania and then in Niger from september 1978 to june 1985. They here underline some guidance in the application of the utilizable surgical techniques, according to environment. The localizations met are described as well as criteria of diagnosis, pathological aspects, and responsible agents. It is important to scrutinize the extension of the lesions, and to carry out a socio-economic survey, prior to take any decision to operate. After a short commentary on the medical treatment, the authors recalled the classical surgical techniques. They explicit the criteria they selected to decide the type of intervention, along their serie. If surgery has still a preponderant position in the treatment of African mycetoma, hopes are in the discovery of a more efficient medical therapy, and the early diagnosis leading to a limited surgical therapy.

[63 cases of mycetoma in the Niger Republic (etiological study based on histopathology)]. / Soixante-trois cas de mycétomes en République du Niger (bilan étiologique basé sur l'histopathologie).

63 samples of mycetomas were examined between 1981 and 1984. Most of them (53 cases) were actinomycotic mycetomas of which 20 were due to Streptomyces somaliensis, 17 to Actinomadura pelletieri, 11 to Nocardia sp., 4 to Actinomadura madurae. The 11 mycotic mycetomas were all due to Madurella mycetomi (= M. mycetomatis).

[Relations of sinusitis and primary glomerulonephritis]. / Rapports entre les sinusites et les glomérulonéphrites primitives.

Certain types of glomerulonephritis develop typically as the result of focal infection, and may recover following effective treatment of the infective focus at cause. Apart from the classical immunity mechanism consisting of the formation of immune complexes with the bacterial antigen, a major role for environmental allergens must also be evoked, as well as the probable existence of different immunity mechanisms at the origin of certain types of GN (mainly mesangial GN with IgA deposits and lipoid nephrosis). Invasion of the pulmonary allergen through a rhinosinusal route is responsible for a rhinosinusitis demonstrating a typical clinical features and course. Progression of the rhinosinusitis runs parallel with that of the GN. The course of the GN may be improved after treatment of the sinusitis and the allergic disposition. Ten particularly significant case-reports of GN associated with rhinosinusitis are studied from various aspects.

[Pseudo-lymphomas of the ocular adnexa: their relations to Sjögren's syndrome (author's transl)]. / Les pseudolymphomes des annexes oculaires: leurs rapports avec le syndrome de Sjögren.

Studies over the last fifteen years, of histological, immunological and hematological parameters has, led to the description of a non-malignant lymphoproliferation: a pseudo-lymphoma which is in the middle of the spectrum between glandular localisation of Sjögren's syndrome and frank neoplasia. This type of proliferation has been also observed in the conjunctiva, without antecedents of Sjögren syndrome. Histologically and immunologically, it is dysimmunitary process which has the potential to regress with appropriate immunosuppressive therapy, or to progress to malignant lymphoma.

[Unusual aspects of Burkitt's disease in Mauritania]. / Aspects particuliers de la maladie de Burkitt en Mauritanie.

The authors report on four observations on Burkitt's lymphoma fro Mauritania: three nodes lymphoma and one abdomen tumor. Mauritania climatic conditions are far from climatic conditions suitable to Burkitt's lymphoma development. Classical monochemotherapy (cyclophosphamide or methotrexate) were inefficient. Therefore, the authors suggest to utilise a polychemotherapy including cyclophosphamide, adriamycin, VM 26, and prednisone.

[Functional aortic systolic murmurs in the elderly]. / Souffles systoliques en écharpe "innocents" des sujets âgés

The authors report a clinical and phonocardiographic study of functional aortic systolic murmurs in 26 elderly patients, in 19 of which the lesion was confirmed pathologically. Systolic murmurs radiating across the chest in elderly have the same clinical characteristics as aortic stenosis from which they may, however, be distinguished owing to the: absence of a thrill during systole. The brief duration and the proto-meso-systolic position of the murmur with early inscription of maximal oscillations on the phonocardiogram. Conversion of the second aortic sound. Almost constant absence of a diastolic murmur. Normal carotid arteriogram, including normal ejection time after correction and time of half rise. "Innocent" systolic murmurs are due to calcification of the aortic valve without stenosis, and/or dilatation of the ascending aorta. There is no systolic pressure gradient between the left ventricle and the aorta during cardiac catheterisation. No lesions were found in the mitral valve suggesting mitral incompetence, therefore, we consider the term mitro-aortic murmur used by Huchard should be dropped; Radiation of the murmur from the apex of the heart up into the neck may be explained by the simultaneous occurrence of anatomical changes due to age and/or hypertension and by the vibratory nature of the murmurs which become propagated above and below their origin, as shown by the intracardiac recordings.

[Various etiologies of systolic murmurs radiating from the apex of the heart to the neck]. / Les variétés étiologiques des souffles systoliques en écharpe

The authors studied systolic murmurs in 89 cases, 50 of aortic stenosis, 14 cases of obstructive cardiomyopathy and 20 cases of mitral incompetence. This systolic murmur is characterised by its exceptional intensity, its raspy character at the base, becoming softer at the apex and in the axilla, the presence of a thrill and irradiation into the neck in 50 to 75% of cases. The etiological diagnosis was ensured precisely by 1) pharmaco-dynamic tests: amyl nitrite accentuates the systolic ejection murmurs and attenuates murmurs due to mitral regurgitation. 2) careful analysis of diastole: a systolic murmur extending into early diastole, a third sound or an opening snap and a low-pitched diastolic murmur, suggest mitral incompetence. A high-pitched diastolic murmur is in favour of aortic stenosis. 3) the carotid arteriogram and catheterisation show the characteristic abnormalities of the carotid arteriogram found in aortic valve disease and the existence of a trans-aortic or intra-ventricular pressure gradient, when there is an obstruction to left ventricular jection. The F wave of the apex cardiogram or left atrial reflux of the contrast medium during cineangiocardiography, confirm mitral incompetence. The main phono-hemodynamic and phono-anatomical correlations have been emphasized: 1. The intensity of the systolic murmur is directly proportional to the degree of obstructive cardiomyopathy or mitral incompetence, but does not parallel the degree of the sub-valvular apparatus. 3. The maximum intensity of the murmur occurs all the later when the stenosis is tight, whilst it is earlier in severe obstructive cardio-myopathy. 4. The lozange shape of the murmur of mitral incompetence on phono-cardiography is, above all, due to those cases with lesions of the sub-valvular apparatus. Finally, a study of the sound recorded by the Allard-Laurens micromanometer permitted us to determine the mechanism of this irradiating systolic murmur.