Paget's disease of the vulva: A challenge for the gynaecologist.

Paget's disease of the vulva is a rare form of extramammary Paget's disease mainly affecting postmenopausal women. Its pathophysiology remains largely unknown. Up to fairly recently, the only treatment for this disease was surgery, often mutilating the vulva, with significant psychosexual repercussions without the assurance of complete therapeutic efficacy. New therapeutic approaches -topical treatments, radiotherapy or chemotherapy- have emerged in recent years but lack consensual guidelines. We present a literature review of the recent results published in this field.

Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.

Vulvar intraepithelial neoplasia (VIN) is classified into two entities: differentiated (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL). dVIN is a premalignant lesion that develops on an existing vulvar lesion such as lichen sclerosus, while vH-SIL is associated with HPV infection. The two entities differ in terms of pathophysiology, background, prognosis, and management. The incidence of VIN in young women is rising and recurrence is common, even after radical surgery, which can cause significant disfigurement. Alternative strategies include topical treatments, ablation, and a watch-and-wait approach. There is currently no consensus on how these lesions should be managed. We review the literature in this field.

Analysis of adenovirus DNA detected in rodent species from the Democratic Republic of the Congo indicates potentially novel adenovirus types.

Different species of adenoviruses (AdVs) infect humans and animals and are known for their role as pathogens, especially in humans, with animals, primarily rodents, often serving as model systems. However, although we know over 100 types of human AdVs, we know comparatively little about the diversity of animal AdVs. Due to the fact that rodents are the most diverse family of mammals and a standard model system for human disease, we set out to sample African rodents native to the Democratic Republic of the Congo and test them for AdV DNA using a semi-nested consensus PCR. A total of 775 animals were tested, and viral DNA was detected in four of them. The AdV DNA found belongs to three different AdVs, all being closely related to murine adenovirus 2 (MAdV-2). Considering the genetic differences of the amplicon were 9%, 11% and 19% from MAdV-2 and at least 10% from each other, they seem to belong to up to three different novel types within the Murine mastadenovirus B species. This evidence of genetic diversity highlights the opportunities to isolate and study additional AdVs that infect rodents as models for AdV biology and pathology.

A socio-economic study of Fasciola infections in cattle and sheep at the Etoudi slaughterhouse, Yaoundé, Cameroon.

A cross-sectional socio-economic study of fascioliasis in livestock was carried out at the Livestock Development Cooperation (SODEPA) slaughterhouse in Etoudi, Yaoundé during the periods covering the beginning and late dry season in the northern and eastern regions of Cameroon. A total of 768 cattle and 267 sheep were inspected for the presence of Fasciola species. The overall infection rate in cattle and sheep was 18% (n = 767) and 27% (n = 267), respectively. For the animals that were Fasciola positive, a total of 267.86 kg of liver in cattle was condemned, resulting in a loss of US$1124, while a total of 57 kg of liver was condemned from the sheep population, amounting to a loss of US$114. A total of US$76,097 was determined as losses incurred from condemnation of liver for both cattle and sheep per annum based on the total number slaughtered each year. The findings indicate that fascioliasis is present in cattle and sheep slaughtered in Cameroon and that it causes great economic losses due to condemnation of liver. The local climatic conditions, husbandry systems and the presence of snails (intermediate hosts) are probably the main factors influencing the incidence of the disease and may account for the epidemiological significance found in this study.

[Nutritional management of patients with head and neck cancer treated with radiation]. / Prise en charge nutritionnelle des patients atteints de cancer de la tête et du cou traité par irradiation.

Radiotherapy and chemotherapy are standard treatment of head and neck cancer alone or associated to surgical treatment. Early (during treatment or the following weeks) and late side effects contribute to malnutrition in this population at risk. In this context, nutritional support adapted by dietary monitoring and enteral nutrition (nasogastric tube or gastrostomy) are often necessary. The early identification of the patients with high malnutrition risk and requiring enteral nutrition is necessary to improve the tolerance and efficacy of treatment.

HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo.

Despite recent declines in HIV incidence, sub-Saharan Africa remains the most heavily affected region in the global HIV/AIDS epidemic. Estimates of HIV prevalence in African military personnel are scarce and inconsistent. We conducted a serosurvey between June and September 2007 among 4043 Armed Forces personnel of the Democratic Republic of Congo (FARDC) stationed in Kinshasa, Democratic Republic of Congo (DRC) to determine the prevalence of HIV and syphilis infections and describe associated risk behaviours. Participants provided blood for HIV and syphilis testing and responded to a demographic and risk factor questionnaire. The prevalence of HIV was 3.8% and the prevalence of syphilis was 11.9%. Women were more likely than men to be HIV positive, (7.5% vs. 3.6% respectively, aOR: 1.66, 95% C.I: 1.21-2.28, p < 0.05). Factors significantly associated with HIV infection included gender and self-reported genital ulcers in the 12 months before date of enrollment. The prevalence of HIV in the military appears to be higher than the general population in DRC (3.8% vs. 1.3%, respectively), with women at increased risk of infection.

Drainage of subperiosteal orbital abscesses complicating pediatric ethmoiditis: comparison between external and transnasal approaches.

OBJECTIVE: The aim of the present study was to compare the external (EA), transnasal endoscopic (TEA), and combined (CA) external and transnasal approaches to drain orbital subperiosteal abscesses complicating pediatric ethmoiditis. METHODS: This retrospective study included 38 children consecutively operated in our center for an orbital subperiosteal abscess complicating an acute ethmoiditis. The distribution of surgical approaches used for our patients was the following: 12 TEA (32%), 21 EA (55%) and 5 CA (13%). All data were retrieved from patients' clinical charts. RESULTS: No surgical complication was observed in the present study regardless of the approach. The percentage of surgical failures requiring additional drainage was almost twice as high after TEA (failure rate: 25%) than after EA (failure rate 14.3%), but this difference was not significant. Parameters which significantly influenced the risk of failure of TEA were the length and width of the abscess. The duration of postoperative hospitalization was significantly lower in the TEA group (3.1 days) than in the EA one (5.4 days). There were no failures in the CA group. CONCLUSIONS: Failures of surgical drainage of orbital subperiosteal abscess complicating pediatric ethmoiditis are not rare and did not differ between external and transnasal endoscopic approaches in our study. The transnasal route is associated with a shorter postoperative duration of postoperative hospitalization. CA seems to be a viable surgical option combining the advantages of both endoscopic and external approaches.

Prevalence of gastrointestinal parasites in primate bushmeat and pets in Cameroon.

To document the prevalence of gastrointestinal parasites in Cameroonian monkeys and to assess the risk of transmission to humans, we sampled 125 primates belonging to 15 species, of which 78 had been captured for bushmeat in the wild, and 47 were pets kept in urban areas. Seven nematode species, one trematode, one cestode and three protozoa were detected. Eight different parasite species were found in Cercopithecus nictitans and six in C. neglectus, C. pogonias and Cercocebus agilis. Helminths were found in 77% of monkeys, and protozoa in 36%. Trichuris sp. and Entamoeba coli were the most frequent parasites, being found in 54% and 36% of animals, respectively. Helminths were more frequent in adults than in juveniles, while the prevalence of protozoa was not age-related. No significant gender difference was found. Bushmeat monkeys had a significantly higher prevalence of helminth infection than pets (92% versus 51%), whereas there was no significant difference in the prevalence of protozoa (32% versus 43%). Among helminth species, Strongyloides fulleborni was more prevalent in bushmeat monkeys than in pets (55% versus 15%), as were Ancylostoma spp. (62% versus 9%). As these parasites are transmitted transcutaneously by infectious larva, they have a high potential for transmission to humans, during butchering. One pet monkey kept in an urban household in Yaoundé was infected by Schistosoma mansoni. The potential public health implications of these findings are discussed.

First report of Rhabdias (Nematoda: Rhabdiasoidea) from lungs of montane chameleons in Cameroon: description of two new species and notes on biology.

The lung nematodes of the genus Rhabdias parasitic in chameleons were previously only known from east Africa and Madagascar. Two new species are described from Cameroon: i) Rhabdias okuensis n. sp., type-host Chamaeleo (Trioceros) quadricomis gracilior, from Mont Oku, is frequent; it resembles R. jarki from Burundi, with a short buccal capsule and a long, thin oesophagus, and is distinguished by its large cervical vesicle and cephalic characters (mouth aperture, papillae). The female parasites are hermaphroditic (spermatozoa identified) and they pierce the lung wall and induce lesions, as R. jarki. In the same locality, another chameleon, C. (T.) w. wiedersheimi also harbours R. okuensis, as demonstrated with the 12S rDNA and coxl gene sequences. ii) R. cristati n. sp., type-host C. (T.) cristatus, from Mount Cameroon, is described from one heavily infected specimen; it resembles R. chamaeleonis from East Africa, and is distinguished by the large buccal capsule and the thick apex of the intestine. The free-living phase, studied in R. okuensis, presents characters of other Rhabdias from chameleons: heterogony, development of larvae through matricidal endotoky, infective larval stages with a thick, rounded caudal extremity, exuvium transformed into a thick cuticular sheeth. Each free-living female produces one larva, as in other African Rhabdias, whereas the female of R. gemellipara, a parasite of a Malagasy chameleon, produces two larvae.

[Biogeographical distribution of snakes in Cameroon: the case of venomous snakes]. / Répartition biogéographique des serpents venimeux au Cameroun.

A preliminary analysis of the distribution of snakes captured in Cameroon between 1999 and 2004 is presented in this study. This work helps to provide a better understanding of the distribution of the venomous snakes. The main focus of this study was to identify regions of high diversity of venomous species, a useful step towards developing a national strategy of snakebite care and antivenom distribution. We recorded 4,910 specimens of 150 species from 361 localities throughout Cameroon. Among the ten provinces in Cameroon, the southwest province recorded the highest number of venomous snakes. Diversity was less in the far-north province, but the high abundance of Echis ocellatus seems to be responsible for many snake bites in the region. Of all venomous snakes, the forest cobra Naja melanoleuca was the most abundant in the forest region. The humid savannah region was dominated by Causus maculatus while the Sahelian part by Echis ocellatus. Given the abundance and high snake bite cases of the latter in the region, snakebite care from a national point of view should begin from the far-north towards the forest region of the south-west Cameroon.

[Distribution of antivenoms in Cameroon]. / Distribution des sérums antivenimeux au Cameroun.

Two snake antivenoms are distributed in Cameroon, though their availability in district hospitals varies. These snake antivenoms are FAV-Afrique (Aventis Pasteur) available at Centre Pasteur Cameroun and Polyvalent serum (Serum Institute of India = SII) distributed by a wholesaler (CENAME). The price remains a very important factor. We have noted that some district hospitals do not stock antivenom at all, while others stock very few and sometimes only one vial whereas a good management of snakebite may require up to 14 vials for some envenomations. However, data collected by the CAMHERP project that permit to identify high-risk areas of envenomation might be used as a database for the distribution of snake antivenom in Cameroon.

Familial aggregation of malignant melanoma/dysplastic naevi and tumours of the nervous system: an original syndrome of tumour proneness.

A five-generation family is here reported in which several members developed malignant melanoma, dysplastic naevi, astrocytoma in all grades, benign or malignant schwannoma, neurofibroma, or meningioma in a single instance. Significant cosegregation of skin and nervous tumours, preclusion of allelism to type 1 neurofibromatosis and phenotypic departure from known syndromes of hereditary proneness to cancer make one suggest an original familial predisposition to both malignant melanoma and central/peripheral nervous tumours.

[Lingual thyroid and intra-lingual thyroglossal cyst. Apropos of 2 cases]. / Thyroide linguale et kyste thyréo-glosse basi-lingual. A propos de deux cas.

Lingual thyroid and intra lingual thyro-glossal cyst are two benign tumours of similar embryological pathogenesis respectively with the arrest in the ectopic position of the thyroid gland during its downward migration and from abnormal persistence of the thyro-glossal tract for the cyst. The occurrence of lingual thyroid is rare 1/100,000 patients and outnumbers the incidence of intra-lingual cyst which represents an estimated 2.1% of the thyro-glossal cysts or fistulas. Both lesions are a rare cause of dysphagia and dyspnoea due to oropharyngeal obstruction, and radionuclide scintigraphy combined with CT and/or MRI will establish the diagnosis. Surgical pharyngotomy with an infra-hyoid approach provides excellent access to the lesions and complete removal of the tumours.

[Autochthonal leprosy]. / Lèpre autochtone.

INTRODUCTION: In continental France, Hansen's disease is now a strictly imported disease. Native contamination is rare since the foyers described early in the century have totally disappeared. CASE REPORT: A case of locally acquired diffuse lepromatous Hansen's disease was observed in a patient who developed acrocyanosis with distal necrosis over a period of several years. Late cutaneomucal signs led to the diagnosis of Hansen's disease after eliminating sarcoidosis and tuberculosis. Skin biopsy with Ziehl stain confirmed the lepromatous nature of the disease. In addition the patient had undergone splenectomy following trauma and also developed babesiasis (a rare protozoan disease in Europe--15 cases reported--similar to Texas fever). DISCUSSION: The source of infection in this case of Hansen's disease was not found. As in the other cases reported in the literature, late diagnosis due to lack of any suggestive context allowed the disease to develop into an advanced stage.

[Synovial sarcoma with cervicopharyngeal expression]. / Sarcome synovial d'expression cervico-pharyngée.

A case is reported of a patient with cervicopharyngeal synovial sarcoma, and the clinical characteristics and therapy of these very rare tumors discussed. It appears difficult to assess prognosis because of the very few cases documented.