[Conjunctival squamous cell carcinoma. Four cases reported in the French West Indies]. / Carcinome épidermoïde conjonctival. A propos de quatre cas aux Antilles.

We report four cases referred to the Ophthalmologic Department of the University Hospital Center of Fort de France for the therapeutic management of a conjunctival malignant tumor. All cases reported involved conjunctival squamous cell carcinoma. All tumors were unilateral, one was localized, another was recurrent, one occurred in a patient with acquired immunodeficiency syndrome, and the last one was seen at the late stage of massive locoregional invasion. Three patients had surgery completed by corneolimbic cryotherapy. The last case was exentered. All of them consulted regularly. These four cases were collected over 5 years in approximately 15,000 patients examined per year in the University Hospital Center of Fort de France. Conjunctival squamous cell carcinoma is rare, even in Martinique, a tropical area. Careful attention to risk factors such as the sun exposure is recommended, as is the histologic diagnosis with any conjunctival tumour, since it changes quickly. The treatment must be adapted to the extension of the disease and to the patient's general health. The high rate of recurrence requires long-term follow-up in corneal and conjunctival intraepithelial neoplasia.

Mandibular pseudocarcinomatous hyperplasia.

AIMS: Three unusual cases of pseudocarcinomatous (pseudoepitheliomatous) hyperplasia (PH) affecting chronic osteomyelitic mandibular sequestra are reported to highlight the differences with the various squamous neoplasms which occur in that site. METHODS AND RESULTS: In two patients carrying a mandibular graft following the excision of an ameloblastoma, mucosal ulcers resulted in chronic osteomyelitis. In a third patient, an apical dental infection was associated with fistulated osteomyelitis. Histology of the three sequestra showed an intraosseous squamous proliferation. It was characterized by a peripheral involvement of medullary spaces, the more mature epithelial layer covering the bone trabeculae without intervening stroma, and the basal type epithelial layer surrounding a central fibrovascular core. There were no histological or cytological signs of malignancy. CONCLUSION: PH shows an inverted pattern when compared with the centro-medullary tumoural islands seen in the various oral or odontogenic squamous neoplasms which occur in the jaws. The lack of signs of malignancy distinguish PH from common squamous cell carcinomas. A short clinical course is an important feature in the distinction of PH from the well differentiated squamous cell carcinomas which may develop in fistulated chronic osteomyelitis.

Vaccine potential of a recombinant glutathione S-transferase cloned from Schistosoma haematobium in primates experimentally infected with an homologous challenge.

Patas monkeys were twice immunized with a Schistosoma haematobium-derived recombinant glutathione S-transferase (Sh28GST) then challenged with an homologous calibrated challenge. BCG and Freund's Complete Adjuvant (FCA) were used as adjuvants in two distinct protocols. Specific IgG and IgA antibody responses were intense and homogeneous in the animals receiving Sh28GST in the presence of FCA, whereas BCG could only induce moderate and heterogeneous antibody titres. No significant effect on worm burdens was evidenced 36 weeks post-infection in either group of Sh28GST-immunized animals compared to their matched controls receiving an irrelevant protein. Although not significant, 50% reductions in the numbers of eggs located in all tissues (FCA group) and in the urogenital system (BCG group) were noted. Moreover, the total number of excreted eggs was dramatically diminished by 60% and 77% in the BCG and FCA groups, respectively. These reductions reached 75% and 80% in the urines of vaccinated monkeys. Bladder pathology was also reduced in the animals displaying the lowest urinary egg excretions. There was no clear positive or negative correlate between antibody responses and individual levels of protection. Taken as a whole, our results show that Sh28GST was capable of significantly reducing S. haematobium worm fecundity in experimentally infected primates. Although FCA induced higher levels of protection, the efficacy of BCG as an adjuvant appeared sufficient to justify consideration of the future application of this new formulation as a vaccine against human urogenital schistosomosis.

Bronchial-pulmonary artery fistula after unilateral lung transplantation: a case report.

We report on a right bronchial-pulmonary artery fistula resulting in fatal hemoptysis in a 54-year-old man, 3 months after right unilateral transplantation for end-stage emphysema. The posttransplantation period was complicated by ulcerative tracheobronchial aspergillosis. Early treatment with itraconazole was performed. All samples of bronchial washing, bronchoalveolar lavage, and bronchial and transbronchial biopsy specimens were free of aspergillus after 3 weeks of treatment. Necropsy showed a fistula between the right pulmonary artery and the main right bronchus, situated just beneath the suture line.

Vaccination of patas monkeys experimentally infected with Schistosoma haematobium using a recombinant glutathione S-transferase cloned from S. mansoni.

The capacity of a recombinant glutathione S-transferase from Schistosoma mansoni (rSm28GST) to vaccinate primates (Erythrocebus patas) against a heterologous infection with Schistosoma haematobium has been tested. Two injections of the purified molecule with Muramyl-Di-Peptide (MDP) as adjuvant resulted in a high level antibody response in the five immunized animals and in a significant reduction in worm fecundity compared to the controls which received adjuvant alone. Mean levels of daily egg excretion in urine an faeces were reduced by respectively 55% and 74% although perfusion revealed that worm burdens were similar in both groups. The protective effect was long lasting since it was maintained up to the end of the experiment, 42 weeks after infection. Hatching rates and the numbers of intra-uterine eggs were also significantly affected by the vaccination. Tissue eggs were also drastically diminished in the urogenital system (-80%) but the reduction was not statistically significant. One animal was not protected by the immunization. There was a good correlation between parasitological data and the intensity of bladder lesions assessed by microscopic examination. Polypoid formations together with an intense exudation of the lamina propria were frequently seen in the controls but rarely in the vaccinated group where formation of scar tissue was predominant. These results underline the vaccine potential of the recombinant Sm28GST as a possible valuable prophylactic tool for the control of egg-induced pathology and transmission of African schistosomes.

Hepatitis B, C, and D virus infections in patients with chronic hepatitis, cirrhosis, and hepatocellular carcinoma: a comparative study in Niger.

Eighty-nine Sahelian African patients with chronic active hepatitis (CAH) (14), cirrhosis (49), hepatocellular carcinoma (HCC) (26), and 47 controls were tested for hepatitis B virus (HBV, hepatitis B surface antigen [HBsAg]) and hepatitis D virus (HDV, anti-HDV antibody). Seventy-three percent of the patients were positive for HBsAg versus 29.8% of the controls (P < 0.0001). With anti-HDV test, 55.0% of the patients were positive versus 17.0% of the controls (P < 0.0001). To assess the prevalence of antibody to hepatitis C virus (HCV), we used an enzyme-linked immunosorbent assay for screening (anti-HCV2): 19.1% of the patients were positive versus 6.4% of the controls (P < 0.05). An association between HBsAg and anti-HDV-positive test results was found in 46.1% of the patients versus 6.4% of the controls (P < 0.0001). A combination of HBsAg and anti-HCV2-positive test results was found in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Anti-HDV and anti-HCV2 test results were positive in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Triple-positive test results (HBsAg, anti-HDV, and anti-HCV2) were found in 11.2% of the patients but in none of the controls (P < 0.025). Triple-negative test results were found in 14.6% of the patients versus 57.4% of the controls (P < 0.0001). The predominant association of the chronic HBV infection with CAH, cirrhosis, and HCC is confirmed in Sahelian Africa. The HDV superinfection (chronic HBV plus HDV infections) may be a major etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gingival lesions in ameloblastoma: value of preoperative biopsy]. / Les lésions gingivales dans l'améloblastome. Intérêt de la biopsie pré-opératoire.

Ameloblastomas are common in Niger. Their main risk is recurrence, which nearly always follows inadequate surgery: these tumors require radical excision followed with mandibular graft. A preoperative diagnosis is therefore indispensable. X-ras are non-specific. In Niger, the danger of osteomyelitis makes surgical biopsies dangerous. The attention is brought to the existence of gum lesions in 8 cases of ameloblastoma in Nigerian patients. Their biopsy may provide the diagnosis in quick and safe conditions.

[Apropos of 1 case of ophthalmologic manifestation of bilharziasis]. / A propos d'un cas de manifestation ophtalmologique de bilharziose.

We present an ocular manifestation of schistosomiasis. We observed the case of a 10 year old young girl living near a flooding canal of the Niger river. She presented a tumor of the left lid associated with an important ptosis. This tumor resulted from numerous polyps of the conjunctiva. The histological analysis of a biopsy of the conjunctiva made the diagnostic. It was confirmed by the analysis of urine and by the important amelioration of inflammation resulting from a specific therapy.

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.

[Non-aplastic N2 operated bronchial cancers. Multifactorial analysis of the prognosis]. / Cancers bronchiques non anaplasiques, N2, opérés. Evaluation multifactorielle du pronostic.

The marked disparity of the published 5-year survival rates (0 to 3%) for non-anaplastic, operated N2 lung cancers would suggest the marked heterogeneity of the patients studied. We prospectively studies 97 N2 tumours for which "curative" resection was performed between 1983 and 1986. The overall survival rate was 28% at 3 years, 19% at 4 years and 12% at 5 years. Survival was studied on the basis of several parameters concerning the tumour: histological type and degree of differentiation, T (TNM), modality of invasion (circumscribed, infiltrating), the quality of the stroma (absent, fibrotic, cellular), the mitotic index, the necrosis rate, presence or absence of microscopic invasion of blood vessels; and concerning the nodes: site, number (solitary, multiple), size of the metastasis (massive, microscopic), macroscopic or microscopic invasion of the capsule. We know the outcome for all of our patients: 81 have died and 16 are still alive. Sixty-one have developed metastases, 5 have developed local and regional recurrences and 3 have both a recurrence and metastases. Univariate analysis demonstrated that a small number of parameters significantly influence survival: microscopic invasion of blood vessel (chi 2 = 5.24, p less than 0.02), macroscopic and microscopic invasion of the lymph node capsule. In order to more clearly define the prognostic factors, we used Cox's multidimensional model. This model was applied to the three significant parameters to which we added two other variables which non-significantly tended to be related to survival: tumour necrosis and number of lymph nodes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anacollagenase by the action of amitriptyline on Clostridium histolyticum collagenase]. / Anacollagénase résultant de l'action de l'amitriptyline sur la collagénase de Clostridium histolyticum.

Intraperitoneal injection of a mixture of collagenase (300 U) and amitriptyline (Laroxyl*, 3 mg) induce no lesions in contrast with the severe effects of collagenase alone. Also, a complete resistance to intraperitoneal collagenase injection is observed when preceded by 3 intramuscular injections of the same mixture (associated with Freund's incomplete adjuvant). This is due to the development of collagenase antibodies, as demonstrated by nephelometry and immunodiffusion. These facts show that amitriptyline neutralizes the enzymatic properties of collagenase, without alterring its antigenicity. We propose to call this new substance anacollagenase. Such a phenomenon has never been observed with a drug. However we got identical results with other tricyclic depressants (clomipramine, imipramine, doxepine, iprindole). The mechanism of the transformation of collagenase into anacollagenase is not yet explained.

Melanin in a dentigerous cyst and associated adenomatoid odontogenic tumor.

The authors report on a case of dentigerous cyst associated with odontogenic adenomatoid tumor in an 8-year-old black Nigerian boy. Both the cyst and the tumor contained melanocytes and melanin-laden epithelial cells. To their knowledge this is the first reported case of melanotic follicular cyst and adenomatoid tumor. A review of the literature revealed that melanin is rarely found in odontogenic lesions. Since the neural crest influence on the development of odontogenic tissues is well established, the occurrence of melanocytes in these tissues is not surprising. A racial predisposition may be present; black patients predominated in the 15 reported cases of melanotic odontogenic lesions.

Cutaneous leishmaniasis in Niger.

This is the first report of cutaneous leishmaniasis in Niger subsequent to the initial finding in 1911 and the report of a second case in 1943. The clinical, histopathological, and epidemiological features of 64 parasitologically confirmed cases are described. Lesions were mostly multiple, situated on exposed areas of skin, but rarely on the face. Two clinical forms were predominant: ulcero-crusted and humid-ulcerous. Nodular lymphangitis was not uncommon. Patients were mostly from rural areas, but urban transmission did occur. The majority of lesions appeared during the June-October rainy season. All features appeared to be similar to those of this disease in other countries in the sahelian endemic zone.

[Development of 62 typical carcinoid tumor of the bronchi surgically treated. Prognostic value of histopathological features]. / Evolution de soixante-deux tumeurs carcinoïdes typiques des bronches opérées. Valeur pronostique des caractères histopathologiques.

The pathological and clinical features of 62 carcinoid tumours of the bronchus operated between 1975 and 1987 were reviewed in order to determine the prognostic value of certain parameters: limit of proliferation, vascular invasion, lymph node involvement. This series corresponded to 36 central tumours and 25 peripheral tumours, all treated surgically. One patient was lost to follow-up, 3 developed recurrences, 56 are still alive without recurrence and 3 died from intercurrent causes. The histological appearance of the tumours was homogeneous and typical. Twenty-eight lesions were strictly intrabronchial, 34 invaded the lung with incomplete limits in twenty cases. The tumour showed signs of vascular invasion in ten cases and the adjacent lymph nodes were invaded in eight cases. The local recurrence was undoubtedly related to an excessively conservative primary resection, as the primary tumour did not demonstrate any unusual features. The two tumours which metastasized showed vascular invasion: one metastasized to a hilar node, but these features were observed in other cases which retained a benign course. The standard histological diagnosis of typical carcinoid tumour does not appear to raise any particular difficulties; it is reliable. The course of the disease is sometimes malignant but no histological parameter is able to accurately predict this outcome.

[Diagnostic approach to basocellular nevomatosis from a dental point of view. Apropos of a new case]. / Démarche diagnostique de la naevomatose baso-cellulaire vue sous l'angle odontologique. A propos d'un nouveau cas.

A new case of basal cell naevomatosis, localized in the jaws as odontogenic keratocysts, is described and the importance of the diagnostic role plaid by the dentist is underlined. Skin lesions, bone involvements and the hereditary character of the disease are described. Special emphasis is given to the importance and the easy accessibility of the oral manifestations. Possible evolution towards advanced forms, and the heterogeneity of the symptoms lay the stress on the need of an early diagnosis and the necessity of a close collaboration with the various specialists concerned.

[Sweat gland tumors in Niger. Anatomopathology]. / Tumeurs sudorales au Niger. Etude anatomo-pathologique.

The authors report 15 cases of sweat gland tumour observed over 2 years in Niger where their pathology was never studied. These tumours accounted for 0.38 p. 100 of all examinations performed during the same period at the pathological laboratory of the University of Niamey. They ranked sixth among the diagnoses of skin pathology. Only routine histological techniques were used. The diagnoses obtained could be divided into 5 groups. Eight women presented with partly solid cystic tumours located on the legs in 5 cases; their structure was typical of nodular hidradenoma. Two male patients had cyst-pitted tumours the superficial portion of which showed a structure of papillary eccrine adenoma, while the deep portion contained a multitude of cysts with atrophic walls; the authors consider this type of tumour as a variant of papillary eccrine adenoma. One patient had a syringocystadenoma which also included a large cyst. Finally, one patient presented with a chondroid syringoma in the axillary region, and 3 patients had histologically aggressive carcinomas located on the sole, forehead and axillary region respectively. Clinical and paraclinical investigations failed to detect any deep malignancy in these three patients, and their tumours were regarded as compatible with sweat gland carcinomas. In this series, two lesions were unusually numerous: carcinomas and nodular hydradenomas. The first named probably are a consequence of the socio-economic conditions prevailing in the population of Niger: poverty prevents patients from consulting for diseases which produce no symptoms, which artificially increases the apparent incidence of aggressive lesions. As for nodular hydradenomas, they are large owing to the presence of cysts.(ABSTRACT TRUNCATED AT 250 WORDS)