[Health anxiety: Another epidemic to prepare for]. / L'anxiété centrée sur la santé : une autre épidémie à laquelle il faut se préparer.

Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France.

Tubulointerstitial nephritis in methylmalonic acidemia.

We report two patients with methylmalonic acidemia (MMA) in whom renal biopsy demonstrated interstitial nephritis, bringing the total of such reported cases to four. In addition, hypertension, observed in one of our patients, has not been previously reported as the presentation of renal disease in MMA. The etiology of interstitial nephritis in MMA did not appear to be due to urate nephropathy. To date, 15 patients with MMA have been reported with renal complications, including chronic renal failure, making it imperative that children with MMA have their renal status evaluated.

Immunoperoxidase in lymphomas induced by host-versus-graft (HVG) reaction.

It appears that the development and type of lymphoid neoplasm in mice depends on the ratio of T cell subsets and the repeated stimulation of the lymphoid systems as well as a genetic predisposition. Mice with HVG disease developed lymphomas in an average of 462 days versus 567 days for normal mice. Murine leukemia virus was detected in the HVG mice perinatally at 3 weeks of age and three months earlier in the noninjected mice. The immunoglobulins were IgA and IgM or IgM alone and IgG in three cases. No IgA was detected.

Immunoproliferative small intestinal disease with duodenojejunal lymphoma: radiologic changes.

The radiologic changes in 1090 cases of lymphoma of the small bowel were analyzed and correlated with the pathologic findings. The material was collected in Iran, a high incidence area for immunoproliferative small bowel disease (IPSID). Of 100 cases of primary intestinal lymphoma associated with IPSID, 48 involved the duodenum and upper jejunum. They were associated with a characteristic spruelike radiologic pattern of the nonlymphomatous segments of the gut, the intensity of which decreased distally. However, the radiologic features of the lymphoma associated with IPSID were identical with those described in other forms of primary small intestinal lymphoma, regardless of histologic type or the presence and absence of alpha-heavy chain secretion.

[Roentgenologic observations in small bowel lymphoma (author's transl)]. / Röntgenologische Befunde bei Lymphomen des Dünndarms.

A comparison of the reontgenologic pattern of 100 cases of lymphoma of the small bowel with the clinical and pathological findings revealed three basic types: 1. The primary lymphoma with malabsorption, in which the classical tumor signs of the lymphoma are accompanied by signs of sprue in the nonlymphomatous mucosa. The disease is most severe in the duodenum and jejunum and less so in the ileal mucosa. The neoplasia is most frequently located in the upper small bowel. Severe diarrhoea, weightloss and clubbing are clinical signs. Th;is pattern is seen in the socalled "Mediterranean lymphoma" or in lymphoma associated with poorly controlled gluten sprue. 2. The primary ileocaecal lymphoma, in which the associated mucosa is usually normal. 3. The secondary lymphoma of the small bowel following disseminated lymphoma, which can not be differentiated from a stage 4 primary lymphoma of the gut. Distention and separation of the bowel loops by enlarged mesenteric lymphnodes always indicates a stage 3 or stage 4 advanced lymphoma.

Gastrointestinal mucosa and primary gastrointestinal lymphoma.

The primary gastrointestinal lymphomas in Shiraz, Iran, and Richmond, Virginia, USA were compared. Upper duodenojejunal lymphoma is always associated with atrophy of the surrounding nonlymphomatous mucosa, plasma cell infiltration and formation of lymph follicles. This is frequently linked to repeated gastroenteritis leading to mucosal atrophy, mutation of plasma cell precursors and secretion of alpha-heavy-chain. Gastrointestinal lymphoma in the USA and other industrialized countries is found in the stomach, where it is accompanied by superficial perifoveolar plasma cell gastritis of the surrounding mucosa, or in the performed lymphoid tissue of the ileocolon, surrounded usually by normal mucosa. A hypothesis for the pathogenesis of the different types of primary gastrointestinal lymphoma, considering the geographic distribution, and mucosal and immunologic antecedents, is presented.

Epidemiologic studies of gastric carcinoma: comparison between Iranians and two racial groups in the USA.

Gastric carcinoma in 226 cases from the two major racial groups--black and white--in Richmond, VA, USA, and in 75 cases from Shiraz, Iran, were studied. The age at onset and the ratio of intestinal to diffuse gastric carcinoma were compared with those for the high- and low-risk groups from Colombia. Poor socioeconomic conditions are directly related to intestinalization of the gastric mucosa and onset of carcinoma at a relatively young age. In Shiraz, the peak incidence of lymphoma, including intestinal lymphoma, is in the third decade of life; for esophageal carcinoma, it is in the fourth decade, and for gastric carcinoma, in the fifth. Comparison of this age distribution with induction times of neoplasia in immunosuppressed patients supports the suggestion of a common cocarcinogenic factor acting early in infancy. In Richmond, the ratio of intestinal to diffuse carcinoma for the black population is consistently higher than for the white. This difference has increased recently due to a more rapid decline in incidence of intestinal-type gastric carcinoma in the white population than in the black.

[Considerations regarding the influence of intrauterine and early postnatal diseases and nutritional deficiencies on immunity and disease epidemiology (author's transl)]. / Erwägungen zum Einfluss von intrauterinen und frühkindlichen Krankheiten und Ernährungsschäden auf die Immunsysteme und spätere Krankheitshäufigkeit

Malnutrition, infectious and toxic stress, hormonal and enzymatic deficiencies as well as graft versus host reactions during the last trimester of pregnancy and during the first six months of life lead to persistent depressions of cell mediated immunity. The subsequent imbalance between the cell mediated and humoral system of immunity leads to differences in disease prevalence in poor and rich populations. Particularly leprosy, tuberculosis, viral disease as for instance frequently fatal measles and diseases due to complexes between humoral antibody and bacterial components as for example acute rheumatic fever occur with increased frequency in B (+) T (-) populations. Desturbances of immune surveillance due to suppression of specific cell mediated immune function leads to an increased frequency of neoplasia, particularly B-cell lymphoma and gastrointestinal tumors. Populations in which the T-cell system can mature without interference show a trend towards diseases in which excessive T-cell response plays a major role, as for instance rheumatoid arthritis, Sjögren syndrome, terminal ileitis, autoimmune angiopathies, multiple sclerosis and possibly also disseminated lupus erythematodes.

Therapy and prophylaxis of Pneumocystis carinii pneumonia.

Pentamidine isethionate and sulfadoxine plus pyrimethamine are excellent therapeutic agents in experimental and hypoergic, hypoimmune pneumocystosis as well as in focal interstitial plasma cell pneumonia (IPCP) in infants. Their effectiveness is seriously limited in cases in which either a diffuse massive plasma cell exudate has been established or in adults in whom the phagocytic and resorptive facility is depressed. Infantile pneumocystosis leading to IPCP can be completely prevented by proper feeding and care of the patient or prophylactic drug therapy with sulfadoxine-pyrimethamine. Similar measures should be taken for adult patients at risk in hospitals where pneumocystosis is frequent or when pneumocystosis has been recently diagnosed.

Endemic infantile pneumocystis carinii infection: the Shiraz study.

Orphanage epidemics of interstitial plasma cell pneumonia (IPCP) occur among premature infants whose passive immunity due to maternally transferred antibodies has lost its effectiveness before the infants' humoral immune systems have reached sufficient maturity to respond effectively to Pneumocystis carinii. IPCP occurs also among mature newborns receiving substandard care in understaffed and crowded orphanages. Infantile diarrhea in these institutions leads to marasmus and deficient immune response in infants 3-4 months after birth. The P. carinii organisms in the alveoli elicit a plasma cell response in the interstitial tissues of the lung, which may be so massive that it interferes with respiration and leads to death by asphyxiation. Such observations at the Shiraz Orphanage are discussed.

Persistent cell mediated immune-deficiency following infantile stress during the first 6 months of life.

The cell mediated immunity as expressed by 2,4 DNCB skin sensitivity was measured in 50 healthy Iranian orphans of the age from 15 years. Complete records of the development of these children from birth were available. Children with severe gastroenteritis leading to marasmus and temporary thymic atrophy during the first 6 months of life showed a persistent atopy 1-5 years later. Less severe disease during this time lead to hyporesponsiveness. Similar stress after the 6th month of life did not lead to persistent changes in their cell mediated immunity. The implications of this for the epidemiology of neoplasia and infectious disease are discussed.

[Radiological evaluation of the course of pneumocystosis (author's transl)]. / Verlaufskontrolle der Pneumocystose im Röntgenbild

Serial chest X rays were performed on 124 infants in an orphanage with endemic Pneumocystic carinii infection. The infection was serologically and autoptically proven in 98 cases. The interstitial infiltrate in the lungs is not specific for Pneumocystis carinii infection, but is the result of the host reaction, which persists after the antigen has been destroyed. The interstitial infiltrate is therefore neither time-related nor diagnostic and cannot be used as a guideline for therapy. The treatment of the patient is completed, while the unspecific infiltrations persist.

Radiological changes in inhalation anthrax. A report of radiological and pathological correlation in two cases.

The radiological changes in two cases of inhalation anthrax are correlated with pathological findings. The earliest radiological sign was widening of the mediastinum, followed by prominent lung markings with peribronchial infiltration due to pulmonary oedema and haemorrhage. Associated pleural effusions are common, and non-specific super-imposed pulmonary infiltration may also be present. Inhalation anthrax must be considered in any case of mediastinal widening in a patient coming in contact with imported animal products or with livestock in endemic areas.

Mycetoma in Iran.

The subject of mycetoma is reviewed and 7 cases are reported for the first time from southern Iran. Four were causes by Actinomyces israelii and one each by Nocardia asteroides, Actinomadura madurae and Allescheria boydii.