[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.

[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.

[Arrhythmogenic effects of antidepressive agents demonstrated by programmed ventricular pacing]. / Effet arythmogène des antidépresseurs. Mise en évidence par la stimulation ventriculaire programmée.

Tricyclic antidepressants and phenothiazines have been blamed for increasing the incidence of sudden death. One of their known mechanisms of action in such cases is to induce torsades de pointes by a so-called "quinidine-like" effect. We report the case of a female patient who was rescued from an episode of cardiac arrest which occurred two months after a myocardial infarction. Right ventricular programmed pacing strongly suggested an arrhythmogenic effect to the antidepressant the patient was receiving. This type of treatment seems to be capable of facilitating the induction of a monomorphous ventricular tachycardia which may degenerate into ventricular fibrillation.

[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.

[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.

[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.

[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.

[Myocardial infarction with normal electrocardiogram]. / Infarctus du myocarde à électrocardiogramme normal.

These two cases concern myocardial infarcts where the electrocardiogram (ECG) was within normal limits at admission and throughout the period of hospitalisation, the diagnosis of an infarct being made secondarily on the basis of raised CPK. Both cases involved infarcts limited to the lateral wall due to occlusion of the first marginal artery of the left border. Several recent studies have evaluated the diagnostic value of the ECG in infarcts and have shown its lack of sensitivity in lateral infarcts. The resultant diagnostic difficulties may lead to delayed treatment, the consequences of which should not be capital since it has been shown that infarcts with a normal or minimally abnormal ECG at the time of admission have a favourable short term prognosis.

[Ventricular extrasystole and arrhythmogenic right ventricular dysplasia. Critical analysis of the diagnostic value of non-invasive tests]. / Extrasystolie ventriculaire et dysplasie ventriculaire droite arythmogène. Analyse critique de la valeur diagnostique des examens non invasifs.

Asymptomatic ventricular extrasystoles were discovered in 2 active sportsmen (32 and 33 years). The cardiology work-up rapidly led to the diagnosis of arrhythmogenic right ventricular dysplasia in one. In the other, the clinical presentation was similar and the initial diagnosis was ventricular extrasystole with a healthy heart. Four years later however, the subject was still asymptomatic but a second evaluation revealed arrhythmogenic right ventricular dysplasia. This delayed diagnosis emphasizes the importance of renewed noninvasive evaluation of patients with asymptomatic ventricular extrasystoles.

[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.

[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.

[The heart and the eosinophil]. / Le coeur et l'eosinophile.

The beneficial effects of polynuclear eosinophils (PE) are well known. However, under certain circumstances, PE can be harmful. The heart is a prime target for PE toxicity which is due to release of basic proteins by eosinophils including major basic protein, cationic protein, and peroxidase. The most common manifestation of PE toxicity is chronic parietal endocarditis (CPE) which regroups two entities: Loeffler's fibroplastic endocarditis and Davies' endomyocardial fibrosis. Loeffler's fibroplastic endocarditis occurs mainly in temperate climates. Patients present high, persistent eosinophil levels similar to those observed in essential hypereosinophilic syndrome (EHS) or Chusid syndrome. Davies' endomyocardial fibrosis occurs in tropical countries where eosinophilic helminthiasis are endemic. The incidence of eosinophilic myocarditis (EM) is low but probably underestimated. EM can be observed in any case involving PE and has been described in many cases of drug-induced atopy, in Churg and Strauss syndrome, and in EHS. The most common cause of death is short-term occurrence of cardiogenic shock or dilated hypokinetic cardiomyopathy. Some patients have been successfully treated by early, intensive corticosteroid therapy and/or heart transplantation. The nosological classification of EM and CPE remains controversial. The two disorders may form a continuum with CPE as the second phase. Other authors have suggested that EM and CPE result from the action of PE on two distinct targets, i.e. endothelial cells for EM and myocytes for CPE. In the future, it may be possible to identify subjects with a predisposition to PE-induced heart disease by studying of genes coding for interleukins (IL-5, IL-4, IL-3) and GM-CSF in the 5q31-q33 region of chromosome 5.

[Cardiovascular risk for the traveler]. / Le risque cardio-vasculaire pour le voyageur.

The incidence of cardiovascular events during travel is rising with the age of the population and number of traveling seniors. Cardiovascular events are the second most frequent reason for medical evacuation and the cause of 50% of deaths recorded during commercial air travel. In most cases the underlying disorder is coronary artery disease which is readily destabilized by stress and fatigue associated with travel. Inflight conditions that can cause problems include altitude-related hypoxia, pressurization, and cramped seating in most sections of the plane. Upon arrival the traveler is exposed to a variety of climatic, food, and environmental factors that can trigger manifestations of latent heart disease. Prophylactic drugs for tropical infectious disease (especially antimalarials of the quinidine group) should be used with caution due to possible adverse interaction with medications used to treat heart disease. A pre-travel examination is necessary to ascertain cardiovascular status and define simple preventive precautions.