[Molecular diagnosis of a fatal primary amoebic meningoencephalitis in Guadeloupe (French West Indies)]. / Diagnostic moléculaire d'une méningoencéphalite amibienne primitive à l'occasion d'un cas fatal en Guadeloupe.

We report the first case of primary amoebic meningoencephalitis in a 9-year-old boy in Guadeloupe. The outcome was rapidly fatal in 7 days. The patient presumably acquired the infection by swimming and diving in a basin supplied by natural thermal water 1 week before onset of the disease. The possibility of a free-living amoeba infection was suspected both on the negativity of all bacterial and viral initial tests and on the observation of peculiar cells in stained cerebrospinal fluid samples. Although the amoeba was not isolated, Naegleria fowleri could be identified by polymerase chain reaction with specific primers on DNA extracted from frozen cerebrospinal fluid samples. Furthermore, as the internal transcribed spacer (ITS1) region of DNA is variable in length between the different strains of N. fowleri, sequencing of the amplified ITS1 demonstrated that the responsible N. fowleri strain belongs to a common genotype present in the American and European continent.

Construction and calibration of a 50 T/m z-gradient coil for quantitative diffusion microimaging.

q-Space imaging is capable of providing quantitative geometrical information of structures at cellular resolution. However, the size of restrictions that can be probed hinges on available gradient amplitude and places very high demands on gradient performance. In this work we describe the design and construction of a small, high-amplitude (50 T/m) z-gradient coil, interfaced with a commercial 9.4 T microimaging system. We also describe a method to calibrate the coil for quantitative measurements of molecular diffusion at very high-gradient amplitudes. Calibration showed linear current response up to 50 T/m, with a gain=1.255 T/m/A. The z-gradient coil was combined with the commercial x- and y-gradients for tri-axial imaging, and its performance was demonstrated by ADC maps of free water and by q-space experiments on water sequestered around polystyrene microspheres (4.5 microm diameter), which showed the expected diffraction peak. In addition, diffusion-weighted images of a fixed mouse spinal cord illustrated the capability of this coil for quantitative imaging of tissue microstructure.

[Hemorrhagic dengue with shock in children in French Polynesia]. / La dengue hémorragique avec choc chez l'enfant en Polynésie française.

The dengue fever is an intertropical arbovirus, well known in French Polynesia where the first cases of dengue haemorrhagic fever appeared at the end of 1989. The authors report their experience in the paediatrics ward of the Centre Hospitalier Territorial (CHT) of Papeete, where, from 1990 to 1992, 310 cases of dengue fever have been registered with 79 cases of dengue shock syndrome (25.5%) and 12 deaths (4%). Then, following an epidemiologic summary and a description of how the clinical picture evolves in children, they insist on the fact that the pathophysiology of dengue fever is unknown, and there is no predictive factor; even if, in this study, the young age seems to be factor of severity. Therefore, an epidemiologic survey, and a very close monitoring of each case are necessary, in order to start an aggressive symptomatic treatment as soon as possible. The antivector's fight is still the only prevention against this arbovirosis.

[Prognosis of asthmatic adolescents in adulthood]. / Pronostic à l'âge adulte de l'asthme de l'adolescent.

Little is known about the long-term outcome of asthmatic adolescents. According to the literature, 20 to 50% of asthmatic adolescents become symptom-free when they become adults. We report 50 cases of asthmatic adolescents, 25 girls and 25 boys, with a mean follow of 4.4 years (range 1-12 years). Only 4 patients (8%) became symptom-free, all 4 were stage I and II patients. One death occurred subsequent to penicillin allergy, but was not related to status asthmaticus. Nor remission was observed in stage III and IV patients, whereas 5.8% and 12% of stage II and II patients respectively grew out of their asthma. The factors predictive of persistent asthma in adulthood were severe asthma at the age of 13 years, female gender, onset of asthma before the age of 7 years, no periodic rhinitis, and exercise induced asthma.

[Hemihypertrophy and scoliosis revealing a Chiari 1 malformation with syringomyelia]. / Hémi-hypertrophie et scoliose révélatrices d'une malformation de Chiari de type 1 avec syringomyélie.

We report the case of a 9-year-old boy with progressive thoracic scoliosis and crossed hemihypertrophy who was discovered with a Chiari 1 malformation and syringomyelia. These disorders are connected by complex physiopathological mechanisms; their association deserves attention. This observation reviews the importance of the clinical examination, particularly the neurological exam, in childhood scoliosis. The features suggesting a neurogenic background of spine deformation should be sought. Scoliosis with hemihypertrophy can be the sign of an underlying neurological abnormality.

[Retrospective study of 45 cases of congenital syphilis in French Guiana from 1980 to 1990]. / Etude rétrospective de quarante-cinq cas de syphilis congenitale en Guyane française de 1980 à 1990.

From 1980 through 1990, 45 cases of congenital syphilis, i.e., 15.5/10,000 births, were reported in French Guyana. Epidemiological and clinical characteristics of these cases were analyzed retrospectively. Most mothers were immigrants (32%) or members of the traditional Maroni community (60%). Congenital infections were often severe (symptomatic in 85% of cases and fatal in 33%). Treatment should be especially aggressive in patients infected with the human immunodeficiency virus.

[Biliary ascariasis. A case of massive infestation; the importance of the peroperative choledoscopy]. / Ascaridiose biliaire. Un cas d'infestation massive; intérêt de la cholédocoscopie per-opératoire.

Ascariasis of the biliary tract is rare in France, but not infrequent in French Guyana and West Indies. The case reported shows a massive infestation of the biliary tract in a 14 years old child and demonstrated the interest of per-operative choledocoscopy for diagnosis and treatment. Ascariasis of the biliary tract is a threatening disease in relation with the associated complications.