[Hepatic amebiasis in France. Apropos of 152 case reports]. / L'amibiase hépatique en France. A propos de 152 observations.

The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.

[Gastroduodenal ulcers in young adults. An epidemiological study (author's transl)]. / Maladie ulcéreuse chez l'adulte jeune. Etude épidémiologique.

An epidemiological survey of gastroduodenal ulcers was carried ut in an homogenous population of 100000 young adults of National Service age, and the results were compared with those of a similar survey which had taken place 6 years previously. Between 1971 and 1977 the overall incidence of gastroduodenal ulcers had risen from 1,57 to 2.14 p. 1000, but there ws a sharper and more significant increase (from 0.14 to 0.41 p. 1000) in gastric ulcers during the same period. Some of the aetiological factors investigated, such as age of onset of the disease, closed or open community housing conditions, individual predisposition, family history of ulcers, family status and inaugural symptoms, had remained unchanged, but there appeared to be a growing tendency for the disease to strike predominantly students and executives. If this were confirmed, these two social categories would be those which bear the brunt of the increase in gastroduodenal ulcers observed during the last few years.

[African schistosomiasis at the invasion stage. Criteria for diagnosis. Control after 5 years (author's transl)]. / Les bilharzioses africaines de première invasion. Eléments de diagnostic. Evolution à 5 ans.

The authors expose their conclusions after controlling 181 young soldiers affected by schistosomiasis in an epidemic having occured in Tchad en 1973-74, none of them having been later on submitted to parasitic infection: --relative value of classical diagnosis criteria (50 p. 100); --reliability of immunologic symptoms; -- frequency, importance and precocity of specific granulomatous hepatic changes, detected by laparoscopie and biopsy (87,2 p. 100 of the cases). The value of niridazole is confirmed but continuance of granulomatosis after clinical recovery is not an exceptionnal possibility five years after the treatment, then raising diagnostic and immunologic problems.

[Delayed relapses of hepatic amoebiasis initially cured by metronidazole: 2 cases (author's transl)]. / Rechutes tardives d'amibiases hépatiques initialement guéries par le métronidazole: 2 cas.

Two cases of hepatic amoebic abscesses are reported as having relapsed--one three times, the other twice--after from several weeks to several months of apparent cure by mitronidazole, without recontamination. The following hypothesis can be eliminated: resistance of E. histolytica to metronidazole, poor absorption or faulty diffusion of the drug, its possible inactivation. The persistance of amoebae in the digestive tract, even if they are not detected, seems probable however: either because they are situated in such a way as to be inaccessible to the active metabolities of the metronidazole or because the intra-luminal concentration of these metabolites is not sufficient. The fact that the intestinal parasitism repeatedly leads to the constitution of successive hepatic abscesses in the same person presupposes the privileged anatomic situation of a colonic ulceration which brings about reiterated dissemination through the portal veinous system.