[29 cases of malaria introduced into New Caledonia from 1992 to 1995]. / A propos de 29 cas de paludisme importé en Nouvelle-Calédonie de 1992 à 1995.

Although located in a tropical zone of the South Pacific, the island of New Caledonia is malaria-free. This retrospective study of imported malaria was conducted jointly by the Pasteur Institute of New Caledonia and the Gaston Bourret Territorial Hospital between January 1, 1992 and December 31, 1995. A total of 29 patients were hospitalized for malaria. Most contracted the disease in Vanuatu. Plasmodium vivax was involved more often than Plasmodium falciparum (22 vs. 11). No case was severe, complicated, or fatal. In most cases treatment consisted of quinine followed by mefloquine. The median duration of hospitalization was 5.7 days. Since the annual incidence of imported malaria is significantly higher in New Caledonia than in France, the authors propose that a Travelers Information Center should be set up in New Caledonia to improve prophylaxis against malaria.

[Hodgkin's disease in French Polynesia. 7 cases observed at the Territorial Hospital Center from 1985 to 1990]. / La maladie de Hodgkin en Polynésie Française. A propos de 7 cas observés au Centre Hospitalier Territorial de 1985 a 1990.

Seven Polynesians suffered from Hodgkin's disease were admitted in the territorial Hospital Center in 6 years. They came from different Polynesian archipelagos. Three of them are 30 years old and 3 are 40 years old. Diagnosis is based on an histological test, but has to be confirmed by a center specialized in lymphomae investigations since a scanner has been installed at the Territorial Hospital Center of Papeete (March 1987) results are satisfactory: echography and abdominal scanner lymphography and thoracic scanner osteoma medullare biopsy and liver biopsy puncture. Six patients presented a diffuse lesion (III B or IV) and one an intermediary phase (II B2). Treatment started by chemotherapy MOPP and ABVD alternatively. Four patients out of seven did not continue their treatment up to the end; one patient aged 34, after six treatments by MOPP and a recovering treatment by MIME got an autograft of bone marrow in Paris in October 1989, and he is actually in a good shape. Most of the patients are out of control. Application of complex therapeutic protocols during several months and inducing side effects, demands a large agreement of both patients and relatives. That is very rarely got nowadays.

Double blind study on efficacy and safety of single doses of ivermectin and diethylcarbamazine for treatment of Polynesian Wuchereria bancrofti carriers. Results at six months.

In 1989, a double-blind trial was implemented in Tahiti to compare both efficacy and tolerability of single doses of ivermectin and diethylcarbamazine (DEC) for treatment of Wuchereria bancrofti carriers. Of 58 carriers, in whom microfilarial (mf) density was greater than or equal to 100 mf/ml, 23, 24 and 11 were randomly allocated to treatment with respectively ivermectin 100 mcg/kg, DEC 3 and DEC 6 mg/kg. One week after treatment, clearance of microfilaremia was complete in 22 of the 23 carriers treated with ivermectin and in one only of the 35 treated with DEC. Adjusted geometric mean for mf densities was significantly lower (p less than 0.001) in carriers treated with ivermectin than in those treated with DEC at one, but neither at 3 (p = 0.26) nor at 6 months (p = 0.63). At 3 and 6 months, mf levels were 14 and 28%, 21.6 and 19.4%, and 10.2 and 8.4% of pretreatment mf levels in carriers treated respectively with ivermectin 100 mcg/kg, DEC 3 and DEC 6 mg/kg. Side effects were experienced by 51 carriers (88%) of whom only 8 (14%) suffered a grade 3 reaction. Onset and intensity of side effects were significantly associated (p less than 0.01) with both pretreatment mf densities and peripheral blood parasite clearance. Efficacy of ivermectin single dose was superior to that of DEC single dose in terms of immediate mf clearance but not in terms of sustained mf decrease at 6 months.

[Gallbladder pathology in the Ivory Coast. Contribution of ultrasonics]. / Etude de la pathologie vésiculaire en Côte-d'Ivoire. Apport de l'échographie.

Ultrasound imaging was first used in the two hospital and university centers of Abidjan in 1983, and findings since then have demonstrated the previously unrecognized frequency and variability of gallbladder affections. Particular conditions of functioning of an ultrasonography department in tropical surroundings are analyzed and ultrasound features of bile stones, cholecystitis and gallbladder cancer described.

[Acute disseminated lupus erythematosus in Ivory Coast (apropos of 9 cases)]. / Le lupus érythémateux aigu disséminé en Côte-d'Ivoire (a propos de 9 observations).

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.

[Incidence of biliary lithiasis in African urban areas (Abidjan): a little known pathology?]. / Incidence de la lithiase biliaire en milieu urbain africain (Abidjan): une pathologie méconnue?

The rarity of cholelithiasis in black Africa is a very classical concept that must be called in question again. With the exception of pigmentary lithiasis frequently found in patients with an homozygous haemoglobinopathy, genetic as well as environmental (particularly food related) factors explain in part the low frequency of cholelithiasis with cholesterol gallstones in Africa. Yet the true incidence of cholelithiasis is too often unappreciated. Before the use of ultrasonography, only symptomatic cholelithiasis were detected, usually by the surgeon (19 cases admitted during a 6 years period in the Internal Medicine Department at Treichville University Hospital, Abidjan). The practice of ultrasonography will ease the detection of asymptomatic cholelithiasis. Since ultrasonography has been set up at Treichville University Hospital, 30 cholelithiasis of which 21 were asymptomatic have been detected during an 8 months period, a high detection level of course for a so-called rare disease.

[57 cases of infectious endocarditis: diagnosis, clinical course, prognostic factors]. / Etude de 57 cas d'endocardite infectieuse: diagnostic, évolution, facteurs du pronostic.

Through a retrospective study on 57 patients, the authors have studied the diagnosis signs, the clinical course, and the factors which affect the prognosis of bacterial endocarditis. Echocardiography has allowed them to establish a diagnosis with 72 p.c. of cases and the bacteriological investigations with 42 p.c. Out of these endocarditides, 39 were found on natural valves, 6 were associated with congenital cardiopathies, 9 followed the replacement of a valvula, and 3 were associated with endomyocardial fibrosis. Cardiac insufficiency (56 p.c.), and renal insufficiency (24 p.c.) were prevailing. The discussion turns on the diagnosis factors and the factors involved in the prognosis. Considering that the death rates were 64 p.c. with the patients who had undergone medical treatment and 14 p.c. with those who had undergone operations, the relevance of the surgical treatment has been emphasized.

The prevalence of diabetes mellitus and impaired glucose tolerance in Melanesians and part-Polynesians in rural New Caledonia and Ouvea (Loyalty Islands).

The study of different ethnic groups living in the same physical environment provides the opportunity to examine interaction of genetic and environmental factors in the aetiology of diabetes mellitus. In rural New Caledonia, the prevalence of diabetes was higher in part-Polynesians than in Melanesians: males - 6.6 versus 0.5%; females - 6.3 versus 3.5% respectively. The prevalence of abnormal glucose tolerance (impaired glucose tolerance and diabetes) was 11.5 and 15.7% in part-Polynesian males and females, respectively, and 4.7 and 9.2% in Melanesian males and females. Mean age and degree of obesity in these ethnic groups were sufficiently similar to suggest that these factors played no significant role in the difference in diabetes prevalence. Furthermore, adjustment of relative risk of impaired glucose tolerance and diabetes for age and obesity indicated that the modest differences between groups were not responsible for the observed variation in diabetes prevalence. The differences in prevalence of impaired glucose tolerance and diabetes between Melanesians and part-Polynesians may be genetically determined, although the role of certain environmental factors other than obesity, e.g. differences in physical activity or qualitative aspects of diet, cannot be excluded.

[Prevalence of diabetes mellitus and glucose tolerance abnormality in Melanesians and subjects of Polynesian descent in the rural areas of New Caledonia and at Ouvea (Loyalty Islands)]. / Prévalence du diabète sucré et de l'anomalie de la tolérance au glucose chez les Mélanésiens et les sujets d'origine polynésienne dans les zones rurales de Nouvelle-Calédonie et à Ouvea (Iles Loyauté).

The screening of different ethnic groups who live in the same natural system have enabled the authors to study interaction between genetic and environmental factors as a part of etiology of diabetes mellitus. In New Caledonian country areas, the prevalences of glucose tolerance abnormality (GTA) and diabetes mellitus (DM) have been higher with people of polynesian descent than with Melanesians. GTA 7.6 p. ct. versus 5.1 p. ct. DM 6.5 p. ct. versus 2.2 p. ct. The prevalence of these combined diseases have been 14 p. ct. with the Polynesians and 7.2 p. ct. with Melanesians. These two ethnic groups have shown mean ages and obesity rates similar enough to lead the authors to deny these two factors a major part in the difference between the ethnic prevalences of DM. Besides, the mean plasmatic glycemia two hours after a dose of glucose and the relative risk of DM and GTA according to age and obesity rate have shown that the slight differences between these groups are not involved in the different prevalences of DM. This inter-ethnic difference may be due to genetic factors. However, some environment linked factors besides obesity (such as diet and daily life activity) may share a major part in this difference.