[Giant cell tumors of the ribs. Apropos of a case]. / Tumerurs à cellules géantes des côtes. A propos d'une observation.

The authors report a case of grade I-II giant-cell tumour of the ribs extending to the thorax and the vertebral column. The tumour was treated by surgical resection followed by vertebral curettage in two stages and adjuvant regional radiotherapy. Giant-cell tumours of the ribs are exceptional and rarely found in the literature. They raise a therapeutic problem (surgery is essential, but radiotherapy is controverted), and a prognostic problem (there is always a potential risk of recurrent malignancy).

[New approaches to phycomycoses (apropos of 2 cases of rhino-entomophthoromycosis)]. / Approches nouvelles des phycomycoses (à propos de deux cas de rhino-entomophtoroses).

It is an uncommon affection (only 100 cases reported), observed primarily in African peri-equatorial zone. The rhinoentomophtoromycoses are caused by a phycomycetous fungus, class of zygomycetes: Conidiobolus coronatus. They are subcutaneomucus mycoses with centro-facial localizations. During the past ten years, three points have been put into light. 1. A true therapeutic revolution thanks to imidazoles. 2. A better knowledge of this disease in which caricatural forms are far form being the most numerous. 3. A socio-cultural African approach better understood, as such a disease is still considered as the result of a transgression or a fault.

[Malaria in the republic of São Tomé and Principe. Epidemiologic evaluation and chemoresistance of P. falciparum]. / Le paludisme en république de São Tomé et Principe. Evaluation épidémiologique et chimiorésistance de P. falciparum.

The authors report the results of a valuation of paludometric indices during mai 1990 in Democratic São Tomé e Príncipe Republic (RDSTP). These investigations (parasitic index and spleen index) suggest that malaria is mesoendemic in these area. Plasmodium susceptibility to chloroquine at posology of 25 mg/kg per os was evaluated (WHO standard 7 days field test). Among 58 children, ranging from 5 to 11 years old, resistance at level R I was observed in 9% of cases, at level R II in 14%. Among 10 strains of P. falciparum, 9 were chloroquine resistant in vitro. 2 strains were also less sensible to quinine.

[Epidemiology and prophylaxis of viral hemorrhagic fevers]. / Epidémiologie et prophylaxie des fièvres hémorrhagiques virales.

A review of virus hemorrhagic fevers has been carried out. The different etiological agents belong either to arboviruses, either to related genera. The authors recall the main epidemiological aspects, in particular the transmission ways and means. Prophylaxis is to be taught of which behaviour can be taken in regard to a questionable case as well as permanent measures of control on the field. Although an extreme carefulness is necessary, the experience of the recent past years indicate that classical measures of isolation are generally adequate to prevent any emergence of secondary cases.

[The Quantitative Buffy Coat test (Q.B.C. test). Monofluo Kit Falciparum. Comparative value in the rapid diagnosis of malaria]. / Quantitative Buffy Coat test (Q.B.C. Test Monofluo Kit Falciparum. Intérêt comparé dans le diagnostic rapide du paludisme.

New emerging atypical forms of malaria, characterized by weak parasitemia, among peoples without premunition, back from Plasmodium falciparum resistant areas, make it necessary to use rapid, sensitive, reliable methods of parasitologic diagnosis. This work concerned two different populations: 394 expatriates back from a 4 months stage in endemic areas. 12 patients admitted for suspected of proved malaria. Authors have studied, by double blind method, versus thin film, two fluorescent techniques: a direct immunofluorescence, the Monofluo kit Falciparum of Diagnostic Pasteur. A nucleic acid fluorescence, on blood samples centrifuged in capillary tubes, the Q.B.C. test of Becton-Dickinson. Both methods seem of great interest for epidemiological surveys. The Q.B.C. test has showed more sensitivity than the thin film: it's rapidity of realisation indicates it for urgent diagnosis.

[Chronic hepatitis caused by hepatitis B virus. Comparative study of the histologic lesions and of viral replication]. / Les hépatites chroniques à virus B. Etude comparée des lésions histologiques et de la réplication virale.

The incidence of two markers of viral replication (viral DNA in sera and HBc Ag on liver) was studied in 22 patients and compared to the histological features of needle biopsy of the liver. We obtained a 100% qualitative correlation between both methods. The presence of these two markers of replication is independent of the histological feature of the hepatic lesions we studied. Using our knowledge of the recent discoveries about chronic HBV infection, we proved that a close examination of both results modifies the predictive value of each one. The pejorative characteristic of the CAH is particularly doubtful in some cases.

[Relevance of a technic for studying hepatitis B virus replication in developing countries]. / Pertinence d'une technique d'étude de la replication virale du virus de l'hépatite B dans les pays en voie de développement.

Using our knowledge of recent discoveries on chronic HBV hepatitis, we consider the indispensable addition that the close study of HBV replication represents. An accurate evaluation of this replication can be obtained through quantitative research of the HBc antigen on liver. The detection is currently facilitated by the production and marketing of good quality antisera and revelation systems. The routine application of these techniques by classical histology departments is possible.

[An outbreak of Schistosoma mansoni bilharziasis. 113 cases in a military unit returning from Central Africa]. / Une épidémie de bilharziose à schistosoma mansoni. 113 observations dans une collectivité militaire au retour d'Afrique centrale.

The authors report on an outbreak of Schistosoma mansoni infestation involving 113 military men who had been contaminated together in a tributary of the Chari river in the Central African Republic. The patients were examined on their return to France 50 days after being contaminated and were compared with a control group of 25 subjects who had lived in Africa under the same conditions but were exempt of bilharziasis. All were subjected to a retrospective questionnaire, physical examination, examination of the faeces and serological test for bilharziasis by indirect haemoagglutination. All received two courses of praziquantel. Follow-up serology was performed after 1 year in 86 cases. The results of this study in both groups are presented and commented upon. With intestinal bilharziasis, prophylaxis against contamination is extremely difficult to carry out in endemic areas among people who visit and work "on the spot". Detection by routine serology must be performed upon return.

[Clinical aspects of AIDS and related syndromes in Pointe-Noire (Peoples' Republic of Congo). Apropos of 73 cases detected in 6 months]. / Aspects cliniques du S.I.D.A. et des syndromes apparentés à Pointe-Noire (R.P. du Congo). A propos de 73 cas dépistés en 6 mois.

A.I.D.S. is a true public health problem in Central Africa since its "appearance" in 1983. Several authors have described its clinical manifestations, as well as the absence of groups at risk and a sex ratio near to 1. The present study, carried out in Pointe-Noire hospital (Popular Republic of Congo) tries to select in connexion with sex and age, one or several clinical symptoms which should indicate the necessity of requesting a HIV serology test. Four groups have been isolated: a) patients with very important loss of weight and chronic or intermittent diarrhea, b) fever with loss of weight and pulmonary X-Ray anomalies, c) polyadenopathies, d) associated opportunistic infections and Kaposi sarcoma. In Africa, A.I.D.S. strikes all age groups and both sex. There is one group at risk: transfused patients, particularly the sickle-cell anemia homozygotes.

[Histoplasmosis]. / Les histoplasmoses.

Histoplasmosis are deep mycoses of present interest: they are part of fungal diseases of A.I.D.S. American histoplasmosis at Histoplasma capsulatum is a world wide disease, particularly present in the U.S.A., time to time observed in Africa south of the Sahara primarily among Europeans. African histoplasmosis at H. duboisii is typically an African continent disease. H. capsulatum is a telluric fungus and man is contaminated from soil to his respiratory tract. It depends on his immunitary status that he develops either a non symptomatic affection or a severe one, even a fatal one. Epidemiology of H. duboisii is still full of unknowns. Pathological manifestations of each disease are very different: American histoplasmosis displays three stages: primary infection, spread attacks spontaneously fatal, chronic pulmonary form simulating sometimes a pseudo-tumor, pathologic manifestations of African histoplasmosis, studied from 206 cases already published, are primarily related to skin, glands and bones attack, displaying either a localized form or an immediately spread form. Diagnosis is based on finding the fungus in different samples, on research of sera-antibodies, often on anatomopathological investigations. At the present time, ketoconazole is the treatment. Histoplasmosis at H. capsulatum as well as at H.duboisii might appear outside endemic zones several years after contamination.

[Laboratory diagnosis of deep mycoses: generalities]. / Le diagnostic au laboratoire des mycoses profondes: généralités.

The mycological, immunological and histological laboratory techniques in deep mycoses are of variable interest according to the responsible fungus. If direct exam is generally possible anywhere, and very valuable in some affections, immunological diagnosis is quite often dependent of a highly specialized laboratory. As injured tissues can be transported at a long distance, with some cares and precautions, histological exams are of great interest, taken into consideration the difficulty of direct as well as indirect exams.

[A new case of African histoplasmosis with multiple localizations in the bones]. / Un nouveau cas d'histoplasmose africaine à localisations osseuses multiples.

Bone localizations of histoplasmosis at H. duboisii are frequent (1 out of 3). Multiple localizations, far less frequent but not exceptional, are immediately diagnosed at the occasion of a systematic X-Ray check-up, or later, as presented in this case. Multiple localizations give evidence of the septicaemic diffusion of the pathogenic agent.

[Training in epidemiology at the Institute of Tropical Medicine of the Army Health Service. Experience over 4 years]. / La formation en épidémiologie à l'Institut de Médecine Tropicale du Service de Santé des Armées. Une expérience de 4 ans.

The authors described the training in epidemiology received by 185 Army medical doctors attached for instruction to the I.M.T.S.S.A. since 1981. Statistical methodology, basic epidemiology, and applied epidemiology are taught in such way that Army medical doctors are better capable of rationalizing and strengthening their action of prevention in their posting either in France or seconded to developing countries. Description of pedagogical targets is underlined as well as methodology of control and evaluation of progress towards these targets. The authors are also able to appreciate, in terms of the level of capacity of the personnel trained, the severity of the consequences either of a strengthening of the pedagogical targets or of a reduction. When the reform of medical education and training imposes very often such an alternative, the authors point out how the leading opinion of the ones who utilize the services of the personnel should be taken into full consideration prior to any decision.