[Interobserver reproducibility of the Knodell score and the Metavir score in chronic viral hepatitis C. Results of 60 liver biopsies].
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Biomedical subjects
Publications and source records attributed to D Monchy.
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Several cases of Bancroftian filariasis were recently reported on Ouvea Island which is part of the archipelago of New Caledonia located in the south Pacific Ocean. Following these reports systematic screening was carried out in a group of 382 adult consultees at two medical dispensaries. Tests to detect microfilariae in the blood and antibodies in serum were performed at the Pasteur Institute in New Caledonia and the Malarde Institute in Papeete, French Polynesia, respectively. Of the two subjects with manifestations consistent with filariasis, one was seropositive but neither presented microfilariae. Overall 14 subjects (3.7 p. 100) presented microfilariae and 124 were seropositive (33.5 p. 100). The serologic index was significantly higher in men than in women (6.1 p. 100 vs 2.1 p. 100). Parasitic and serologic indexes were significantly higher (p < 0.001) in subjects living in the northern than southern part of the island. As in previous studies in New Caledonia, present data showed that Bancrofitian filariasis is asymptomatic on Ouvea Island. This finding contrasts with the symptomatic forms described on other islands in the south Pacific.
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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.
Bancroftian filariasis is a tropical disease transmitted by mosquitoes that most often causes lymphadenitis. This article reports on a breast nodule due to Wuchereria bancrofti in a woman living in New Caledonia. The diagnosis was done by fine needle aspiration, which showed several microfilariae and avoided surgical treatment.
A 33 yr old man with a history of pilomatrixoma of the scalp, presented 5 mths later with a metastatic undifferentiated carcinoma in a submandibular lymph node. The cutaneous and lymph node tumors showed close histological similarity and features of malignancy. Investigations over 30 mths excluded a primary neoplasm elsewhere and consequently led to the diagnosis of malignant pilomatrixoma. These tumors are rare and most often located on the scalp. Most of the affected patients are middle age males. Wide excision is advised to avoid recurrences.
New Caledonia is a South Pacific Island inhabited by more than 170,000 people: most of them are melanesians or europeans. Multidrug therapy for Hansen disease has been employed since 1983; so we made an epidemiologic and histopathologic study of the new cases diagnosed for 10 years, from 1983 to 1992. Local (clinical, histological, microbiological and immunological) means of diagnosis are described. In New Caledonia, the endemic level is lower than in the small neighbouring Pacific islands but there is still a native reservoir of Mycobacterium leprae with 40% multibacillary types. Nearly half of the new cases are less than 25 years old. They are often male melanesians. The diagnosis of indeterminate forms is debated when there is no acid-fast bacillus. Border-line forms are rare. Tuberculoid leprosy poses many differential diagnosis problems. Despite available multidrug therapy, one cannot yet consider that the incidence is decreasing significantly.
The Cancer Registries have been operational in the South Pacific since 1958 (Papua New Guinea), Fiji (1965) and New Caledonia (1977) and complete cancer incidence rates are available, based on histologic data. We studied 97 melanomas, histologically confirmed, which were diagnosed in New Caledonia from 1973 to 1991. New Caledonia is located in the same latitude as Queensland in Australia, known for having the highest incidence of melanoma in the world. Standardised incidence rates (world population) were 9.82 and 7.65/100,000/year for European males and females, compared to 1.65 and 1.05 for Melanesian and Polynesian males and females. The European population is exposed and Melanesians/Polynesians are relatively protected as are black Americans or Africans. The mixed populations are protected, but no study is available as to the exact proportion of mixed people (20%?) in the entire population. For Europeans, among males, the main areas in which melanomas occur are the trunk (45%) the arm (13%) and the leg (13%). Among females, the main areas are the leg (27%), the trunk (20%) and the head (18%). Screening for melanoma has been more effective in the last 6 years, a period in which we diagnosed half the total cases and generally at earlier stages. Prognosis was poor for this period (1973-1991): the five year survival rates were 64% +/- 8%, not as good as in Europe or Australia, but these lesions were diagnosed between 1973 and 1985 and were generally more invasive. A better prognosis will probably be observed in a few years, and another evaluation of melanoma screening should be made in the future as well the study of precursors and early lesions.
A case of ocular medulloepithelioma is reported and the authors review the literature concerning these rare tumors. This report concerns a ten-month-old girl in whom ophthalmic examination showed a large tumor arising in the ciliary body with such rapid progression that enucleation was necessary. Pathological findings were compatible with a malignant teratoid medulloepithelioma. According to preceding descriptions, slit lamp examination and ultrasonography are the best approach to the diagnosis. Medulloepithelioma is a tumor composed of poorly differentiated neuroepithelial cells and the predominant histological feature is a net-like pattern. Teratoid forms contain cartilage or brain tissue or bundles of skeletal muscle. The main criterion for malignancy is the presence of neuroblastic cells. Local excision is sufficient when the tumor is mall, otherwise enucleation or even exenteration may be necessary. The prognosis is generally good even when the tumor presents malignant features on pathological examination, provided treatment is instituted rapidly.
The main deep-seated fungal diseases and their encountered pathology in New Caledonia and other islands of the South Pacific are reviewed (1970-96). Cryptococcosis is encountered in all islands of the South Pacific, Australia and Papua New Guinea, with a predominance of variety gattii, which is associated with some species of Eucalyptus. Histoplasmosis is not uncommon, and there was an epidemic in New Caledonia in 1994 among people who had visited a bat-inhabited cave. Mycetomas, in particular presenting as pale granules in tissues, are encountered in New Caledonia, Vanuatu, Papua New Guinea, Fiji and French Polynesia. Other fungal infections, such as zygomycosis, sporotrichosis (three cases) and chromomycosis (six cases) are rarely observed in New Caledonia.
Dirofilariosis usually concerns dogs among which it is transmitted by mosquito bites. Human infection is rare and we describe here a case observed in a 75 years old woman in New Caledonia. A systematic pulmonary radiograph showed suspicious pulmonary nodules. At microscopic examination one can see pulmonary infarctus with thrombosis and Dirofilaria immitis inside a vessel. Diagnosis is usually made by histologic examination because biological investigations are of a little interest. Surgical treatment is enough. Chemioprophylaxia for dogs can reduce the risks of man infection.