Ecole d'été de l'A.C.E.M.I.—Ha?ti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

Arthrite rhumato?de juvénile et HLA-B27.

Forty children with juvenile rheumatoid arthritis were studied to determine the frequency of the histocompatibility antigen HLA [human leukocyte antigen)-B27 in this disease and to characterize the arthropathy associated with this antigen. HLA-B27 was detected in four patients (10%). Its presence was associated in a statistically significant manner with sacroiliitis demonstrated radiologically and with a greater age at the time symptoms in the joints first appeared; this age was, on average, 10 years, compared with 6.29 years for the children without HLA-B27.     

Prévalence d'Aeromonas spp. dans les gastro-entérites de l'enfant.

A selective medium and biochemical tests were used to search for Aeromonas spp. in the stools of 536 children, more than 90% of whom had "gastroenteritis", seen at Sainte-Justine Hospital, Montreal, in June or July 1986. The organism was found in seven children, six of whom had bloody diarrhea. One of the six, a 6 1/2-year-old boy, required intravenous alimentation and later manifested ulcerative colitis; the other five recovered. The remaining child, a 14-year-old boy, had synovitis of the knee and spondylarthritis. Two of the seven carried other enteric pathogens. The authors discuss the pathogenicity of Aeromonas spp., which is not very marked in temperate climates, in human summer diarrhea and its possible role in the development of ulcerative colitis.     

Epidémie de dysentérie bacillaire.

An outbreak of bacillary dysentery in 1978 affecting 928 persons, most of whom were living in the village of St-Jacques, PQ, is described. An epidemiologic study suggested the water supply as the source of the infection, and it was established that the water carried by the municipal aqueduct was contaminated by feces containing the causal agent, Shigella sonnei. This epidemic, the largest mentioned in he Canadian medical literature, demonstrates how contagious this infection is.     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

Epididymite,M. S. T. et Fertilité

Before the antibiotic’s era, the clinicians have shown the relation between epididymitis and Infertility. At the moment, venerial diseases are the principal cause of Epididymitis by the young man. The early diagnosis of the urethral infection (acute or not) associated with a suitable antibiotherapy will allow to protect the fertility.     

Psychothérapie des cas difficiles. Perspectives phénoménologiques

The author provides a brief overview of clinical anthropology. To achieve better understanding of clinical anthropology, it is very important to grasp its close relationship with the development of phenomenology, most notably existential analysis. This paper mainly references L. Binswanger, S. Freud, V. von Weizsäcker and J. Schotte, arguing that the anthropological perspective is up to date in the psychotherapy of difficult cases. Four fields of application and a clinical case of a psychotic patient’s replacement of medications by psychotherapy after 30 years of use show how the anthropological perspective can create a new way of looking at pathology, help achieve a better relationship with the patient and revitalise the representation of what we call a clinical fact.     

L'éléphantiasis péno-scrotal. A propos d'un cas

Massive scrotal lymphoedema with gross genital deformation is called penoscrotal elephantiasis. It is a rare syndrome outside of filariasis endemic regions. It is usually idiopathic and rarely congenital or secondary. It is both physically disabling and emotionally distressing for the patient. Surgical treatment is often necessary. The authors report a case of a patient with penoscrotal elephantiasis in whom no aetiology could be found. Complete surgical resection of the diseased tissue and scrotum and penile reconstruction were performed with good cosmetic and functional results.     

Déficit androgénique lié à l’âge. Que faut-il attendre de l’androgénothérapie?

With the exception of disease or drug-induced changes in Leydig cell function, aging is accompanied by specific changes of androgen status in healthy men. The level of testosterone production decreases in contrast with the rise in plasma protein testosterone binding capacity. Free testosterone, considered to be the biologically active fraction, decreases, leading to tissue androgen deficiency. The resulting clinical picture mimics hypogonadism, including physical and psychological asthenia, decreased libido and sexual behaviour, increased fat mass and decreased lean mass, gynaecomastia, osteoporosis and pro-atherogenic metabolic changes. The cut-off value for plasma testosterone below which androgen deficiency can be considered to be responsible for clinical signs is a key point which determines the therapeutic approach. In the absence of clearly validated data in healthy aging males, this cut-off value has been consensually defined as the mean plasma testosterone levels of men between 30 and 50 years of age minus two standard deviations, corresponding to the zone of hypogonadism in adult males. The association of clinical signs compatible with hypogonadism and reduced total (or preferably bioavailable) plasma testosterone level justifies initiation of hormone replacement therapy after excluding any contraindications (especially prostatic). The aim of this treatment is to reverse the consequences of age-related hypogonadism. Some benefits of this treatment have been clearly demonstrated, such as a decrease of fat mass, and an increase of lean mass and muscle strength. Similarly, bone mineral density increases, particularly in men with the lowest pretreatment plasma testosterone levels. It must be stressed that these changes are observed in truly hypogonadal aging men, but not in aging men with normal plasma testosterone levels. Testosterone replacement therapy can promote the development of gynaecomastia, while dihydrotestosterone tends to reduce gynaecomastia. Finally, androgen replacement therapy appears to improve a hypogonadism-related decrease in libido or sexual behaviour, provided other associated non-endocrine factors have been previously treated. Androgen replacement therapy improves well-being, and physical and psychological asthenia in hypogonadal men. However, this treatment has not been demonstrated to be effective in healthy aging men. Although androgen replacement therapy does not have a negative impact on lipid parameters, its possible cardiovascular protective effects have not yet been demonstrated. In conclusion, androgen replacement therapy, respecting the contraindications, is beneficial in patients of all ages with clearly demonstrated hypogonadism, but has no efficacy on symptoms in other cases.     

Sélection artificielle pour la résistance au méthidathion chezPhytoseiulus persimilis A. H.

Résumé La toxicité du méthidathion a été mesurée sur 7 souches dePhytoseiulus persimilis provenant de collections de laboratoire, d'unités de production ou du terrain. Les résultats obtenus se sont avérés être très variables: la CL50 de la souche la plus résistante est 100 fois plus élevée que celle de la souche la plus sensible. Chaque souche a ensuite été sélectionnée pour la résistance à cet insecticide; toutes les souches ont répondu à la sélection et ont atteint des niveaux de résistance similaires. Elles ont ensuite été mélangées, à nouveau sélectionnées pour la résistance au méthidathion et à d'autres insecticides et utilisées dans les programmes de lutte intégrée. La résistance a pu ainsi être légèrement augmentée et la souche obtenue, bien qu'encore affectée par le méthidathion sur le terrain, n'est plus complètement éliminée par les traitements et est moins sensible aux résidus présents sur les feuilles.