[Mutilating acrodystrophic neuropathy of alcoholic origin in the French West Indies]

Among principal causes of acrodystrophic neuropathy-ie, leprosy, diabetes, amyloid neuropathy, hereditary sensory neuropathies-alcoholism is controversial since first descriptions (Bureau et al, 1957) incriminating heavy drinking. This retrospective review of 38 cases occurring in West-Indian rhum abusers, tends however to confirm its etiologic role. Patients present with three non specific signs or symptoms of the lower extremities: anaesthetic foot, plantar ulcers, and chronic, indolent, mutilating arthropathies. Motor function is spared. Male gender, massive (> or = 150 g pure alcohol daily) and prolonged (> or = 12 years) rhum intake, hygiene deficiency, poverty and social distress, exposition to repeated foot microtrauma and a protracted, non fatal, but disabling course leading to amputation, are the main features of this syndrome. The pathophysiology is poorly documented, and many questions remain unanswered including a genetic predisposition or a particular neuro-toxicity of West Indian rhum. However, the clinical and epidemiologic data presented here favour the concept of an "alcoholic foot" or true alcoholic acrodystrophic neuropathy, quite different from the most common sensory-motor form.

[Cerebrovascular accidents and AIDS]

A number of pathological and clinical data suggest that AIDS could be an underestimated cause of cerebro-vascular disease, especially in young individuals. Eight retrospective cases of stroke in AIDS patients are reported. Mean age was 39 years, mean CD4 cells count 57/mm3. Pathogenic mechanism, particularly the role of opportunistic infections remains unclear. Prognosis does not seem constantly pejorative: only one patient died from stroke, six are still alive with a 6 months follow-up, without relapse and with minor or no sequellae. Alcohol or cocaine (crack) abuse was present in half the cases. The role of specific risk factors and consequently adapted prophylaxis is questionned.

Visceral leishmaniasis in HIV-infected patients in the south of France

Between 1989 and 1993, investigations by classical parasitological procedures of 139 HIV-infected adults living in visceral leishmaniasis (VL) endemic areas showed that 10 of them (7.2%) were positive for Leishmania (by stained smears and culture). In the same period we identified 15 VL cases in patients not infected with HIV. Thus, 40% (10/25) of our VL cases were associated with HIV infection.