[Hepatic amebiasis in French Polynesia. 16 cases in 2 years]

Asymptomatic amebiasis in known for long ago in French Polynesia; the presence of Entamoeba histolytica cyst carriers have been shown by several parasitological investigations. But, until now, no hepatic amebiasis case has been reported in this geographical area. An homogeneous series of 16 cases of hepatic amebiasis is reported here. The diagnosis was made by hepatic ultrasonography and confirmed by immunology (Indirect immunofluorescent tests gave always a positive reaction for a dilution of 1/512 or more). Clinical, biological and radiological signs are well known in tropical pathology. Therapy was always conducted with metronidazol by the authors. From the epidemiological point of view, 14 out of 16 cases come from Tuamotu Archipelago. This epidemiological fact appears important enough to carry out systematically hepatic ultrasonography and amebic++ serology for every patient evacuated from this Archipelago to Tahiti. Hence it must be kept in mind the possibility of hepatic amebiasis not only in people living in French Polynesia but also, for the ones coming from over there but living in France.

[Outcome of infants operated on for aortic coarctation before 3 months of age]

Between January 1966 and June 1982, 177 infants less than 3 months of age underwent surgical cure of coarctation of the aorta. Seventy-one percent had associated cardiac lesions not including a patent ductus arteriosus. With the cure of the coarctation either by resection anastomosis or angioplasty, 45% underwent associated surgical procedure, mainly pulmonary artery banding. Early mortality was 26% for the last 4 years of the study. Early deaths, significantly correlated with the severity of the preoperative heart failure and the importance of pulmonary hypertension, were not correlated with an associated heart disease. Of the 95 survivors operated on before December 31, 1981 and with a long follow-up, 18 died later on. Late deaths are related with associated cardiac malformations. Thirty-nine (41%) of the survivors had recurrent coarctation. This was correlated with the year of surgery and not with the surgical technique. In cases with coarctation of the aorta surgical cure should not be withheld before age 3 months, when there is heart failure, with or without associated cardiac malformations. The mortality, even in isolated coarctation (6%), the occurrence of sudden deaths after good surgical repair, the frequency of recoarctations lead to suggest that in infants under 3 months of age, careful supervision and conservative medical treatment should be considered, if the coarctation is isolated and well tolerated.

[Secondary closure of the sternum in open-heart surgery. 50 cases]

In intrathoracic cardiac and vascular surgery, immediate repair of median sternotomy sometimes results in rapid haemodynamic failure. We therefore chose delayed sternal closure in 50 patients with complex heart disease. Three cases of infection were recorded. This safe and easy procedure presents the advantage of being life-saving for more than one third of the patients.