Le traitement symptomatique de la betathalassemie homozygote est principalement constitue de transfusions regulieres de concentres globulaires. Ces transfusions entrainent une accumulation de fer dans les tissus malgre un traitement chelateur bien conduit. Ces depots de fer peuvent induire chez ces patients des myocardiopathies et des cirrhoses secondaires a l'hemosiderose. La transplantation combinee du coeur et du foie peut alors constituer la seule therapeutique possible dans certains cas selectionnes d'insuffisances cardiaque et hepatique terminales. Nous rapportons un cas de transplantation combinee coeur-foie. chez un jeune patient thalassemique qui avait developpe une decompensation cardiaque terminale et une cirrhose. Il s'agit du premier cas belge de transplantation combinee coeur-foie.
L'amelioration des conditions d'hygiene dans les pays industrialises a entraine une diminution du risque d'infection par le virus A chez les enfants et les jeunes adultes. En contrepartie, ceci signifie qu'un plus grand nombre de personnes restent sensibles a l'infection jusqu'a un âge avance ou la maladie est plus grave. Le vaccin contre l'hepatite A est sur, tres immunogene et efficace. La strategie de vaccination contre l'hepatite B orientee vers les groupes a risque n'a pas permis de reduire l'incidence generale de l'infection. En consequence, la vaccination universelle de tous les enfants est actuellement preconisee, associee a la poursuite de la vaccination des groupes a risque. Les vaccins disponibles sont egalement surs et efficaces. En outre, on rappellera les indications de l'immunisation passive.
Background: Peptic ulcer surgery may carry an increased risk for pancreatic cancer development. Molecular analysis of K-ras codon 12, frequently mutated in conventional pancreatic cancers, might provide insight into the aetiological mechanisms.Methods: The relative risk of pancreatic cancer was computed by multivariate and person-year analysis in a cohort of 2633 patients who had undergone gastrectomy. Lung cancer risk was analysed as an indirect means of assessing smoking behaviour. K-ras codon 12 mutational analysis was performed on 15 postgastrectomy pancreatic cancers.Results: There was an overall increased risk of pancreatic carcinoma of 1.8 (95% confidence interval, 1.3 to 2.6) five to 59 years postoperatively, which gradually increased to 3.6 at 35 years or more after surgery (chi(2) test for trend, p < 0.05). Multivariate analysis indicated that parameters other than postoperative interval did not influence the risk. Lung cancer risk was significantly increased after surgery, but no time trend was observed. The spectrum and prevalence of K-ras codon 12 mutations were comparable to conventional pancreatic cancer.Conclusions: Remote partial gastrectomy is associated with an increased risk of pancreatic cancer. Postgastrectomy and non-postgastrectomy pancreatic cancers may share similar aetiological factors, such as smoking. However, the neoplastic process in patients who have undergone gastrectomy appears to be accelerated by factors related to the surgery itself.
The authors describe a case of pseudomembranous colitis secondary to rifampicin, providing for the first time all the clinical, epidemiological, endoscopic, histological and laboratory evidence of the responsability of the antibiotic. Clostridium and its toxin were present in the feces.
