The authors report two new observations of collagenous colitis. In both cases the signs were of functional colonopathy, and the diagnosis was only made after rectal and colic biopsies. In one case, electron microscopy revealed that the collagen band was independent of the epithelial membrane. The collagenous deposit contained many nerve endings, which seems to suggest an inflammatory origin of the disease. The clinical condition of a female patient was greatly improved by mepacrine, but the histological lesions remained unchanged.
A 50-year old man developed a nonpigmented malignant melanoma in the anorectal area. The diagnosis was established by a biopsy. The histologic diagnosis of this highly malignant tumor can be difficult in nonpigmented forms, and can benefit from the use of PS 100 and HMB 45 as immunological markers. Although surgery is the mainstay of management, the best method is not agreed on, and the prognosis seems more closely dependent on the stage ct the disease than on the type ct surgical procedure performed. The role of radiation therapy and chemotherapy needs to he evaluated.
To prevent post-transfusional hepatitis B and C, two epidemiologic studies were performed. The first, based on the frequencies distribution of hepatitis B virus serological markers versus sex and classes of age, has permitted the assessment of the profile of the infection in a population composed of 573 north vietnamese blood donors. There is no significant difference between men and women frequencies of HBs antigen (11.5%), anti-HBs antibody (70.2%) and anti-HBc antibody alone (3.8%), but a significant difference of no-marker frequencies: 7.8% and 17.9% in men and women respectively (X2 = 9.11; p = 0.010). The percentage of no-marker decreases when the mean age of each class increases. The second, using the increase of the serum alanine aminotransferase (ALAT) activity as an indirect marker of non-A, non-B hepatitis for determining in a population of more than 25,000 parisian blood donors, the percentage of donors eliminated. They are between 0.70 and 0.76 in women and 2.26 and 2.46 in men. These investigations can be applied to prevent the hepatitis B transmission in a population of 102 south vietnamese women in age to procreate or to determine the percentage of blood donors eliminated (3.12%) in a population of 2,950 Parisians composed in majority (50.9%) of new donors. The hemobiologist will have an important role to elaborate strategies for orientation of blood gifts with hepatitis B and C virus markers.
The authors report 4 new cases of splenic abscess treated by percutaneous drainage. The originality of this study concerns the rarty of this disease and the value of percutaneous drainage as a new effective method of treatment. The characteristics of our patients are : mean age : 35.75 years ranging from 38 to 70. Male 1, female 3. Was percutaneous drainage US guided. the cause of the splenic abscess was a urinary tract infection in 2 cases, and aortic dissection complicated with embolism with infected splenic infarction. 3 patients have diabete. E coli was isolated from the pus, only in one case. For all patients, antibiothics were associated with percutaneous drainage. Percutaneous drainage was completed by surgery, in only one case.
The authors report a case of external post traumatic pancreatic fistula in a 24-year-old patient who had been operated for abdominal injury. Resistance to repeated conservative treatment and the appearance of pancreatic abscess led to pancreatic resection. Surgical treatment of external post-traumatic fistula remains the appropriate solution in particular cases.
Focal nodular hyperplasia (FNH) is a rare benign tumour of the liver arising from hepatocytes and bile canaliculi. it is observed at all ages, but mainly in adults with a marked female predominance: It can occur independently of oral contraceptive use, but these agents can facilitate the development of complications. The diagnosis is essentially based on medical imaging, particularly CT angiography, MRI and Technetium 99 liver scan. Exploratory laparotomy may be necessary in rare cases to eliminate a diagnostic doubt between adenoma and hepatocellular carcinoma. FNH has a favourable course and treatment is generally conservative.
Upper gastrointestinal bleeding (UGIB) has a very serious prognosis, particularly in the elderly, despite progress in diagnosis and treatment. The objective of this study was to identify aetiological factors and to define the lesions responsible for UGIB in subjects over the age of 60 years. 64 hospital files and endoscopy reports (34 males and 30 females) were selected from the 284 patients presenting with UGIB between January 1993 and December 1996. Treatment with anti-inflammatory drugs was reported in 34.3 % of cases. Consumption of spicy foods was reported in 42.1 % of cases. 14 patients were followed for cirrhosis of the liver, 12 for duodenal ulcer. 50.0 % of patients presented with haematemesis and melaena, 37.5 % with melaena alone and 12.5 % with haematemesis alone. Endoscopy revealed 7 Gases of gastric ulcer, 32 cases of duodenal ulcer, 22 cases of ruptured oesophageal varices, 1 case of peptic oesophagitis, 1 case of gastric cancer and 1 case of haemorrhagic gastritis, secondary to aspirin. The mortality remained high despite early endoscopic diagnosis. The introduction of therapeutic endoscopy techniques will certainly help to improve the prognosis of upper gastrointestinal bleeding in the elderly.
Objective: The main objective of the study was to evaluate the efficacy of a treatment regimen combining several doses of omeprazole in patients with gastro-oesophageal reflux, with or without oesophagitis. Patients and method: 231 patients with symptoms of isolated reflux or associated with non-confluent (grade I) oesophagitis were treated with 20 mg of omeprazole per day for 2 months; after 2 months, responding patients then received 10 mg of omeprazole per day for another 4 months (arm A). 196 patients with confluent or circumferential oesophagitis (grades 2-3) were initially treated for 4 months with 20 or 40 mg of omeprazole per day. The dosage was adjusted after 2 months according to the persistence of symptoms. After 4 months, in cured and relieved patients, the dose of omeprazole was reduced to 10 mg or 20 mg depending on the effective dosage during the initial treatment phase for another period of 8 months (arm B). Reflux symptoms were evaluated by a score (1-4) and the Spechler index, and oesophagitis was evaluated according to the Savary-Miller classification. Results: 1) Arm A: 96 % of patients treated with 20 mg of omeprazole were relieved after 2 months of treatment. This rate was maintained at 92 % after another 4 months of treatment with 10 mg of omeprazole. 2) Arm B: 94 % of patients were healed after 4 months of treatment with omeprazole. During the maintenance phase, 89 % of patients were treated with 10 mg of omeprazole. The dosage reduction after induction treatment allowed maintenance of endoscopic and symptomatic remission in 70 % of patients. Conclusion: The extensive dose-antisecretory effect relationship of omeprazole allows adaptation of the dose prescribed to each patient according to the objective defined (symptomatic relief and/or healing).
The authors report three cases of Budd Chiari syndrome, in three females 21, 30 and 40 years old, and then describe the radiologic features.
The authors report 11 cases of primary hepatic tuberculosis (PHT), observed between January 1982 and December 1996. The mean age of the patients was 30 years. Circumstances of discovery were: right upper quadrant pain (6 cases), chronic fever (4 cases), and cholestatic jaundice (1 case). laboratory tests revealed a raised erythrocyte sedimentation rate (9 cases), inflammatory anaemia (7 cases) and an inflammatory tuberculin skin test (4 cases). Ultrasonography allowed a precise morphological investigation, but failed to confirm the diagnosis, which could only be established by pathological examination of biopsies taken during laparoscopy or by ultrasound-guided percutaneous needle biopsy. Diagnostic certainty was therefore obtained in all patients by visualization of a giant cell granuloma with central caseating necrosis. A favourable course was observed in response to well adapted and well conducted specific medical treatment.
The coexistence of gastric lymphoma and adenocarcinoma is unusual. Only 37 cases have been reported in the Western literature and 45 cases in the. Japanese literature. The authors report a case of synchronous gastric tumour associated with MALT lymphoma and carcinoma in a 75-years-old man. The patient was operated in an emergency for upper gastrointestinal bleeding and died. The gastrectomy specimen presented a 3 cm. Histologic examination showed two components : a superficial carcinoma and a high degree MALT lymphoma. The intestinal carcinoma is more frequent 77 %, and MALT lymphoma represents 43 %, essentially low degree (72 %). The tumours are often separated (58.5 %). 64 % of carcinomas are superficial. 54 % of lymphomas are at an early stage. Helicobacter pylori are present in 73 % of cases.
Objectives: to determine how hospital-based gastroenterologists in Paris, France, manage Crohn's disease, Methods:A questionnaire was sent to 223 gastroenterologists working in gastroenterology departments of teaching hospitals in Paris, The 58 items grouped in seven sections covered the main therapeutic situations in Crohn's disease, with the exception of surgical treatment. Results: The 61 fully-completed questionnaires were included in the study. More than 2/3 of respondents agreed on use of antiinflammatory drugs (corticosteroids or 5-aminosalicylate) in uncomplicated flares, corticosteroid regimens, maintenance therapy after a drug-induced remission, and management of steroid-dependent patients requiring more than 15 mg/d. Replies were more variable and more often in contradiction with current recommendations in the following areas : adjuvant therapy during flares or corticosteroid therapy, management of steroid-dependent patients requiring less than 15 mg/d, azathioprine dosage, prophylactic treatment of postsurgical relapses, contraception, and pregnancy, Conclusion :A high level of agreement was found among gastroenterologists regarding the main therapeutic problems in Crohn's disease. There was more variability, however, regarding less common therapeutic problems and situations for which objective data are scarce or lacking.
The aim of this study was to assess the feasibility and results of the ultrasound guided biopsies of digestive tumors localized at the level of the submucosa in 21 patients (11 men and 10 women) mean age. 36. The lesions were: 9 stomach tumors, 2 small intestine tumors, and 10 colon tumors. The feasibility of the ultrasound guided biopsies was 100%, the sensibility and specificity were 100% better than the endoscopic biopsy. The ultrasound guided biopsy determine the etiology and the histology of the tumors submucosa, in 20 patients, in only one patient, the chirurgical biopsy was necessary for diagnosis. No side effects were observed in this study. This procedure is very while, so it's could replace surgical biopsy in the histologic diagnosis of digestive tumors submucosa developped.
We report a case of bile duct compression caused by a cavemous transformation of the portal vein. The biliary symptoms were obstructive jaundice and laboratory signs of cholestasis. The responsibility of the portal cavernoma was established at laparotomy. Bile duct compression caused by a cavernous transformation of the portal vein is very uncommon. Compression by the turgescent venous network combined with a sclero-inflammatory reaction of the biliary tract are the most likely causes. Cholangiogram showed extrinsic compression of biliary tract. Treatment of this disease is surgical, but C. Buffet reported one case, whick resolved after endoscopic treatment.
We describe a 64-year-old man with solitary rectal ulcer, and external prolapse complicated by rectal stenosis. The diagnosis was established 15 years after the onset of symptoms. Treatment consisted of colorectal resection and colo-anal anastomosis. Solitary associated rectal ulcer associated with prolapse and complicated by stenosis is the cause of diagnostic difficulties.
The vascular involvement, occuring in 30 to 60% of cases of Behcet's disease, concerns essentially the veins of the extremities and the vena cava. The involvement of the mesenteric vein is unusual. We report one case of enteromesenteric venous infarct in a patient treated for neurobehcet and discuss venous mesenteric thrombosis in Behcet's disease. Despite the rarity of this entity, the authors stress the fact that the diagnosis of enteromesenteric venous infarct must be raised in every patient with Behcet's disease and abdominal symptomatology. Early anticoagulation is emphasized. The authors suggest a management strategy to improve the prognosis of this life threatening complication.
This study is based on 937 upper GI endoscopies performed in the paediatric setting to investigate upper gastrointestinal bleedingover a 10-year period (January 1986 to December 1996). The age of these patients ranged from 7 days to 19 years, 35% of them were under the age of 2 years and 50% were over the age of 5 years. Endoscopy was performed during the 24 hours following bleeding in only 15% of cases and more than 72 hours after bleeding in 54% of cases. External bleeding in the form of haematemesis was observed in 91% of subjects, with a small volume in 48% of patients. Endoscopy established the aetiological diagnosis of the bleeding in 75% of cases, with direct visualization of a bleeding lesion in 50% of cases. Three predominant types of lesions were demonstrated: gastroduodenitis in 29% of cases, peptic oesophagitis in 24% of cases, bleeding oesophageal varices in 14% of cases. A gastric or duodenal ulcer was responsible for bleeding in 5.7% of cases. Associated lesions were observed in 18% of cases. Analysis of these results emphasizes the frequency of potentially severe upper gastrointestinal bleeding and the need for early endoscopy in any child presenting with haematemesis or melaena.
Objectives: to define the chronology of protein synthesis during hepatic regeneration and to verify the possibilities of stimulation. Methods: 70% hepatectomy was performed in 3 groups of 33 rats: a control group, one group receiving 15 mu g/kg/day of Epidermal Growth Factor (day -1 to day 14) and one group receiving 4 mu g/day of Interleukin 6 (day 1 to day 14). m RNAs coding for protooncogene c-Myc, alpha-foetoprotein, alpha 2-macroglobulin, actin, albumin, heat shock protein, glucose-6-phosphate dehydrogenase, were quantified after sacrifice scheduled from the 30(th) minute to the 14(th) day following hepatectomy. Results were interpreted after analysis of variance. Results: 1) Controls: mRNA concentration of alpha 2-macroglobulin and alpha-foetoprotein increased, by 20 and 10 times the baseline level respectively at the 20(th) hour and c-Myc mRNA increased by 10 times at the 72(nd) hour. The mRNA concentration of other proteins did not change during the experiments. 2) Epidermal Growth Factor had no stimulating effect when compared with controls. 3) The mRNA concentration of alpha 2-macroglobulin reached 40 times the baseline level at the 20(th) hour when Interleukin 6 was used while that of heat shock protein significantly increased at the 72(nd) hour. These variations were different from those of the controls. The mRNAs of other proteins did not vary. Conclusion: Reconstructive processes are activated early; the remnant liver is receptive to stimulation; Epidermal Growth Factor had no effect; Interleukin 6 stimulates reconstructive processes.
