Summary Background Epidemiological data concerning hepatitis B are scarce in France. Aim To describe epidemiological, clinical, virological and histological features of HBsAg‐positive patients followed at non‐academic hospitals in France. Methods Clinical, biological, virological and histological data of all HBsAg‐positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. Results Nearly 1166 HBsAg‐positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 ± 15 years. Twenty‐nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg‐positive and 57% HBeAg‐negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years ( P < 0.05), HBeAg‐negative status ( P < 0.02) and histological activity ( P < 0.0001). Factors associated with cirrhosis: age ( P < 0.0001), platelet count <150 000/mm 3 ( P < 0.0001) and viral co‐infection ( P < 0.03). Conclusion HBV infection represents a significant workload for hepatogastroenterologists at non‐academic hospitals in France.

Ayho-fetoprotein-producing poorly differentiated gastric adenocarcinoma: hepatoid carcinoma? Moniko KMIECIAK LE CORGUILL, Bruno PETITJEAN, Sandrine BEAULIEU, Rene-Louis VITTE, Ruth TENNENBAUM, Philippe ROCHER, Claude EUGENE (Gastroenterol Clin Biol 2004;28:77-79) We report the case of a 42-year-old man with a poorly differentiated gastric cancer revealed by a very high level of serum alphafetoprotein-protein, associated with liver metostasis, and treated by chemotherapy. We discuss the possible diagnosis of hepotoid carcinoma.

Isolated pancreatic tuberculosis is rare, and can mimic pancreatic carcinoma. We report a case of pseudoneoplastic pancreatic tuberculosis revealed by an obstructive jaundice in a 35-Year-old man. Surgical pancreatic histopathology showed a caseating granulomatous inflammation and diagnosis was confirmed by detection of Mycobacterium tuberculosis DNA using specific polymerase chain reaction-based assay (PCR). The patient was successfully treated with quadruple antituberculous therapy. In the context of the diagnostic work-up of a hypodense pancreatic mass, the diagnosis of tuberculosis relies on the presence of pancreatic caseating granulomas, that can be obtained by endosonography-guided biopsy, thus avoiding laparotomy.

Interferon-alpha (IFN) monotherapy results in sustained virological clearance in a minority of patients with chronic hepatitis C. The aim of this study was to assess the effect of a reinforced regimen combining ribavirin and high-dose IFN for 48 weeks compared with a nonreinforced regimen combining a standard IFN regimen and ribavirin for 24 weeks in nonresponders with chronic hepatitis C. A total of 231 patients with chronic hepatitis C and previous nonresponse to IFN monotherapy were randomized. The reinforced group (n = 114) received IFN-2b 6 million units (MU) thrice weekly (TIW) and ribavirin for 48 weeks, and the nonreinforced group (n = 117) received IFN-2b 3 MU TIW and ribavirin for 24 weeks. The main outcome measure was a sustained virological response, defined as negative serum hepatitis C virus (HCV)-RNA 24 weeks following the end of treatment. This endpoint was determined in 98 patients of the reinforced group and 105 patients of the nonreinforced group. At the end of follow-up, a sustained virological response was observed in 29 of the 98 patients (29.6%) in the reinforced group vs 16 of the 105 patients (15.2%) in the nonreinforced group (P = 0.014). In multivariate analysis, factors associated with a sustained virological response were treated with a reinforced regimen [odds ratio (OR) 2.9; P = 0.06] and genotype 2 or 3 (OR 8.8; P < 0.0002). A total of 160 patients had paired biopsies before and after treatment. Histological activity improvement was observed in 32 of 80 patients (40%) and fibrosis worsening in 26 of 80 patients (33%) in the reinforced group vs 13 of 80 (16%) and 19 of 80 (24%) in the nonreinforced group (P = 0.30 and 0.20, respectively). Hence in nonresponders, a high-dose 48-week regimen of IFN and ribavirin combination was more effective than a regimen with interferon at lower dose and ribavirin for 24 weeks only.

BACKGROUND/AIMS:The prevalence and risks factors of bacteriuria in cirrhotics have not been assessed by case-control study, and there are conflicting data concerning the role of liver failure and of ascites. The aims of this study were: i) to evaluate the prevalence of bacteriuria in cirrhotics, ii) to search for associated factors, iii) to evaluate the role of bladder post-void residual volume, and iv) to test the sensitivity of isolated bacteria to norfloxacin. METHODS:The prevalence and risk factors of bacteriuria on admission were determined by a multicenter prospective case-control study. RESULTS:Two hundred and forty-four cirrhotic patients and 240 controls were studied. Bacteriuria was present in 38 patients (15.6%; IC 5%: 11%-20%) and 18 controls (7.5%; IC 5%: 4.2%-11%; p<0.001). By univariate analysis, female sex and ongoing diuretic treatment were associated with bacteriuria (p<0.0001 and p<0.04, respectively). Pugh's grade, ascites and bladder residual volume were not associated with bacteriuria. By multivariate analysis, female sex (p<0.0001) and Child-Pugh score (p<0.03) were predictors of bacteriuria. Sensitivity of bacteria to norfloxacin was observed in 94.7%; sterile urine cultures were noted in 95.2% of patients treated with this antibiotic. CONCLUSION:Bacteriuria is twice as frequent in cirrhotic patients as in matched controls, and there is a trend to association with female sex and liver insufficiency.

Bonnard, Philippe M.D.; Vitte, René-Louis M.D.; Barbare, Jean-Claude M.D.; Denis, Jacques M.D.; Stepani, Philippe M.D.; Di Martino, Vincent M.D.; Coutarel, Pierre M.D.; Eugène, Claude M.D.; Van Batten, Christine M.D.; Cadranel, Jean-François M.D. Author Information

During the acquired immunodeficiency syndrome, most cases of cholangitis develop at an advanced stage of disease. We report a case of cholangitis in a 47-year-old homosexual man, stage IIa according to Center of Disease Control classification. An isolated jaundice was the first manifestation of the disease. The number of CD4 was 380/mu L. Ultrasonography and endoscopic retrograde cholangiography showed a 7 cm stenosis of the common bile duct, and cystic duct stenosis, with associated intra-hepatic biliary duct dilatation. No infectious agent was found. Cholecystectomy and hepaticojejunostomy were performed. Pathological examination of liver biopsy and a sample of the resected common bile duct was consistent with sclerosing cholangitis. The postoperative course was uneventful. During a three year follow-up period, the patient was disease free but he suddenly died of uncontrolled bleeding from duodenal ulcer. In HIV-infected patients, surgical treatment can be performed in case of symptomatic long stenosis of the common bile duct.

During the acquired immunodeficiency syndrome, most cases of cholangitis develop at an advanced stage of disease. We report a case of cholangitis in a 47-year-old homosexual man, stage IIa according to Center of Disease Control classification. An isolated jaundice was the first manifestation of the disease. The number of CD4 was 380/microL. Ultrasonography and endoscopic retrograde cholangiography showed a 7 cm stenosis of the common bile duct, and cystic duct stenosis, with associated intra-hepatic biliary duct dilatation. No infectious agent was found. Cholecystectomy and hepaticojejunostomy were performed. Pathological examination of liver biopsy and a sample of the resected common bile duct was consistent with sclerosing cholangitis. The postoperative course was uneventful. During a three year follow-up period, the patient was disease free but he suddenly died of uncontrolled bleeding from duodenal ulcer. In HIV-infected patients, surgical treatment can be performed in case of symptomatic long stenosis of the common bile duct.

We report a case of hepatic and splenic angiosarcoma in a 34 year-old man presenting with hemoperitoneum and consumption coagulopathy. Histological and immunohistological diagnosis was based on a biopsy specimen obtained through the transjugular route. Embolization via the splenic artery for the most significant lesions and intravenous chemotherapy resulted in a partial response in the liver and splenic tumour masses and survival with a good quality of life. The initial complications reoccurred after chemotherapy was stopped and death occurred after 15 months. The benefit of arterial embolization and chemotherapy in this rare and usually rapidly fatal disease should be assessed in other patients.