Adenocarcinomas of the small intestine are among the rarest tumours of the digestive tract. Their prognosis, which is usually very bad, is due to late diagnosis. In a 54 year-old-man, formerly tuberculous, the first sign was abdominal pain without any specific character. The diagnosis was confirmed by jejunal endoscopy, with biopsy under direct vision. The technique was made easier by the tumour developing on the first loop of small intestine, leading to a curative surgical operation.

A 27-year-old patient, originally from Martinique, presented with a progressive hepatic granulomatosis with hepatomegaly, splenomegaly, and non-icteric cholestasis, associated with bronchial granulomatosis lesions. The sarcoidosis regressed rapidly after high doses (60 mg/day) of prednisone. Portal hypertension developed later and provoked a severe hematemesis from rupture of esophageal varices. Signs of pulmonary arterial hypertension were then observed, and the diagnosis confirmed by pressure tests after catheterization, and angiography. A portocaval shunt caused the esophageal varices to subside, but the pulmonary arterial hypertension, resistant to corticotherapy, was rapidly fatal. In the case reported, the pulmonary arterial hypertension, independent of any parenchymatous lesion, was attributed to fibrosis of the arterial walls. The association of portal and pulmonary arterial hypertension with sarcoidosis is a very rare occurrence, and the pathogenesis of this association remains a debatable subject.

Le lymphosarcome primitif du caecum est rarement dépisté à son stade initial, alors que la tumeur est encore localisée. Si l'examen radiologique permet de découvrir la néoformation du bas-fond caecal, seule la biopsie dirigée sous le contrôle de la coloscopie, affirme la nature histologique de la lésion. Dès lors, la conduite thérapeutique sera déterminée par l'extension tumorale. Le cas rapporté comporte actuellement une survie de deux ans après exérèse chirurgicale et polychimiothérapie complémentaire.

The diagnosis of chronic gastritis can be made from the macroscopic lesions seen on endoscopy, and the severity of the changes noted in the mucosa after biopsy under direct vision. Gastric intubation can also be used to confirm the pathological results. If the atrophied mucosa shows highly differentiated diffuse intestinal metaplasia, the examinations should be repeated at regular intervals, as they could herald the onset of malignant changes. The authors discovered 312 cases of intestinal metaplasia in 4 920 patients who had been gastroscoped in the Digestive Endoscopy Center of François-Moutier. A total of 157 of them, were noted to have very highly differentiated diffuse lesions, and 54 of these cases had at least yearly repeat gastroscopies. A diagnosis of intrinsic cancer was made in four patients, and this was confirmed by taking serial sections of the specimens removed.

The authors describe a case of very severe orthostatic hypotension with an invariable pulse arising during the course of considerable motor diarrhea. The diagnosis of primary dysautonomia was made only after eliminating the many organic causes of diarrhea: microbial, toxic, tumoral endocrine including diabetes. Shy and Drager's syndrome was rejected because of the spontaneously regressive course after a period of 4 years, the patient having had no further signs of orthostatic hypotension.