Gastroenterologie Clinique Et Biologique最新文献

We report the case of a young woman hospitalized for a chronic appendicular syndrome. The histological examination of the resected specimen revealed a rare tumor: tubulovillous adenoma, discovered in 0.02% of all appendectomy procedures. Treatment is most often limited to appendectomy, but in the event of incomplete excision or associated adenocarcinoma, right hemicolectomy may be required. After surgery, a follow-up colonoscopy is recommended due to the higher risk of second gastrointestinal neoplasms in patients with appendicular tumors.

Nous rapportons le cas d’une jeune femme hospitalisée pour un syndrome appendiculaire chronique. L’analyse de la pièce d’appendicectomie a révélé une tumeur peu fréquente : un adénome tubulovilleux. Elle est en effet mise en évidence sur 0,02 % des pièces d’appendicectomie. La prise en charge se limite le plus souvent à une appendicectomie mais elle peut nécessiter une colectomie droite en cas d’exérèse incomplète ou d’adénocarcinome associé. La coloscopie est également recommandée en postopératoire car la fréquence des tumeurs digestives augmente chez les patients atteints par ces lésions.

Human genetic factors that influence HCV treatment responses have been identified by a recent landmark discovery. A SNP has been identified (rs12979860) located in chromosome 19,3 kb upstream of the IL28B gene that encodes IFN-λ3, which was strongly associated with the sustained virological response (SVR) to pegIFN and ribavirin in more than 1000 patients with genotype 1 chronic hepatitis C. In patients of European ancestry, as well as in African-American and Hispanic patients, the CC genotype was associated with a two-fold greater SVR rate than the TT genotype, CT being closer to TT than to CC. More information is now needed to understand the mechanisms that underlie this association.

Récemment, un facteur génétique associé à la réponse virologique a été mis en évidence chez les malades ayant une hépatite chronique C de génotype 1. Un polymorphisme (rs12979860) situé sur le chromosome 19, en amont du gène IL28B qui code pour l’IFN-λ3, a été identifié comme fortement lié à la réponse virologique soutenue (RVS) chez plus de 1000 malades traités par pegIFN et ribavirine. Chez les malades caucasiens, comme pour les afro-américains ou hispaniques, le génotype CC était associé à une probabilité de RVS deux fois plus importante que pour les génotypes TT ou CT. D’autres études doivent être menées pour comprendre le mécanisme impliqué dans cette observation.

Background

Secondary polycythemia is a rare condition, which is usually associated to neoplasia or chronic pulmonary disorders.

Case report

A 41-year-old man man with no history of liver disease was admitted for erythrocytosis. The paraclinical investigations revealed an increased erythropoietin level in the serum and a voluminous hepatic tumor but its identification was unclear. A liver resection was performed and the histopathological examination concluded that the tumor was a giant cavernous haemangioma with extensive myxoid changes. After surgical resection of the haemangioma, normal haemoglobin and serum erythropoietin were obtained without any further treatment.

Conclusion

Liver haemangioma must be included in rare cause of secondary polycythemia, and surgical resection of the haemangioma should be considered as the standard to induce complete remission.

Davis et al. projected the future prevalence of chronic hepatitis C (CHC) and its complications in the United States, using a multicohort natural history model with a tree model. First, the model predicted that in 2010 many patients have already progressed to F4, including to decompensanted cirrhosis and HCC. Second, the model emphasized that cirrhosis and its complications are most common after 60 years old, regardless of when the infection occurred. Finally, the model showed that current treatment patterns will have little effect on the incidence of the complications hepatitis C.

Introduction

Enteropathy-associated T-cell lymphoma (EATL) is a rare complication of celiac disease (<1% of lymphomas) and has a poor prognosis.

Methods

International literature review with PubMed search (up to January 2009) of pathophysiological, clinical and therapeutic data.

Results

EATL is found in patients with a mean age of 59 years, often with a complication that signals its diagnosis. Refractory celiac disease (RCD), equivalent to low-grade intraepithelial T-cell lymphoma, could be an intermediary between celiac disease and high-grade invasive T-cell lymphoma. The median survival is 7 months, with no significant difference between stages; the cumulative 5-year survival is less than 20%. The poor prognosis is determined by disease that has often spread before it is diagnosed (50%), multifocal involvement of the small bowel (50%), poor general health status and undernutrition, and recurrence of complications (infections, perforations, gastrointestinal haemorrhages, occlusions), thus delaying the chemotherapy and contributing to frequent chemotherapy resistance. There is currently no effective and consensual treatment: preventive surgery for complications is controversial, and the results of chemotherapy are disappointing. The classic CHOP protocol (combination of doxorubicin–cyclophosphamide–vincristine–prednisone) does not have satisfactory results and survival remains poor, especially in patients with underlying RCD. High-dose chemotherapy with autotransplantion seems to only improve the prognosis in localised forms. Allogeneic bone marrow transplantation was not evaluated. In all, 1/3 of patients, being unfit for treatment, die before 3 months and half of treated patients stop chemotherapy prematurely due to inefficacy, intolerance and/or complications.

Conclusion

Improvement of the prognosis requires collaboration in order to compose a national cohort, to evaluate new diagnostic and therapeutic strategies and to define prognostic factors.