Annales de gastroenterologie et d'hepatologie最新文献

Unlabelled: Hepatocyte transplantation could be an alternative to whole liver transplantation. Allogeneic hepatocytes are rejected if transplanted without immunosuppression. The aim of this study was to transplant allogeneic hepatocytes in the peritoneum and to protect them from rejection by encapsulation in a new semi-permeable membrane.

Methods: rats hepatocytes were encapsulated in hydrogel-based hollow fibers, obtained from AN69 polymer, before being transplanted into the peritoneum of rats. Outcome of allogeneic hepatocytes encapsuled in hollow fibers was compared to that of free allogeneic hepatocytes. Cell viability was assessed by erythrosine exclusion, morphology by electronic microscopy and function by albumin release.

Results: Up to 90 days, viability of allogeneic hepatocytes in hollow fibers was above 80%. The morphology remained normal at electronic microscopy. Albumin release was 16.5 +/- 0.3 (day 15), 14.2 +/- 2.0 (day 30), 8.8 +/- 0.1 (day 60) and 11.4 +/- 0.3 mg/24h/10(6) hepatocytes (day 90). Free hepatocytes did not survive at day 15.

Conclusion: Viability and function of encapsulated allogeneic hepatocytes were maintained up to 90 days after transplantation, without immunosuppression.

During our first communication [1], the complexity of vitamin B12 digestive transport was considered. This second presentation demonstrates the route of the vitamin in the body. As cobalamin or vitamin B12 has existed for four billion years, they figure without any doubt amongst those molecules which have the most complex structure. The rarity of an architecture organised around a cobalt atom confirms their high level of originality. Their exceptional character is reflected in their cycle such as for mammals and for man where the intervention of binders, such as intrinsic factor, transcobalamin and haptocorrin is necessary for transporting them. As far as cellular metabolism is concerned, it is especially loaded sometimes with folates in the transfer of the methyl group. The molecules are spiked with hydrophobic sites. Their membrane transfer is facilitated by several types of receptors. The intestinal absorption, which appears to require the presence of two receptors and two transporters, remains for the moment a unique assimilation model. The very probable existence of an enterohepatic cycle as well as a renal reabsorption saves this molecule, itself synthesised by microorganisms only.

It is classical to separate gastro-intestinal non Hodgkin lymphomas into two epidemiological profiles: an "occidental" type frequently encountered in West countries (Europe and USA) and an "occidental" type which is dominant in the Middle East regions and is distinguished from the occidental type by the following features: the younger age of patients, the rarity of gastric involvement compared to the small intestinal involvement, the prevalence of Immuno Proliferative Small Intestinal Disease within the small intestinal non Hodgkin lymphomas. An epidemiological study was done on 100 cases of digestive non Hodgkin lymphomas seen in Lebanon between 1965 and 1991 in hospitals affiliated with Saint-Joseph University. The statistical analysis of our study leads to several conclusions: the ISPID is disappearing in Lebanon during the last twenty-five years; the site of gastrointestinal involvement is changing with time, the small intestinal involvement becoming more rare and the gastric involvement more frequent. So during this twenty-five years period, there was an occidentalization of the epidemiological profile. This varying pattern with time in the epidemiology of gastrointestinal non Hodgkin lymphomas could be due to changing in the environmental factors like the intestinal bacterial and parasitological infestation.

This study reports three cases of leiomyosarcoma of the small intestine (a rare malignant neoplasm) presenting in our department of general surgery over a period of ten years. Tumors in these three patients were located in the jejunum and clinical features included severe gastrointestinal bleeding, intestinal obstruction and/or abdominal pain. All three patients underwent radical surgery. None received radiotherapy and chemotherapy in addition. One is alive and in complete remission for four years while the other two died, after two and twenty-two months respectively. There follows a discussion, based upon the literature, of epidemiological, histopathological, clinical, diagnostic and treatment aspects. Particular stress is placed upon the difficulty of establishing the diagnosis before surgery, since symptoms are often absent or non-specific and vague until the malignant small bowel tumor has progressed to the point of causing a complication. Surgery continues to play a primary role in the treatment of leiomyosarcoma. Further studies are required to identify prognostic factors and to assess the efficacy of radiotherapy and chemotherapy in this type of malignant neoplasia.

The incidence of disseminated candidiasis is increasing. Liver involvement is frequent but rarely diagnosed. The authors report a case of disseminated candidiasis due to Candida glabrata with liver metastases. The presence of hepatic lesions was diagnosed by CT scan and parasitological examination of liver abscess contents obtained by CT-scan-directed puncture-aspiration. The outcome was favorable with amphotericin-B (cumulative dose of 1 g) and flucytosin. Aspects of hepatic involvement in disseminated candidiasis is discussed, together with the role of Candida glabrata in pathology of this type.

The authors report two cases of tuberculous liver abscess. They stress the rarity of this site, and differential diagnostic difficulties with other types of infection and liver tumors, notably amebiasis, hydatid cyst and carcinoma. Echo- or Scan-guided needle biopsy is useful for diagnosis and, in some cases, treatment by drainage of the purulent cavity.

The authors report a case of cystic lymphangiomatosis of the spleen. Study of this case and a review of the literature confirm the rarity of this site and problems of differential diagnosis with hydatid disease. Treatment remains surgical and the prognosis is good.

The history of military medicine has always been closely linked with that of vaccinations. Doctors of Armed Forces, doctors of collectivities, have contributed to vaccination progresses in large amounts. But evolutions are often rapid here: epidemiological modifications, improvements in the existing vaccines or creation of new vaccines, diversification of military specificities. Three recent modifications in the vaccination schedule of the Armed Forces show this necessary adaptation: systematization of the meningococcal A+C vaccination during the incorporation, because of the modification of the disease's epidemiological profile; increase of the frequency in serogroup C with a mortality increase (9 cases of death out of 10 observed between 1991 and 1992); cancellation of antityphoid vaccination for recruits serving in home country. Indeed the disease has become rare in France, and this is often due to imported cases (3 cases in the Armed Forces in 1992); introduction in 1994 of vaccination against viral hepatitis A, systematic under the age of 25 years and after a serological selection above for servicemen having to serve overseas or for outside operations. These 3 examples show the necessity to have updated and adaptable vaccination schedules.

Inflammatory fibroid polyp is a rare benign tumor of the digestive tract. The authors report three cases: two intestinal and one gastric. These cases are of particular interest because of the association ill one case of an intestinal submucosal lipoma with the inflammatory fibroid polyp, and the existence in the gastric case of an inflammatory reaction caused by food debris. This offers, further evidence in support of the theory implicating a chronic inflammatory reaction.