Annales de gastroenterologie et d'hepatologie最新文献

The aim of this retrospective study was to describe care patterns and conditions surrounding the resumption of social and work activities after intestinal resection for Crohn's disease. Fifty-eight patients were evaluated regarding their stay in the department of surgery, use of care and resumption of social and work activities within the first year after intestinal resection. Data were obtained from medical records and answers to a medical questionnaire. Forty patients replied to the questionnaire. Mean length of stay in the department of surgery was 16 +/- 9 days. Length of stay was positively correlated to non-elective surgery, colonic resection, presence of fistulae or abscesses, and to the creation of a stoma. Main interval between surgery and resumption of work was 11 +/- 8 weeks. Only one patient was unable to return to work because of the disease. Seventy per cent of the patients who went back to work said that their quality of life was improved after surgery in comparison with their preoperative status. In conclusion, this study suggests that most of the patients undergoing intestinal resection for Crohn's disease can go back to work without particular difficulties, and consider that their quality of life has been improved by surgery.

Tumor seeding of the abdominal wall during fine needle puncture-aspiration of the liver is a very rare complication. The authors report a case of this complication affecting a 50-year-old Senegalese woman. She underwent echo-guided fine needle cyto-puncture of a hepatocellular carcinoma arising from the left lobe, followed by left lobectomy. The subcutaneous nodule was discovered 42 months after cyto-puncture. Histology following its excision revealed infiltration of carcinomatous hepatocytes between the fibers of rectus abdominis. There was no recurrence and the patient was well 10 months after excision of the subcutaneous nodule. With a review of 10 others cases reported in the literature, the authors feel that, although rare, this complication must be avoided and suggest a system for the protection of structures through which the needle passes.

The efficacy of boehmite (Rocgel) and of ranitidine was compared in a randomized, double-blind 4-week trial in patients with symptomatic, endoscopically free macroscopic reflux oesophagitis. Of the 64 patients who completed the study 33 received boehmite and 31 ranitidine. Significant symptomatic improvement occurred in both treatment groups (global clinical score and self evaluation by patients) (p < 0.001). Disappearance of heartburn was 52 per cent (15/29) with boehmite and 53 per cent (16/30) with ranitidine. Disappearance of regurgitation was 48 per cent (10/21) with both treatments. 33% of the patients became totally symptom-free. Our results indicate that boehmite seems to be at least as effective as ranitidine in relieving symptoms. Cost of treatment with boehmite, on the other hand is cheaper than ranitidine. As a safe, locally active mucosal protecting agent and antacid, boehmite is an effective drug for the treatment of reflux oesophagitis without macroscopic lesions.

The frequency of food-induced anaphylactic shocks (FIAS) has been investigated beside 46 emergency departments, 29 departments of Dermatology, and 19 departments of Intern Medicine or Pneumology. 794 A.S. have been reported. FIAS represent 10.2% of the etiologies. More than a third of them are relapsing anaphylaxis. Food allergy had been previously identified in 23.4% of cases. The allergen was present as a hidden allergen or inadvertently consumed in 30.8% of FIAS. 9.9% of the patients were asthmatic. An enhancing factor was heightened in 25.9% of cases: alcohol, exercise, simultaneous intake of aspirin, beta-blockers, conversion enzyme inhibitors. Other factors predisposing to food anaphylaxis were a cross-reactivity shared by pollens and fruit, latex and exotic fruit, house dust mites and snails, or mastocytosis. More than 15 allergens were detected: egg (11.6%), fish (10.4%), crustaceans (10.4%), milk (6.5%), fruit-latex group (6.5%), peanut and other leguminosae (soy, peas, lentils, guar gum...), celery, garlic, etc... The food allergen still remained unknown in 25% of cases. However, the rate of efficiency of the diagnosis reached 94% in the Allergy Units. In addition 10.2% of A.S. were considered idiopathic, raising the hypothesis of allergy to masked food allergens. Compared to a previous study from the 1982's, this survey shows a striking increased prevalence of FIAS.(ABSTRACT TRUNCATED AT 250 WORDS)

This study reports five cases of anorectal melanoma treated at Centre Val d'Aurelle-Paul Lamarque in Montpellier. There follows a discussion based upon the literature of epidemiological, clinical, histopathological and therapeutic aspects. Surgery is the treatment of choice but there is major controversy regarding the best method. The decisive prognostic factor appears to be the stage of the disease rather than the type of treatment. The role of radiotherapy, adjuvant chemotherapy and immunotherapy remains to be evaluated.

The authors report a retrospective study of 27 cases of "ileo-caecal tuberculosis" collected over a period of 10-years. Sixteen women and eleven men, between 14 and 55 years of age (with a group mean age of 28 years), were included. This is still a common disease in Morocco, despite attempts to achieve universal BCG vaccination. Diarrhoea, abdominal pain and a general physical deterioration are the most indicative signs, but are not specific. Tests for M. tuberculosis hominis are often negative, except in cases in which bacteria proliferate in pulmonary excavations, and this makes it difficult to establish a definite diagnosis. The detection of narrowing of the ileum or colon in a country where infection is endemic suggests the possibility of tuberculosis. Colonoscopy, which is becoming increasingly widespread in Morocco, makes an essential contribution. Although it is rare for caseum to be detected in biopsy fragments, the main value of histopathology is that it can eliminate cancer, making it possible to start antibacterial treatment without a diagnostic laparotomy. The outcome of medical treatment is nearly always positive. Clinical improvement, bacteriology tests and X-ray examinations are criteria that a cure has been obtained.

The fact that tumors require polyamines for growth has been repeatedly demonstrated. In vivo polyamines are available both from endogenous (intracellular biosynthesis) and exogenous sources (food and intestinal microflora). We investigated in rats grafted with Mat-Lylu prostatic adenocarcinoma the distribution between tumor and tissues of orally administered (14C) putrescine (Pt). The amount of radioactivity retained by tumors was directly proportional to the tumor volume. In a tumor of 25 cm3 19% of the totally retained radioactivity was found. The accumulation of Pt by intestinal brush-border membrane vesicles prepared from tumor-bearing animals was significantly higher than by vesicles from healthy rats. Our results indicate that the presence of a tumor induces an adaptive response in the small intestine which stimulates the uptake of exogenous polyamines. Our therapeutic strategy was to realise a total blockade of all endogenous and exogenous sources of polyamines by feeding animals with a drug (DFMO, MDL 72527, antibiotics) containing polyamine deficient chow. We observed that polyamine deprivation largely reduced both primary tumor and metastatic development. Natural Killer cell cytotoxic activity and blood formula were restored to normal values after treatment. Furthermore polyamine deprivation enhanced anti-tumoral efficacy of chemotherapy.

This retrospective study is based upon 38 cases of rectal carcinomas occurring in young individuals aged under 25, collected during the 15 year period from January 1978 to December 1993. The mean age of the patients was 23 (range: 14 to 25), with a gender ratio of 2.1. Histology revealed a well differentiated adenocarcinoma in 12 cases, a moderately or slightly differentiated and undifferentiated carcinoma in 14 cases, a colloid carcinoma in 10 cases and a villous tumor with malignant change in 2 cases. Curative surgical excision was possible in only 11 patients. Sixteen patients underwent a palliative procedure, while 12 refused surgery. No treatment was proposed to 3 patients with visceral metastases. Only 11 patients could be followed up, with a mean 5-year survival rate of 10%. The prognosis of rectal carcinoma in young individuals is poor because of late diagnosis at an advanced stage and the aggressive histologic forms encountered.