Precision Measurement of Vibrational Quanta in Tritium Hydride.

Saturated absorption measurements of transitions in the (2-0) band of radioactive tritium hydride are performed with the ultrasensitive noise-immune cavity-enhanced optical-heterodyne molecular spectroscopy intracavity absorption technique in the range 1460-1510 nm. The hyperfine structure of rovibrational transitions of tritium hydride, in contrast to that of hydrogen deuteride, exhibits a single isolated hyperfine component, allowing for the accurate determination of hyperfineless rovibrational transition frequencies, resulting in R(0)=203 396 426 692(22) kHz and R(1)=205 380 033 644(21) kHz. This corresponds to an accuracy 3 orders of magnitude better than previous measurements in tritiated hydrogen molecules. Observation of an isolated component in P(1) with reversed signal amplitude contradicts models for line shapes in hydrogen deuteride based on crossover resonances.

Lamb Dip of a Quadrupole Transition in H_{2}.

The saturated absorption spectrum of the hyperfineless S(0) quadrupole line in the (2-0) band of H_{2} is measured at λ=1189 nm, using the NICE-OHMS technique under cryogenic conditions (72 K). It is the first time that a Lamb dip of a molecular quadrupole transition has been recorded. At low (150-200 W) saturation powers a single narrow Lamb dip is observed, ruling out an underlying recoil doublet of 140 kHz. Studies of Doppler-detuned resonances show that the redshifted recoil component can be made visible for low pressures and powers, and prove that the narrow Lamb dip must be interpreted as the blue recoil component. A transition frequency of 252 016 361 164 (8) kHz is extracted, which is off by -2.6 (1.6) MHz from molecular quantum electrodynamical calculations therewith providing a challenge to theory.

Lamb-dips and Lamb-peaks in the saturation spectrum of HD.

The saturation spectrum of the R(1) transition in the (2-0) band in hydrogen deuteride (HD) is found to exhibit a composite line shape, involving a Lamb-dip and a Lamb-peak. We propose an explanation for such behavior based on the effects of crossover resonances in the hyperfine substructure, which is made quantitative in a density matrix calculation. This resolves an outstanding discrepancy on the rovibrational R(1) transition frequency, which is now determined at 217,105,181,901 (50) kHz and in agreement with current theoretical calculations.

[Stomach cancer: a descriptive study of 101 cases at the gastrointestinal endoscopy center at Aristide Le Dantec University Hospital]. / Le cancer gastrique : étude descriptive de 101 cas dans le centre d'endoscopie digestive du CHU Aristide Le Dantec.

INTRODUCTION: Stomach cancer is a real public health problem in Black Africa. We report its epidemiological, endoscopic, and histological aspects, as observed in our gastrointestinal endoscopy center at Aristide Le Dantec University Hospital in Dakar (Senegal). PATIENTS AND METHODS: This retrospective study covered the 5-year period from January 1, 2006, to December 31, 2010 and included all patients with stomach cancer confirmed by anatomo-pathological examination. We collected data about age, sex, indications for the examination, and description of the gastric lesions and any other associated lesions from the upper GI endoscopy reports. We also recorded information from the histological reports of all lesions. RESULTS: The study included 101 patients. The incidence of gastric cancer was 20 cases/year. Patients' mean age was 58 years [range: 24-83]. The sex ratio was 2.48. The main indications for the upper GI endoscopy were epigastralgia (33.3%), vomiting (26.1%), and tumoral hepatomegalia (10.81%). The examination found mainly ulcerative and protruded lesions (59.40%). Other types of lesions associated with the tumor were esophageal candidiasis (34.6%), peptic esophagitis (25%), and gastroesophageal junction incompetence (25%). The tumor was located in the antrum in 68% of the cases and was an adenocarcinoma in 83.2%. CONCLUSION: A cancer register to determine the characteristics and prevalence of stomach cancer in Senegal would be useful. The link with Helicobacter pylori requires further study.

[Spontaneous bacterial peritonitis in Dakar, Senegal: study of 55 patients with cirrhosis]. / Infection spontanée du liquide d'ascite à Dakar, Sénégal : étude de cinquante-cinq patients cirrhotiques.

OBJECTIVES: To report the prevalence of spontaneous bacterial peritonitis (SBP) and its clinical and laboratory features in patients with cirrhosis followed at the Aristide Le Dantec Hospital in Dakar (Senegal). PATIENTS AND METHODS: From May through December, 2010, we prospectively included patients with cirrhosis and a first episode of ascites on clinical examination. Diagnostic abdominal paracentesis was performed in all cases to determine the macroscopic appearance of the fluid, protein concentration, and cell count, and to culture the ascitic fluid in a blood culture bottle. SBP was diagnosed when the fluid contained more than 250 polymorphonuclear leukocytes per cubic millimeter of fluid. The data were analyzed with Epi-Info software, version 3.5.2. Comparisons used Fisher's exact and Chi-square tests, with significance set at p < 0.05. RESULTS: The study included 55 patients with cirrhosis, with a mean age of 45 years and a male/female sex ratio of 1.89 (36 men). The prevalence of SBP was 27.3%. Factors significantly associated with SBP were female gender, malnutrition, turbid appearance of the ascites, and neutrophilia. In samples from patients with SBP, the mean protein concentration was 20.7 g/L, the white cell count was 1797/mm(3), and the neutrophil count 1,102/mm(3). Ascitic fluid culture was positive in 20% of the SBP cases (n=3). CONCLUSION: In Dakar, cirrhosis is found especially in young adults, and the prevalence of SBP in our population was 27.3%. Improved technical equipment would improve the hospital's ability to determine the causes of cirrhosis and identify the various germs responsible for SBP.

[Esophageal variceal band ligation in Dakar, Senegal]. / La ligature élastique des varices œsophagiennes à Dakar (Sénégal).

After a preliminary study in the gastrointestinal endoscopy center of the Aristide-Le-Dantec Teaching Hospital in Dakar, Senegal, demonstrated the feasibility and effectiveness of endoscopic ligation of esophageal varices, this procedure entered regular use for management of patients admitted for upper digestive tract bleeding due to these varices. This study sought to assess its effectiveness. Patients and method. This study, conducted from July 2005 through January 2010, included all patients with upper digestive tract bleeding due to rupture of esophageal varices. Results. In all, 140 patients with a mean age of 36 years [range: 16-75] were admitted for this diagnosis and included in the study: 93 men and 47 women (sex-ratio = 1.98). The presence of at least one clinical sign of portal hypertension was noted in 72% of cases. Esophageal varices were graded as stage III in 75.7% of cases. The underlying cause of portal hypertension was cirrhosis in 94.3%, presumptively due to hepatitis B virus among 37.1%. The varices were successfully eradicated in 64 patients (45.7%). The mean number of sessions required was 2 [range: 2-4] in patients with stage II and 3.4 [range, 3-8] in patients with stage III varices, and the mean number of bands applied per session was 5.1 [range: 2-6] and 5.6 [range: 2-10], respectively. The interval between sessions was 4 weeks [range: 3 -12]. Bleeding recurred in 8 patients (5.7%) before eradication was achieved; 4 (2.8%) of them died. Conclusion. Esophageal variceal ligation is an effective therapeutic and prophylactic procedure for management of esophageal varices in Senegal.

Creation of a therapeutic digestive endoscopy suite in Senegal: renovation, training and university certification. Results of a Belgian-Senegalese inter-university project.

Therapeutic digestive endoscopy did not exist in sub-Saharan Africa before 2005. However, the prevalence of digestive diseases that could potentially benefit from basic endoscopic treatment is very high in this region. Portal hypertension with variceal bleeding and severe dysphagia associated with benign or malignant upper gastrointestinal tract diseases are prominent in these countries. The aim of the Project described in this report was to create a digestive endoscopy facility in Dakar (Senegal, West Africa), that would also provide local training in therapeutic endoscopy to doctors and nurses and facilitate regional autonomy with the opening of a University Certification in Gastroenterology. It took about 10 years to achieve these targets - 5 years to prepare realistic aims that took into account local needs, available local resources, and funding, and 4 years for the Project itself (2005-2009). At the present time, Senegalese colleagues and nurses are autonomous for basic therapeutic procedures in the upper and lower gastrointestinal tract. Two years after the end of funding, the rate of therapeutic activity has increased from 0% in 2005 to 12 % of digestive endoscopic activity in 2011. Key points of success were preparation, confidence of medical personnel, university involvement, shared funding, local multidisciplinary training, and facilitation of autonomy. Belgian healthcare workers were present on-site in Dakar for a total of about 6 months over the 4-year Project period, with an annual budget of less than € 80000. The Project has enabled an efficient North-South collaboration with a minimal budget, which has changed the healthcare provision of digestive endoscopy in Senegal, and has also provided autonomy, and facilitated the development of South-South cooperation.

[Endoscopic features of esophageal cancer in Dakar, Senegal: study of 76 observations]. / Aspects endoscopiques du cancer de l'oesophage à Dakar (Sénégal): étude de 76 observations.

OBJECTIVE: In response to the lack of cancer register and paucity of publications on esophageal cancer in Senegal, this retrospective descriptive single-center study was undertaken to determine epidemiological, clinical, endoscopic and histological features of the disease at a digestive endoscopy center in Dakar. PATIENTS AND METHOD: Reports describing upper digestive tract endoscopy procedures performed at the Aristide Le Dantec Teaching Hospital in Dakar between January 2006 and December 2009 were reviewed. Cases involving histologically confirmed esophageal cancer were compiled and patient data including age, sex, and indication for endoscopy as well as endoscopic and histological findings were analyzed. RESULTS: A total of 78 reports were collected including 76 patients with suitable data for analysis. Esophageal cancer accounted for 0.97% of upper digestive tract endoscopy procedures performed. Mean patient age was 49 years and the sex-ratio was 1.9. The main indication for endoscopy was dysphagia (92.1%). The most frequent endoscopic finding involved budding lesions with (42%) or without (29%) ulceration. The most common location was the middle third of the esophagus (50%). The most frequent histological type was squamous cell carcinoma (92.1%). CONCLUSION: Esophageal cancer observed at the endoscopy center of the Aristide Le Dantec Teaching Hospital in Dakar mainly affects young male adults. Lesions are generally located in the middle third of the esophagus and corresponded to squamous cell cancer. There is a need to establish a cancer register and to conduct multicentric studies to gain insight into risk factors for esophageal cancer in Senegal.

[Helicobacter pylori and gastroduodenal lesions in Dakar, Senegal]. / Helicobacter pylori et pathologie gastroduodenale a Dakar (Sénégal).

INTRODUCTION: The bacteriological characteristics of Helicobacter pylori (HP) vary in function of time and place. The aim of this study was to update histological and bacteriological feature of HP infection in patients presenting gastroduodenal lesions in Dakar, Senegal. PATIENTS AND METHOD: This prospective study included patients with gastroduodenal lesions managed over a 6-month period in a digestive endoscopy center in Dakar. In all cases gastric biopsy was performed to obtain specimens for histological diagnosis according Sydney modified classification and HP culture with antibiogram. RESULTS: A total of 158 patients were included. Mean patient age was 48.7 years and the sex-ratio was 1.2. Endoscopic lesions were ulcer in 88 cases, gastritis in 54 cases and tumors in 16. Histological examination demonstrated chronic gastritis in 100% of cases, inflammatory activity in 79.1%, metaplasia in 78.5%, gastric atrophy in 41.1%, adenocarcinoma in 7.6%, dysplasia in 5.7%, and MALT lymphoma in 2.5% with presence of HP in 72.8% of cases. Cultures were positive for HP in 65.8% of cases. Antibiograms indicated that HP was sensitive to amoxicilline in 100% of cases, clarithromycine in 96.6%, ciprofloxacine in 84.1%, and métronidazole in 29.5%. CONCLUSION: Chronic gastritis is a constant feature of gastroduodenal lesions in Dakar. Histology combined with culture showed HP infection in 78.5% of cases. The antibiotic sensitivity of HP in Dakar has changed over the past decade.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]. / Apport de la coloscopie dans le diagnostic des rectorragies à Dakar (Sénégal).

INTRODUCTION: Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal. PATIENTS AND METHODS: This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed. RESULTS: A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%). CONCLUSION: Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]. / Perforation et hémorragie d'ulcères du bulbe duodénal chez une enfant.

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Clinical and endoscopic features of solitary rectal ulcer syndrom in the digestive endoscopy unit of Hospital Aristide Le Dantec in Dakar]. / Aspects cliniques et endoscopiques du syndrome de l'ulcère solitaire du Rectum dans l'unité d'endoscopie digestive du CHU A. Le Dantec de Dakar: à propos de 11 cas.

INTRODUCTION: The solitary rectal ulcer syndrome is a rare disease. In Africa only few studies have been held on this subject. The aim of this study was to determine the epidemiological, clinical and endoscopic aspects of this syndrome in the digestive endoscopy unit of hospital Aristide Le Dantec in Dakar. PATIENTS AND METHOD: It was a retrospective study based on all the cases of solitary rectal ulcer regarding to the conclusion of endoscopic examination from January 1994 to June 2002. All the patients without histological confirmation were excluded. RESULTS: We had recruited 11 cases among 4250 endoscopic exam (0.26 %). The mean age was 40 years (extreme 23 to 63 years). Female to male ratio was 1.75 with 4 males and 7 females patients. The main indications of endoscopic examination were frequently associated and were dominated by intermittent bleeding (8 cases) chronic constipation (6 cases) and false chronic diarrhea with muco hemorrhagic discharge (4 cases). The mean duration of the symptoms was 5 years. Ulcers were ovoid or circular. Their mean diameter was 8 mm and they were located 8 cm above the anal margin. The lesion was unique in 55 % of the cases and concerned the anterior wall of the rectum in 74% of the cases. There was an internal rectal prolapse in 54% of the cases. CONCLUSION: The solitary rectal ulcer syndrome is not frequent in the endoscopy unit of hospital Aristide Le Dantec in Dakar. It affects mostly young adult female. The symptoms are chronic and non specific. In tropical areas the disease is frequently misdiagnosed as colic amoebiasis.

[Hemorrhoids in Dakar: epidemiological, clinical and endoscopic aspects of 168 cases]. / Aspects epidemiologiques, cliniques et endoscopiques de la maladie hemorroidaire a Dakar. A propos de 168 cas.

INTRODUCTION: haemorrhoidal disease symptoms lead frequently to medical consultation. The aims of our study were to determine its epidemiological, clinical and endoscopic characteristics in Dakar. PATIENTS AND METHODS: we conducted a prospective multicentric study in the hospitals and in the private offices with endoscopic unit in Dakar from November 2nd 2003 to July 31 2004. A questionnaire with clinical and epidemiological features was applied to patients who presented haemorrhoid to the endoscopic exam. We included those who accepted the questionnaire. RESULTS: We recruited 168 patients. The mean age was 39.6 years. The sex ratio was 1.66 (male to female). The mean duration of symptoms was 6 years (range 1 month - 32 years). The symptoms that lead to medical visit were mainly: rectal haemorrhage (50.5%), anal pain (23.2%), constipation (13.1%) and anal tumefaction (9.5%). At the anamnesis the most frequently symptoms noted were constipation (80.4%), anal tumefaction (74.4%), anal pain (73.8%), rectal haemorrhage (64.9%) and anal pruritus (58.3%). The haemorrhoids were internal in 116 cases and external in 52 cases. According to the endoscopic classification, 35% of patients were at the first stage, 43% at stage II, 18% at stage III and 4% at the stage IV. An anitis was noted in 29.1% cases. We noted as associated lesions 18 fistulas and 15 anal fissures. CONCLUSION: The epidemiological, clinical and endoscopic characteristics of haemorrhoidal disease in Dakar are similar to those described in medical literature.

[Dakar physicians' therapeutic attitude towards non complicated peptic ulcer disease]. / Attitude therapeutique des praticiens de la ville de dakar fa ce a la maladie ulcereuse gastro-duodenale non compliquee.

Peptic ulcer disease is topic of guidelines in developed countries. In South area, without consensus conference, physicians' attitude towards this disease is varied. So, we aimed to describe therapeutic decisions of physicians in Dakar, regarding literature and the role of Helicobacter pylori in gastro-intestinal diseases. From 2001 december first to 2002 January 31, a survey was made in a sample of 171 physicians in Dakar with a questionnaire. All generalists, internists and gastroenterologists working in public or private health places of Dakar were concerned. The rate of responses was 68%. 65.5% of physicians had not read guidelines about peptic ulcer disease and H. pylori but 89% of them had read articles on these topics. Most of the physicians (76%) ordered systematically or mainly treatment to eradicate H. pylori. 95% of them did not require proof of infection before treatment. Association of gastric antisecretory drug with amoxicillin and metronidazole was mostly used (77.5%). Double dose of antisecretory drug was prescribed by 51.5% of physicians. For 40.5% of them, the duration of treatment was 7 days while 53.5% prolonged duration to 10 or 14 days. Complementary antisecretory drug was systematic for most of physicians (83.5%). These multiple therapeutic options, sometimes not in accordance with recommandations, militate in favour of more intensive participation of Dakar physicians to scientific meetings, in order to rationalize their therapeutic attitude towards peptic ulcer disease and take into account local data.

[Gastroduodenal peptic ulcer: descriptive study]. / Etude descriptive de la maladie ulcéreuse gastro-duodénale non compliquée.

Our goals were to describe the epidemiological, clinical and endoscopic aspects of gastrointestinal ulcer and to determine the frequency of H. pylori, we included 140 gastrointestinal peptic ulcers from January 1999 to June 2000. Diagnosis of ulcerous disease delt with the presence of an ulcer discovered during a high digestive endoscopy. Gastro-duodenal ulcers bleeding or with stenosis have been excluded as well as patients who were under anticoagulant treatment or antibiotics or under pump of protons inhibitors during the previous month. Data were collected from a unique questionnaire specifying the sociodemographic characteristic, the history of the ulcerous disease, the antecedents, the style of life, and the endoscopic findings. Five biopsies were done using sterile grips and a fast urease test and the direct exam of the smear. The prevalence of gastro-duodenal ulcers in our population of survey was 6.2%. One hundred twenty eight duodenal ulcers (91.4%), and 12 gastric ulcers (8.6%) were found. The average of age was of 37.1 years +/- 15.3. The sex ratio was 2.9. The gastro-duodenal disease had begun for more than 5 years at 40.8%. No difference in the characters of the pain and signs has been found between duodenal and gastric localization of the ulcer. Hp was associated in 91.4% (91.4% when duodenal ulcers, 88.9% when gastric ulcers and all gastric and duodenal ulcers). We conclude that gastrointestinal ulcers occupies an important place in our gastroenterological practice and the infection rate with H. pylori infection is so high during gastro-duodenal ulcers in our country that the eradication of Hp could be proposed in any case of gastro-duodenal ulcer diagnosed by endoscopy.

[Gastrointestinal hemorrhage in cirrhosis at Dakar. Predictive factors study]. / Hémorragies digestives au cours de la cirrhose du foie a Dakar. Etude des facteurs prédictifs.

Our aim were to describe the epidemiological and clinical as well as therapeutical features and to look for predictive factors of occurrence of gastrointestinal hemorrhage among cirrhotic patients. We included all cirrhotic patients with acute gastrointestinal hemorrhage hospitalized in the Service of Internal Medicine of Aristide Le Dantec University Teaching Hospital from January 1990 to December 1999. The diagnosis of cirrhosis was established according to two situations: prebiopsic criteria with clinical, biological, ultrasound and endoscopic data or the histological criteria. Gastrointestinal hemorrhage was present in 28.9% of the patients with an average age of 38.7 years and a sex ratio of 1.4. It revealed the cirrhosis in 82% of the cases, whether alone in 45.2% or associated with other complications in 36.8%. Previous bleeding episodes were found in 76 cases (9.6%). Gastrointestinal hemorrhage is the first cause of death among our cirrhotic patients with an overall mortality of 29.4%. The gastrointestinal hemorrhage was significantly associated with the young age (< 40 years). On the other hand, the clinical and biological parameters did not seem predictive of bleeding. The risk of hemorrhage was positively correlated with the presence of esophageal varices and their stage, the gastric varices and the portal gastropathy. The other lesions (watermelon stomach and erosive gastritis) did not seem to play a role in gastrointestinal hemorrhage. However the CHILD-PUGH classification was a poor predictor of either first hemorrhage or re-bleeding in this present study. We conclude that gastrointestinal hemorrhage is frequent among cirrhotic patients in our country. It constitute in this study the first cause of death in this population. instrumental treatment methods might prevent most of gastrointestinal hemorrhages in patients with high risk.

[Gastro-esophageal reflux in adults: clinical and endoscopic features at the Le Dantec Hospital of Dakar]. / Le reflux gastro-oesophagien de l'adulte: aspects cliniques et endoscopiques au CHU Le Dantec de Dakar.

We carried out a prospective study in the digestive endoscopy unit of Medical Clinic of the University Hospital Le Dantec, in order to better clarify the clinical and endoscopic features of gastro-esophageal reflux ( GER ) in our country. Patients whose endoscopy was indicated by symptoms of GER and those who presented oesophagitis were concerned in this study. We so included 317 patients, representing 16.75% of all patients undergoing upper gastro-intestinal endoscopy from september 1999 to august 2000. Clinical symptoms could be analysed in 164 patients (51.74%). Mean age was 40 years and sex-ratio 0.83. The most frequent digestive symptoms were epigastric pains ( 72.6 % ), heartburn ( 60.4 % ), and acid regurgitations ( 56.7% ). Non gastro-intestinal symptoms were present in 43.9% of cases for Ear Nose and Throat signs. 36.6% for chest pains and 14.6% for pulmonary manifestations. Peptic oesophagitis was present in 40.69% of patients with a mean age of 44 years. Savary and Miller grade IV was rare and was represented by oesophageal ulcers only. GER aspects in our departement are characterized by high frequency of epigastric pains and atypical symptoms, and rarity of severe forms of oesophagitis.

[Methotrexate, liver and rheumatoid arthritis in tropical areas]. / Méthotrexate, foie et polyarthrite rhumatoïde en milieu tropical.

Rheumatoid arthritis (RA) is a common disease in tropical areas. Methotrexate which has become the main first-line treatment in western countries is increasingly used in tropics. Well documented liver toxicity of methotrexate led the American College of Rheumatology to provide guidelines about monitoring patients. In endemic areas of hepatitis B and C methotrexate may interfere with the natural history of these infections and exarcerbate liver damage, on the other hand, RA causes extra-articular manifestations which are rare and exceptionnally serious in the liver. The most important hepatic disorders associated with RA are: intrahepatic portal hypertension without cirrhosis, amyloidosis, drug hepato-toxicity and viral interferences. - Intrahepatic portal hypertension Several cases of portal hypertension without cirrhosis have been reported. Most cases were related to Nodural Regenerative Hyperplasia (NRH) which is made of diffuse nodules of hepatocytes without fibrosis. The pathogenesis of this entity is unknown. Distal vascular changes and abnormal perfusion of liver are mentioned. Presentation is cholestasis in one third of cases. Portal hypertension has no particularity and may cause esophageal variceal bleeding. NRH is closely associateed with Felty's syndrome. - Amyloidosis Hepatic amyloidosis is a classical complication of RA even rare. It is a secondary amyloidosis of AA type. Hepatic injury is generally silent and renal symptoms are dominant. - Drug hepatotoxicity Several medications used in the management of RA are potentially hepatotoxic : salicylates, nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, gold, sulfasalazine and methotrexate above all. Methotrexate hepatotoxicity is well documented in carcinology with high doses but also in psoriasis patients treated with low doses. Hepatic damage related to methotrexate includes elevation of aminotransferases, portal fibrosis and cirrhosis. But data on methotrexate toxicity show small risk of serious liver disease in RA patients. Long duration of therapy and age (> 60 years) have been found to be independent risk factors for the development of hepatic disease. Other identified risk factors are alcohol intake, diabetes, obesity and prior history of hepatitis B or C. The American College of Rheumatology has published guidelines about monitoring patients for liver toxicity. Hepatic tests and Hepatitis B and C serologic studies are recommended before starting treatment with methotrexate. Liver biopsy is only recommended in case of alcoholism, prolonged abnormalities of aminotransferases and chronic hepatitis B or C infection. - Methotrexate and hepatitis B or C infection These infections are endemic in tropical areas. Chronic hepatitis B or C is a contra indication for methotrexate therapy, due to the immuno-suppressive effect of the drug. Positive ELISA tests to C virus must be confirmed with RIBA tests to avoïd false positive tests which have been reported in Africa. The "healthy" HBs Ag carrier state is not in theory a contra indication for methotrexate therapy but the risk of hepatitis B reactivation needs a close monitoring. The biological tests required for are sophisticated and quite impossible in routine practice in tropical areas. So HBs Ag carrier state is usually incompatible with methotrexate treatment. Studies would be useful to prove that in endemic areas of viral hepatitis B and C as in western countries, methotrexate is enough safe to become the main first-line treatment of rheumatoid arthritis.