[Toxocariasis and functional intestinal disorders. Presentation of 4 cases]. / Toxocarose et troubles fonctionnels intestinaux. Présentation de 4 cas.

We report 4 cases of adults patients, suffering from irritable bowel syndrome, which had been attributed late to toxocariasis and for whom the treatment led to recovery. Hypereosinophilia was present only in 3 cases. These cases show that toxocariasis is not limited anymore to its two classical expressions: visceral larva migrans and ocular toxocariasis. So it is useful to think of it to confirm and treat it in the case of patients suffering from irritable bowel syndrome. This enables shorter diagnosis delay (14 months in average for our patients) and this is essential for therapeutic efficiency.

[Primary prevention of digestive hemorrhage, caused by rupture of esophageal varices, by endoscopic sclerotherapy in patients with liver cirrhosis. Multicenter randomized controlled study]. / Prophylaxie primaire des hémorragies digestives par rupture de varices oesophagiennes par sclérothérapie endoscopique chez le malade atteint de cirrhose. Etude contrôlée randomisée multicentrique.

The severity of esophageal variceal bleeding in cirrhotic patients justifies prophylactic therapy. A multicenter controlled study was carried out in Languedoc in 116 cirrhotic patients with esophageal varices and no history of bleeding. Patients were randomly assigned to two groups: 60 control patients without therapy; 56 patients treated by endoscopic sclerotherapy (209 sessions). The mean follow-up was 20 +/- 11 months. Esophageal varices disappeared in 35 patients (62.5%) or became smaller in 10 other patients (18%). Varices reappeared in 9 of these 35 patients within 3 months. Minor (fever, dysphagia, stenosis) or major complications (variceal bleeding, bacterial peritonitis) were noted in 26 patients (46%). Esophageal variceal bleeding occurred in 13 of the treated patients and in 10 control patients. Actuarial curves of bleeding and survival were similar for both groups. Twenty controls and 21 treated patients died during the study. In conclusion, prophylactic sclerotherapy of esophageal varices should not be performed in cirrhotic patients, considering lack of efficacy and high rate of side effects.

[Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?]. / Hépatites à la clométacine (Dupéran). Etude rétrospective de 30 cas. Un modèle d'hépatite auto-immune médicamenteuse?

Thirty cases of clometacin-induced hepatitis were retrospectively collected over a nine-year period in hepatogastroenterological units of non university, public hospitals. There was a strong female predominance (90 percent). Clometacin (Dupéran) was taken because of arthritis in 8 out of 10 cases. Administration was continuous in 85 percent of cases and median duration was 445 days. median dose was 450 mg per day. Jaundice, fatigue, and weight loss were the most frequent symptoms, but edema, ascites and palmar erythema were not uncommon. Thrombopenia (38 percent) was the most frequent hematologic abnormality. Renal failure, always with benign course, was present in 1/4 of cases. Biochemical disorders indicated hepatocellular and cholestatic hepatitis in 3/4 and 1/4 of cases respectively. Hypoprothrombinemia below 50 percent was noted in 1 out of 6 cases, and was associated with death in half cases. Gamma-globulins were increased in 80 percent of cases, with a predominant increase of IgG. Antinuclear or anti-smooth muscle antibodies were present in 60 percent of cases, whereas antimitochondrial and antimicrosomes were absent. Histopathological examination of the liver biopsy specimens obtained in 25 patients showed acute hepatitis in 8 and chronic active hepatitis with fibrosis in 17--including 6 patients with cirrhosis; there were no epidemiological, clinical (except ascites), or biochemical differences between these two groups. Four of the 7 patients tested had HLA B8 antigens; they all had chronic active hepatitis, with autoantibodies in 3 cases. Median duration of hospitalization was 21 days. Hepatitis was directly responsible for death in 3 patients; biochemical sequelae (hypergammaglobulinemia or anicteric cholestasis) were present in 8 patients, 2 of whom most likely had cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Severity of desmoid tumors with retroperitoneal development in Gardner's syndrome. Apropos of 2 cases]. / Gravité des tumeurs desmoïdes à développement rétropéritonéal au cours du syndrome de Gardner. A propos de deux observations.

We report two cases of retroperitoneal desmoid tumours in patients with Gardner's syndrome. These tumours are rare and of poor prognosis. In our two cases, the predominant clinical manifestations were caused by compression of the ureters, bladder and nerve roots. In the first patient, the tumours developed after colectomy, while in the second patient the discovery of the desmoid tumour preceded that of a cancer of the colon. Finally, in the first patient, an attempted treatment with a non-steroidal anti-inflammatory agent (sulindac) had to be discontinued after 4 months on account of side-effects.

[Maintenance therapy of ulcer disease. Comparative multicenter study of sucralfate, cimetidine and a placebo]. / Traitement d'entretien de la maladie ulcéreuse. Etude multicentrique comparative du sucralfate, de la cimétidine et d'un placebo.

Relapse rates were studied in one hundred patients in a multicentric, randomized trial during and after maintenance therapy comparing sucralfate, cimetidine and placebo. These patients were previously treated by cimetidine for peptic ulcer and were considered cured after endoscopic examination. Outpatients were randomly assigned to a 6 month maintenance treatment with either cimetidine (600 mg daily), sucralfate (300 mg daily) or a placebo. All patients underwent endoscopic evaluation after 3 and 6 months of therapy. A clinical évaluation was performed 6 months after all treatment had ceased. Clinical and endoscopic results proved the significant superiority of both sucralfate and cimetidine over the placebo. Remission rates with sucralfate were respectively 80,4 p. 100 after 6 months and 68,5 p. 100 after 12 months. These results were slightly superior to those observed with cimetidine (69,3 p. 100 and 61,3 p. 100). However, this difference is not statistically significant. Results for the placebo group were 47,9 p. 100 and 37,7 p. 100. Sucralfate is an effective medication in preventing the recurrence of peptic ulcer. Its pharmacological action, its few side effects and its effectiveness seem to make this medication very interesting in treating the ulcerous disease.

[Acute pancreatitis caused by foreign bodies. 2 cases]. / Pancréatite aiguë à corps étrangers. 2 observations.

We report the cases of two patients with acute pancreatitis caused by the insertion of foreign bodies in the ampulla of Vater: vegetal residues in the first case and beltbuckle in the second case. The acute pancreatitis was revealed by severe epigastric pain, jaundice and a serum amylase increase to more than 9 times the upper limit of normal level. The presence of foreign bodies was detected by endoscopic retrograde cholangiography and pancreatography in the first case and by abdominal X-ray examination in the second case. Extraction of vegetal residues was performed by endoscopic route whereas that of the beltbuckle required surgery. From these 2 cases and 8 others previously reported cases, the clinical features and course of acute pancreatitis caused by foreign bodies have been analysed.

[Cerebromeningeal location of chronic lymphoid leukemia. Rapid immunochemical diagnosis and complete remission by intrathecal chemotherapy]. / Localisation cérébroméningée d'une leucémie lymphoïde chronique. Diagnostic immunochimique rapide et rémission complète par chimiothérapie intrathécale.

Central nervous system (CNS) involvement is a rare complication of chronic lymphoid leukaemia (CLL). The occurrence of lymphocytic meningitis in the course of CLL suggests either CNS involvement by the leukaemic process or infection (especially tuberculosis) related to continuous immunodepression. We report a case of CLL in which leukaemic cells had surface IgM and produced IgM kappa without significant depression of other immunoglobulins. When the patient developed meningitis, measurement of serum and CSF albumin IgG and IgM levels showed that 88% of CSF IgM resulted from local synthesis, while 70% of CSF IgG resulted from serum transsudation. These results suggest that a large number of neuromeningeal lymphoid cells produce the same class of IgM as leukaemic cells and therefore constitute a localization of the disease. Complete remission of the meningitis by intrathecal anti-leukaemic chemotherapy confirmed this hypothesis.