[Proctitis of diversion on an excluded rectum in patients with hemorrhagic rectocolitis]. / Proctite de diversion sur rectum exclu chez des patients atteints de rectocolite hémorragique.

OBJECTIVES: Diversion colitis is characterized by inflammatory lesions affecting colon or rectum excluded from the fecal stream for varied etiologies. These lesions may mimic both ulcerative colitis and Crohn's disease. The aim of our study was to examine the excluded rectum in patients with ulcerative colitis, and to study the evolution of the pathological lesions after ileo-rectal anastomosis. METHODS: Eighteen patients with ulcerative colitis treated by total colectomy before ileo-rectal anastomosis were studied. The pathological features i.e. glandular alteration, inflammatory infiltrate and mucosal ulceration or fissure, were studied during 3 periods: initial colectomy, excluded rectum at surgery for anastomosis and rectal biopsies after anastomosis. RESULTS: We observed on the excluded rectum a follicular lymphoid hyperplasia (18 cases), granulomas with giant cells (9 cases), mucosal fissures (9 cases). The inflammation extended to the submucosa in all cases and was occasionaly transmural. These lesions disappeared after the anastomosis and then seemed to be connected with the rectal diversion. CONCLUSIONS: The pathological changes of diversion proctitis that includes mucosal fissures, granulomas with giants cells or transmural inflammation, may lead to an erroneous diagnosis of Crohn's disease. The review of the previous colectomy is then mandatory to confirm the initial diagnosis of ulcerative colitis. These lesions disappear after anastomosis.

[Periarteritis nodosa and parvovirus B19 infection]. / Périartérite noueuse et infection par le parvovirus B19.

The authors report a case of polyarteritis nodosa which coincide with serological conversion to parvovirus B19. After review of the literature, they recall the role of this virus in human pathology and also the role of different infectious agents in the PAN pathogenesis.

[Fatal mesenteric ischemic accident caused by mesenteric inflammatory veno-occlusive disease]. / Accident ischémique mésentérique fatal par maladie inflammatoire veino-occlusive du mésentère.

A 72-year-old woman in good general health presented a massive intestinal and colonic ischemia with rapid post-operative death, due to mesenteric inflammatory veno-occlusive disease. Mesenteric inflammatory veno-occlusive disease, first described in 1994, is a vasculitis of unknown etiology limited to the mesenteric area, affecting exclusively veins and venules and sparing arteries. Histologically, there are acute lesions of lymphocytic and/or necrotizing, sometimes granulomatous phlebitis and chronic lesions of myointimal hyperplasia reducing the lumen of the veins. In this case, polymorphonuclear eosinophils were particularly numerous.

[Hamartoma of Brunner's glands. Report of two cases]. / Hamartome des glandes de Brünner. A propos de deux observations.

Two cases of duodenal hamartoma of the Brunner's glands are reported in a 41-year-old woman and a 61 year-old man. These polypoid lesions measured more than 4 cm and presented with haemorrhages. These forms are infrequent. Because of their atypical and sometimes severe clinical symptoms, and their endoscopic appearance, a diagnosis of malignancy could be done. Their pathological features demonstrate that these benign lesions have a dysembryoplastic pattern and can be called hamartomas.

Dual-energy CT in the diagnosis and quantification of fatty liver: limited clinical value in comparison to ultrasound scan and single-energy CT, with special reference to iron overload.

BACKGROUND/AIMS: It has been suggested that dual-energy CT could differentiate irregular fatty liver from other hypodense lesions. We compared dual-energy CT to ultrasound scan and single-energy CT in the diagnosis and quantification of fatty liver, with special reference to iron overload. METHODS: Twenty-seven patients were included according to ultrasound: fatty liver (n=16) and normal liver (n=11). Single and dual-energy CT were performed. Attenuation measurements of hepatic lobes and control tissues were taken at 140 kV and 80 kV CT-guided liver biopsy was done in fatty liver patients, the degree of infiltration was estimated, and the histologic iron overload determined (iron overload, n=11; iron-free, n=5). RESULTS: The mean changes in attenuation for the right hepatic lobe were: normal liver: -0.8 (ns); iron overloaded fatty liver: 1.5 (ns); and iron-free fatty liver: 7.7 (p<0.0053). A spleen-liver attenuation differential threshold of 12H (140 kV, single-energy CT) and a right hepatic lobe 140 kV to 80 kV attenuation differential threshold of 9 H (dual-energy CT) were specific for fatty liver. Histology confirmed all cases of fatty liver diagnosed by ultrasound, independently of iron overload. Ultrasound did not differentiate cases of irregular from diffuse fatty liver detected on CT. Iron overload produced a masking effect in CT, decreasing its sensitivity: fatty liver was diagnosed in 67% of cases by single-energy CT and in 20% by dual-energy CT. Degree of fatty infiltration correlated with single-energy CT. CONCLUSIONS: Ultrasound diagnosed fatty liver best. Single-energy CT quantifies fatty infiltration, and best differentiates the irregular from the diffuse forms. Dual-energy CT is limited by poor sensitivity, especially in iron overload.