Results of a prospective randomised multicentre controlled trial comparing a new 2-L ascorbic acid plus polyethylene glycol and electrolyte solution vs. sodium phosphate solution in patients undergoing elective colonoscopy.

BACKGROUND: Elective colonoscopy is used increasingly to screen at risk patients for colonic malignancy. Bowel preparation quality is a critical factor for successful screening. Preparations used include high doses of potent laxatives, e.g. sodium phosphate solution or high volume polyethylene glycol. Because of constraints and limited patient acceptability, there remains a need for a more acceptable bowel preparation with at least equivalent cleansing to existing preparations. AIM: To determine if a 2-L polyethylene glycol solution with electrolytes and ascorbic acid (polyethylene glycol + ascorbic acid) produces equivalent bowel cleansing to sodium phosphate solution, and is acceptable to patients and well tolerated. METHODS: This was a single blind, parallel group, equivalence study comparing polyethylene glycol + ascorbic acid with sodium phosphate solution in 352 patients undergoing elective colonoscopy. A blinded, independent expert scored a video recording of each colonoscopy. Patients completed a questionnaire reporting acceptability of the bowel preparation process. RESULTS: Clinically successful bowel preparation was reported in 72.5% of cases prepared using polyethylene glycol + ascorbic acid and in 63.9% of cases prepared using sodium phosphate solution (treatment difference +8.6%, 95% confidence interval -2.3%, +19.4%). The new solution was well accepted and better tolerated than sodium phosphate solution. CONCLUSIONS: The new 2-L solution of polyethylene glycol + ascorbic acid was at least as efficacious as sodium phosphate solution with comparable efficacy and a better tolerability profile.

[A case of diffuse inflammatory colonic pseudopolyposis caused by Crohn's disease]. / Un cas de pseudopolypose inflammatoire diffuse colique due à une maladie de Crohn.

Inflammatory pseudopolyposis of the colon is an uncommon anatomoclinical entity. It is generally associated with ulcerative colitis, Crohn's disease or schistosomiasis. We report a case of a pseudopolyposis in Crohn's disease involving the entire colon. This case was characterized by three particular facts: a) the pseudopolyps were composed of granulation tissues only, b) severe exudative enteropathy was the most important symptom, c) the endoscopic ablation of the polyps, performed for the first time in Crohn's disease pseudopolyposis, resulted in clinical and biological improvement.

[Isolated jejunal tuberculosis mimicking Crohn disease. Diagnosis by push video-enteroscopy]. / Tuberculose jéjunale isolée simulant une maladie de Crohn. Diagnostic par vidéo-entéroscopie poussée.

Intestinal tuberculosis is relatively unfrequent in Western countries, but immigrants and AIDS patients remain groups at particular risk for this disease. The diagnosis of intestinal tuberculosis is often difficult to establish because of close similarities with other conditions, in particular Crohn's disease. We report a case of jejunal tuberculosis in a 33-year-old man with severe weight loss and unexplained fever. The diagnosis was obtained on histological examination of the distal jejunum biopsies performed during pushed video-enteroscopy. Interestingly, culture of the biopsies and specific PCR remained negative. Dramatic improvement was observed during the first days of antituberculous treatment. The main clinical and paraclinical manifestations of intestinal tuberculosis are also reviewed, as well as recent epidemiologic observations and new developments in diagnosis and treatment.

[Treatment of Crohn's disease with azathioprine or 6-mercaptopurine. Retrospective study of 126 cases]. / Traitement de la maladie de Crohn par l'azathioprine ou la 6-mercaptopurine. Etude rétrospective chez 126 malades.

Over the past 15 years (1974-1989), 126 patients with Crohn's disease received azathioprine (n = 123) or 6-mercaptopurine (n = 3). Seven patients were lost of follow-up during the first month and were not analyzed. Among the 119 patients analyzed (52 men, 67 women, mean age 31.6 years), the median duration of treatment was 9.1 months (range: 8 days to 15 years). Most of the 109 patients with active disease at the beginning of the immunosuppressive therapy were either steroid-dependent (n = 63) or steroid-resistant (n = 23); 19 had frequent relapses and/or extensive involvement of the gastrointestinal tract; 4 had severe perianal disease. Among these 109 patients, 25.4, 51, 60.4 and 64.4 percent were in clinical remission at 3, 6, 9 and 12 months (life-table analysis) respectively. There was no difference in outcome of patients with colonic, ileocolonic or small intestinal involvement. Steroid-resistant patients fared better than steroid-dependent patients (81 percent vs 59 percent of remission within the first year; p less than 0.001). In the 62 patients with quiescent disease treated with azathioprine or 6-mercaptopurine, previous remission had been achieved with immunosuppressive therapy in 52, 8 were treated after a bowel resection which was assumed to be curative; 2 had achieved remission after total parenteral nutrition. In these patients, the percentages of relapse were 15.3 at the end of the first year and 20.3 at the end of the second year. Among the 8 patients treated with azathioprine after bowel resection, only one relapse occurred 1.5 months after surgery. Nineteen percent of the patients had adverse reactions that required discontinuation of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple primary intraductal tumors of Wirsung's duct: demonstration of a relation between benign and malignant tumors]. / Tumeurs intra-canalaires primitives multiples du canal de Wirsung: démonstration d'une filiation entre tumeurs bénignes et malignes.

A case of multiple villous and, more rarely, tubulovillous adenomas of the main pancreatic duct, associated with a diffuse infiltrating adenocarcinoma of the pancreas in which evidence for a link between these lesions is supported by histopathologic features, is reported in a 53 year old patient. Clinical presentation included abdominal pain, weight loss and chronic diarrhea with steatorrhea related to pancreatic insufficiency. Retrograde endoscopic pancreatography showed a complete stenosis of the main pancreatic duct located 3 mm beyond the ampulla of Vater. CT scan showed an heterogeneous cephalic pancreatic tumor with extensive enlargement of the main pancreatic duct. After total pancreatectomy, recovery was maintained (follow-up 18 months). By analogy to colorectal tumors, a new pathologic classification of these rare neoplasms may be proposed.

[Effect of levamisole on the prevention of developmental flare-ups in quiescent Crohn's disease: a prospective multicenter controlled trial in 155 patients]. / Effet du levamisole sur la prévention des poussées évolutives de la maladie de Crohn quiescente: un essai prospectif multicentrique contrôlé sur 155 malades.

The prevention of relapse in quiescent Crohn's disease remains a major therapeutic challenge. The present study is a double blind placebo (P)-controlled, randomized, multicentre cooperative trial designed to test the effectiveness of levamisole (L) in the prophylaxis against flare up in patients with quiescent Crohn's disease. The trial included 2 successive phases: a) phase I:167 patients with inactive disease (but who had not had previous resection of all diseased tissue) were randomly and double blindly assigned to receive either L (150 mg orally once weekly) or P; patients were randomized in 2 strata: those having experienced a recent flare up (within the 3 months preceding their entry into the trial: red strata) versus others (blue strata). Patients were followed up at 3 monthly intervals during 2 years. Initially there was no significant difference between L and P groups as regard to age, sex ratio, duration of disease at the time of randomization, incidence of prior intestinal resection, Crohn's disease topography, clinical activity; biological activity was slightly but significantly higher (P less than 0.05) in the P group. Twelve patients were withdrawn from analysis (lost to follow-up: 2; inadequate respect of the protocol: 10), leaving 155 patients (78 L, 77 P) who completed the study. L did not significantly influence any of the following parameters: incidence of attacks (L: 37 p. 100; P: 35 p. 100), lag time between the entry into the trial and the occurrence of the attack (L: 32.7 +/- 5.2; P: 41.8 +/- 5.8; m +/- SEM; weeks), curves of maintenance in remission (Kaplan-Meier method), outcome rank, severity of attacks. Attempts to analyse separately certain subgroups--subjects with purely colonic (+/- anal) disease, subjects with small bowel localization (+/- anus), patients of the red or blue strata--did not show any statistical difference between L and P. Thirteen patients left the trial for minor intolerance (10 L, 3 P). b) Phase II lasted one further year and involved the patients still in remission and in the trial at the end of phase I (n = 57). Those who had received L during phase I were randomized between continuance of L (L leads to L) vs. a change to P (L leads to P); those who had been on P during phase I were randomized between continuance of P vs. a switch to L.(ABSTRACT TRUNCATED AT 400 WORDS)

[Treatment of duodenal ulcer outbreak with omeprazole. Results of a multicenter non-controlled study]. / Traitement de l'ulcère duodénal en poussée par l'oméprazole. Résultats d'une étude non contrôlée multicentrique.

Sixty-one patients with symptomatic endoscopically confirmed duodenal ulcer, 5 mm or more in diameter, were treated with omeprazole 30 mg once daily in the morning for 4 weeks. Complete ulcer healing was assessed by endoscopy performed after 15 and, if necessary, 29 days of treatment. The healing rate as 83 p. 100 (49/59 patients) after 2 weeks, and 98 p. 100 (58/59 patients) after 4 weeks. Only 5 patients remained symptomatic on day 15. Fifty-six patients did not take any antacid during the course of treatment. There were few adverse effects. No clinically significant changes in laboratory parameters were observed. These results confirm: the remarkable efficiency of omeprazole in short-term treatment of duodenal ulcer, the good tolerance to this drug, at least in short duration treatment.

[Hemorrhagic rectocolitis associated with idiopathic thrombopenic purpura]. / Rectocolite hémorragique associée à un purpura thrombopénique idiopathique.

This case report documents severe autoimmune thrombocytopenia in a 20 yrs. old patient with ulcerative colitis. Diagnosis of idiopathic thrombocytopenic purpura was made on the presence of bound antiplatelet antibodies and on the absence of any other disorder capable of provoking a platelet fall. Colonic lesions were moderate but were resistant to steroids and total parenteral nutrition. Thrombocytopenia resisted to steroids and vincristine and a major fall in the platelet count (less than 10,000/mm3) occurred in two instances. However, platelets rose transiently after high-dose intravenous gamma-globulins. The patient underwent splenectomy, colectomy and ileostomy because of life-threatening colonic hemorrhage. The platelet count rose to normal levels within one week after surgery. Ileorectal anastomosis was subsequently performed. One year later the patient was in good health and his platelet count had returned to normal.

[Paraneoplastic intestinal pseudo-obstruction revealing small cell lung carcinoma: "the anti-Hu syndrome"]. / Pseudo-obstruction intestinale paranéoplasique révélatrice d'un carcinome pulmonaire à petites cellules: le syndrome anti-Hu.

A 67-year-old woman was admitted for intestinal pseudoobstruction associated with peripheral sensitive neuropathy. Jejunal biopsies performed during laparotomy, showed axonal degeneration and lympho-plasmocytic infiltration in myenteric plexus. High titer of seric anti-Hu antibodies suggested a paraneoplastic syndrome. Thoracic CT scan showed mediastinal lymph nodes. Their histological examination confirmed the diagnosis of metastatic small-cell lung carcinoma. Her condition gradually deteriorated despite supportive parenteral nutrition, chemotherapy, steroids and intravenous immunoglobulins. She died 12 months after the onset of symptoms.

[Fibrovascular polyp of the esophagus]. / Polype fibrovasculaire de l'oesophage.

A case of large intraluminal tumour located in the cervical portion of the oesophagus and removed by thoracotomy is presented. Detailed histological study was necessary, since hypervascularization and hypercellularity made it difficult to diagnose a fibrovascular polyp and to establish its histopathological prognosis. The patient has now been followed up for 7 years and remains cured. Intraluminal tumours are reviewed. Whether fibrovascular polyps should be removed surgically or endoscopically depends on their site and on their size.

Treatment of duodenal ulcer with rioprostil: a randomized multicentre double-blind study.

The effectiveness of rioprostil, 300 micrograms b.d. is evaluated in evolutive duodenal ulcer in a double-blind study in five French and North African centres. A total of 115 patients are included in the study (57 in the rioprostil group and 58 in the placebo group). After a 4-week treatment period, a significantly higher endoscopic healing rate is observed in the rioprostil group (57%) compared with the placebo group (33%) (p less than 0.01). The mean time with abdominal pain is significantly lower in the rioprostil group (5.6 +/- 4.4 days) compared to the placebo group (12.7 +/- 5 days) (p less than 0.001). Clinical and biological tolerance is excellent. The only side effect is diarrhoea (3.5% in the rioprostil group). In only one case does diarrhoea necessitate cessation of treatment. Rioprostil, 300 micrograms b.d., is thus effective in the treatment of developing duodenal ulcer.