[Autoimmune chronic active hepatitis: anatomoclinic's study of 50 patients]. / Les Hépatites auto-immunes (HAI) chroniques de l'adulte: étude anatomoclinique d'une série de 50 patients.

PURPOSE: To analyse anatomoclinic and evolutive aspects of autoimmune hepatitis (AIH) through 50 observations collected in two Internal Medicine departments in Algiers from 1998 to 2002 and to make a review of the literature. METHODS: The study is prospective. The diagnosis of autoimmune hepatitis (AIH) is established according to the recommendations of the score of the International Autoimmune Hepatitis Group (1991) or/and hepatitic damage confirmed by histology. RESULTS: Fifty patients were studied: (32 women-18 men) and the mean age was 38 years (17 to 73). Autoimmune extra-hepatitic manifestations were associated in 26%. The AIH type 1 has been noted in 58%. AIH were type 2 in only 6%. In 22% of the cases AIH were sero-negative and the others AIH represented 14% were classed as overlap-syndrome (5 cases of primary biliary cirrhosis and 2 cases of primary sclerosing cholangitis hepatitis overlap syndrome). The first liver biopsy tissue showed strong necrotic-inflammatory activity in 56% and cirrhosis was identified in 19 patients (38%). The treatment (azathioprine and corticosteroid) was prescribed in 37 patients (74%) in active chronic hepatitis or in compensed cirrhosis. FOLLOW-UP: 28% of the patients died (9-36 months) because cirrhosis's complications or because complications of hepatocarcinoma (3 cases). CONCLUSION: The diagnosis of AIH must be established early for each patient with chronic liver disease particularly is those are supposed as a crypto genetic hepatitis. The prognosis is compromised by delayed diagnosis and the mortality in middle following up is high.

Immunoproliferative small intestinal disease in Algerians. I. Light microscopic and immunochemical studies.

Twenty-two cases of immunoproliferative small intestinal disease (IPSID) were studied with an immunoperoxidase technique. Sixteen of these had serologic evidence of alpha heavy chain disease (AHCD) and have a characteristic immunochemical pattern that allows a diagnosis on jejunal biopsy. kappa-light chain was found in a case of AHCD in the benign appearing plasma cell proliferation and in the associated malignant lymphoma suggesting that failure of light chains is not constant in AHCD. Four cases of IPSID showed secretion of polyclonal IgA in the plasma cell infiltrate providing evidence that some cases may be associated with secretion of complete IgA molecules. This polyclonal pattern is suggestive of a reactive process. Two cases of IPSID without evidence of AHCD showed an immunohistochemical pattern characteristic of AHCD and may represent nonsecreting forms of the disease. Alternatively they may be secreting nondetectable amounts of AHCD protein or an abnormal protein not recognized by standard antisera.