[Toxic cholestatic hepatitis secondary to chrysotherapy]. / Epatite tossica colestatica secondaria a crisoterapia.

An unusual case of cholestatic toxic hepatitis observed during the treatment of rheumatoid arthritis with gold salts (colloidal sulphide) is reported. The primarily histological diagnosis was supported by the absence of hepatotoxic drugs and the ruling out of other forms of liver disease. Furthermore, the histological picture fitted that described in the few cases in the international literature.

Gastric lipid islands in the gastric stump and in non-operated stomach.

The lipid islands in the gastric mucosa are small, well delimited white or yellowish-white patches varying in diameter from 0.5 to 3 millimeters. Microscopically they constitute accumulations of macrophages full of lipids. This endoscopic and histological finding was observed in 0.38% of patients who had not undergone gastric resection, and in 18.0% of those who had the intervention, the basis being a case-list of 1381 endoscopic examinations of the upper digestive tract. The endoscopic and histological aspects and the clinical correlations of the gastric lipid islands are discussed, emphasizing the importance of biliary reflux as an etiological factor. The presence of gastric lipid islands must be considered as the expression of a prolonged inflammatory process of the gastric mucosa.

A prospective study on Candida as a gastric opportunistic germ.

Report of results from a study on the presence of Candida as a stomach opportunistic germ in 149 patients consecutively undergoing gastroscopy. Candida was isolated in 23 patients (15.4%). None of the following factors influenced the appearance of the fungus as an opportunist in the stomach: age, sex, smoking, alcohol intake, associated systemic diseases, concomitant gastroduodenal diseases or gastric histological findings. The only favoring factor revealed was that of cardiotonic treatment in 43.5% of the patients with a positive outcome, and in 15.1% of those with a negative outcome (p less than 0.01). Species isolated were Candida albicans in 15 patients (65.2%), Candida tropicalis, Candida pseudo-tropicalis and Candida glabrata in 2 patients each (8.7%), Candida krusei and Candida guillermondi in 1 patient each.

Invasive candidiasis does not complicate short-term cimetidine treatment of duodenal ulcer.

The purpose of this study was to record the frequency of invasive candidiasis of duodenal ulcer and to determine whether or not it is enhanced by cimetidine treatment. Our multicenter prospective trial involved 99 patients with endoscopically proven duodenal ulcer who were undergoing a 4- or 8-week cimetidine (800 mg/day) treatment program. At the endoscopic examination, performed before and after the 4- or 8-week treatment, three biopsy samples were taken from the ulcer edge or from the healed tissue. Ulcer infiltration by Candida was presumed by the presence of mycetes in stained tissue samples. Healing rate was 76% at 4 weeks and 89.9% at 8 weeks. Candida infiltration was not seen in any biopsy specimen. Short-term treatment with cimetidine does not promote invasion of mycetes into the duodenal ulcer lesion.

A prospective study of relationships between benign gastric ulcer, Candida, and medical treatment.

Results of a multicenter prospective study on the relationships between benign gastric ulcer, Candida, and medical treatment is reported. In a group of 66 patients, mycetes were seen in six cases (9.1%). Candida-contaminated ulcers were diagnosed solely by histological examination, with periodic acid-Schiff staining being more effective than hematoxylin and eosin staining. All contaminated ulcers were healed by treatment either with cimetidine alone, or combined cimetidine-carbenoxolone, without antimycotics. No cases of Candida-contaminated ulcers were seen after 6 wk of treatment. The finding of contamination was more common in older patients. Under the conditions of our study, Candida-contamination of benign gastric ulcers does not affect the rate of healing, does not need specific treatment, and has no particular endoscopic features. Cimetidine or carbenoxolone treatment was not associated with persistence of the fungus.