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1.
Gastroenterol Clin Biol ; 32(12): 1092-4, 2008 Dec.
Artículo en Francés | MEDLINE | ID: mdl-18706783

RESUMEN

Primary epiploic appendagitis are considered to be a rare cause of acute abdomen. They are frequently misdiagnosed as either acute appendicitis or acute diverticulitis and the diagnosis is usually made during surgery. We report a case in which computed tomography (CT) suggested the diagnosis and helped in avoiding unnecessary surgery.


Asunto(s)
Colitis , Adulto , Colitis/diagnóstico , Colitis/cirugía , Humanos , Masculino
2.
Gastroenterol Clin Biol ; 32(8-9): 792-7, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18757147

RESUMEN

OBJECTIVE: In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management. METHODS: Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score. RESULT: The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6+/-10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p=0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1+/-44.4 UI/L versus 78.4+/-11.8 UI/L; p=0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8. In conclusion, severe alcohol withdrawal (Cushman score>or=8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.


Asunto(s)
Delirio por Abstinencia Alcohólica/epidemiología , Delirio por Abstinencia Alcohólica/etiología , Alcoholismo/complicaciones , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad
3.
Ann Biol Clin (Paris) ; 64(2): 166-9, 2006.
Artículo en Francés | MEDLINE | ID: mdl-16556528

RESUMEN

We report the case of a 46 year-old woman presenting an acquired angioedema. Angioedema is an C1 inhibitor deficiency. Patients present recurrent non inflammatory swelling of the head and extremities and recurrent attacks of severe abdominal pain. This clinical presentation is non specific : investigation of complement is useful for diagnosis. Laboratory testing show low serum levels of C4 with normal levels of C3. Low C1 esterase inhibitor confirm the diagnosis. If acquired angioedema, a cause must be searched.


Asunto(s)
Angioedema/diagnóstico , Angioedema/etiología , Proteína Inhibidora del Complemento C1/fisiología , Femenino , Humanos , Persona de Mediana Edad
4.
Ann Chir ; 131(10): 595-600, 2006 Dec.
Artículo en Francés | MEDLINE | ID: mdl-16859630

RESUMEN

AIM OF THE STUDY: To determine diagnostic modalities and both immediate and long-term treatment of superior mesenteric venous thrombosis. PATIENTS AND METHODS: Retrospective study from 1997 to 2004 in two institutions concerning patients with superior mesenteric vein thrombosis. RESULTS: Nine patients (all males, mean age=55 years), were included. Abdominal pain (100%), vomiting (44%), and bowel activity disorders (44%) were the most common symptoms. A personal or familial thrombosis history was present in 67% of patients. A genetic predisposing factor of thrombosis was present in 78% of patients. The diagnosis was established with CT-scan in 8 cases with a mean delay of 8 days. Treatment was exclusively medical in 33% of patients and included surgery in 67%. All operated patients underwent resection for bowel infarction and only one had immediate anastomosis. All enterostomies were subsequently closed. No patient died. CONCLUSION: Diagnosis of superior mesenteric vein thrombosis is frequently delayed and relies on CT-scan with intravenous contrast. Prognosis is globally favourable but depends on early application of anticoagulation therapy. In case of surgery, bowel-sparing resection is indicated and enterostomies are often needed. Genetic disorders predisposing to thrombosis are very frequent, that may indicate prolonged even definitive anticoagulation therapy.


Asunto(s)
Oclusión Vascular Mesentérica/diagnóstico , Venas Mesentéricas/patología , Trombosis de la Vena/diagnóstico , Dolor Abdominal/diagnóstico , Enterostomía , Fibrinolíticos/uso terapéutico , Predisposición Genética a la Enfermedad , Humanos , Infarto/cirugía , Enfermedades Intestinales/diagnóstico , Intestino Delgado/irrigación sanguínea , Masculino , Oclusión Vascular Mesentérica/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Trombectomía , Terapia Trombolítica , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trombosis de la Vena/genética , Trombosis de la Vena/terapia , Vómitos/diagnóstico
5.
Presse Med ; 34(14): 1009-10, 2005 Aug 27.
Artículo en Francés | MEDLINE | ID: mdl-16225255

RESUMEN

INTRODUCTION: Imaging of the pancreas soon after diagnosis of diabetes can help screen for tumors. CASE: A 45 year-old man with recently diagnosed insulin-dependent diabetes and no other notable history was found to have intraductal papillary mucinous tumour of the pancreas (IPMTP), a month after an unexplained and benign acute pancreatitis. DISCUSSION: The histology of IPMTP differs from that of the adenocarcinomas usually described in these circumstances, and they are far rarer. Because they carry the risk of malignant degeneration, early diagnosis is important. Surgery is the only curative treatment and should therefore be discussed.


Asunto(s)
Cistoadenoma Mucinoso/diagnóstico , Diabetes Mellitus Tipo 1/complicaciones , Conductos Pancreáticos , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/complicaciones , Enfermedad Aguda , Adenocarcinoma/diagnóstico , Cistoadenoma Mucinoso/diagnóstico por imagen , Cistoadenoma Mucinoso/patología , Cistoadenoma Mucinoso/cirugía , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pancreatectomía , Conductos Pancreáticos/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Pronóstico , Factores de Tiempo , Tomografía Computarizada por Rayos X
7.
J Radiol ; 85(11): 1947-9, 2004 Nov.
Artículo en Francés | MEDLINE | ID: mdl-15602418

RESUMEN

The fat halo sign in the small intestine may sometimes be observed in patients with chronic inflammatory bowel diseases, but it can represent a normal finding that is possibly related to obesity. The authors report two cases showing these findings.


Asunto(s)
Enfermedad de Crohn/diagnóstico por imagen , Íleon/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Radiografía
8.
Presse Med ; 28(14): 735-7, 1999 Apr 10.
Artículo en Francés | MEDLINE | ID: mdl-10230409

RESUMEN

BACKGROUND: Lymphocytic colitis is a chronic diarrhea syndrome with no endoscopically detectable anomaly and histological colonic lesions. CASE REPORT: A 52-year-old woman was hospitalized for chronic diarrhea. She experienced 10 to 30 liquid bowel movements per day. Symptoms had begun 8 days after taking piroxicam fl-cyclodextrin. Intraepithelial cell counts on rectum and colon endoscopic biopsies showed more than 20% lymphocytes, giving the diagnosis of lymphocytic colitis. The patient was given 5ASA 3 g/24 h. Symptoms regressed in less than one week. DISCUSSION: Lymphocytic colitis is uncommon. The cause remains unknown but a secondary autoimmune mechanism triggered by drugs has been suggested. This case would implicate nonsteroidal antiinflammatory drugs. Certain authors have demonstrated that they can be involved in the development of collagen colitis.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Colitis/tratamiento farmacológico , Ciclodextrinas/uso terapéutico , Diarrea/inducido químicamente , Piroxicam/uso terapéutico , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Crónica , Ciclodextrinas/efectos adversos , Femenino , Humanos , Linfocitosis/tratamiento farmacológico , Persona de Mediana Edad , Piroxicam/efectos adversos
9.
Presse Med ; 27(8): 354-6, 1998 Feb 28.
Artículo en Francés | MEDLINE | ID: mdl-9767999

RESUMEN

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is reduced as no contrast agent is required and there is no risk of infectious contamination due to catheterism. Unlike endoscopic retrograde cholangiography which requires anesthesia, there is no risk of morbidity. We report one observation of Todani type Ia cystic dilation of the main bile duct explored preoperatively with MR-cholangiography. CASE REPORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the diagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hepato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic dilatation of the main bile duct are biliary pain, fever and jaundice. The MR-cholangiogram provides a map of the bile duct system directly with a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerous cases, surgery is a formal indication in patients with angiocholitis.


Asunto(s)
Colangiografía/métodos , Colangitis/etiología , Quiste del Colédoco/diagnóstico , Imagen por Resonancia Magnética/métodos , Dolor Abdominal/etiología , Adulto , Colecistectomía , Quiste del Colédoco/clasificación , Quiste del Colédoco/complicaciones , Quiste del Colédoco/cirugía , Femenino , Fiebre/etiología , Humanos , Ictericia/etiología , Cuidados Preoperatorios
10.
Presse Med ; 28(12): 629-31, 1999 Mar 27.
Artículo en Francés | MEDLINE | ID: mdl-10228459

RESUMEN

BACKGROUND: Cystic lymphangioma is an uncommon congenital malformation usually encountered in children and often discovered fortuitously. CASE REPORT: A 46-year-old man was hospitalized for acute alcoholic hepatitis with edematoascitic decompensation. The abdominal and pelvic CT scan showed homogeneous hepatomegaly and a tumoral process involving the terminal ileal loops without signs of occlusion or node enlargement. Pathology reported benign mesenteric multicystic lymphangioma. DISCUSSION: Cystic lymphangiomas account for 7% of all intra-abdominal cystic formations. The ileal localization predominates with little or no clinical expression. Ultrasonography and CT scan provide complementary information on the relations with other organs. Magnetic resonance imaging is currently the gold standard allowing precise diagnosis of the anatomic relations and identifying intracystic hemorrhage. The pathology examination is required to eliminate possible benign multicystic mesothelioma which may occasionally take on an aggressive form. Complete surgical excision provides cure.


Asunto(s)
Linfangioma Quístico/diagnóstico , Quiste Mesentérico/diagnóstico , Humanos , Linfangioma Quístico/cirugía , Imagen por Resonancia Magnética , Masculino , Quiste Mesentérico/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía
11.
Presse Med ; 29(32): 1759-61, 2000 Oct 28.
Artículo en Francés | MEDLINE | ID: mdl-11098270

RESUMEN

BACKGROUND: Cystic dystrophy of the duodenal wall is characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. Diagnosis is difficult and endosonography is considered as the most useful investigation. CASE REPORTS: A 40-year-old man was hospitalized for abdominal pain triggered by ingestion of alcoholic beverages and for vomiting after food intake. The diagnosis of acute atypical cephalic pancreatitis was initially made. Magnetic resonance cholangiography then magnetic resonance imaging suggested the diagnosis of cystic dystrophy of the duodenal wall in a heterotopic pancreas which was confirmed by endosonography. DISCUSSION: Magnetic resonance imaging evidenced several cystic formations within a thickened duodenal wall leading to the correct diagnosis. MRI appears to provide all the elements necessary for the diagnosis of cystic dystrophy of the duodenal wall, avoiding the need for invasive investigations.


Asunto(s)
Coristoma/congénito , Quistes/congénito , Enfermedades Duodenales/congénito , Duodeno/anomalías , Imagen por Resonancia Magnética , Páncreas , Adulto , Colangiografía , Coristoma/diagnóstico , Coristoma/patología , Quistes/diagnóstico , Quistes/patología , Diagnóstico Diferencial , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/patología , Duodeno/patología , Humanos , Masculino , Valor Predictivo de las Pruebas
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