[Incidence and treatment of complications observed after endoscopic mucosal resection of superficial digestive tumours in a regional general hospital]. / Incidence et traitement des complications observées après résections endoscopiques muqueuses des tumeurs digestives superficielles dans un Centre Hospitalier Régional.

Superficial digestive tumours resection by endoscopic mucosal resection and sub-mucosal dissection causes very few complications according to the results obtained in expert centers. This work reports the rate of complications observed in a regional hospital, also comparing the results of their therapeutic management. The first 100 patients treated by endoscopic mucosal resection and sub-mucosal dissection, conducted by conventional techniques, were studied. The usual complications (stenosis, bleeding, perforation) were identified and details of their treatment reported. The overall complication rate was 16 %. Symptomatic stenoses are observed in 4 % of patients. Secondary bleeding occurs in 5 % of cases. Endoscopic management of these complications is effective in all cases, when it is attempted. Perforations complicate 7 % of the procedures. Two patients were assigned to surgery, successfully, the other 5 patients were treated by endoscopic sutures without damage. The complication rates observed in our department are comparable with results reported by the reference western centers. Their endoscopic management is usually successful and rescue surgery is unfrequent.

La résection par mucosectomie et dissection sous-muqueuse des tumeurs digestives superficielles n'entraîne que très peu de complications selon les résultats obtenus dans les centres experts. Ce travail rapporte le taux de complications observé dans un centre hospitalier régional, comparant également les résultats de leur prise en charge. Les 100 premiers patients ayant été traités par mucosectomie et dissection sous-muqueuse, effectuées selon les techniques classiques, ont été étudiés. Les complications habituelles (sténoses, hémorragies et perforations) ont été répertoriées ainsi que les détails de leur traitement. Le taux global de complications est de 16 %. Les sténoses symptomatiques affectent 4 % des patients. Les hémorragies secondaires surviennent dans 5 % des cas. La prise en charge endoscopique de ces complications est efficace dans tous les cas, lorsqu'elle est tentée. Les perforations compliquent 7 % des procédures. Deux patients ont été confiés à la chirurgie, avec succès, les 5 autres patients ont été traités par sutures endoscopiques sans séquelle. Le taux de complications observé dans notre service est comparable aux résultats rapportés par les centres occidentaux de référence. Leur prise en charge endoscopique est régulièrement efficace et le recours à la chirurgie est peu fréquent.

Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response.

AIM: To evaluate the efficacy of early interferon alpha-2b in non-post-transfusion acute hepatitis C virus: a prospective study with historical comparison. PATIENTS: Group A: 28 patients prospectively treated for acute hepatitis C virus with daily regimen of interferon 5 million units for 2 months. Group B: historical series of 16 patients with untreated acute hepatitis C virus. RESULTS: There was no significant difference between the two groups with regard to gender, age, icterus, alanine aminotransferase, or genotypes. In group B, hepatitis spontaneously resolved in three of 16 (19%) patients (follow-up 1-7 years). In group A, 21 of 25 patients became sustained viral responders (75%; P = 0.0003 vs. group B). Factors include not predictive of sustained viral response: age, gender, sources of infection, presence of icterus, alanine aminotransferase peak, bilirubin peak, incubation period, presence of hepatitis C virus antibodies at presentation, or genotypes. The time from presentation to the start of therapy was, however, significantly shorter in sustained viral responders (43 +/- 31 days) than in relapsers or non-responders (88 +/- 52 days) (P = 0.016). CONCLUSIONS: Early treatment of acute hepatitis C virus with interferon prevents chronicity. A short waiting time from presentation to treatment appears as the most relevant predictive factor for sustained response.

Autonomic dysfunction in the Guillain-Barré syndrome. Hemodynamic and neurobiochemical studies.

In 12 patients suffering from the Guillain-Barré syndrome, with autonomic dysfunction, a hemodynamic study was performed and biological counts of neurotransmitter metabolites were repeatedly taken in the urine, the plasma and the lumber cerebrospinal fluid. In the course of the Guillain-Barré syndrome with autonomic dysfunction the changes in hemodynamic indices suggest a state of sympathetic hyperactivity. There is an increase in cerebrospinal neurotransmitter metabolite levels with an increase in central cathecholaminergic and serotoninergic activity. The findings point to an interference of central structures in the sympathetic hyperactivity observed.

[Five years survival after treatment of gallbladder metastasis of malignant melanoma]. / Survie à 5 ans après traitement d'une métastase vésiculaire d'un mélanome malin.

A case of an isolated gallbladder metastasis from a malignant melanoma is reported in a 32 year old woman. The patient has been treated by cholecystectomy and chemotherapy and was free of any recurrence 5 years after treatment.

[Ganglio-esophageal fistula revealed by hematemesis: a rare complication of silicotuberculosis]. / Fistule ganglio-oesophagienne révélée par une hématémèse: complication rare d'une silico-tuberculose.

We report a case of fistula between a silicotic mediastinal lymph node and the esophagus with protrusion of a stiff and darkish concretion into the oesophageal lumen. The patient, a 68-year-old coal miner, presented with cough since a few months and the lesion was revealed by haematemesis. The general course was rapidly favourable. Association with tuberculosis was recognized only a few months later.

[Percutaneous angioscopy of the iliac and femoral arteries]. / L'angioscopie percutanée des artères iliaques et fémorales.

Very few papers about peripheral angioscopy are reported in literature. Percutaneous angioscopy (P.T.A.) of 25 peripheral arteries (21 iliac and 4 femoral arteries) have been performed by the authors without surgery and without anesthesia. Three observations are selected. The first one demonstrates an eccentric stenosis altering its diameter during pulsations; an irregular ulcerated atheroma is observed. The second case shows the signs of a centric atheroma with an intimal fragment. The last one is an intimal dissection due to PTA. The prospective aspects of this new technique are discussed.

[Systemic manifestations of angiitis with asthma and hypereosinophilia. Study of 10 cases]. / Manifestations systémiques d'angéite avec asthme et hyperéosinophilie. Etude de 10 observations.

We report 10 cases of systemic manifestations of angiitis with asthma and hypereosinophilia, some of which had the pathologic features of an allergic granulomatous angiitis of Churg and Strauss. We compare these 10 cases with 109 observations previously reported in the literature from which they differ by a high incidence of digestive tract involvement and by a near constant increase of total plasma immunoglobulin E concentration during the evolutive phases of vasculitis. Broncho-alveolar lavage had been performed in 3 patients, showing pulmonary hypereosinophilia. We discuss the clinical, biological and pathogenic features which differentiate this syndrome, particularly from periarteritis nodosa.

[Leiomyosarcoma of the superior vena cava. Case report]. / Leiomyosarcome de la veine cave supérieure. A propos d'un cas.

Leiomyosarcoma of the blood vessels is a rare malignant tumor, and its localization in the superior vena cava is exceptional. We had the opportunity to study such a case and we compared our clinical, histological and ultrastructural results with those of 5 other reported cases.

[Juvenile xanthogranuloma localized in the parotid gland]. / Xanthogranulome juvénile de localisation parotidienne.

Juvenile xanthogranuloma of parotid gland is reported in a 9-year-old boy. This kind of tumor is thought to be very rare in salivary glands. Histological, immunohistochemical and ultrastructural data showed characteristic features and excluded a Langerhans cell histiocytosis. Follow-up was uneventful after 18 months.

[Lipoblastic liposarcoma of the lung. Ultrastructural study of a case]. / Liposarcome lipoblastique du poumon. Etude ultrastructurale d'un cas.

A case of fatal lipoblastic pulmonary liposarcoma in a 20 year-old female is reported. A thoracotomy was performed but failed to yield the pathological diagnosis. This diagnosis was obtained by ultrastructural study of a cerebral metastasis. To our knowledge, only seven cases of pulmonary liposarcoma have been previously described in the literature and the lipoblastic aspect was never mentioned.

[Silicone inclusions in the spleen in a patient under chronic hemodialysis]. / Inclusions de silicone dans la rate chez une hémodialysée chronique.

A 67-year-old woman with chronic renal failure, in periodic hemodialysis, presented an hemolytic anemia in relation to splenic sequestration. Light Microscopic examination of the spleen revealed multiple granulomatous reaction. Numerous macrophages contained inclusions which were non-birefringent and non-staining with routine stains. Electron microscopy, scanning electron microscopy and energy dispersive X-Ray analysis were performed and revealed silicone. Its origin was silicone tubing of the hemodialysis equipment. Pathogenic effects of silicone are discussed.

[Abdominal localization of invasive thymomas. Contribution of tomodensitometry]. / Localisations abdominales des thymomes invasifs. Apport de la tomodensitométrie.

Routine abdominal and thoracic computed tomography examinations in 20 patients with invasive lympho-epithelial thymomas demonstrated the frequency of abdominal localizations (9 cases), particularly in renal (7 cases) and adrenal (3 cases) tissues. The mode of extension and course during treatment of these tumors are discussed, and the different diagnostic procedures, particularly ultrasonography, are compared.

[Paradox: when a prothrombotic disorder is responsible for an upper gastrointestinal bleeding. Case report of hepatoportal sclerosis]. / Paradoxe: lorsqu'un état prothrombotique est responsable d'une hémorragie digestive. Observation d'un cas de sclérose hépatoportale.

Variceal bleeding is frequently the initial presentation of a previously unknown cirrhosis. Portal hypertension and its complications without liver cirrhosis should raise the possibility of presinusoidal portal hypertension, and the diagnosis of hepatoportal sclerosis. These patients need to be investigated for coagulation disorders. A hypercoagulable state is often associated. Risks and benefits of anticoagulation should be further investigated in these patients.

[Primary non-parasitic cyst of the diaphragm. Review of the literature. Apropos of a case]. / Kyste primitif non parasitaire du diaphragme. Revue de la littérature. A propos d'un cas.

The authors report a case of mesothelial cyst of the diaphragm, discovered on ultrasonography performed for pain in the right hypochondrium and treated by simple surgical excision. Based on a review of the literature, they define the topographical, histological and therapeutic aspects of these lesions, which are now recognised more frequently due to the progress in medical imaging.

[Syndrome of transverse testicular ectopia with persistent Müllerian vestiges or empty bursa with overfilled funiculus spermaticus]. / Le syndrome d'ectopie testiculaire transverse avec persistance de vestiges mulleriens ou la bourse vide et le cordon trop plein.

Transverse parorchidium is characterized by the presence of two testes in the same bursa, and may be associated with persistent Müllerian vestige in the spermatic cord of the normally situated testis. Persistence of Müllerian vestige is related to inadequate production of anti-Müllerian hormone by the embryonal testis. Transverse parorchidium is caused by the emergence of both deferent ducts into the Müllerian vestige. Diagnosis is evoked by the presence of an empty bursa associated with an abnormally hard spermatic cord contralaterally. This syndrome should be known of surgeons, as ablation of the Müllerian vestige consecutive to surgical management of a hernia or ectopic testis may lead to the sectioning of the deferent ducts.