[Acute pancreatitis disclosing an uncommon form of annular pancreas]. / Pancréatite aiguë révélant une forme particulière de pancréas annulaire.

We report a case of an acute pancreatitis revealing an annular pancreas associated with a pancreas divisum. Diagnosis was performed by endoscopic retrograde pancreatography with successful injection of major and minor papillae. Coexistence of pancreas divisum and annular pancreas is a rare congenital anomaly. Our case is original because the annular duct system encircling the duodenum is the ventral pancreas duct.

[Incidence of esophageal cancer synchronous with upper aerodigestive tract cancers (100 cases): value of vital staining with lugol and toluidine blue]. / Fréquence du cancer de l'oesophage synchrone des cancers des voies aéro-digestives supérieures (100 cas): intérêt des colorations vitales au lugol et au bleu de toluidine.

A number of studies have demonstrated a high incidence of synchronous or metachronous esophageal carcinoma in association with carcinoma of head and neck. Carcinoma of the esophagus must be systematically looked for before the treatment of head-neck carcinomas and during follow-up. The aim of this study was to determine the incidence of synchronous esophageal carcinoma in patients with head and neck carcinoma and to evaluate the advantages of lugol and toluidine blue vital staining in fiberoptic endoscopy. One hundred patients (97 males and 3 females, mean age 54.9 years) were studied. A fiberoptic esophagoscopy was performed in all patients. Vital staining was realized with 5 p. 100 lugol in 40 cases and with 1 p. 100 toluidine blue e in 20 cases. Squamous cell carcinoma of the esophagus was observed in 12 patients, typical grossly in 5 cases and occult in 7 cases. In these latter cases, lugol (2 cases) or toluidine blue (5 cases) stain facilitated the forceps biopsies. Histological examination was positive in all cases. The incidence of esophageal carcinoma synchronous to carcinoma of the mouth was high (35.3 p. 100). Lugol vital staining seems to be sensitive, non-specific and easy to realize. Toluidine blue staining calls for a more difficult and prolonged technique. Although it can reveal occult carcinoma, false positive or negative results may be observed.

[Natural history of glandulocystic fundic polyposis in Gardner's syndrome]. / Histoire naturelle de la polypose fundique glandulo-kystique dans le syndrome de Gardner.

The authors report 3 cases of fundic gland polyposis associated with Gardner's syndrome. Control endoscopies revealed fundic gland polyposis disappearance 14, 14, and 7 years respectively after discovery, and colectomy performed at ages 29, 30, and 32, respectively. This regression, described in autonomous fundic gland polyposis, is poorly documented in Gardner's syndrome. This phenomenon is not related to colectomy. However no explanation is currently available, and further studies are necessary to determine the factors related to the natural history of fundic gland polyposis in familial adenomatosis coli/Gardner's syndrome.

[Upper esophageal varices. Study of 6 cases and review of the literature]. / Varices oesophagiennes supérieures. Etude de 6 cas et revue de la littérature.

Distal esophageal varices are most frequently associated with portal hypertension, while varices of the upper esophagus are occasionally observed in patients with vena caval obstruction. One hundred and nineteen cases of upper esophageal varices (downhill varices) have been reported in the literature. We report 6 cases (4 men and 2 women), with vena caval obstruction. Upper gastrointestinal hemorrhage occurred in one patient. Endoscopy showed varices in the proximal third of the esophagus in 5 patients and in the proximal half of the esophagus in the other patient. Superior vena cavogram demonstrated total or partial occlusion of the vena cava in 6 cases, with opacification of the right azygos vein in 4 cases and thrombosis of this vein in one case. Superior vena caval obstruction was secondary to malignant lymphoma in 2 cases, to malignant thymoma in 2 cases, to malignant thyroid tumor in one case and to anaplastic bronchogenic carcinoma in one case. Clinical symptoms of vena caval obstruction are present in 91.4 p. 100 of the cases in the literature. Upper gastrointestinal hemorrhage are observed in 7.6 p. 100 of cases. It is generally agreed that the predominant factors involved in the determination of the downward extension of varices along the esophagus are the level of superior vena caval obstruction and its duration. Because of the risk of digestive hemorrhage and of the topographic meaning of the degree of extension, upper esophageal varices should be routinely searched in patients with vena caval hypertension.

[Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis]. / Biopsies d'un rectum et d'un côlon endoscopiquement normaux: une nécessité. Fréquence de la colite collagène et de la colite microscopique.

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.

[Intraduodenal development of diverticula of the lower choledochus. Apropos of 2 cases]. / Développement intraduodénal des diverticules du bas cholédoque. A propos de deux observations.

Two cases of intraduodenal development of a low choledochal diverticulum were observed during the last ten years. Preoperative diagnosis of this biliary malformation is difficult. Clinical presentation consisted of chronic upper abdominal pain and high gastrointestinal obstruction, without either cholangitis or pancreatitis. In both patients, treatment consisted of resection of the diverticulum and suture of its neck via a transduodenal approach. The post-operative course was uneventful and long-term follow-up (2 and 11 years) is satisfactory, showing that cure has been achieved by means of this simple and radical procedure. This particular biliary anomaly must therefore be distinguished from other diverticula of the common bile duct, because of its clinical presentation, diagnostic approach and treatment required.

[Tomographic study of the intra-abdominal digestive tract. Contributions of percutaneous echography and scanner in daily practice]. / Exploration par coupes du tube digestif intra-abdominal. Apports de l'échographie percutanée et du scanner en pratique quotidienne.

Endoscopy and radiological imaging are complementary. However the gastro-intestinal tract is routinely being imaged in CT and ultrasound, often performed for other indications. When an abnormality is discovered, several questions have to be addressed. Is the lesion due to a bowel abnormality? When bowel wall thickening is present, is it due to poor opacification or is it due to inflammation or tumor? Circumferential symmetrical thickening is more in favor of an inflammatory lesion, while focal asymmetrical thickening is more in favor of a neoplastic lesion. Inflammatory and lymphomatous lesion can have similar appearances. Guidelines to aid in diagnostic interpretation of gastrointestinal lesions are discussed, including features of appendicitis and obstruction.

[Hydrocele of pancreatic origin. X-ray computed tomographic study of an intrascrotal collection in an acute outbreak of chronic pancreatitis]. / Hydrocèle d'origine pancréatique. Etude scanographique d'une collection intrascrotale lors d'une poussée aiguë de pancréatite chronique.

In an alcoholic 46-year-old man complaining of painful scrotum enlargement, CT examination allowed to refer the intrascrotal fluid collection to its pancreatic origin.

[Chemical colitis caused by glutaraldehyde]. / Colite chimique au glutaraldéhyde.

Glutaraldehyde disinfectant solution may be a cause of toxic chemical colitis. We report two cases. Ultrasonic features were studied in one case and mimic colonic ischemia, inflammatory and/or infectious colitis. These findings were colonic wall thickening especially mucosal (hypoechogenicity) and submucosal (hyperechogenicity) layers. This diagnosis should be discussed when one sees a patient with echographic findings of acute left-sided colitis just after uncomplicated colonic endoscopy.

A liver-enriched transcriptional activator protein, LAP, and a transcriptional inhibitory protein, LIP, are translated from the same mRNA.

LAP, a transcriptional activator, and LIP, a transcriptional repressor, are translated from a single mRNA species by using two AUGs within the same reading frame. These two proteins share the 145 C-terminal amino acids that contain the basic DNA-binding domain and the leucine zipper dimerization helix. Probably owing to its higher affinity for its DNA cognate sequences, LIP can attenuate the transcriptional stimulation by LAP in substoichiometric amounts. As revealed by transient transfection experiments, a moderate increase in the LAP/LIP ratio results in a significantly higher transcriptional activation of an appropriate target gene. The LAP/LIP ratio increases about 5-fold during terminal rat liver differentiation and is thus likely to modulate the activity of LAP in the intact animal.

The 5' flanking region of the rat LAP (C/EBP beta) gene can direct high-level, position-independent, copy number-dependent expression in multiple tissues in transgenic mice.

The efficiency and tissue-specificity of transgene expression in animals is usually subject to the position of integration into the host chromatin. We have discovered that a 2.8kbp fragment flanking the rat gene encoding the transcription factor LAP (C/EBP beta) directs position-independent, copy number-dependent expression in transgenic-mouse livers. Concomitantly, the DNAse I hypersensitivity pattern normally observed in the liver is established in the integrated transgene construct demonstrating that this region is capable of creating chromatin structures equivalent to the endogenous situation. These observations are reminiscent of the locus control regions (LCR) described for several genes. Additionally, this LAP element functions with both intron-less and intron-containing genes. The tissue specificity of this element, however, is not restricted to liver. The 2.8kbp region is capable of allowing position-independent, copy number-dependent expression in brain, kidney, heart, spleen, and lung, but in a construct-dependent manner. This is, to our knowledge, the first transcription factor gene with which a cis-linked LCR-like element has been associated.

CCAAT/enhancer-binding protein mRNA is translated into multiple proteins with different transcription activation potentials.

The CCAAT/enhancer-binding protein (C/EBP) alpha is a leucine zipper protein that is preferentially expressed in certain cell types, such as adipocytes and hepatocytes. Here we show that C/EBP alpha mRNA is translated into two major proteins, C/EBP-42 and C/EBP-30, that differ in their content of N-terminal amino acid sequences. These results are best explained by a ribosome-scanning mechanism in which a fraction of ribosomes ignore the first two AUGs and initiate translation at an AUG located 351 nt downstream of the first one. Because C/EBP-30, the translation product initiated at the third AUG, is devoid of the potent transcription-activation domain contained in C/EBP-42, the former protein stimulates transcription from the mouse albumin promoter much less efficiently than the latter. The gene encoding the liver-enriched transcriptional-activator protein LAP (C/EBP-beta) has also been shown to issue two proteins, LAP and the liver-enriched transcriptional-inhibitory protein LIP, with different transcription-activation potentials. The production of multiple proteins from a single mRNA is not only shared between different C/EBP family members but also appears to be conserved in vertebrate evolution.