[Bone loss owing to inflammatory bowel disease: prospective study, 50 cases]. / Perte osseuse au cours des maladies inflammatoires chroniques de l'intestin: etude prospective a propos de 50 cas.

AIMS: To evaluate the prevalence of osteoporosis during inflammatory bowel disease (IBD) and to determine the risk factors. METHODS: We conducted a prospective study that includes IBD patients. For all patients, bone mineral density was measured by dual-energy X-rays absorptiometry. RESULTS: Study has included 50 IBD patients; thirty had Crohn's disease and 20 had ulcerative colitis. The average age of our patients was of 36.4 + 9.9 years. A low osseous mineral density was noted in 21 patients (45%) distributed in 13% of osteoporosis and 32% of osteopenia. Only the age superior to 35 years, the duration of evolution of the disease superior to 10 years and intestinal resection constituted a risk factors of osteoporosis. After adaptation on the age and the intestinal resection the duration of evolution superior to 10 years persisted as risk factor of osteoporosis. The other risk factors: sex, type of IBD, denutrition and corticoids were not incriminated in the low osseous mineral density during IBD. CONCLUSION: These results confirm the necessity of the systematic search of the osteoporosis during IBD with the aim of proposing an early and effective treatment.

A gastric collision tumor composed of adenocarcinoma and gastrinoma: case report.

BACKGROUND: Collision tumors of the stomach are exceedingly rare, with only six previous reported instance in which adenocarcinoma of the stomach were found in association with carcinoid tumor. Only in one case the adenocarcinoma was associated with a gastrinoma. AIM: we report the second case of Collision tumor between adenocarcinoma and gastrinoma. OBSERVATION: A 55 years old man was admitted in our department for an exploration of gastric pain with rapid weight loss. Physical examination showed an epigastric mass. Upper endoscopy showed in the fundic region of the stomach an exophytic process wildly ulcerative in his center associated with the presence of a multiple polypoid tumors. The pathologic examination of the biopsy specimen of the process revealed an adenocarcinoma and of the polypoid tumors showed a carcinoid type tumor. There was no merged appearance between both tumors suggesting collision tumor. The biopsies of the non tumoral gastric mucosa were normal. The Zollinger Ellison syndrome was then suspected. The serum gastrin level showed a rate raised at 8676pg/ml. The diagnosis of collision type tumors between adenocarcinoma and gastrinoma was retained. The assessment of extension revealed the presence of hepatic and ganglion nodes. The patient was treated by chemotherapy but he died three months after initiation of chemotherapy because of tumoral progression. CONCLUSION: Through this observation and with a review of literature, the coexistence of adenocarcinoma and carcinoid tumor of the stomach is discussed.

[Eosinophilic gastroenteritis with ascites: a case report]. / La gastroenterite avec ascite a eosinophile: a propos d'un cas.

BACKGROUND: Eosinophilic gastroenteritis is a rare pathology, of undetermined etiology which incidence is in increase. It is characterized by eosinophilic infiltration of the wall of the gastrointestinal tract. Clinical manifestations are very variable and the severity of the clinical picture depends on the site involved and the wall layers infiltrated. AIM: We point out the clinical, evolutionary and therapeutic characteristics of this rare affection. CASE REPORT: We report the case of a 65 years old man, with the history of allergic asthma. He was admitted for diarrhea associated with vomiting and slimming quantified to 3 kg in 3 weeks. Physical examination noted an edematous-ascitic syndrome. Biology showed the presence of high peripheral eosinophilia. Paracentesis disclosed exudative effusion with high level of eosinophil. The morphological assessment highlighted a segmental parietal thickening of the small intestine and a dense eosinophilic infiltration of the mucosal duodenal layer. The patient was treated by corticotherapy with a favorable evolution. CONCLUSION: Despite its rarity, the diagnosis of gastroenteritis with ascites should be evoked even when the etiologic assessment is negative.

[Acute pancreatitis revealing Behçet disease]. / Pancréatite aiguë révélant une maladie de Behçet.

We report here a case of acute pancreatitis revealing Behcet's disease in an 18-year-old woman. Pancreatitis was due to ischemia secondary to severe abnormalities of the celiac trunk arteries with pseudo-aneurysms. The outcome was favourable after the administration of corticosteroids and cyclophosphamide. The patient did not experience relapse of pancreatitis 2 years after diagnosis.

[Corticosteroid dependence and resistance in Crohn's disease: prevalence and predictive factors]. / Corticodependance et corticoresistance au cours de la maladie de Crohn: prevalence et facteurs predictifs.

The aim of our study was to determine the prevalence of corticosensibility, corticodependency, and corticoresistance in patients with Crohn's disease. Ninety four treatments with corticoids were prescribed to the patients during the follow-up. The rates of corticosensibility, corticodependency, and corticoresistance were 66%, 16%, 18%. Corticodependency and corticoresistance are frequent in Crohn's disease. Corticodependency is more frequent in young patients and when corticoids were previously taken. A high CDAI was the only factor associated with a higher risk of corticoresistance.

Macrocystic pancreatic cystadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions.

BACKGROUND: Benign pancreatic serous cystadenoma usually is morphologically distinguishable from mucinous cystadenomas, which require resection because of their malignant potential. A macrocystic variant of serous cystadenoma recently has been described, rendering this important distinction more difficult. The aim of this study was to determine the EUS and tumor marker characteristics of mucinous cystadenoma compared with macrocystic serous cystadenomas. METHODS: Medical records for consecutive patients seen between 1995 and 2002, with a histopathologic diagnosis of mucinous cystadenoma or macrocystic serous cystadenoma after surgery, who had undergone a detailed EUS examination, including EUS-guided FNA, were retrospectively reviewed. RESULTS: A resection specimen was available for 32 mucinous cystadenomas and 9 macrocystic serous cystadenomas. No significant differences were observed with regard to clinical data (age, gender, presence of symptoms), lesion size, and location within the pancreas. All mucinous cystadenomas had a discernible cyst wall (thickened, 66%; focal parietal nodules, 25%) compared with 56% of macrocystic serous cystadenomas (p<0.0001). A thick echo content also was more frequent in mucinous cystadenoma (56% vs. 11%; p=0.04; statistical significance removed by the Bonferroni correction). Microcysts were only observed in macrocystic serous cystadenomas (44%; p=0.0008). The combination of a cyst wall that is thickened and the absence of microcysts had a sensitivity of 100% and specificity of 78% for the diagnosis of mucinous cystadenoma compared with macrocystic serous cystadenoma. Although intracystic carbohydrate-associated antigen 72-4 and mucins M1 were non-discriminatory, low carcinoembryonic antigen (<5 ng/mL) and carbohydrate-associated antigen 19-9 (<50,000 U/mL) values were found in macrocystic serous lesions (respectively, 100% and 100%; p=0.0002 and p=0.0002). CONCLUSIONS: Although there is considerable overlap, helpful EUS characteristics that differentiate mucinous cystadenoma from macrocystic serous cystadenoma include a thick cyst wall and microcysts. These features, coupled with analysis of aspirated fluid for tumor markers (especially carcinoembryonic antigen), should help to confirm the diagnosis.