[Clostridium difficile: a serious outpatient infection?]. / Clostridium difficile: vers des infections graves en médecine ambulatoire?

Secondary to severe hospital outbreaks due to hypervirulent strains of Clostridium difficile, several surveillance systems in North-America and Europe observed an increase in infections due to this micro-organism, also in the outpatient setting. The case reported in the present article illustrates the fulminant presentation that a C. difficile colitis can show in a previously healthy person without prior contact with healthcare facilities. It introduces a review of some recent publications on the current changes in the epidemiology, clinical presentation, diagnosis and treatment of this disease.

Anti-liver-kidney microsome antibody-positive autoimmune hepatitis associated with alopecia.

A 14-year-old girl presented with anti-liver-kidney microsome autoimmune hepatitis preceded by alopecia 3 years earlier. Both pathologies were greatly improved by immunosuppressive therapy. Alopecia is a newly reported extrahepatic manifestation of type 2 autoimmune hepatitis. Its appearance could alert the clinician to an increased risk of autoimmune hepatitis in children.

Sclerotherapy of rectal varices.

Rectal varices represent a rare condition even in cases of portal hypertension. A case of bleeding ano-rectal varices presenting as the first manifestation of portal hypertension is reported. Treatment by sclerotherapy was successful.

[Constipation and incontinence: significance of colonic transit time, anorectal manometry and defecography]. / Constipation et incontinence: intérêt du temps de transit colique, de la manométrie ano-rectale et de la défécographie.

Constipation and fecal incontinence are frequent motives of gastroenterological consultation. An etiological diagnosis can often be suspected from the history and can be confirmed by functional testing. We here report our experience with the measurement of colonic transit time (TTC), anorectal manometry (MAR) and defecography (D). Whilst TTC was unhelpful, MAR revealed abdomino-pelvic asynchrony (anismus) in 60 constipated patients and 7 (47%) of 15 incontinent patients. Perineal descent was suspected in 25 constipated patients and confirmed by defecography, which also revealed associated static pelvic disorders. Our experience confirms the role of functional exploration in the investigation of constipation and fecal incontinence and permits a more precise therapeutic approach.

[Endoscopic sclerotherapy and esophageal varices]. / Sclérose endoscopique et varices oesophagiennes.

60 consecutive patients underwent sclerotherapy for hemorrhage from ruptured esophageal varices. Sclerosis was always started within the first 48 hours. 12 patients (20%) died during initial hospitalization, but only 5 from recurrent bleeding. Of 48 survivors, 22 (46%) did not rebleed during a mean 18-month follow-up, whereas 26 (54%) had recurrences, 27 of these bleeding episodes occurred early (within 4 months) and 17 late (mean 16.5 months). Eradication of the varices was achieved in 29 patients (60%) with a mean of 6.2 sessions and within a mean of 6 months. Of these 48 patients 2 have been lost to follow-up, 25 (52%) are alive after a mean follow-up of 29 months, and 21 (44%) died (though only 2 from variceal bleeding). The survival curve (Kaplan-Meier) of these 60 bleeders is 45% and 37% at 2 and 4 years respectively. Sclerotherapy caused no death and only minor adverse effects. These results confirm those in the literature. We advocate endoscopic sclerosis as first choice in the treatment of ruptured esophageal varices.