Dupuytren's contracture, alcohol consumption, and chronic liver disease.

This prospective study was undertaken to assess the prevalence of Dupuytren's contracture (DC) and its relationship with possible causes, especially alcohol consumption and chronic liver disease. Four hundred thirty-two consecutively hospitalized patients were examined for evidence of DC. They were divided into five groups based on the following clinical, biologic, and histologic criteria: alcoholic cirrhosis (89 patients), noncirrhotic alcoholic liver disease (55 patients), chronic alcoholism without liver disease (46 patients), nonalcoholic chronic liver disease (68 patients), and a control group (174 patients). The prevalence of DC in these five groups of patients was 32.5%, 22%, 28%, 6%, and 12%, respectively; the prevalence of DC was higher in patients with cirrhotic or noncirrhotic alcoholic liver disease (25.5%) than it was in patients with nonalcoholic liver disease (6%), but it was not significantly different in alcoholic patients with or without liver disease. The relationship between DC and age, sex, manual labor, previous hand injuries, diabetes mellitus, alcohol consumption, and cigarette smoking was assessed by univariate and logistic regression methods. Nine variables were significantly different in patients with or without DC: age, sex, manual labor, previous hand injuries, diabetes mellitus, daily alcohol consumption, duration of alcohol consumption, total alcohol consumption, and duration of cigarette smoking. In our patients, variables that could explain DC were, in decreasing order, age, total alcohol consumption, sex (male), and previous hand injuries. In alcoholic patients, these variables were age and previous hand injuries; in nonalcoholic patients, these variables were age and cigarette smoking. These results emphasize the high prevalence of DC in alcoholic patients and the absence of a correlation between DC and chronic liver disease. Age and alcohol consumption are the best explanatory variables of DC in hospitalized patients.

Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis.

OBJECTIVE: Large-volume paracentesis associated with plasma volume expansion with albumin is an effective, safe, but costly therapy for ascites in patients with cirrhosis. The aim of this study was to compare the use of a synthetic plasma expander, hydroxyethyl starch (HES), with that of albumin. DESIGN: Sixty cirrhotic patients with ascites were studied. Patients were randomly assigned to be infused with either albumin (8 g/l of ascites removed, n = 33) or HES (200 ml/l of ascites removed, n = 27). None of the patients was treated with diuretics or had renal impairment or hyponatremia at entry. Clinical and laboratory data were obtained before and 1, 3 and 15 days after treatment. RESULTS: There were no significant differences in clinical and laboratory parameters between the two groups at entry into the study. None of the patients developed renal impairment during the trial. One patient (HES group) presented with hyponatremia. Plasma atrial natriuretic factor and aldosterone levels did not differ between the two groups at baseline or at 1 and 3 days after paracentesis. The volume of ascites removed did not differ between the albumin (7.9 +/- 4.4 l) and HES (6.9 +/- 5.3 l) groups. However, there was a significant difference in weight loss between the albumin and HES groups (7.9 +/- 5.2 kg vs 4.7 +/- 3.4 kg; p = 0.01). Clinical and laboratory parameters indicated that HES was well tolerated except for hypoalbuminemia. CONCLUSION: HES is well tolerated in patients with cirrhosis. There is no difference between HES and albumin in the prevention of complications related to large-volume paracentesis. The lesser degree of weight loss observed with HES needs further study.

Hepatitis C virus infection risk factors in patients admitted in hospital emergency departments in Picardy. Value of oriented screening based on recommendations of the 'Direction Générale de la Santé'.

OBJECTIVE AND DESIGN: Oriented hepatitis C virus (HCV) screening on the basis of transfusion, previous or current parenteral drug addiction, invasive procedures, and in family members of patients with hepatitis C, was recommended in France by the 'Direction Générale de la Santé' (DGS). The aim of this study was to estimate the frequency of these risk factors in patients admitted in hospital emergency departments in Picardy. METHODS: Between 1 June and 31 July 1996, physicians of the emergency units of seven hospitals in Picardy were asked to question admitted patients about risk factors mentioned in the DGS recommendations, and to suggest a screening test when at least one of these risk factors was present. RESULTS: Among 1648 patients, 68.7% had at least one of these risk factors. Screening was accepted by 723 patients, 58.7% of those with at least one risk factor, and more than 70% of those with history of transfusion and/or drug addiction. It was immediately performed in 451, and 2.4% had anti-HCV antibodies. The prevalence of anti-HCV antibodies was 1.5% in patients without history of transfusion or drug addiction and 7.9% in those with at least one of these two risk factors. CONCLUSION: Oriented screening based on transfusion or drug addiction history seems to have better efficiency than the screening policy recommended by the DGS. Poor reliability of answers about medical history was observed probably because of stress related to emergency circumstances. A screening test proposed to patients with these major risk factors by their usual physician would be probably more efficient.

[Serum activity of mitochondrial aspartate aminotransferase and extrahepatic cholestasis]. / Activité sérique de l'aspartate aminotransférase mitochondriale et cholestase extrahépatique.

Serum mitochondrial aspartate aminotransferase (mAST) level and the mitochondrial aspartate aminotransferase/total aspartate aminotransferase ratio (mAST/AST) have been proposed as sensitive markers of chronic alcoholism. Their specificity, however, remains poorly defined. The purpose of this study was to compare these markers in three groups of hospitalized patients: group I, 80 patients with chronic alcoholic liver disease; group II, 51 patients with chronic liver disease without alcoholism; group III, 44 patients with extrahepatic cholestasis (due to choledocholithiasis in 21 and malignant in 23). mAST was measured after immuno-precipitation of cytoplasmic aspartate aminotransferase. The normal values of mAST (less than or equal to 2 mu/l) and mAST/AST (less than or equal to 6 p. 100) were defined in a group of 59 non alcoholic subjects without liver disease (controls). mAST was increased as compared with controls in 91 p. 100 of the patients of group I, 20 p. 100 of group II, 61 p. 100 of group III. mAST was comparable in groups I (mean +/- SD: 10 +/- 10.8) and III (10.3 +/- 12.9), and higher than in group II (1.8 +/- 2.4). m/AST was increased in 59 p. 100 of the patients of group I, 6 p. 100 of group II and 36 p. 100 of group III. It was higher in group I (8 +/- 4 p. 100) than in group III (6 +/- 4 p. 100, p less than 0.02), and particularly higher in both these groups than in group II (2 +/- 1 p. 100, p less than 0.00001). mAST was correlated to AST in each of these three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopy in tumors of the Oddi region. Diagnostic and therapeutic possibilities]. / Endoscopie dans les tumeurs de la région oddienne. Possibilités diagnostiques et thérapeutiques.

Between 1976 and 1983, 92 patients (mean age: 70 years) with ampullary or periampullary tumors, were evaluated by endoscopic procedures. The ampulla appeared malignant in 66 p. 100 of cases, enlarged but not obviously malignant in 15 p. 100 and normal in 18 p. 100. In one case, a tight duodenal stenosis prevented the endoscopist from seeing the ampulla. ERCP was performed in 70 patients and the common bile duct was opacified in 63 cases; it was dilated in 60 patients. Two types of tumors could be distinguished: 67 p. 100 grew within the duodenum and were seen by duodenoscopy and 33 p. 100 grew outside the duodenum and ERCP opacified a dilated common bile duct above a stenotic region; in these cases, diagnosis was established by biopsies performed through the ampulla, after endoscopic sphincterotomy (EST). Biopsy specimens were obtained in 67 p. 100 of cases and yielded a diagnosis of adenocarcinoma in 59 p. 100, questionable carcinoma in 15 p. 100, benign tumor in 16 p. 100 and normal mucosa in 10 p. 100. In 8 patients with the preoperative diagnosis of non-malignant tumor, operative biopsies finally revealed carcinoma in 7. EST or infundibulotomy was performed in 42 patients with 2 deaths from hemorrhage and cholangitis. Twenty-three patients received only EST as final treatment with complete disappearance of jaundice and/or cholangitis in 70 p. 100. Our results confirm the efficacy of duodenoscopy, ERCP and EST in the diagnosis and sometimes in the treatment of ampullary and periampullary tumors.

[Colonic endoscopic screening and familial antecedent of sporadic rectocolonic cancer. Controlled prospective study]. / Dépistage endoscopique colique et antécédent familial de cancer rectocolique sporadique. Etude prospective contrôlée.

We searched for colorectal tumors in asymptomatic patients older than 40 years with family history of sporadic colorectal cancer (only first degree relatives). One hundred and four patients at risk had a left-sided (n = 60) or a total colonoscopy (n = 44) and were compared to 104 control patients, matched for age, sex and type of colonic investigation. Three cancers were detected in the group at risk, 1 in the control group (NS). One or more adenomas without carcinoma were found in 10 percent of the patients at risk and in 9 percent of the controls (NS). There was no difference between groups in the number, size, histologic type, degree of dysplasia, or location of adenoma in the colon. These results do not exclude a family predisposition to sporadic colorectal cancer or adenoma. Because of the low rate of adenoma detection, relatives of patients with sporadic colorectal carcinoma but without personal risk factors cannot be considered as a high risk group for colorectal endoscopic screening.

[Elective sclerotherapy in hepatocellular carcinoma complicated by digestive hemorrhage]. / Evaluation de la sclérothérapie élective dans les carcinomes hépatocellulaires compliqués d'hémorragie digestive.

Between April 1984 and October 1988, 10 patients with hepatocellular carcinoma who bled from esophageal varices were included in a polidocanol sclerotherapy program, after the cessation of bleeding. Sixty cirrhotic patients without hepatocellular carcinoma were included as controls in the same sclerotherapy program for the same period. According to Okuda's classification, 1 patient was grade I, and 9 were grade II. At 1 year, 41 percent of patients with hepatocellular carcinoma and 51 percent of controls had rebled (non significant). Varices were obliterated in 7 of 10 patients with hepatocellular carcinoma and in 41 of 60 control patients (non significant). At one year, treatment failed (rebleeding or death) in 54 percent patients with hepatocellular carcinoma and in 59 percent control patients (non significant). Child-Pugh's score was the principal prognostic factor for treatment failure in both groups. Portal vein thrombosis was found in 2 of the 3 hepatocellular carcinoma patients who rebled. Unlike propranolol, elective sclerotherapy treatment might be proposed to patients with hepatocellular carcinoma without portal thrombosis.

[Propranolol prevention of hemorrhagic recurrence caused by rupture of esophageal varices: worsened prognosis in ascites and jaundice]. / Prévention par le propranolol de la récidive hémorragique par rupture de varices oesophagiennes: valeur pronostique péjorative de l'ascite et de l'ictère.

Between October 1981 and December 1983, 46 consecutive unselected cirrhotic patients who had been admitted for variceal hemorrhage were assigned to propranolol for the prevention of variceal rebleeding and followed for a mean period of 13.3 months (ranges: 1 day, 45 months). At the time of inclusion, 87 p. 100 of patients had alcoholic cirrhosis: ascites was present in 43 p. 100, jaundice in 43 p. 100 and encephalopathy in 33 p. 100 of cases. The goal of this retrospective study was to assess the effectiveness of propranolol in these unselected patients and to determine variables associated with a high rebleeding rate. Twenty-four patients (52 p. 100) rebled from esophageal varices within a mean time of 8.2 months (range: 6 days, 39 months) and 12 of these patients died. The percentage of patients who rebled from varices was 27 p. 100 at 6 months, 43 p. 100 at 1 year, 52 p. 100 at 18 months. Patients with ascites at the time of inclusion were 3.5 times more likely to rebleed than patients without ascites (p = 0.007). Patients with jaundice (total bilirubin greater than or equal to 50 mumol/l) were 3.1 times more likely to rebleed than patients without jaundice (p = 0.01). One year after the beginning of this treatment, the probability of rebleeding was 19 p. 100 in the 17 Pugh-Child class A cirrhotic patients, 60 p. 100 in the 15 class B patients, 55 p. 100 in the 14 class C patients. Neither proper acceptance in taking propranolol nor alcohol withdrawal were associated with significantly modified risks of rebleeding in these unselected alcoholic patients.

[Results of endoscopic sphincterotomy in common bile duct lithiasis]. / Résultats de la sphinctérotomie endoscopique pour lithiase de la voie biliaire principale.

Endoscopic sphincterotomy (ES) was attempted in 409 patients with common bile duct stone(s) (CBDS). The mean age of patients was 72.0 +/- 0.8 years (m +/- SEM); 47 p. 100 presented risk factors; 57 p.100 had previously been cholecystectomized while 43 p. 100 had not. On an average, patients in the former group were older (80 +/- 0.7 years) than in the latter 65.4 +/- 1.0 years, p less than 0.001). The procedure was successful in 98 p. 100 of the patients, after a standard ES in 78.5 p. 100 or after different technical artifices in 21.5 p. 100. The vacuity of the CBD was obtained in 96.5 p. 100 of the cases. During the first month after the ES, 13 p. 100 of the patients had complications and 4 p. 100 died; 37 complications (9 p. 100) were related to the ES and were responsible for death in 4 patients: 18 episodes of bleeding at the site of ES, 7 acute pancreatitis, 6 cholangitis, 4 retroperitoneal perforations and 2 other complications. The occurrence of these complications was closely related to the technique of ES being more frequent after technical artifices than after a standard ES (p less than 0.001). On the other hand, these complications occurred independently of the age of patients or of previous cholecystectomy. Seventeen complications (4 p. 100) did not depend directly on ES and were responsible for death in 14 patients (3 p. 100): pneumopathy, pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognosis of acute viral hepatitis in patients with alcoholic cirrhosis]. / Pronostic des hépatites virales aiguës survenant chez des malades atteints de cirrhose alcoolique.

We report 20 cases of alcoholic cirrhosis with superimposed episodes of acute viral hepatitis. Four had acute type B hepatitis and 16, presumed non A non B hepatitis. Before hepatitis, 17 patients had stopped drinking and only four had a complicated cirrhosis. Eighteen patients had received a blood transfusion within the 6 months before the occurrence of hepatitis (mean: 52 days). All patients developed jaundice, 7 encephalopathy, and 5 ascites. The ASAT/ALAT ratio was greater than 1 in 18 patients. Two patients died of hepatic failure. Follow-up was known in 17 of the 18 surviving patients: in all patients jaundice disappeared and transaminases returned to values less than 3 times the upper limits of normal. In our experience, the prognosis is good when viral hepatitis occurs in patients with non complicated alcoholic cirrhosis.

[Chronic alcoholic pancreatitis: relation of pain to withdrawal and pancreatic surgery]. / Pancréatite chronique alcoolique: relations de la douleur avec le sevrage et la chirurgie pancréatique.

A group of 73 patients suffering from painful alcoholic, chronic pancreatitis, hospitalized from 1971 to 1981, has been analyzed retrospectively. The aim was to assess the effects of alcohol withdrawal and pancreatic surgery on the course of pancreatic pain. The mean number of years during which the patients complained of pain was 3.5 +/- 0.5 (m +/- SEM). At the end of follow-up, 70 p. 100 of the patients did no longer suffer, alcohol withdrawal was obtained in 45 p. 100 and surgery had been performed in 41 p. 100. Continued alcohol abuse did not prevent pain relief: 60 p. 100 of patients continuing to drink at the end of follow-up, did not suffer any longer. One year after pancreatic surgery, pain relief was more frequent, if alcohol abstinence had been obtained before surgery (p less than 0.01). Among the 53 patients followed up to 5 years after the start of pain: a) the cumulative actuarial probability of disappearance of pain was 17 p. 100 at 2 years, 52 p. 100 at 5 years, 62 p. 100 at 8 years after the start of pain. Alcohol abstinence and surgery were observed during the first five years of pain; b) the mean number of years of pain was lower among the patients who became abstinent early (less than 4 years after the beginning of pain) than among those who did not (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of ascites in patients with liver cirrhosis without neither hyponatremia nor renal insufficiency. Results of a randomized study comparing diuretics and punctures compensated by albumin]. / Traitement de l'ascite chez les malades atteints de cirrhose sans hyponatrémie ni insuffisance rénale. Résultats d'une étude randomisée comparant les diurétiques et les ponctions compensées par l'albumine.

Previous studies have suggested that treatment of ascites in cirrhotic patients by repeated paracenteses and albumin infusion is fast, effective and safe. In one of these studies including patients with hyponatremia or renal impairment, this treatment was associated with a reduction of duration of hospital stay in comparison with large dose diuretics. The aim of this randomized study was to compare paracentesis with albumin perfusion and low dose diuretics in cirrhotic patients with ascites, but without hyponatremia or renal impairment. Twenty-six patients (group 1) were treated with paracentesis (4 L/day) and 27 patients (group 2) were treated with spironolactone (225 to 300 mg/day), associated with furosemide (40 to 80 mg/day), when inefficient alone. Ascites and peripheric edema disappeared more rapidly in group 1 than in group 2, 8.6 +/- 9.6 vs 13.5 +/- 6.7 days (P = 0.001) and 4.1 +/- 2.6 vs 10.5 +/- 6.5 days (P = 0.001) respectively. During hospitalisation, the incidence of complications was higher in group 2 than in group 1: 56 vs 26% (P = 0.03). Hyponatremia occurred in 30% of patients in group 2 and 4% of patients in group 1 (P = 0.04). The duration of hospital stay was shorter in group 1 (15.0 +/- 10.4 days) than in group 2 (21.0 +/- 11.7 days) (P = 0.007). During follow-up, ascites reappeared in 32% of patients in group 1 and 57% of patients in group 2 (P = 0.09). At 3 months, one patient in group 1 and 2 patients in group 2 developed spontaneous peritonitis whereas survival was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Imaging of nodular regenerative hyperplasia of the liver. Study of 9 cases]. / Imagerie de l'hyperplasie nodulaire régénérative du foie. Etude de 9 cas.

Radiologic patterns of the liver in nodular regenerative hyperplasia are poorly known. The authors describe the features of the liver observed during ultrasonography, angiography, computed tomography and magnetic resonance imaging in 9 patients with nodular regenerative hyperplasia. Generally the liver appeared normal, occasionally with signs of portal hypertension. However, a pseudotumoral pattern was observed in 2 patients: they had well limited hypoechoic lesions on ultrasonography, and in one patient angiography showed hypervascularity.

[Pseudotumor nodules of the liver in cirrhotic patients. Study of 7 cases]. / Nodules pseudo-tumoraux du foie chez le cirrhotique. Etude de 7 cas.

Hepatocellular pseudotumor (HCP) occurs in cirrhotic liver and can resemble hepatocellular carcinoma. Liver ultrasonography shows a space-occupying lesion. The aim of this study was to describe the clinical, radiological and histologic features of HCP based on seven patients (3 women, 4 men), mean age 48 years (24 to 62), with histologically proven cirrhosis (alcoholic, 4 cases; autoimmune, 1 case; postnecrotic, 1 case, idiopathic, 1 case). Serum alphafetoprotein was below 16 ng/ml in 5 patients and remained over 120 ng/ml in the remaining 2. Desgammacarboxyprothrombin, performed in 3 cases, was below the upper limit of normal range. Real time ultrasonography of the liver showed a homogeneous parenchyma in 1 case and median size (20-48 mm) space-occupying nodular lesions in 6 cases. Sonography patterns of hepatocellular pseudotumor were as follows: anechoic lesions in 5 cases and mixed pattern (sonodense and hypoechogenic) in 1 case. Angiographic findings exhibited different patterns: hypervascular or hypovascular nodules, multinodular uptake after lipiodol bolus injection. Computed tomography showed iso- or hypodense space-occupying lesions. Lipiodol injection, performed in 3 cases, showed nodular lipiodol uptake. Fine needle biopsy always showed normal hepatocytes. At laparotomy, performed in 3 cases, an hyperplastic nodule was found in 1 case only. All patients were alive at 12 to 36 months. These findings are consistent with the fact that hepatocellular pseudotumor is a true entity. Differential diagnosis is difficult. Iodine oil nodular fixation on CT scan may be non specific for hepatocellular pseudotumor. Histologic data is mandatory before beginning a non surgical therapeutic regimen for suspected hepatocellular carcinoma.

[Value of molluscum pendulum in the diagnosis of colorectal neoplastic lesions]. / Valeur du "molluscum pendulum" pour le diagnostic des lésions néoplasiques colorectales.

A routine search for skin tags was made before performing colonoscopy in 220 patients, whose mean age was 61.8 years. Sixty-one p. 100 of patients were male. The reasons for colonoscopy were digestive symptoms (95 cases), past history of malignant disease of the colon (MDC) or rectum (67 cases) or other symptoms (58 cases). Eighty-five patients had one or more skin tags, while 78 patients had one or more MDC. MDC in patients with skin tags was more frequent than in patients without skin tags (43.5 p. 100 vs. 30.4 p. 100 respectively, p less than 0.05). However this relationship was age-dependent. No significant relationship was found between the discovery of skin tags and the number of MDC, the carcinomatous nature of the lesion or not, or its degree of dysplasia. In 153 patients without personal history of MDC there was no significant relationship between the existence of skin tags and the discovery of colorectal lesions at colonoscopy. In this series of 220 patients, the sensitivity and specificity of skin tags associated with MDC on colonoscopy was poor (0.47 and 0.66 respectively).

[Obstructive icterus in patients with hepatic tumor. Result of non-surgical biliary drainage]. / Ictère obstructif chez les malades ayant une tumeur hépatique. Résultat du drainage biliaire non chirurgical.

Seventeen patients with biliary obstruction and hepatic tumors were treated by endoscopic or percutaneous transhepatic drainage with an endoprothesis. There were 9 men and 8 women (mean age = 61 +/- 13 years). Four patients had primary hepatic carcinoma and 13 had hepatic metastases. Decrease of serum bilirubin of more than 75 percent was achieved in 12 of the patients (71 percent). The success rate was related to the level of the biliary obstacle and not to the importance of hepatic parenchymal involvement. Failure was significantly more frequent (p = 0.003) in patients with type III hilar strictures compared to the other patients with pedicular or type I and II hilar strictures. Cholangitis was the major complication (29 percent) and occurred only in the patients with type III hilar strictures. Mortality was 24 percent at 30 days. This rate was 57 percent in the group of patients with type III hilar strictures and significantly higher (p = 0.015) than other patients. Cumulative survival was better in patients with relief of jaundice than that observed in the other patients (p less than 0.01). Two patients with metastatic carcinoma of the breast treated by chemotherapy survived more than 20 months without jaundice. Analysis of these data indicates that in patients with hepatic tumors and obstructive jaundice, palliative treatment with endoprothesis can provide relief of jaundice and that prolonged survival may be observed in patients with chemosensible tumors.

[Long-term outcome of alcoholic patients after a stay in a hospital hepatogastroenterology unit]. / Devenir des malades alcooliques après une hospitalisation en hépato-gastroentérologie.

The long term results of psychologically oriented treatment for alcoholism were evaluated in 147 patients hospitalized in a liver unit and followed for 1-5 years. Twenty-three percent of the patients were hospitalized for treatment of alcoholism, while 61 percent were hospitalized for alcohol-related disease. The main patient characteristics were: males: 71 percent; age: 48 +/- 10 years (mean +/- SD); alcoholic cirrhosis: 48 percent; initial request for help in abstinence: 9 percent; and unemployment: 35 percent. During the hospitalization (16 +/- 10 days), each patient had 1 to 4 psychotherapeutic interviews. Seventy-four percent of patients responded to follow-up after discharge and contact was maintained in 23 percent of patients 2 years thereafter. The only two independent prognostic variables for long-term follow up were the need for medical supervision (P less than 0.001) and employment (P less than 0.005) (Cox model). Only 10 percent of the patients attended a post-hospitalisation psychotherapeutic program. Among the 108 patients who were followed, 35 percent were totally abstinent immediately after discharge and 17 percent did not relapse during the 2 following years. Relapse was unpredictable according to any of the initial variables. Half of the patients who were abstinent immediately after discharge remained totally so at long-term follow-up. Total abstinence was obtained for 39 percent of patients during a mean period of 27 +/- 34 months. Medical, social, or psychological improvement was observed more often in abstainers (61 percent) than in non abstainers (11 percent, P less than 0.001). We conclude that: a) long-term follow-up and abstinence were infrequently obtained in unselected alcoholic patients hospitalized in a liver unit; b) no initial criteria could predict the alcoholic relapse or select patients for alcoholism treatment; c) long-term results seemed more favorable when the patients where totally abstinent immediately after discharge.

[Prognosis of spontaneous ascitic infection in cirrhotic patients]. / Pronostic de l'infection spontanée d'ascite chez le cirrhotique.

The aim of this retrospective study was to define prognostic factors for cure and survival after spontaneous bacterial peritonitis. In a 4-year period from 1982 to 1986, spontaneous bacterial peritonitis was diagnosed in 38 consecutive hospitalized cirrhotic patients (positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3). Twenty-five patients recovered from their infection (69 p. 100) in a mean time of 9 +/- 7 days. The cumulative survival was 68 p. 100 at one week, 50 p. 100 at one month, and 25 p. 100 at one year. The best independent prognostic factors for lack of cure from peritonitis were a low ascitic pH value (p less than 0.001), an elevated serum creatinine level (p = 0.01) and the presence of hepatocellular carcinoma (p less than 0.05). The best prognostic factors for death were low ascitic pH value (p = 0.001) and gastrointestinal hemorrhage (p = 0.005). A low ascitic pH value was correlated with other signs of severe infection (signs of generalized infection, ongoing infection during the first week after diagnosis), with signs of severe liver disease (encephalopathy, hepatocellular carcinoma) or severe renal dysfunction (high serum creatinine level, low arterial pH value). Because of the late high-death rate associated with spontaneous bacterial peritonitis, liver transplantation should be considered in these patients.

[Effect of alcohol and cirrhosis on the presence of Helicobacter pylori in the gastric mucosa]. / Influence de l'alcool et de la cirrhose sur la présence de Helicobacter pylori dans la muqueuse gastrique.

The aim of this study was to determine whether there was any relationship between alcohol consumption, cirrhosis and Helicobacter pylori associated antral gastritis. One hundred and forty-four patients undergoing upper gastrointestinal endoscopy were prospectively included and classified in four groups. The first group of 23 patients had cirrhosis and an alcohol consumption below 80 g per day. The second group of 31 patients had cirrhosis and an alcohol consumption over 80 g per day. The third group of 34 patients had an alcohol consumption over 80 g per day without cirrhosis. The fourth group of 56 patients had an alcohol consumption below 80 g per day without any preexisting liver disease and underwent upper gastrointestinal endoscopy for non specific digestive symptoms. The diagnosis of Helicobacter pylori was made at histological examination using the hematoxylin and eosin stain and the Whartin-Starry stain in each case. Histopathological results were confirmed by a bacteriological study in 15 cases. One hundred and twelve of 144 patients (78 percent) had gastritis. Gastritis was more frequent (p less than 0.01) when Helicobacter pylori was present than when it was not (90 percent vs 68 percent). Gastritis was more frequent when alcohol consumption was high (86 percent vs 72 percent). Helicobacter pylori was found in 26 percent of the first group, 48 percent of the second group, 65 percent of the third group and 45 percent of the fourth group. These differences were significantly different (p less than 0.05). A statistically significant relationship between high alcohol consumption and the presence of Helicobacter pylori was noted, even in the presence of cirrhosis (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Current results of endoscopic sphincterotomy for lithiasis of the common bile duct]. / Résultats actuels de la sphinctérotomie endoscopique pour lithiase de la voie biliaire principale.

Between January 1989 and June 1990, endoscopic sphincterotomy was performed in 308 consecutive patients with common bile duct stones (mean age: 74 years). Complete clearance of common bile duct was achieved at the first attempt in 65% of cases. This rate was significantly related to the size and the number of biliary stones. The success rate reached 97 percent after repeated endoscopic sessions (127 patients), mechanical lithotripsy (20 patients), extracorporeal or intracorporeal lithotripsy (18 and 11 patients, respectively). During the month following the endoscopic sphincterotomy, 39 patients (13%) developed one or more complications and 11 patients (3.7%) died. The complication rate was related to the time elapsed between biliary opacification and endoscopic sphincterotomy (P = 0.04) and between endoscopic sphincterotomy and total common bile duct clearance (P = 0.0007). No patient younger than 75 years died, but death occurred in 4.5% of the patients older than 75 years. Thirty patients (10%) developed endoscopic sphincterotomy-related complications. Cholangitis and bleeding were the most frequent complications (4 and 2%, respectively). Cholangitis occurred more frequently among the patients older than 75 (P < 0.05) or when transhepatic guided endoscopic sphincterotomy or intracorporeal lithotripsy was used (P < 0.005). Cholangitis led to death in 2 patients, 86 and 87 years old (0.7%). Endoscopic sphincterotomy related complications developed within 48 hours in all but 4 patients (2 patients with pancreatitis and 2 patients with cholecystitis).