[Diagnosis of herpetic esophagitis in the immunocompetent subject by PCR (Herpès Consensus Générique-Argène). Report of six cases]. / Diagnostic d'oesophagite herpétique à HSV1 chez le sujet immunocompétent par PCR (Herpès Consensus Générique-Argène). A propos de six cas.

AIM OF THE WORK: We have researched and identified Herpes viruses on the esophageal biopsies taken during the period between September 2006 and March 2008 for 15 suspected patients. PATIENTS AND METHODS: The esophageal biopsies were transferred to the laboratory being conserved in physiological serum and frozen at -80 degrees C for PCR. A fragment was conserved for histopathological analysis. The specimen was defrozen and refrozen in liquid azote (to limit the inhibitors) and crushed to the powder form. Extraction was then done following the prerecognised protocol (Herpès Consensus Générique-"Argene"). That kit allows the amplification consensus of the viral genome of the most frequently encountered Herpes family virus: HSV1, HSV2, CMV, VZV, EBV and HHV6. The identification of the implicated virus was done by the Hybridowell Herpes Identification (Argene) kit in parallel with the migration of SDS gel of the obtained amplifications. RESULTS: HSV1 was identified in seven esophageal biopsies between the 15 studied. HHV6 and the association HHV6/EBV for two patients and only one biopsy had inconclusive. The endoscopy and the histopathological examination had confirmed ulcerated esophagitis with cytopathogene aspect in favour of viral infection for six patients. CONCLUSION: In absence of inhibitors, the adaptation of the extraction technique of the fragments of tissue for few millimetres and the amplifications by PCR had allowed rapid confirmation of the diagnosis of herpetic esophagitis secondary to HSV1 even before the results of the histopathological examination. Treatment by acyclovir entrained regression of the disease.

[Decompensated post-schistosomiasis portal hypertension in Richard-Toll, Senegal: first case treated by splenorenal anastomosis in Dakar]. / Hypertension portale post-bilharzienne décompensée à Richard-Toll au Sénégal: premier cas traité à Dakar par anastomose splénorénale.

UNLABELLED: Since the Diama dam on the Senegal river became operative in 1986, an exceptional outbreak of intestinal schistosomiasis occurred in northern Senegal. This is the first case report from this region of a splenorenal derivation performed in Dakar to cure decompensated portal hypertension due to Schistosoma mansoni. CASE REPORT: In June 1998, a 16-year old boy, native from Richard-Toll in the Senegal River Basin, was admitted to the paediatric department of Hôpital Principal, Dakar, Senegal, with a 3 years of recurrent hematemesis. Blood transfusions were required despite propranolol and multiple oesophageal varices sclerotherapies. On admission he weighed 33 kg and was noted to have pallor and moderate hepatosplenomegaly. Lab work included normal liver function tests, a Hgb of 58 mg/L, negative HBs antigen, and high titers of schistosomiasis antibodies (> 1/2000 by the hemagglutination method). Ultrasound revealed an homogeneously enlarged liver, periportal fibrosis and spleen with a grade 2 portal hypertension (WHO score). Endoscopy showed stage 3 oesophageal varices with red spots but no active haemorrhage. After transfusions, a Warren distal splenorenal anastomosis was performed. During the operation, a liver biopsy was obtained, showing periportal fibrosis and schistosomiasis granulomas. The patient was discharged without complication. After 4 years he remains free of any recurrence of his upper gastrointestinal haemorrhage and haemoglobin rate is normal. COMMENTS: Before the inauguration of the dam in 1986, S. mansoni infection was never reported from the Senegal River Basin. But as early as 1988, the first cases of intestinal schistosomiasis began to show up. A few years later, this focus had dramatically extended and in 1991 the first cases of hepatic fibrosis were detected in ultrasonography surveys. The present case involves the first patient from northern Senegal who required surgery for haemorrhagic complications of schistosomiasis induced by liver disease. Considering the high prevalence in this area, and the difficulties of medical management, the need for porto-systemic derivations is likely to rise. These operations are difficult and require specially trained surgeons. They have been largely unavailable in Senegal until now. This case report, involving a child only 10 years after the beginning of the epidemic, underlines the acute need for improving both prevention and medical treatment in order to avoid progression to clinical stages of hepatic schistosomiasis where surgery is unavoidable. In addition, the training of local surgical teams able to deal with these complications is urgently needed in Senegal.

A controlled trial comparing ciprofloxacin with mesalazine for the treatment of active Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: The aim of this randomized controlled study was to investigate the efficacy of ciprofloxacin compared with mesalazine in treating active Crohn's disease. METHODS: Patients with a mild to moderate flare-up of Crohn's disease (mean Crohn's Disease Activity Index [CDAI]; 217; range, 160-305) were randomized to receive ciprofloxacin 1 g/day or Pentasa 4 g/day for 6 wk. Complete remission was defined at wk 6 as a CDAI < or = 150 associated with a decrease (delta) in CDAI > 75. Partial remission was defined as a CDAI < or = 150 with 50 < delta CDAI < 75 or a CDAI > 150 with delta CDAI > 50 at wk 6. Group sequential procedure with triangular continuation regions was used to monitor the trial through the difference in complete remission rates, every 20 patients included. RESULTS: Inclusion of patients was stopped at the second step, i.e., after 40 inclusions, with the conclusion of no difference in complete remission rates between ciprofloxacin- and Pentasa-treated groups. Among the 18 patients taking ciprofloxacin, two decided to stop treatment during the trial and three were considered as treatment failures because of deterioration at wk 3. Among the 22 patients taking mesalazine, one patient was lost to follow-up and eight patients were considered as treatment failures. Complete remission was observed in 10 patients (56%) treated with ciprofloxacin and 12 patients (55%) treated with mesalazine and partial remission was observed in three and one patient, respectively. CONCLUSIONS: This study suggests that ciprofloxacin 1 g/day is as effective as mesalazine 4 g/day in treating mild to moderate flare-up of Crohn's disease.

[Percutaneous drainage of a presacral and spinal extra-dural abscess complicating Crohn's disease]. / Drainage percutané d'un abcès présacré et rachidien extra-dural compliquant une maladie de Crohn.

A 43-year-old man with Crohn's disease was hospitalized because of bilateral radicular pain secondary to a presacral abscess penetrating into the extra-dural space from L5 to S3. Conservative treatment using computed tomography guided percutaneous drainage of the abscess and parenteral antibiotherapy allowed complete recovery.