Diagnostic and therapeutic aspects of endoscopic retrograde cholangiography in papillomatosis of the bile ducts: analysis of five cases.

BACKGROUND: Biliary papillomatosis is an uncommon disease, the definitive diagnosis and treatment of which generally require surgery. In the present study, we described the diagnostic and therapeutic aspects of endoscopic retrograde cholangiography in five such patients. METHODS: Since 1982, five patients with biliary papillomatosis have been admitted to our unit. All these patients underwent endoscopic retrograde cholangiography. RESULTS: Endoscopic examination of the ampulla of Vater showed a dilated papillary orifice with mucin discharge in all five patients. Biliary papillomatosis was diagnosed from the following features: multiple filling defects in the lumen of the biliary system in four patients and several supple stenoses in one patient. Histologic examination of biliary specimens taken after endoscopic sphincterotomy showed typical lesions of papillomatosis in the five patients. Palliative endoscopic treatment was performed in three patients. CONCLUSION: This case series reports the typical endoscopic retrograde cholangiography and endoscopic biopsy findings in biliary papillomatosis. For inoperable patients, endoscopic palliative evacuation of mucus and debris and/or stent placement are of benefit.

[Liver cirrhosis and granulomatous hepatitis after prolonged ingestion of lysine acetylsalicylate]. / Cirrhose et hépatite granulomateuse après la prise prolongée d'acétylsalicylate de lysine.

We report the case of a 75-year-old woman who was hospitalized for serum aminotransferase elevation. She had taken 1 g/d of salicylate therapy (Aspegic 1000) for 5 years, clorazepate for 10 years, naftidrofuryl for 8 months and quinapril for 3 months. Liver histology showed cirrhosis and granulomatous hepatitis. Discontinuation of salicylate therapy resulted in normalization of liver tests, although other drug administration was pursued. This observation suggests that salicylate therapy can induce cirrhosis.

[Fitz-Hugh and Curtis syndrome]. / Le syndrome de Fitz-Hugh et Curtis.

The Fitz-Hugh and Curtis syndrome is a perihepatitis following a genital infection. It usually occurs in young women but male cases have been reported. Chlamydia trachomatis is the most frequent causal agent observed in Europe and the United States. This germ is the number one cause of salpingitis in developed countries. Clinical signs include acute or recurrent pain in the right hypochondria. Liver tests are not modified and the sonographic examination is normal. The diagnosis can be suspected on the basis of serology results using either indirect immunofluorescence with live antigens specific for serotype D or K or ELISA. Positive predictive value is 80-90% and negative predictive value 96-99%. Diagnosis is formally established with laparoscopy. In our experience with more than 100 patients, the perihepatitis (glissonitis with pseudo-membranes) is frequently associated with adherences. The peritoneum is inflammatory and there are usually a small amount of liquid. Specimens are taken for culture. Polymerase chain reaction will improve the detection of Chlamydia since this germ is very difficult to culture. Antibiotic treatment with adapted drugs given for sufficient time is effective.

[Palliative endoscopic treatment of adenocarcinoma of Vater's ampulla: medium and long-term results]. / Traitement endoscopique palliatif des adénocarcinomes de l'ampoule de Vater: résultats à moyen et long terme.

The palliative endoscopic treatment of tumors of the ampulla of Vater provides good short-term symptomatic results, while long-term results remain unknown. This study to assessed the course of 17 patients with carcinoma of the ampulla of Vater treated palliatively by endoscopy and monitored for a 5-year-period. From january 1985 to december 1989, 35 patients were diagnosed as having carcinoma of the ampulla of Vater. For 18 of them, curative surgery was performed, while for the 17 remaining 17 patients, palliative endoscopic treatment was proposed because of metastatic extension or surgical risk. Endoscopic treatment always included endoscopic sphincterotomy, and, in some cases, insertion of a biliary endoprosthesis. All patients were monitored until death or the end of follow-up on September 30, 1990. Endoscopic sphincterotomy was performed in 13 of the 17 patients, either alone in 10 cases, or with prosthesis in the other 3 cases. For the 4 other patients, endoscopic sphincterotomy could not be performed (large tumor in 2 cases, presence of duodenal diverticulum in 2 other cases). The 13 patients who underwent endoscopic treatment experienced rapid symptomatic improvement. Jaundice and cholangitis consistently recurred within a period of 1 to 44 weeks regardless of initial treatment. All recurrences except one, were successfully retreated by endoscopy (enlargement of initial sphincterotomy in 6 cases, insertion or replacement of prosthesis in 12 cases).(ABSTRACT TRUNCATED AT 250 WORDS)