RÉSUMÉ
A recombinant canarypox virus vectored vaccine co-expressing synthetic genes encoding outer capsid proteins, VP2 and VP5, of African horse sickness virus (AHSV) serotype 4 (ALVAC(®)-AHSV4) has been demonstrated to fully protect horses against homologous challenge with virulent field virus. Guthrie et al. (2009) detected weak and variable titres of neutralizing antibody (ranging from <10 to 40) 8 weeks after vaccination leading us to hypothesize that there could be a participation of cell mediated immunity (CMI) in protection against AHSV4. The present study aimed at characterizing the CMI induced by the experimental ALVAC(®)-AHSV4 vaccine. Six horses received two vaccinations twenty-eight days apart and three horses remained unvaccinated. The detection of VP2/VP5 specific IFN-γ responses was assessed by enzyme linked immune spot (ELISpot) assay and clearly demonstrated that all ALVAC(®)-AHSV4 vaccinated horses developed significant IFN-γ production compared to unvaccinated horses. More detailed immune responses obtained by flow cytometry demonstrated that ALVAC(®)-AHSV4 vaccinations induced immune cells, mainly CD8(+) T cells, able to recognize multiple T-epitopes through all VP2 and only the N-terminus sequence of VP5. Neither VP2 nor VP5 specific IFN-γ responses were detected in unvaccinated horses. Overall, our data demonstrated that an experimental recombinant canarypox based vaccine induced significant CMI specific for both VP2 and VP5 proteins of AHSV4.
Sujet(s)
Virus de la peste équine africaine/immunologie , Peste équine/immunologie , Peste équine/prévention et contrôle , Virus de la variole du canari/génétique , Protéines de capside/immunologie , Vaccins antiviraux/administration et posologie , Virus de la peste équine africaine/génétique , Animaux , Protéines de capside/génétique , Test ELISA , Femelle , Cytométrie en flux/médecine vétérinaire , Equus caballus , Immunité cellulaire/immunologie , Immunisation/médecine vétérinaire , Interféron gamma/sang , Mâle , Vaccins synthétiques/administration et posologie , Vaccins synthétiques/génétique , Vaccins synthétiques/immunologie , Vaccins antiviraux/génétique , Vaccins antiviraux/immunologieRÉSUMÉ
CONTEXT: Cystic dystrophy of the digestive wall, a rare but well-known complication of heterotopic pancreas when it is located in the duodenum, has been mainly described in adult series. Cystic dystrophy of the heterotopic pancreas within the gastric wall has been reported in only six adult cases. To our knowledge, no pediatric case has been described. CASE REPORT: We report a 15-year-old boy surgically treated for cystic dystrophy located in the antrum, complicated by an intracystic hemorrhage and fistulisation into the stomach. CONCLUSION: The diagnosis of heterotopic pancreas must be considered in case of submucosal cystic-gastric lesions, even in pediatric cases. Although the surgical approach is not systematic, it is recommended when cystic dystrophy is symptomatic (e.g., occlusion or hemorrhage).
Sujet(s)
Choristome/complications , Choristome/anatomopathologie , Fistule gastrique/complications , Hémorragie/complications , Pancréas , Maladies de l'estomac/complications , Maladies de l'estomac/anatomopathologie , Adolescent , Humains , MâleRÉSUMÉ
OBJECTIVES: To compare the accuracy of transvaginal sonography (TVS) and rectal endoscopic sonography (RES) for the diagnosis of deep infiltrating endometriosis (DIE), with respect to surgical and histological findings. METHODS: This was a longitudinal study of 81 consecutive patients referred for surgical management of DIE, who underwent both TVS and RES preoperatively. The diagnostic criteria were identical for TVS and RES, and were based on visualization of hypoechoic areas in specific locations (uterosacral ligaments, vagina, rectovaginal septum and intestine). We calculated the sensitivity, specificity, predictive values and accuracy of TVS and RES for the diagnosis of DIE. RESULTS: Endometriosis was confirmed histologically in 80/81 (98.7%) patients. Endometriomas and DIE were present in 43.2% and 97.5% of the women, respectively. For the diagnosis of DIE overall, TVS and RES, respectively, had a sensitivity of 87.3% and 74.7%, a positive predictive value of 98.6% and 98.3%, and an accuracy of 86.4% and 74%. For the diagnosis of uterosacral endometriosis, they had a sensitivity of 80.8% and 46.6%, a specificity of 75% and 50.0%, a positive predictive value of 96.7% and 89.5% and a negative predictive value of 30% and 9.3%. For the diagnosis of intestinal endometriosis, they had a sensitivity of 92.6% and 88.9%, a specificity of 100% and 92.6%, a positive predictive value of 100% and 96% and a negative predictive value of 87% and 80.6%. CONCLUSION: TVS is apparently more accurate than is RES for predicting DIE in specific locations, and should thus be the first-line imaging technique in this setting.
Sujet(s)
Endométriose/imagerie diagnostique , Endosonographie/méthodes , Adulte , Femelle , Humains , Études longitudinales , Adulte d'âge moyen , Valeur prédictive des tests , Rectum , Sensibilité et spécificité , VaginRÉSUMÉ
PURPOSE: No underlying cause is found in as many as 30% of patients with acute pancreatitis. The aim of this study was to evaluate the usefulness of endoscopic ultrasonography in the diagnosis of biliary tract pathology or chronic pancreatitis in these patients. SUBJECTS AND METHODS: We evaluated 168 patients who were referred with idiopathic pancreatitis. Diagnoses obtained by endoscopic ultrasonography were prospectively compared with those obtained at surgery in 101 patients, by endoscopic cholangiopancreatography in 49 patients, or by bile crystal analysis and medical follow-up in 18 patients. RESULTS: Endoscopic ultrasonography was abnormal in 135 (80%) patients, 124 of whom had biliary tract disease. When the results of endoscopic ultrasonography were compared with those made after multidisciplinary investigations, endoscopic ultrasonography correctly identified the cause-most commonly biliary tract disease-of the "idiopathic" pancreatitis in 155 (92%) of the 168 patients. CONCLUSIONS: Endoscopic ultrasonography is valuable in determining the cause of acute pancreatitis in patients initially considered to have idiopathic pancreatitis.
Sujet(s)
Pancréatite/imagerie diagnostique , Pancréatite/étiologie , Maladie aigüe , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Bile/composition chimique , Enfant , Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie , Diagnostic différentiel , Endoscopie digestive , Femelle , Vésicule biliaire/anatomopathologie , Vésicule biliaire/chirurgie , Humains , Mâle , Adulte d'âge moyen , Pancréatite/diagnostic , Pancréatite/métabolisme , Valeur prédictive des tests , Échographie/méthodesRÉSUMÉ
BACKGROUND: The rate of spontaneous migration of bile duct stones through the duodenal papilla is not well known. Endoscopic retrograde cholangiography (ERC) has been the standard method to diagnose bile duct stones, but accumulating data show there is a good agreement between ERC and endoscopic ultrasonography (EUS). The aim of the study was to evaluate the incidence and time course of stone migration in patients with bile duct stones by analyzing discrepancies between EUS and ERC as a function of the elapsed time between these two procedures. Stone migration was considered as the absence of stones at time of ERC regardless of the number of stones seen at EUS. METHODS: The main criterion for inclusion was the presence of bile duct stone as shown by EUS. Ninety-two consecutive patients were prospectively included in this study. RESULTS: Choledocholithiasis was absent at ERC in 12 patients. In univariate analysis, presence of gallbladder was significantly associated with an increased rate of stone migration (correction for multiple testing would remove this statistical significance). The size of the stone was the only independent factor to predict migration. CONCLUSION: Migration occurred in about 21% of cases within 1 month. Our study emphasizes the need to analyze carefully the results of comparative imaging studies of bile duct stones.
Sujet(s)
Calculs biliaires/diagnostic , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Maladies des canaux biliaires/diagnostic , Cholangiopancréatographie rétrograde endoscopique , Lithiase biliaire/diagnostic , Endosonographie , Femelle , Calculs biliaires/thérapie , Humains , Mâle , Adulte d'âge moyen , Études prospectivesRÉSUMÉ
Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis.
Sujet(s)
Diverticulite/diagnostic , Maladies du duodénum/diagnostic , Endosonographie , Pancréatite/diagnostic , Tomodensitométrie , Maladie aigüe , Adulte , Cholangiopancréatographie rétrograde endoscopique , Diagnostic différentiel , Diverticulite/complications , Maladies du duodénum/complications , Maladies du duodénum/congénital , Maladies du duodénum/chirurgie , Duodénoscopie , Duodénum/malformations , Duodénum/imagerie diagnostique , Duodénum/chirurgie , Humains , Mâle , Pancréatite/étiologieRÉSUMÉ
Medical imaging techniques have gradually lost their place in the diagnosis of gastric neoplastic tumors since endoscopic ultrasonography appears. Today, classical esophageal gastric duodenum barium examination is only practiced in preoperative staging. Anyway, endoscopic ultrasonography and transabdominal sonography have a great part in the staging of locoregional and general extension, as well as in patients observation.
Sujet(s)
Tumeurs de l'estomac/diagnostic , Imagerie diagnostique , Endosonographie , Humains , TomodensitométrieRÉSUMÉ
Fine-needle aspiration (FNA) of pancreatic disorders with ultrasound or computed tomographic, and recently echo-endocopic guidance has become commonplace to diagnose the nature of a pancreatic lesion. It is specially usefull in diagnosing solid neoplasms. Most often, FNA is performed to confirm a diagnosis of ductal adenocarcinoma. The aspirate shows cellular clusters with high nuclear-to cytoplasmic ratio, overlapping nuclei and prominant macronucleoli. The cytologic features that permit a diagnosis of neuroendocrin neoplasm are loose cellular aggregates with round nuclei, evently dispersed nuclear chromatin, a moderate amount of amphophilic cytoplasm and rosette formation. Immunocytochemistry can provide additional confirmatory information. Difficulties are encountered in diagnosing cystic neoplasms. The major cytologic differences between serous and mucinous tumors are the absence of mucin and presence of low cuboidal glycogen-containing cells in the microcystic adenoma vs the presence of goblet cells in the mucinous tumors. Except for the presence of necrotic debris, and in the absence of obvious malignant cytologic features, it is impossible to predict the behaviour of mucinous neoplasms. The lower accuracy for cystic neoplasm can be attributed to predominantly bloody specimens and limited cellularity. These problems illustrate the importance of knowing the clinical and radiological features of pancreatic cystic neoplasms.
Sujet(s)
Ponction-biopsie à l'aiguille/méthodes , Pancréas/anatomopathologie , Ponction-biopsie à l'aiguille/effets indésirables , Endosonographie , Humains , Maladies du pancréas/anatomopathologie , Tumeurs du pancréas/anatomopathologieRÉSUMÉ
The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.
Sujet(s)
Bile/composition chimique , Lithiase biliaire/diagnostic , Adulte , Sujet âgé , Bile/imagerie diagnostique , Lithiase biliaire/imagerie diagnostique , Endoscopie gastrointestinale/méthodes , Femelle , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Sensibilité et spécificité , ÉchographieRÉSUMÉ
BACKGROUND: Endoscopic sphincterotomy is sometimes done unnecessarily in patients with suspected choledocholithiasis. Our aims were to assess the diagnostic accuracy of endoscopic ultrasonography and endoscopic retrograde cholangiography (ERC) and to find out whether endoscopic ultrasonography may help to prevent unnecessary sphincterotomy or surgical explorations. METHODS: We recruited 119 patients aged 70.4 (SD 16.1) years with strongly suspected choledocholithiasis who presented to our endoscopy unit between January, 1994, and January, 1995. During the same spell of sedation or within 2 h of each other, endoscopic ultrasonography and ERC were carried out by investigators unaware of the patient's history. Endoscopic sphincterotomy with instrumental exploration was then done as the gold standard for the presence or the absence of stones. FINDINGS: 78 (66%) patients had choledocholithiasis; 17 (14%) had other bileduct diseases; 24 (20%) had a clear bileduct or did not require an invasive endoscopic procedure. The sensitivity of endoscopic ultrasonography was 93%, specificity 97%, positive predictive value 98%, and negative predictive value 88%. The corresponding values for ERC were 89%, 100%, 100%, and 83%. There were five false-negative cases by endoscopic ultrasonography (of which three were also negative with ERC) and one false-positive. The morbidity rate was 4.1%. INTERPRETATION: We conclude that endoscopic ultrasonography is at least as sensitive as ERC. Endoscopic ultrasonography may prevent inappropriate invasive explorations of the common bileduct.
Sujet(s)
Cholangiopancréatographie rétrograde endoscopique , Calculs biliaires/imagerie diagnostique , Échographie interventionnelle/méthodes , Adulte , Sujet âgé , Algorithmes , Cholangiopancréatographie rétrograde endoscopique/économie , Coûts et analyse des coûts , Femelle , Calculs biliaires/chirurgie , Humains , Mâle , Adulte d'âge moyen , Valeur prédictive des tests , Études prospectives , Sensibilité et spécificité , Sphinctérotomie endoscopique , Échographie interventionnelle/économieRÉSUMÉ
The frequency of gallbladder stones is as high as 10% in the general population over 50 years. Nevertheless, only 10% to 20% of patients become symptomatic. The diagnosis of symptomatic forms is important because treatment must be early before the advent of severe complications. This brief article describes technologic points and semeiologic endoscopic ultrasound (EUS) finding of gallbladder stones, analyzes the studies, and describes specific situations warranting the use of EUS.
Sujet(s)
Lithiase biliaire/imagerie diagnostique , Endoscopie , Femelle , Humains , Mâle , Sensibilité et spécificité , ÉchographieRÉSUMÉ
BACKGROUND: Preoperative localization of gastrinomas by current imaging techniques such as computed tomography (CT) scan and angiography is still difficult because of the small size of tumor(s) in most patients undergoing operation. This study evaluated the diagnostic value of endoscopic ultrasonography. METHODS: Twenty-two patients presenting with Zollinger-Ellison syndrome underwent exploratory laparotomy after preoperative attempts to identify the gastrinoma(s) by CT scan, upper gastrointestinal endoscopy, and endoscopic ultrasonography. Surgery included intraoperative ultrasonography and duodenal transillumination in all cases. The sensitivity and specificity of imaging techniques were then evaluated. RESULTS: At least one tumor was found in 19 patients (four had two tumors and one had multiple tumors). Duodenal, lymph node, and pancreatic gastrinomas were found in 42%, 38%, and 17% of the patients, respectively. Sensitivity of endoscopic ultrasonography was 50% for duodenal wall tumors (conventional endoscopy, 40%), 75% for pancreatic tumors (CT scan, 25%), and 62.5% for tumoral lymph nodes (CT scan, 0%). The specificity of all techniques was excellent. Correct diagnosis was made by endoscopic ultrasonography alone in 41% of the patients. The combination of conventional endoscopy and endoscopic ultrasonography provided correct diagnosis in 60% of the patients. CONCLUSIONS: Endoscopic ultrasonography should be considered as a first-choice imaging technique for preoperative detection of gastrinomas. Although small duodenal gastrinomas are still obviously difficult to detect, an accurate exploration of the pancreatic area was provided by this technique.
Sujet(s)
Tumeurs du duodénum/imagerie diagnostique , Endoscopie gastrointestinale , Gastrinome/imagerie diagnostique , Tumeurs du pancréas/imagerie diagnostique , Échographie interventionnelle , Syndrome de Zollinger-Ellison/imagerie diagnostique , Adulte , Tumeurs du duodénum/anatomopathologie , Tumeurs du duodénum/chirurgie , Femelle , Études de suivi , Gastrinome/anatomopathologie , Gastrinome/secondaire , Gastrinome/chirurgie , Humains , Soins peropératoires , Laparotomie , Métastase lymphatique/imagerie diagnostique , Métastase lymphatique/anatomopathologie , Mâle , Adulte d'âge moyen , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/chirurgie , Études prospectives , Sensibilité et spécificité , Tomodensitométrie , Transillumination , Résultat thérapeutique , Syndrome de Zollinger-Ellison/anatomopathologie , Syndrome de Zollinger-Ellison/chirurgieRÉSUMÉ
OBJECTIVES: The aims of this study were to assess the circumstances of diagnosis and accuracy of imaging procedures in patients with cystic pancreatic tumours. METHODS: Thirty-five consecutive patients with cystic pancreatic tumours (serous cystadenomas: n = 19, mucinous cystadenomas: n = 9, cystadenocarcinomas: n = 7) were studied from 1988 to 1993. Respective diagnostic values of ultrasonography, endoscopic ultrasonography, CT scan and analysis of cyst fluid were evaluated. RESULTS: The circumstances of diagnosis were abdominal pain (74%), weight loss (23%), jaundice (8%), abdominal mass (6%), asymptomatic (6%). Initial diagnosis of cystadenoma was correctly made by ultrasonography, CT scan and endoscopic ultrasonography in 63%, 77% and 84%, and the type of cystadenoma was correctly diagnosed in 20%, 51% and 55%. A pseudocyst was falsely diagnosed in 28%, 12% and 3%, respectively. After blind review of CT scans and endoscopic ultrasonography records, the type of cystadenoma was correctly diagnosed in 82% by both procedures. Cytological examination of cyst fluid of 18 cystic tumours gave correct diagnosis in 10 cases with sufficient material. A low CEA (P < 0.002), Ca 19.9 (P < 0.003) and absence of mucins (P < 0.002) in cyst fluid was evocative of serous cystadenoma. CONCLUSIONS: Abdominal pain was the main circumstance of diagnosis in cases of pancreatic cystadenomas. The type of cystadenoma was correctly diagnosed in 82% by CT scan and endoscopic ultrasonography. Cytological examination, tumoural marker and mucin levels in cyst fluid were helpful for an accurate diagnosis of cystic tumours.
Sujet(s)
Cystadénocarcinome mucineux/imagerie diagnostique , Cystadénome mucineux/imagerie diagnostique , Cystadénome séreux/imagerie diagnostique , Tumeurs du pancréas/imagerie diagnostique , Adulte , Sujet âgé , Biopsie , Antigène CA 19-9/analyse , Cystadénocarcinome mucineux/anatomopathologie , Cystadénocarcinome mucineux/chirurgie , Cystadénome mucineux/anatomopathologie , Cystadénome mucineux/chirurgie , Cystadénome séreux/anatomopathologie , Cystadénome séreux/chirurgie , Femelle , Humains , Mâle , Adulte d'âge moyen , Mucines/analyse , Tumeurs du pancréas/anatomopathologie , Tumeurs du pancréas/chirurgie , Peptidyl-Dipeptidase A/analyse , Tomodensitométrie , ÉchographieRÉSUMÉ
BACKGROUND/AIMS: Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis. Accuracy for the diagnosis of choledocholithiasis by ultrasonography and computed tomography were prospectively compared with endoscopic ultrasonography in 62 consecutive patients. METHODS: Final diagnosis was determined by endoscopic retrograde cholangiography with or without sphincterotomy or intraoperative cholangiography with or without choledochoscopy. All of the patients had abdominal ultrasonography, computed tomography, endoscopic ultrasonography, and either an endoscopic retrograde (n = 40) or intraoperative cholangiography (n = 32) performed. RESULTS: Choledocholithiasis was confirmed in 22 patients. Thirteen patients had a stone with a diameter < 1 cm, and 14 had a nonenlarged common bile duct. Endoscopic ultrasonography was more sensitive (97%) than ultrasonography (25%; P < 0.0001) and computed tomography (75%; P < 0.02). Specificity and positive predictive value were not significantly different. Negative predictive value of endoscopic ultrasonography (97%) was better than that of ultrasonography (56%; P < 0.0001) and computed tomography (78%; P < 0.02). Results were unchanged after six patients in whom the absence of choledocholithiasis was considered probable after follow-up were excluded. Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography appears to be the best diagnostic tool for the diagnosis of choledocholithiasis compared with other noninvasive procedures.
Sujet(s)
Endoscopie gastrointestinale , Calculs biliaires/imagerie diagnostique , Échographie/méthodes , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Conduit cholédoque/imagerie diagnostique , Femelle , Calculs biliaires/chirurgie , Humains , Mâle , Adulte d'âge moyen , Valeur prédictive des tests , Études prospectives , Sensibilité et spécificité , TomodensitométrieRÉSUMÉ
Primary carcinoid tumors of the pancreas are exceedingly rare, only few cases have been reported in the literature. We present a case of primary carcinoid tumor of the pancreas occurring on chronic pancreatitis. The CT, as well as endosonographic features are described. Those two techniques might contribute to an early preoperative diagnosis which is important since carcinoid tumors have a better prognosis than the common pancreatic adenocarcinoma.
Sujet(s)
Tumeur carcinoïde/imagerie diagnostique , Tumeurs du pancréas/imagerie diagnostique , Tumeur carcinoïde/anatomopathologie , Maladie chronique , Endoscopie , Humains , Mâle , Adulte d'âge moyen , Tumeurs du pancréas/anatomopathologie , Pancréatite/étiologie , Pronostic , Tomodensitométrie , ÉchographieRÉSUMÉ
Several types of biliary tract abnormality of undetermined origin have been described among AIDS patients. The aims of this study are: (1) to evaluate whether biliary tree involvement is in fact one or several homogeneous morphological entities, (2) to specify the role of CMV or Cryptosporidium sp. infection, and (3) to evaluate the possible efficacy of treatment. Since ultrasound had revealed abnormality in the biliary tree, 26 consecutive AIDS patients underwent cholangiography. Cholangiograms enabled us to distinguish between two types of biliary tract involvement: (1) gradual and regular stenosis of the terminal portion of the common bile duct associated with dilation but without irregularity of the intrahepatic biliary ducts was present in 27% of our cases, and (2) distal stenosis of the extrahepatic biliary ducts combined with diffuse irregularity of the caliber of the intrahepatic bile ducts was present in 73% of our cases. Concomitant infection by CMV or Cryptosporidium sp. was significantly more frequent when intrahepatic duct irregularities were present (94%) than when absent (14%, P < 0.001). Anti-CMV treatment and sphincterotomy were unsuccessful in treating anomalies of the intrahepatic biliary tract. Conversely, sphincterotomy caused rapid and lasting disappearance of pain in all our patients. In conclusion, biliary tract involvement in AIDS patients is of two types. CMV infection and infection by Cryptosporidium sp. are most frequent when the large intrahepatic ducts are implicated.
Sujet(s)
Syndrome d'immunodéficience acquise/complications , Maladies des canaux biliaires/étiologie , Infections opportunistes liées au SIDA/diagnostic , Infections opportunistes liées au SIDA/épidémiologie , Infections opportunistes liées au SIDA/étiologie , Infections opportunistes liées au SIDA/thérapie , Syndrome d'immunodéficience acquise/diagnostic , Syndrome d'immunodéficience acquise/épidémiologie , Syndrome d'immunodéficience acquise/thérapie , Adulte , Maladies des canaux biliaires/diagnostic , Maladies des canaux biliaires/épidémiologie , Maladies des canaux biliaires/thérapie , Voies biliaires/imagerie diagnostique , Cholangiographie , Association thérapeutique , Cryptosporidiose/diagnostic , Cryptosporidiose/épidémiologie , Cryptosporidiose/étiologie , Cryptosporidiose/thérapie , Infections à cytomégalovirus/diagnostic , Infections à cytomégalovirus/épidémiologie , Infections à cytomégalovirus/étiologie , Infections à cytomégalovirus/thérapie , Endoscopie digestive , Femelle , VIH-1 (Virus de l'Immunodéficience Humaine de type 1) , Humains , Mâle , Études prospectives , ÉchographieRÉSUMÉ
Ten patients in whom cystic dystrophy developed in a heterotopic pancreas of the duodenal (nine patients) or gastric (one patient) wall are reported. All were young or middle aged white men, only two of whom were alcoholic. The symptoms were caused by intestinal or biliary stenosis, or both, secondary to the inflammation and fibrosis. Only endosonography provided strong evidence for the diagnosis in three patients. All patients underwent surgery: a pancreaticoduodenectomy was performed in eight patients. The surgical specimen showed cystic lesions of the gut wall, occurring in inflammatory and fibrous heterotopic pancreatic tissue. The pancreas proper was normal in all patients. It is suggested that cystic dystrophy is an uncommon and serious complication of heterotopic pancreas. Similar cases associated with chronic pancreatitis of the pancreas have been observed and it is suggested that this process could be responsible for some of the chronic pancreatitis encountered in young, non-alcoholic patients.
Sujet(s)
Choristome/anatomopathologie , Kystes/anatomopathologie , Tumeurs du duodénum/anatomopathologie , Pancréas , Adulte , Choristome/chirurgie , Kystes/chirurgie , Humains , Mâle , Adulte d'âge moyen , Duodénopancréatectomie , Tumeurs de l'estomac/anatomopathologieRÉSUMÉ
BACKGROUND: Cholangitis in patients with the acquired immunodeficiency syndrome (AIDS) is usually associated with opportunistic infections by cryptosporidium species or cytomegalovirus, but in about a third of cases no opportunistic agent is identified. We suspected some of these cases of biliary disease might be explained by infection with the microsporidia species Enterocytozoon bieneusi, an obligate intracellular protozoan that causes chronic diarrhea in patients infected with the human immunodeficiency virus (HIV). METHODS: We studied eight HIV-infected homosexual men (in either group IV of the classification of the Centers for Disease Control and Prevention or group II, with a CD4 cell count of < or = 10 per cubic millimeter) who were referred because of cholangitis for which no causative agent had been found by standard tests. All the patients underwent abdominal ultrasonography and endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography with collection of bile from the common bile duct. One patient had transhepatic biliary catheterization, and two others had cholecystectomy. Bile samples, duodenal- and liver-biopsy specimens, and gallbladder tissue were studied by light and electron microscopy. RESULTS: All eight patients with unexplained AIDS-related cholangitis had biliary microsporidosis. Intraepithelial E. bieneusi spores (1 to 2 microns) and supranuclear plasmodia (3 to 8 microns) were identified in the six duodenal-biopsy specimens. May-Grünwald-Giemsa staining of bile samples revealed free forms of microsporidia in all eight patients, and the presence of E. bieneusi was confirmed by electron microscopy. E. bieneusi was also identified in ductal biliary cells on a liver biopsy, in one common-bile-duct smear, and in gallbladder epithelium (in two patients). Four patients were found to have associated but previously undetected biliary or duodenal cryptosporidiosis, whereas another had biliary infection associated with cytomegalovirus. CONCLUSIONS: Infection of the biliary tract with E. bieneusi is associated with and may be a cause of AIDS-related cholangitis.
Sujet(s)
Infections opportunistes liées au SIDA/complications , Angiocholite/parasitologie , Microsporida , Microsporidiose , Adulte , Animaux , Bile/parasitologie , Angiocholite/complications , Angiocholite/anatomopathologie , Cryptosporidiose/complications , Infections à VIH/complications , Homosexualité , Humains , Mâle , Microsporida/isolement et purification , Microsporida/ultrastructure , Microsporidiose/complications , Microsporidiose/parasitologie , Microsporidiose/anatomopathologie , Adulte d'âge moyen , Études prospectivesRÉSUMÉ
Endoscopic transrectal ultrasonography (EUS) is performed with an ultrasonic transducer (7.5 mHz or 12 mHz) situated in the tip of a side viewing endoscope. Its accuracy to assess the depth of rectal cancer invasion was studied prospectively in 31 patients. The ultrasonic examination was complete in 26 cases; in 5, the stricturing tumour could not be passed by the probe. The depth of invasion was correctly evaluated in 27 of the 31 patients (accuracy: 90 per cent). The 7 superficial lesions were all correctly detected with EUS. EUS appears to be a very promising method for the pretherapeutic staging of rectal cancer.