[Peroperative enteroscopy in recurrent hemorrhage of the small intestine]. / L'entéroscopie per-opératoire dans les hémorragies récidivantes de l'intestin grêle.

Two cases of severe, recurrent gastrointestinal bleeding due to a small vascular lesion of the small intestine are presented. In the two patients, the diagnosis was established by intra-operative enteroscopy; in the first patient during laparotomy carried out after negative preoperative investigations; in the second, 48 hours after a right ileo-colic resection was performed for Crohn's disease of the ileum thought to be the cause of the bleeding. These two cases confirm that intra-operative enteroscopy is a very effective method to detect bleeding from small intestinal lesions, and that it should be used when pre-operative investigations and intraoperative examination are unsuccessful.

[Involvement of arterial trunks of the upper limbs in giant cell arteritis. Apropos of 7 cases]. / Atteinte des troncs artériels des membres supérieurs au cours de l'artérite à cellules géantes. A propos de 7 observations.

On 91 patients with temporal arteritis (TA) and/or polymyalgia rheumatica (PMR), we observed 7 females aged 62 to 73 years with upper extremities ischemia. Arm claudication and/or Raynaud's phenomenon were the initial manifestations of the disease in 2 cases, or appeared simultaneously with other symptoms in 2 cases, or complicated decreasing corticosteroid therapy in 3 cases. A temporal artery biopsy was performed on 6 patients with, in all of them, typical giant cell granulomatous arteritis pathology findings. Angiograms showed, in all cases, multiple bilateral smooth stenosis and/or obliterations of post vertebral subclavian arteries and/or axillary arteries. Symptoms always improved on corticosteroid treatment and no patient needed reconstructive surgery. In conclusion, large arteries involvement, which can occur in TA and/or PMR, affect in our experience most commonly the subclavian and axillary arteries, with female predominance as found in Takayasu's arteries. These disorders should be considered in cases of occlusive disease of the arms in elderly women and the response to steroids is usually adequate to eliminate the need for early surgical intervention. Early recognition of asymptomatic large artery involvement by Doppler evaluation, in all TA and/or PMR patients, and transient anticoagulant therapy might prevent vessels occlusions.

Ontogeny of rat gastric H+-K+-ATPase activity.

Gastric H+-K+-ATPase activity was examined in subcellular fractions (P1, 1,000 g; P2, 20,000 g; P3, 100,000 g) obtained from fundic mucosae of fetal, newborn, and adult rats. Depending on the tissue secretory state the distribution of this enzyme activity predominates in P3, i.e., resting adult, or in P2, i.e., stimulated adult, while total enzyme activity (P2 + P3) remains constant. Enzyme activity was detected as soon as day 19 of gestation and P2 + P3 reached 2.2 +/- 0.2 mumol Pi X mg prot-1 X h-1 at parturition. H+-K+-ATPase activity steadily decreased from 4.0 +/- 0.7 mumol Pi X mg prot-1 X h-1 on day 6 after birth to approximately 0 on day 12. This activity recovered as soon as day 13 (3.5 +/- 0.6 mumol Pi X mg prot-1 X h-1) and continued to rise slowly until adulthood. Incubation of subcellular fractions with 0.1 mM omeprazole resulted in a total loss of H+-K+-ATPase activity at all the stages of development examined. These studies of functional relationship during the development between gastric acid secretion and distribution of gastric H+-K+-ATPase activity among P2 and P3 fractions indicate that this last could be considered as an index of the secretory state of the parietal cell. This enzyme's pattern of development in P2 + P3, correlated with the one previously observed for stimulated H+ secretion in intact tissue, suggest that the H+-K+-ATPase is the limiting step in response to secretagogues during postnatal period.

[Movement of Na+ and Cl- across the isolated fetal rat stomach]. / Mouvements de Na+ et Cl- à travers l'estomac isolé de foetus de rat.

Unidirectional and net isotopic fluxes of Na+ and Cl- were determined at steady state across isolated stomach of rat fetuses on days 19 and 21. On day 19, when parietal cells are not yet functional, net absorptions of Na+ and Cl- (respectively: 3.8 +/- 1.1 and 5.2 +/- 1.7 mu eq X h-1 X cm-2) were observed. By contrast, active secretion of Cl- (-2.1 +/- 1.8 mu eq X h-1 X cm-2) associated with decreased absorption of Na+ (45%) was noted on day 21, and both Na+ and Cl- net movements accounted for the short-circuit current, as observed on adult gastric mucosa. These results show that Na+ active absorption precedes Cl- secretion in fetal rat at the time of parietal cells differenciation.

[Development of gastric sensitivity to histamine in the rat]. / Développement de la sensibilité gastrique à l'histamine chez le rat.

Sensitivity of the developing rat stomach to histamine (HA) was examined on isolated gastric mucosae of rats of various ages from the fetal to adult periods. Spontaneous acid secretion in mu eq/h.cm2 occurred at all the ages studied, at a basal rate of 0.45 +/- 0.07 in fetuses to 0.22 +/- 0.03 (day 5), 0.11 +/- 0.04 (day 10), 0.12 +/- 0.04 (day 12), 0.22 +/- 0.08 (day 16) and 0.33 +/- 0.04 (adults). In the fetal rats as in the adults, marked responses to respectively 10(-5) and 10(-4) M HA were demonstrated. The H2-receptor antagonist cimetidine diminished HA-induced secretion by 66 and 57% in fetuses and adults respectively. Between these two stages (from days 5 to 12), basal secretion and the response to HA dropped significantly. On day 21 of gestation, as well as on the critical days 5 and 12 after parturition, db-cAMP (10(-4) M) caused maximal stimulation of acid secretion. These results indicate that the development of responsiveness to HA in the rat is biphasic. They suggest that after birth, the H2-receptor adenylate cyclase system undergoes major modifications which might lead to the complete lack of responsiveness to HA by day 12.

[Epiphyseal detachment of the proximal end of the tibia in a child with a vascular lesion. Apropos of a case]. / Décollement épiphysaire de l'extrémité supérieure du tibia chez l'enfant avec lésion vasculaire. A propos d'un cas.

The authors report a case of lesion of the popliteal artery associated with a fracture involving separation of the upper end of the tibia in a child following a serious accident. This lesion was treated by resection-vein graft after reduction of the fracture and immobilisation by two pins. In the light of this case, the authors undertake a review of the world literature, then assess the mechanism and the bone and vascular lesions, the various pathological classifications and the aetiologies. Finally, they emphasize the difficulty in diagnosing the bone lesion and, above all, the vascular lesion. Arteriography is indicated where there is the slightest doubt.