[Scintigraphic detection of gastrointestinal hemorrhage. Value and limitations]. / Localisation scintigraphique des saignements digestifs. Intérêts et limites.

A technetium-99m labelled red blood cell scintigraphy was performed in 51 patients with an unexplained gastro intestinal bleeding. Static images were acquired on the injection day then at 24 hours. Forty one patients had a positive scintigraphy. In 13 patients with a positive scintigraphy, on the injection day (5 cases) and later (8 cases), no intestinal bleeding was identified in spite of further investigations guided by scintigraphy. In 24 patients, with a positive scintigraphy on the injection day (20 cases) and later (4 cases), an intestinal lesion was identified and treated; data were confirmed in 19 cases: there were 15 colon lesions, localized on caecum in 10 cases and 4 small bowel lesions. Clinical value and limitations of the investigation are discussed. The scintigraphic localization is usually accurate if the abnormal focus activity is noticed on the injection day. It helps to guide further investigations of the bleeding site. This non invasive method should be performed more quickly to help to localize intestinal bleeding which poses a diagnostic problem.

[Cholestatic hepatitis caused by ketoconazole]. / Hépatite cholestatique au kétoconazole.

The authors report a new Ketoconazole-induced hepatitis in which clinical, chemical and histological features show evidence of a cholestatic injury in a 62 yrs-old female recovering once therapy is stopped. In this case-report, delay of onset of the illness is very short for a 200 mg-a-day prescription and no feature leads towards an immune response. This, may be, means that Ketoconazole-induced hepatitis should be led by an idiosyncrasic mechanism. Even if fatal hepatitis are rare, prescriptors have to beware of this therapy.

[Contribution of proctosigmoidoscopy in colonopathies caused by Candida albicans]. / Apport de la proctosigmoïdoscopie dans les colopathies a Candida albicans.

When the endoscopic lesion typical anorectocolonic candidiasis is absent, the author demonstrates that mild cases of colonopathy due to Candida albicans do not always present the commonly described classic symptoms of anomarginal, copperhued, running lesions... The proctosigmoidoscope reveals that in half of the cases with concurrent ordinary digestive troubles and Candida albicans present in the stools, the mucosa is congestive and, very often, the rectal cytology disturbed. A good correlation exists between modifications of the rectosigmoid mucosa and the number of Candida albicans colonies isolated from the feces of these patients. In addition, anal pruritus, a rare clinical event by itself, can be attributed to candidiasis using the proctosigmoidoscope and coproculture. Mild anorectocolonic candidiasis can exist as a secondary infection with chronic inflammatory colitis (ulcerative colitis, etc.) or acute mucous colitis. These infections can also be primary and, in these cases, sometimes appear consequent to recent antibiotic therapy.