[Endoscopic ligation of esophageal varices: prevention of hemorrhagic recurrences caused by rupture of esophageal varices. Results in 45 patients]. / Ligature endoscopique des varices oesophagiennes: prévention des récidives hémorragiques par rupture de varices oesophagiennes. Résultats chez 45 malades.

OBJECTIVES: The aim of this study was to assess the morbidity and efficacy of endoscopic variceal ligation for the prophylaxis of rebleeding from oesophageal varices. METHODS: Forty-five patients with cirrhosis (Child's class: A: 18, B: 16, C: 11) and recent (< 48 h) variceal bleeding were included. Eleven of the patients were included after failure of sclerotherapy. All patients were treated by endoscopic ligation until the complete eradication of oesophageal varices. The mean follow-up was 8.7 +/- 6.8 months. RESULTS: Oesophageal varices were eradicated in 40 patients (89%) after an average of 2 sessions (range: 1-5). In a subset of 11 patients treated after failure of sclerotherapy, 8 (73%) had complete eradication of oesophageal varices. Six of the 45 patients (13%) had recurrence of haemorrhage, due to post-ligation ulcerations in 5 cases and to rupture of oesophageal varices in one case. The rate of complications was 7%. Of the 40 patients whose oesophageal varices were eradicated, 7 (17%) were lost for follow up, and another treatment was performed in 4 (10%): liver transplantation in 2, and transjugular intrahepatic portosystemic shunt in 2. Recurrence of oesophageal varices after eradication was observed in 3 (10%) of the remaining 29 patients after a follow-up of 8.9 +/- 12.9 months. Of these 3 patients, only one (3%) presented with recurrence of haemorrhage due to ruptured oesophageal varices. Three patients (7%) died before eradication of oesophageal varices from causes unrelated to the technique. CONCLUSION: This study confirms that endoscopic ligation is effective for eradication of oesophageal varices, with a low morbidity. This technique appears to be a method of choice in the prophylaxis of rebleeding from oesophageal varices, especially when sclerotherapy is ineffective.

[Rectal ganglioneuromatosis and multiple type IIb endocrine neoplasia]. / Ganglioneuromatose rectale et néoplasie endocrinienne multiple de type IIb.

Intestinal tract ganglioneuromatosis was discovered in a 27-year old man through surgical biopsy specimens obtained after acute intestinal obstruction. The patient then developed type IIb endocrine neoplasia including a marfanoid morphotype, mucosal neuromatosis, metastatic medullary carcinoma of the thyroid and bilateral pheochromocytoma. The histological and clinical features, the pathophysiological mechanisms of intestinal ganglioneuromatosis and its place within the intricate group of neurocristopathies are discussed.

Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis.

In a double-blind, randomized, comparative trial of the prokinetic drug cisapride and the H2-blocker cimetidine, mucosal healing and changes in symptoms of gastroesophageal reflux were evaluated in patients with erosive reflux esophagitis. The patients were treated with either cisapride, 10 mg four times a day (N = 36) or cimetidine, 400 mg four times a day (N = 37) for six weeks, or for 12 weeks if mucosal healing was not obtained by week 6. Upon entry, two thirds of the patients in each group had grade I (Savary-Miller) esophagitis, and the remainder grade II or III. At the end of treatment, endoscopy showed mucosal healing in 56% (38-72%; 95% confidence interval) of cisapride and 57% (39-73%; 95% confidence interval) of cimetidine patients. After six weeks, both drugs significantly (P less than 0.01) decreased the intensity and frequency of heartburn, regurgitation, and the postural syndrome. No significant intergroup differences were found regarding endoscopic parameters or the improvement of heartburn and regurgitation. Concomitant antacid use was also comparable. Adverse effects were reported by four cisapride and nine cimetidine patients. These results indicate that the effects of cisapride compare well with those of cimetidine in terms of both esophageal mucosal healing and symptom relief.

[Efficacy and tolerability of enprostil in the treatment of duodenal ulcer. Comparison with cimetidine]. / Efficacité et tolérance de l'enprostil dans le traitement de l'ulcère duodénal. Comparaison à la cimétidine.

Enprostil, a synthetic PGE2, has been shown to have an inhibitory effect on gastric acid secretion, a mucoprotective effect and a postprandial lowering effect on gastrin. A double blind randomized study was performed in 80 patients, in order to evaluate the efficacy and safety enprostil (35 mu b.i.d) as compared to cimetidine (400 mg b.i.d) in duodenal ulcer. Healing rates after two, four and six weeks of treatment, as based on endoscopic evaluation, were 35, 72 and 83 p. 100 for enprostil and 45, 73 and 83 p. 100 for cimetidine, respectively. There were no significant differences between treatment groups. The time to relief of nighttime and daytime ulcer pain and antacid consumption were similar in the two groups. The patient's overall subjective assessment was better in the cimetidine group, but this was not confirmed by physicians' opinions. Diarrhea was observed in 7 p. 100 of patients treated by enprostil compared with 5 p. 100 for patients treated by cimetidine. One enprostil treated patient withdrew from the trial prematurely because of abdominal pain. This study demonstrates the efficacy and safety of enprostil in the treatment of active duodenal ulcer at the dosage of 35 micrograms twice daily.

Combined therapy with cisapride and cimetidine in severe reflux oesophagitis: a double blind controlled trial.

Combined treatment with cimetidine 1 g daily and cisapride 40 mg daily in patients with endoscopically diagnosed severe reflux oesophagitis was compared with single drug therapy (cimetidine and placebo). At the end of the six to 12 weeks treatment, 11 (46%) of the 24 patients under single drug therapy were endoscopically healed and three were improved. In contrast, 16 (70%) of the 23 patients under combined therapy were healed and all of the remainder were improved (p = 0.025). The severity of diurnal and nocturnal heartburn, decreased significantly more (p less than 0.05) on cimetidine + cisapride than on cimetidine + placebo. The combined treatment was well tolerated. These results suggest that combined therapy with cisapride and cimetidine may be useful in patients with severe reflux oesophagitis.

Sucralfate versus alginate/antacid in the treatment of peptic esophagitis.

Fifty patients in whom endoscopy revealed peptic esophagitis were included in a double-blind study in which either sucralfate (1 g four times a day) or an alginate/antacid compound (5 g four times a day) were randomly assigned. After six weeks of treatment, efficacy and clinical safety were evaluated in 23 patients in the sucralfate group and 22 patients in the alginate/antacid group. No significant difference between the two treatments was detected with regard to efficacy, evaluated on the basis of clinical and endoscopic criteria. Clinical safety was also good in both groups. Sucralfate was, therefore, found to be as effective and as well tolerated as the alginate/antacid compound in the treatment of peptic esophagitis.

[Bucco-pharyngeal and esophageal localizations in Crohn's disease]. / Localisations bucco-pharyngée et oesophagienne de la maladie de Crohn.

A case of upper esophageal stenosis associated with pharyngeal lesions in Crohn's disease is reported. The esophageal stricture was intractable by endoscopic dilatation. This patient was managed successfully by total esophagectomy. The left colon was used to replace the esophagus through a posterior mediastinal route. Histologically, the lesions were epithelioid granulomas with ulcerative fissurations and submucosal lymphoid nodules and were suggestive of Crohn's disease involving the upper esophagus and pharynx only. Similar cases involving only the upper digestive tract with pathologic proof have not yet been reported in the literature.

[Carcinoembryonic antigen. Evaluation in intestinal lavage fluids and in the tissue of colorectal tumors]. / Antigène carcinoembryonnaire. Evaluation dans les liquides de lavage intestinal et dans le tissu des tumeurs colorectales.

Carcinoembryonic antigen in pre-operative or pre-endoscopic intestinal lavage rinsing fluids was assayed in 21 healthy subjects, 15 presenting polyps and 12 presenting colorectal cancer. Comparison of the results with those of histological and immunohistological studies showed that this assay did not allow detection of intestinal cancer or evaluation of its developmental stage.

[Hepatic anomalies in Mediterranean boutonneuse fever]. / Anomalies hépatiques au cours de la fièvre boutonneuse méditerranéenne.

We report 3 cases of rickettsial hepatitis observed in the Lyon area which were secondary to boutonneuse fever. The temperature was elevated and clinical signs were an often painful hepatomegaly and digestive disorders. These signs are only indicative when accompanied by atypical pneumonopathy or exantherma. Indeed, if the inflammatory syndrome is clear, hepatic function is little perturbed. Diagnosis is sometimes influenced by the epidemiological situation, and depends on serologic tests and histological evidence of granulomatous hepatitis (2 of the 3 cases here). The successful antibiotic treatment shows that patients presenting febrile granulomatous hepatitis should be tested for rickettsiosis.

[Endoscopic dilatation of ureteroileal stenosis in Bricker diversions. Apropos of 11 patients]. / La dilatation endoscopique des sténoses urétéro-iléales dans les dérivations de Bricker. A propos de onze patients.

Eleven patients with stenosis of an uretero-ileal anastomosis following Bricker's operation underwent endoscopic dilatation of these stenoses via an inferior approach with Eder-Puestow's apparatus or Savary's dilators. The preliminary results were favourable in 7 patients with clinical, endoscopic and radiological improvement. An uretero-ileal drainage catheter was inserted in each case and was changed regularly after the operation. In one patient, a stone trapped in the anastomosis was able to be removed via the endoscopic procedure. No complications were observed. The two technical failures required surgical re-operation in one case and dilatation via a superior approach with an inflatable balloon catheter. This technique demonstrates the value of gastrointestinal endoscopy in the treatment of certain complications in patients with a urinary diversion using a segment of the intestinal tract.

[Highlights of the physiopathology of gastroesophageal reflux]. / Le point sur la physiopathologie du reflux gastro-oesophagien.

Manometric studies have shown that the principal barrier against gastro-oesophageal reflux is the inferior oesophageal sphincter. The factors capable of physiologically and pathologically modifying the sphincter pressure are analysed. Other factors may be involved as well as a decrease in the pressure of the inferior oesophageal sphincter: the length of the abdominal oesophagus, the oesophageal clearance, delayed gastric emptying, duodeno-gastric reflux. Thus, in many patients, gastro-oesophageal reflux reflects a disturbance of the motility of the upper gastrointestinal tract and not just the oesophagus.

[Carcinoembryonic antigen in intestinal lavage fluids and the tissue of colorectal tumors]. / Etude de l'antigène carcinoembryonnaire dans les liquides de lavage intestinal et dans le tissu des tumeurs colorectales.

Determination of carcinoembryonic antigen (CEA) was carried out in 48 intestinal washing fluids (21 from healthy subjects, 15 from patients with polyps and 12 from patients with colorectal carcinoma). The histologic study of polyps and the histologic and immunohistochemical studies of tumors were realized. In the polyps's group, the mean of ACE is significantly higher than that of the volunteers's group, but 7 subjects have a CEA level below the mean and 8 subjects have a CEA level twice this mean. Furthermore, the CEA level seemed to be independent of histologic grade of polyps. The mean of CEA levels in the subjects with colorectal carcinoma is significantly higher than that of volunteers, but 4 of 12 patients have a CEA level below the mean of healthy subjects. The CEA levels are very variable for an identical stage of tumor's differentiation and is independent of Dukes stage (B-C or D). CEA determination in intestinal washing fluids allows neither the detection nor the appreciation of intestinal carcinoma's extend.

[Treatment of newly formed oesophageal varices and peptic oesophagitis after upper polar gastrectomy for portal cavernoma (author's transl)]. / Traitement de varices oesophagiennes néoformées et d'une oesophagite peptique après gastrectomie polaire supérieure pour cavernome portal.

The management of peptic oesophagitis after upper polar oesophagogastric resection is difficult, when this upper polar gastrectomy is carried out for prehepatic portal hypertension, the constant presence of newly formed oesophageal varices which often bleed, complicates the problem of the therapeutic indications. We adopted in one case an etiological solution by performing an end-to-side spleno-renal anastomosis after splenectomy which was symptomatic by interposition between the oesophagus and the stomach of part of the descending colon. Modern methods of mechanical suture facilitated this surgical operation.

[G2 technic : a simplified procedure of reconstitution of the angle of His, applied to the treatment of hiatus hernia and malposition of the greater tuberosity (242 cases) (author's transl)]. / Technique G2 : un procédé simplifié de reconstitution de l'angle de His, appliqué au traitement des hernies hiatales et malpositions oeso-cardio-tubérositaires. A propos de 242 cas.

A simple procedure of reconstitution of the angle of His applied to the treatment of hiatus hernia and malposition of the greater tuberosity is reported. Applied to 242 cases, it presents compared with the classical procedure several advantages : easy to carry out, including no complex manoevre, it does not endanger the vagus nerve and maintains firmly the anastomosis. Radiological control and, above all, the clinical results were excellent or good in 96% of cases, suggesting that this new procedure is perfectly valid.

[Original treatment of headache and migraine]. / Un traitement original des céphalées et des migraines.

Headache and migrain are frequant motives for requesting advice of the general practitioner or specialist. They often participate in a general picture of "masked depression". Among the many propounded therapies, a place of choice should be made for Tiapridal, the more so that its antalgic effect is combined with an antiemetic and slightly anticompulsive action.