Bone changes in alcoholic cirrhosis of the liver. A histomorphometric study.

The effects of alcoholic liver cirrhosis on the calcium, calciotropic hormones (parathyroid hormone and 25 hydroxy vitamin D) and testosterone were examined in twenty men. A transiliac bone biopsy was performed in each patient. A double tetracycline labeling was done in 17 patients. Radiological signs of osteoporosis (crushed vertebrae and rib fractures) were rarely observed but a low trabecular bone volume (BV/TV) was consistently encountered (BV/TV = 14.2 +/- 4.6; normal 18.8 +/- 4.8; p less than .001). Osteomalacic signs were never observed in spite of very low calcium and 25 hydroxy vitamin D levels in the blood. Increased osteoclastic eroded surfaces (ES/BS = 8.1 +/- 5.2; normal 3.7 +/- 1.1; p less than .001) were not related with an hyperparathyroidism but a significant correlation was found with testosterone levels (r = .45; p less than .05). Histodynamic measurements indicate a drastically decreased osteoblastic activity with a very low bone formation rate (BFR/BS = .009 +/- .001; normal .0175 +/- .0125; p less than .001). This could explain the net increase of eroded surfaces and that osteomalacia cannot be observed even in the presence of profound calcium and vitamin D changes in alcoholics.

[Myocardial infarction and rectocolonic polyps]. / Infarctus du myocarde et polypes rectocoliques.

The prevalence of polyps in the rectum and sigmoid colon was estimated in 103 patients with recent myocardial infarction and 200 controls. All patients were asymptomatic and older than 35 years. A flexible proctosigmoidoscopy was performed. One or more adenomatous polyps were found in 19.6 p. 100 of patients with myocardial infarction and in 16.2 p. 100 of controls (difference not statistically significant). In males, the odds ratio for adenomatous polyps was 0.92 (confidence limits, 0.43-1.93). Acceptability of the flexible rectosigmoidoscopy was excellent in controls and poor in patients with myocardial infarction (1.0 p. 100 and 26.4 p. 100 of patients respectively refused this procedure). Tolerance, bowel preparation and the length of the explored rectosigmoid were not different. There was no statistically significant difference in the site, number or size of polyps. This study shows a high prevalence of polyps in patients with myocardial infarction and control groups although not statistically different. Consequently, a screening procedure for polyps is not indicated in patients with myocardial infarction.

[Endoscopic excision of malignant colorectal polyps. Study of a series of 82 cases]. / Exérèse endoscopique des polypes malins rectocoliques. Etude d'une série de 82 cas.

The management of malignant colonic polyps removed by endoscopic polypectomy is a controversial subject. We reported a series of 81 patients with 82 malignant polyps removed by endoscopic polypectomy between 1977 and 1984. 15 polyps contained carcinoma in situ and were treated by endoscopic polypectomy alone. 36 polyps contained superficial cancer; 35 were treated by EP alone; 1 was treated by endoscopic polypectomy and colectomy. 26 polyps contained invasive carcinoma and 2 were classified as polypoid adenocarcinomas. 19 had clear resection margins at polypectomy and seven had involved resection margins: 17 were treated by endoscopic polypectomy alone, 9 were treated by endoscopic polypectomy and colectomy. The patients were followed with colonoscopy. Follow-up has been 6 to 74 months (mean 32 months). The patients whose polyps were treated by endoscopic polypectomy alone, had had no evidence of recurrent tumor at the polypectomy site. Of the 12 patients undergoing colectomy, 4 had residual tumor at the polypectomy site. No patients had involved lymph nodes. There was no evidence of recurrence in any of these cases. Polyps containing contained carcinoma in situ and superficial cancer, polyps containing invasive carcinoma and clear resection margins can be treated with endoscopic polypectomy alone. Polyps with invasive carcinoma and involved resection margins should undergo segmental colonic resection. This approach must be weighed against the age of the patient, the medical status and the morbidity and mortality of the surgical procedure.

[Value of ultrasonography in the diagnosis of cirrhoses. Prospective study of 128 patients]. / Valeur de l'ultrasonographie dans le diagnostic des cirrhoses. Etude prospective de 128 patients.

This prospective study was carried out in order to assess the accuracy of ultrasound in the diagnosis of cirrhosis. One hundred and twenty eight alcoholic patients were included. A careful ultrasonographic examination of the liver was performed before liver biopsy (100 patients). In 15 cases, liver histology was normal, steatosis and/or fibrosis, cirrhosis were diagnosed in 13 and 72 cases respectively. Ultrasonic patterns were classified by the same examiner, according to several criteria: volume, irregular outline, coarse and fine bright echo pattern, attenuation of the ultrasound beam, splenomegaly, ascite, portal hypertension. Cirrhosis was diagnosed in 58 out of 72 patients (80.5%). Specificity was 78.5%, positive and negative predictive values were 90.6% and 61% respectively, and global efficacy was 80%. Irregular outline (0.66), hepatomegaly (0.66) and attenuation of the ultrasound beam (0.64) were the best signs. In case of fine bright echo pattern, the diagnosis of cirrhosis would be missed. The results suggest that ultrasonography is a good test for screening alcoholics for cirrhosis. Therefore, it is useful when liver biopsy is contra indicated or refused or when liver is not detected at the clinical examination.

[Ultrasound aspect of fascioliasis of the biliary tract]. / Aspect ultrasonore de la distomatose des voies biliaires.

Concerning two cases of biliary distomiasis, the authors describe the sonographic patterns leading to the ultrasonic diagnosis of this parasite. Gallbladder distomiasis appears as an echogenic, oval structure, without acoustic shadow. It characteristically displays mobility and variable shape. The aspect of common bile duct distomiasis is reported for the first time. It is a nonshadowing linear structure and however non specific.

A non-tumoral esophago-bronchial fistula managed by isobutyl-2-cyanoacrylate.

Non-tumoral esophago-bronchial fistulas are usually treated by gastrostomy. This case-report describes the endoscopic obstruction with an acrylate glue in a 75-year-old woman.

[Antibodies against gastric parietal cells in gastritis (author's transl)]. / Les anticorps anti-cellule pariétale gastrique dans les gastrites.

Antibodies directed against gastric parietal cells were investigated in the serum and gastric mucosa of 45 patients with gastritis, and the results were compared with those of standard histological examination and direct immunofluorescence studies on biopsy specimens. It was confirmed that the antibodies were more frequently found in the serum of patients with gastric atrophy (12/19) than in that of patients with chronic atrophic gastritis (6/13) or chronic superficial gastritis (2/13). In 8 cases of globulin material was detected by direct immunofluorescence test in the parietal cells of gastric mucosa sections. The tole of these auto-antibodies in the pathogenesis of gastritis is discussed.