[Chromobacterium violaceum peritonitis: case report and literature review]. / Péritonite à Chromobacterium violaceum: observation et revue de la littérature.

We report a case of Chromobacterium violaceum infection and we review the literature for all published cases. C. violaceum grew from a peritoneal fluid of a 47-year-old woman operated on for peritonitis following perforative gastroduodenal ulcer. She was just coming back from a 1-month-holyday in French Guyana, where she might have been in contact with this micro-organism. The patient fully recovered after surgical management associated with antibiotic therapy consisting of ofloxacin plus piperacillin-tazobactam. Among the more than a hundred of published cases of human infections with C. violaceum that we retrieved, there was not any other case of peritonitis.

In vivo pefloxacin-resistant Campylobacter fetus responsible for gastro-intestinal infection and bacteremia associated with arthritis of the hip.

The authors report a case of Campylobacter fetus subsp. fetus gastro-intestinal infection and bacteremia with poly-arthritis, mainly of the hip, in a French patient simultaneously suffering from cirrhosis of the liver. The outcome was eventually favorable, however only after a trial of ineffective pefloxacin-gentamicin therapy. The authors suggest: (i) gentamicin should not be given alone in C. fetus subsp. fetus infections, and (ii) pefloxacin should not be given if antibiotic sensitivities data are not available. The inconclusive reliability of disk diffusion tests for C. fetus subsp. fetus should be recognized.

Susceptibility of multiresistant serotype 012 Pseudomonas aeruginosa to fosfomycin in combination with other antibiotics.

Serotype 012 represented 15% of 244 isolates of Pseudomonas aeruginosa isolated in the hospital over a 2 year-period and most isolates of this serotype were resistant to multiple antibiotics. Combination experiments showed that fosfomycin and amikacin together were active against 92% of 012 isolates. It is recommended that serotyping be used systematically to identify 012 strains rapidly and fosfomycin/amikacin be considered as a presumptive antipseudomonal therapy in 012 infections.

[Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis]. / Biopsies d'un rectum et d'un côlon endoscopiquement normaux: une nécessité. Fréquence de la colite collagène et de la colite microscopique.

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.

[Cyclic enteral nutrition and Crohn's disease localized in the distal ileum and/or the colon. Trial of a dietary polymer mixture]. / Nutrition entérale cyclique et maladie de Crohn à localisation iléale distale et/ou colique. Essai d'un mélange diététique polymérique.

UNLABELLED: Cyclic enteral nutrition (CEN) is a technique regularly used during the active phases of CDIC. Elemental or semi-elemental diets are usually employed. We tested the tolerance and efficacy of a ternary polymeric diet for nightly administration on a discontinuous basis (Polydiet). CEN was given to 12 malnourished patients with active CDIC of moderate intensity (6-9 Harvey Bradshaw Index). Corticosteroid therapy with prednisolone (0.3 to 0.9 mg/kg) was given in combination in 6 patients throughout the course of CEN. Duration of CEN, energy and protein intake, age, sex, degree of activity of CDIC and lesional extent, and percentage of malnutrition were comparable in both groups of patients. In all cases, clinical tolerance was remarkable allowing therapy to be maintained. No significant change in laboratory test values of hepatic or renal functions or of plasma lipids occurred. A positive significant variation was noted in both groups for the following parameters: body weight (p less than 0.01); muscle circumference (p less than 0.001); serum albumin (p less than 0.001), transferrin (p less than 0.01), clinical score (p less than 0.001). Triceps skin fold and lymphocyte count did not vary significantly. Corticosteroid therapy at the above dosage did not alter these parameters. Positive maintenance of nitrogen balance was obtained in all cases at the end of the first week of CEN. CONCLUSION: With equivalent nutritional value and for a lower cost, polymeric diets could be used more frequently in the treatment of CDIC. Tolerance and correction of nutritional disorders appear comparable to elemental products if lesions affect only the distal small intestine and/or colon.

[Uro-colonic tumors. Etiopathogenic data and practical implications]. / Tumeurs uro-coliques. Données étiopathogéniques et implications pratiques.

The authors report a case of uro-colonic tumour developing four years after ureterosigmoidostomy in a male patient treated for invasive bladder tumour. After a current follow-up of five years for this colonic tumour, they studied their case in comparison with the data from the literature and the experimental model in order to better understand the natural history of these tumours. The following principal points are discussed: time to onset, histological nature and course of these tumours; essential elements in this type of carcinogenesis, practical clinical implications and follow-up of patients after ureterosigmoidostomy.

Epidermolysis bullosa acquisita and Crohn's disease. A case report with immunological and electron microscopic studies.

A review of the literature shows that the association of epidermolysis bullosa acquisita and Crohn's disease is rare. A 27-year-old man developed cutaneous blisters on the trauma-prone areas that were consistent with the diagnosis of epidermolysis bullosa acquisita. Immunological and electron-microscopic studies of the skin showed intense IgG deposits located beneath the basal lamina. Three years later, Crohn's colitis was diagnosed. Prednisolone and sulfasalazine treatment resulted in an improvement of the bowel disease but without appreciable effect on the skin lesions.

[Immunoblastic lymphoma of the ileocecal region in chronic lymphoid leukemia. Richter's syndrome localized in the intestine and disclosed by ascites]. / Lymphome immunoblastique de la région iléo-caecale au cours d'une leucémie lymphoïde chronique. Syndrome de Richter localisé à l'intestin et révélé par une ascite.

The authors report the case of a patient with chronic lymphocytic leukemia well controlled during five years, and then complicated with immunoblastic lymphoma of the ileo-caecal area. The tumor was revealed by a protein-rich peritoneal effusion containing numerous large undifferentiated lymphoid cells. Only five cases of Richter's syndrome, apparently localized to the digestive tract, have been published to date.

[Value of velocimetric and echotomographic examination in monitoring central catheterizations]. / Intérêt de l'examen vélocimétrique et échotomographique dans la surveillance des cathétérismes centraux.

Thrombosis around a centrally-implanted catheter is a complication of this method of venous approach. Usually asymptomatic, it is normally detected by phlebography, histopathology or computed angiotomography. Thirty-five patients with catheters in internal jugular vein composed of silicone (13 cases) or polyurethane (22 cases) were followed up by velocimetric and echotomographic examinations before introduction and one and three weeks after introduction of a catheter, these exploratory procedures possessing the advantage of being rapid, repetable and non-invasive. Three thrombosis were diagnosed using this method, including two without clinical signs, one on a silicone and two a polyurethane catheter. This represents 8.6% of total population, comparable with results of phlebography and histopathology reported in the litterature. The echotomographic appearance of the fibrinoplatelet sleeve left by the catheter after its removal is also described. Combined velocimetric and echotomographic examination is an investigational method which is non-invasive, reliable, rapid and repeatable for evaluation of appearance, localization, extension and also follow up of thrombosis.

Leiomyoblastoma of the stomach: endoscopic treatment.

Since 1960, about 250 cases of leiomyoblastoma of the stomach have been reported. The diagnosis was always made after surgical resection or necropsy. We report the first case of gastric leiomyoblastoma successfully treated by endoscopic resection, in a 76-year-old woman presenting with upper gastrointestinal bleeding. This therapeutic procedure would seem to be the one of choice, in view of the age of the patient, the limited size and the pedunculated form of the tumor. Endoscopic follow-up should be instituted since local recurrence of the tumor and distal metastases have been reported.