[Reversible nephrotic syndrome in Crohn's disease complicated with renal amyloidosis]. / Syndrome néphrotique réversible au cours d'une maladie de Crohn compliquée d'amylose rénale.

A 24-year-old woman suffered from ano-rectal Crohn's disease and nephrotic syndrome due to glomerular amyloidosis AA. She received azathioprine and colchicine for two years. Both Crohn's disease and nephrotic syndrome resolved. However amyloid renal lesions were still present. This course is exceptional, and leads to a discussion of the treatment of amyloidosis associated with Crohn's disease.

Lymphocytic and collagenous colitis: an immunohistochemical study.

OBJECTIVES: An increase of intraepithelial lymphocytes (IEL) is commonly found in lymphocytic colitis (LC) and collagenous colitis (CC), and has also been observed in the colonic mucosa of some patients with celiac disease or celiac-like disease. Thus, a similar mechanism could play a role in these apparently different entities. The aim of this work was to determine the phenotype of IEL and of lamina propria lymphocytes in the setting of LC and CC. METHODS: Biopsies were taken from all segments of the large bowel and from the ileon of eight patients with CC, four patients with LC, and 10 controls. An immunohistochemical study using monoclonal antibodies directed against IEL, T-cells, helper T-cells, suppressor/cytotoxic T-cells, HLA DR antigens, T-cell-bearing T-cell receptor (TcR) alpha beta, and TcR gamma delta was carried out. RESULTS: There was an increased in mean numbers of IELs in both LC and CC, with significantly more CD 8 IELs than CD 4 IELs. Most IELs were bearing TcR alpha beta; TcR gamma delta-bearing cells were not increased in CC or LC. CD 4+ helper T-cells predominated in the lamina propria. Epithelial cells of colonic mucosa abnormally expressed HLA DR antigens. There were no significant differences between findings in LC and CC. CONCLUSION: This study suggests that the immune abnormalities are similar in LC and CC and that a MHC-restricted immune mechanism could be involved in both diseases. Evidence for this includes: 1) the accumulation of CD 4+ T-cells within the lamina propria, 2) epithelial damage closely related to the increase of CD 8 TcR alpha beta IELs, and 3) abnormal class II MHC molecule expression on epithelial cells of colonic mucosa. Furthermore, the results suggest that the putative immune mechanisms underlying LC or CC are probably different from those that are incriminated in celiac disease.

[Liver abscess caused by Lactobacillus acidophilus]. / Abcès hépatique à Lactobacillus acidophilus.

Lactobacillus acidophilus is usually considered to be non pathogenic. We report a case of liver abscess due to Lactobacillus acidophilus in a 39 year-old man with chronic pancreatitis complicated by both endocrine and exocrine insufficiency, and with a choledoco-duodenostomy. Lactobacillus acidophilus was isolated in blood and liver samples. Complete recovery of the liver abscess occurred after antibiotherapy. We suggest that the abnormally low duodenal pH secondary to pancreatic insufficiency may have promoted both Lactobacillus acidophilus adhesion and multiplication in this patient. The choledoco-duodenostomy may then have promoted biliary tract colonisation.

[Unilateral isolated purpura disclosing scurvy]. / Purpura isolé unilatéral révélant un scorbut.

We report a case of scurvy. This case is interesting by the unilateral character of the ecchymotic leg's purpura. Ascorbic acid assays do not yet enable subclinical vitamin C deficiency to be reliably detected. Hence the importance of knowing the situation which expose to this deficiency.

[Sensitivity of gastric parietal cells to histamine after administration of enprostil and ranitidine during 4 weeks in healthy subjects]. / Sensibilité des cellules pariétales gastriques à l'histamine après administration pendant 4 semaines d'enprostil et de ranitidine chez le sujet sain.

Parietal cell sensitivity is increased in patients with active duodenal ulcer. It has been shown to increase in healthy volunteers after a 4-week treatment with H2-receptor blockers. Metaanalyses of therapeutic trials have indicated that time to first relapse was longer after ulcer healing with prostaglandins (PG) than after healing with H2-receptor blockers, which might be due to a different effect of the two treatments on parietal cell sensitivity. OBJECTIVES--To study, in healthy volunteers, basal gastric acid secretion, acid secretory responses and parietal cell sensitivity to histamine before and after a 4-week treatment with enprostil (E) and ranitidine (R). METHODS--This was a randomized double-blind double-dummy crossover study. Twelve male healthy volunteers (22-44 years) were randomly assigned to receive a 4-week treatment with either E (35 micrograms bid) or R (150 mg bid). After a 2-month washout period, they were crossed to the alternate treatment. Basal acid output (BAO), acid secretory responses to low-dose histamine infusion (histamine dihydrochloride 2.5 micrograms/kg/h) (LDAO), to a high-dose histamine infusion (25 micrograms/kg/h) (HDAO) and parietal cell sensitivity (PCS = LDAO/HDAO x 100) were measured 24 hours before the first administration and 72 hours after the last administration of each medication. RESULTS--All secretory parameters were similar before treatment with E and R. As compared to pretreatment values: a) HDAO tended to increase after both treatments (NS); b) LDAO (m +/- sem) slightly increased after R (18.4 +/- 2.6 vs 13.9 +/- 3.3 mEq) (NS) but not after E (12.5 +/- 1.8 vs 13.2 +/- 1.9 mEq); c) PCS (m +/- sem) was unchanged after R (36 +/- 4 vs 33 +/- 6) but decreased after R (30 +/- 6 vs 36 +/- 0.5; P < 0.02). When secretory parameters after treatment with R and treatment with E were compared, the difference was significant for LDAO (P < 0.02) and PCS (P < 0.05). CONCLUSIONS--If also found in patients with duodenal ulcer disease, these results might, at least partly, explain the lesser propensity of the ulcers to relapse early after healing with PG than after healing with H2-receptor blockers. However enprostil has been with-drawn from the market and it is now well established that one factor influencing the relapse rate is the efficiency of the treatment given to achieve ulcer healing in eradicating Helicobacter pylori. Consequently, the interest of our results is presently mostly physiological.

[Colonic lymphoma simulating cryptogenetic colitis associated with common variable hypogammaglobulinemia]. / Lymphome colique simulant une colite cryptogénétique et associé à une hypogammaglobulinémie commune variable.

We report the case of a 72 year-old woman with late-onset common variable immunoglobulin deficiency who was hospitalized for diarrhoea and fever. Colonoscopy showed aphtoïd and deep ulcerations in the rectum, the sigmoid and transverse colon, suggestive of Crohn's disease. Histologic and immunohistochemical study revealed a low grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma. This is an unusual presentation for colonic lymphoma, and the second case of colonic lymphoma associated with late-onset common variable immunoglobulin deficiency.

[Cystic dystrophy in an antro-duodenal heterotopic antroduodenal pancreas]. / Dystrophie kystique sur pancréas aberrant antro-bulbaire.

The authors report a case of cystic dystrophy in heterotopic pancreas in the absence of disease of the proper pancreas. This case is particular in regard of its association to pancreas divisum, its antro-bulbous localization, and its evolutive character marked by hyperamylasemia, ascite, and sharped inflammatory lesions of resection specimen. The diagnostic usefulness of endoscopic ultrasonography is outlined.

[Toxic megacolon with colonic perforation complicating Campylobacter jejuni ileo-colitis]. / Colectasie avec perforation colique compliquant une iléo-colite à Campylobacter jejuni.

Campylobacter jejuni is an enteropathogen with invasive ability which may be responsible for acute colitis. We report the case of a 38-year-old woman who was hospitalized for severe acute colitis. Stool specimen examination revealed Campylobacter jejuni. A laparotomy was performed due to clinical deterioration and toxic megacolon. Colic perforations were observed. The examination of the colectomy specimen revealed ulcerative pancolitis. This is the first published case of Campylobacter jejuni infection complicated by toxic megacolon and perforation.

[Chronic small intestine obstructions]. / Occlusions chroniques du grêle.

Chronic small bowel obstruction may be related either to disordered motility or to progressive chronic stenoses. Disordered motility (or intestinal pseudo-obstruction) is the consequence for muscular and/or intrinsic nerve impairment with 2 main types, one of which is primary (including so-called visceral myopathies and visceral neuropathies), the other one being secondary (generally due to systemic, or sometimes immunologic disease). Chronic stenoses have a different pathophysiology and occur in the setting of chronic inflammatory bowel disease or of systemic diseases such as vasculities. Chronic stenoses lead to intestinal stasis and in fine to mechanical obstruction. In any case, chronic obstruction poses difficult diagnostic and therapeutic problems. Management calls for tight medico-surgical cooperation. Atypical surgical operations may be warranted, and specific, sometimes aggressive medical care is mandatory. Moreover the nutritional consequences of chronic small bowel obstruction may become highly disabling due to alimentary restriction, disordered transit, bacterial overgrowth and malabsorption. In this setting nutritional support should be a matter of prime concern.

[Is ileorectal anastomosis still a valid therapeutic alternative in the surgical treatment of hemorrhagic rectocolitis? Analysis of the functional, endoscopic and histologic result of 74 cases]. / L'anastomose iléo-rectale est-elle encore une alternative thérapeutique valable dans le traitement chirurgical de la rectocolite hémorragique? Analyse du résultat fonctionnel, endoscopique et histologique de 74 observations.

The objectives of this study were to determine the functional results of ileorectal anastomosis (IRA) and the endoscopical and histological outcome of the rectal stump in 74 patients operated on for ulcerative colitis. Median follow-up was 7.5 years (range 1 to 35). Functional results, as defined by the usual accepted criteria, were good in 80% of patients. The mean daily number of bowel movements was 4.2 +/- 1.6 (SD). Long term endoscopical and histological features improved in most of cases and only 13.3% of rectal biopsies showed the persistence of acute inflammatory changes; 28.4% of the patients had one or more episodes of acute proctitis during the follow-up period, but none of the patients required proctectomy. One case of severe dysplasia was disclosed, leading to proctectomy. A second case of proctectomy was performed in a patient with microrectum. Biopsies performed preoperatively in this case showed the only case of moderate dysplasia found in our population. Provided that the usual contraindications to this surgical procedure are observed, IRA is still a valid option in the surgical treatment of ulcerative colitis.