[Recent portal and mesenteric venous thrombosis associated with Fusobacterium bacteremia]. / Thrombose veineuse mésentérico-porte aiguë associée à une septicémie àFusobacterium necrophorum.

SUMMARY: Septic pylephlebitis is usually a complication of intraabdominal infection in the region drained by the portal venous system. We report two cases of portal and mesenteric venous thrombosis associated with Fusobacterium necrophorum bacteremia, which did not show any obvious intra-abdominal source of infection with noninvasive imaging procedures. In one case, early anticoagulation treatment was associated with repermeation of the portal vein and its right branch. As in Bacteroides bacteremia, portal and/or mesenteric venous thrombosis should be searched for in case of Fusobacterium bacteremia of unknown origin. Repermeation of the portal vein and relief of extrahepatic portal hypertension can be achieved in these cases with early anticoagulation.

Epidemiology of chronic hepatitis B infection in France: risk factors for significant fibrosis--results of a nationwide survey.

BACKGROUND: Epidemiological data concerning hepatitis B are scarce in France. AIM: To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France. METHODS: Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. RESULTS: Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg-negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm(3) (P < 0.0001) and viral co-infection (P < 0.03). CONCLUSION: HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.

Latent autoimmune thyroiditis in untreated patients with HCV chronic hepatitis: a case-control study.

In order to establish a relationship between Hepatitis C virus (HCV) chronic infection and autoimmune thyroiditis, 97 untreated patients with biopsy-proven HCV chronic hepatitis and 97 controls were studied. An ultrasound examination of the thyroid and an assay of serum thyroid-stimulating hormone (TSH), thyroid hormones and anti-thyroid antibodies were performed in all cases. The overall prevalence of thyroid abnormalities was higher in patients than in controls (17 vs. 4%, P<0.01) and the prevalence of anti-thyroid antibodies was significantly different between the two groups (P<0. 02). HCV patients with (n=13) compared to HCV patients without anti-thyroid antibodies (n=84) were older, predominantly female, and more frequently had increased serum TSH levels or a hypoechogenic pattern of the thyroid gland, while Knodell's score and prevalence of cirrhosis were similar. Latent autoimmune thyroiditis is more frequent in untreated HCV patients than in controls. This finding raises questions about the mechanism of autoimmunity induced by HCV and provides an explanation for the high rate of overt autoimmune thyroiditis during interferon treatment in these patients.

Prevalence and risk factors of bacteriuria in cirrhotic patients: a prospective case-control multicenter study in 244 patients.

BACKGROUND/AIMS: The prevalence and risks factors of bacteriuria in cirrhotics have not been assessed by case-control study, and there are conflicting data concerning the role of liver failure and of ascites. The aims of this study were: i) to evaluate the prevalence of bacteriuria in cirrhotics, ii) to search for associated factors, iii) to evaluate the role of bladder post-void residual volume, and iv) to test the sensitivity of isolated bacteria to norfloxacin. METHODS: The prevalence and risk factors of bacteriuria on admission were determined by a multicenter prospective case-control study. RESULTS: Two hundred and forty-four cirrhotic patients and 240 controls were studied. Bacteriuria was present in 38 patients (15.6%; IC 5%: 11%-20%) and 18 controls (7.5%; IC 5%: 4.2%-11%; p<0.001). By univariate analysis, female sex and ongoing diuretic treatment were associated with bacteriuria (p<0.0001 and p<0.04, respectively). Pugh's grade, ascites and bladder residual volume were not associated with bacteriuria. By multivariate analysis, female sex (p<0.0001) and Child-Pugh score (p<0.03) were predictors of bacteriuria. Sensitivity of bacteria to norfloxacin was observed in 94.7%; sterile urine cultures were noted in 95.2% of patients treated with this antibiotic. CONCLUSION: Bacteriuria is twice as frequent in cirrhotic patients as in matched controls, and there is a trend to association with female sex and liver insufficiency.

The management of metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary.

A patient is diagnosed with an unknown primary of the head and neck when metastatic disease is present in the cervical lymph node or nodes and no primary lesion is detected by thorough physical examination, directed biopsies of suspicious or most likely primary sites, and imaging studies. The optimal management of patients who have this syndrome is still unclear and controversial. We report our results and analysis of the management of 24 patients with this syndrome. From 1976 through 1992, 24 patients who had metastatic squamous cell carcinoma in the cervical lymph nodes were seen in our medical center. A thorough search did not detect a primary lesion in any of them. Patients underwent radical neck dissection of the involved neck; 23 had unilateral and I had bilateral neck disease. Postoperative radiotherapy was delivered to both sides of the neck and to the potential primary mucosal and submucosal sites. The relation between clinical N stage, histologic findings of numerous involved lymph nodes, presence of extracapsular tumor extension, and survival were statistically analyzed. The Kaplan-Meier method was used for the survival analysis. The p values of log-rank test for the comparison of the two groups 1) N1 and N2 versus N3, and 2) presence of extracapsular tumor extension versus its absence are less than 0.005, with extracapsular tumor extension versus nonextracapsular tumor extension slightly smaller. The 5- and 10-year disease-free survival rate for the entire group was 54.2% (70.5% for N1 and N2, and 14.2% for N3). Three patients had locoregional failure, two in the primary sites, one in the nasopharynx, and the other in the oropharynx (the latter also had recurrent disease in the undissected neck). In 8 patients, distant metastases developed 7 to 38 months after radiotherapy. All 11 patients (45.8%) who had recurrent disease had advanced clinical N stage, microscopic findings of numerous involved lymph nodes, and prominent extracapsular tumor extension to the surrounding soft tissue and blood vessels. The high incidence of distant metastases shortly after treatment suggests a hematogenous spread before treatment in patients who had extensive nodal and extranodal disease. Our long-term disease-free survival beyond ten years seems to indicate combined treatment modalities, including radical neck dissection with postoperative radiotherapy of the neck, and the potential primary site in patients with N2 and N3 disease (our N1 group is too small for analysis). Further improvement of cure rate can be expected in the future with early detection and treatment.

External beam radiation therapy for squamous cell carcinoma of the soft palate.

PURPOSE: External beam radiation therapy for carcinoma of the soft palate aims to achieve loco-regional control with normal speech, nasal function, swallowing mechanism, and minimal side effects such as nasal speech and regurgitation of food into the nasopharynx. In this report we present our results of radiotherapy in the treatment of 24 patients with squamous cell carcinoma of the soft palate. METHODS AND MATERIALS: A total of 24 patients with squamous cell carcinoma of the soft palate were treated at the Veterans Administration Medical Center Minneapolis, MN, between February 1977 and May 1992. Of the 24 patients 2 had T1, 19 T2, 1 T3, and 2 had T4 lesions. Nineteen patients did not have clinical nodal disease, stage (N0), 1 had N1, 2 N2, and 2 N3 disease (Table 1). All the patients were treated by 4 MeV linear accelerator. A 1.75 Gy median dose was administered per fraction to a total of 70 Gy median dose. Bilateral opposed compensated shrinking fields technique was used. RESULTS: The 3-year disease free survival rate after external beam radiation therapy was 100% (1 out of 1), 64.7% (11 out of 17), 100% (1 out of 1), and 0%, for patients with T1, T2, T3, and T4 disease, respectively. Salvage surgery for recurrent disease was successful in 57.1% (4 out of 7 patients (Table 2). The ultimate 3-year disease free survival rate for the entire group, including surgical salvage, was 81% (17 out of 21) (Fig 1). CONCLUSION: Radiation therapy alone in our institution resulted in tumor control and survival rates compare favorably to previously published reports in the literature. Surgery can be reserved as salvage procedure.

Radiation therapy in early carcinoma of the glottic larynx T1N0M0.

PURPOSE: The Purpose of this report is to present the local control rate and survival of patients treated by radiation therapy for T1N0M0 squamous cell carcinoma of the glottic larynx. METHODS AND MATERIALS: A total of 41 patients with squamous cell carcinoma of the glottis were treated at the Veterans Administration Medical Center Minneapolis, MN, between 1976 and 1990. Of the 41 patients, 40 are available for retrospective analysis with a minimum of a 2-year follow-up and a median follow-up of 5.8 years. Treatment was given to all the patients by a 4 MeV linear accelerator. The vast majority of the patients were treated with bilateral laryngeal opposed wedged 6 x 6 cm fields with a dose of 1.75 Gy per fraction to a total of 70 Gy in 40 fractions over 56 elapsed treatment days. RESULTS: The data indicated local control and survival of 92.3 % at 2 years and 91.8 % at 3 years, post irradiation, with ultimate disease-free survival after surgical salvage of 97.4 % and 97.2 % at 2 years and 3 years, respectively. These local control and survival rates are comparable to those published in the literature when a higher fractional dose was given. No patients developed notable complications with our technique. CONCLUSIONS: A dose of 1.75 Gy to 1.8 Gy per fraction to a total of 70 Gy in 56 elapsed treatment days is well tolerated and yields ultimate disease free-survival of 97.2% at 3 years. This time-dose fractionation could be used safely for treating patients who demonstrate low tolerance to irradiation with a risk of laryngitis, laryngeal edema, or difficulty of swallowing, with a higher fractional dose.