Assessment of gastric neuropathy using electrogastrography in asymptomatic diabetic patients. Correlation with cardiac autonomic neuropathy.

This study assessed gastric neuropathy in type 1 diabetes mellitus and its relationships with cardiac autonomic neuropathy. Fifty-four asymptomatic type 1 patients (43 +/- 12 years) and 15 healthy subjects participated in the study. Cutaneous electrogastrography (EGG) was recorded for 4 h before, during, and 4 h after the ingestion of a standard meal. EGG frequency was divided into three bands: bradygastria [< 2 cpm), normal (2-4 cpm) and tachygastria (4-10 cpm)]. Assessment of diabetic autonomic neuropathy was based on Ewing tests and time and frequency domain indexes, which were analyzed from 24-h continuous ECG recordings. Tachygastria was significantly more common in diabetic patients than in controls throughout the recording period (38 +/- 5 vs 23 +/- 11.8%, p < 0.001), before (37 +/- 6 vs 26.5 +/- 8.9%, p < 0.001), during (41 +/- 7.8 vs 23 +/- 10.5%, p < 0.001) and after the meal (37 +/- 6.9 vs 29 +/- 9.8%, p < 0.001). The percentage of dominant frequency in the normal range was significantly lower in diabetic patients than controls (49 +/- 6 vs 63.3 +/- 11.1%, p < 0.001). Tachygastria was correlated with duration of diabetes (r = 0.234, p < 0.05), but not with glycaemic control. Abnormalities in gastric myoelectrical activity were not correlated with Ewing tests or time and frequency domain indexes.

[Diabetic autonomic gastric neuropathy: contribution of the electrogastrogram]. / Neuropathie végétative gastrique diabétique: apport de l'électrogastrogramme.

OBJECTIVE: The aim of this study was to characterize the features of vegetative gastric neuropathy observed in diabetic patients based on surface electrogastrographic recordings. PATIENTS AND METHODS: An electrogastrogram was recorded over an 8 hour 30 minute period in 63 patients with asymptomatic insulin-dependent diabetes and in 15 non-diabetic controls. Normal the electrical frequency of the stomach is 2 to 4 cycles per minute (cpm). Bradygastria is defined as a frequency below 2 cpm and tachygastria by a frequency above 4 cpm. RESULTS: The diabetic patients showed a below normal gastric frequency and enhanced tachygastria over the entire recording period and during the pre, per and post-prandial periods. These vagal alterations were not correlated with the principle features of diabetes. CONCLUSION: Electrogastrography confirms that vegetative gastric neuropathy occurs early in patients with asymptomatic insulin-dependent diabetes. The tachygastria could lead to the increased rate of gastroparesis reported in these patients.

[Value of magnetic resonance cholangiography in the diagnosis of common bile duct cystic dilation]. / Intérêt de la cholangio-IRM dans le diagnostic de la dilatation kystique du cholédoque.

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is reduced as no contrast agent is required and there is no risk of infectious contamination due to catheterism. Unlike endoscopic retrograde cholangiography which requires anesthesia, there is no risk of morbidity. We report one observation of Todani type Ia cystic dilation of the main bile duct explored preoperatively with MR-cholangiography. CASE REPORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the diagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hepato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic dilatation of the main bile duct are biliary pain, fever and jaundice. The MR-cholangiogram provides a map of the bile duct system directly with a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerous cases, surgery is a formal indication in patients with angiocholitis.

[Viral hepatitis A with prolonged course in adults]. / Hépatite virale A d'évolution prolongée de l'adulte.

OBJECTIVE: The aim of this study was to determine the clinical and virological characteristics of patients with type A viral hepatitis and a protracted course. METHODS: Twenty-seven patients with hepatitis A virus and elevated serum ALT levels for more than 6 months were studied. Patients were tested for hepatitis C and E virus using conserved serums. RESULTS: A biological relapse was defined by a decrease of the serum ALT levels > or = 50% followed by a > or = 50% increase in the minimal value. Biological relapses occurred in all patients. The median time between the onset of the disease and the first relapse was 87 days. During relapse, jaundice and ascites were present in five and one patients, respectively. All patients recovered. Serum aminotransferase activities returned to the normal range in a median of 230 days. None of the 17 tested patients had hepatitis C virus antibodies. Sixteen patients were tested for hepatitis E virus antibodies; 8 were positive for IgG and one for IgM. Sixteen control patients with acute hepatitis A of short duration, matched for date and country of contamination, were also tested for antibodies to hepatitis E virus; 11 were positive for IgG and none for IgM. CONCLUSION: A protracted course of type A viral hepatitis is characterised by relapses with or without symptoms. The high frequency of a positive test for hepatitis E IgG associated with a negative test for IgM in patients with and without a protracted course does not suggest that hepatitis E virus plays a role in patients with a protracted course. These positive results might be due to either false positive results or to past contamination.

Short report: polymerase chain reaction detection of hepatitis E virus in north African fecal samples.

Epidemics of enterically-transmitted non-A, non-B hepatitis were described in 1983-1984 involving French soldiers in Chad and in 1979-1980 in residents of Algeria. Hepatitis E virus (HEV) was subsequently implicated by serology. In this study, the presence of HEV in patient stool specimens from both outbreaks and from sporadic cases in residents of Chad (1994) was documented. This virus was detected in fecal suspensions by antibody capture of the virus and reverse transcriptase-polymerase chain reaction amplification of the viral RNA in the 3' end of open reading frame 2. Two of five epidemic cases from Chad (1983-1984) were positive, as well as one of five sporadic cases from Chad (1994), and two of three epidemic cases from Algeria (1979-1980). Of these 13 patients, 12 had detectable anti-HEV IgG in their serum. These results confirmed that HEV was the cause of hepatitis in at least five of these 13 patients.

[Viral hepatitis E]. / L'hépatite virale E.

Thanks to progress in serologic techniques evidence was obtained in 1980 showing that acute hepatitis epidemics observed in India were due to neither virus A nor virus B. The presence of another virus was confirmed and its genome was cloned and sequenced in 1991. Hepatitis virus E is a small RNA virus that differs from other known human viruses. Man and probably a few animal species maintain dissemination by the fecal route. Subjects not previously contaminated are susceptible and produce protective antibodies. Contamination occurs by the fecal-oral route general from water or tainted food. Direct contamination is rare. Vertical transmission from mother to fetus can also be observed. Outbreaks of the disease are characterized by epidemic proportions, preferential involvement of adolescent and young adults, and high incidence of fulminant cases especially in pregnant women. Outbreaks have been observed in endemic settings in southern Asia, Africa, and Mexico where sporadic cases are observed. Endemic areas are found in all developing countries. Hepatitis E is not clinically different from other acute viral hepatitis. Asymptomatic forms are common especially in children. The course of the disease is usually benign with little risk of development of chronic symptoms and cirrhosis. However hepatitis E is associated with a high incidence of severe cases with a mortality of 1 to 2% from icteric forms which occur in 15 to 20% of cases involving women contaminated during the last three months of pregnancy. Diagnosis can be made using either synthetic proteins or recombinant peptides. for the epitopes of the virus. Prevention depends on protection of the water supply and proper sewage disposal. Successful active immunization of monkeys holds promise for development of a vaccine. Due to its magnitude and high mortality rate hepatitis E is a major health problem for numerous regions around the world including Southeast Asia.

Hepatitis type E in a French population: detection of anti-HEV by a synthetic peptide-based enzyme-linked immunosorbent assay.

Four synthetic peptides were used to develop an ELISA for detecting hepatitis type E infections. Antibodies to HEV were detected in 54 of 64 patients present during two outbreaks previously recognized as being due to hepatitis E virus. Those patients included French soldiers stationed in Chad at the time, and Algerian civilians residing in Algeria and considered as positive controls. Anti-HEV were also detected in 3 out of 74 cases of sporadic non-A, non-B, non-C hepatitis in France, and in 2 out of 150 anti-HAV-IgM-positive sporadic cases, also in France, but in none of 278 healthy adults from the general French population. Among a total of 34 anti-HEV-positive cases in French subjects, 32 were shown to be associated with travel outside of western Europe; in two cases, however, HEV transmission appeared to have taken place in Europe. Using this ELISA, a rapid drop in anti-HEV antibodies to undetectable levels following the acute phase of the disease was observed in a high proportion of the infected subjects. Thus, the present test would appear to be more suitable for diagnostic purposes than for epidemiological investigations.

Mapping of linear B cell epitopes on open reading frames 2- and 3-encoded proteins of hepatitis E virus using synthetic peptides.

Hepatitis E virus (HEV) is the causative agent of non-A, non-B hepatitis which is transmitted by the fecal-oral route and occurs principally in the form of large epidemics and outbreaks in developing countries. Two overlapping synthetic peptides corresponding to overlapping DNA sequences of the ORF 3 of HEV genome were found to be immunoreactive with sera from patients involved in two epidemics of enterically transmitted non-A, non-B hepatitis. The results suggested the existence of two distinct epitopes. The four synthetic peptides representing these two epitopes from Burma and Mexico strains of hepatitis E virus, were used to investigate anti-HEV reactivities. HEV antibodies were detected in 84-88% of HEV-infected individuals according to the peptide used. The results suggest that a peptide-based ELISA can provide an accurate tool for the diagnosis of acute hepatitis type E.

Hepatitis E and hepatitis C virus infections among French soldiers with non-A, non-B hepatitis.

Serologic markers of HCV and HEV were investigated in 74 French soldiers with non-A, non-B hepatitis and in 18 patients involved in an outbreak of non-A,non-B hepatitis in Algeria. Moreover, anti-HCV antibodies were detected in 13 patients with non-A,non-B hepatitis of parenteral origin. HEV antibodies were investigated in 61-65% of patients involved in the 2 enterically transmitted outbreaks of non-A,non-B hepatitis observed in Algeria and Chad. The third cluster of non-A,non-B hepatitis observed in French soldiers serving in French Guyana is more likely to be attributed to malaria prophylactic treatment with Amodiaquine than to a viral origin. HCV infection was observed in 93% of acute or chronic cases associated with blood transfusion or parenteral drug abuse. Among acute cases, none of the soldiers who contracted the disease in Africa or in French Guyana was found to be anti-HCV positive compared to 78% of those who contracted the disease in France. HCV infections resulted in chronic hepatitis in 61% of cases.

Antibody response to preS1 in hepatitis-B-virus-induced liver disease and after immunization.

Antibodies to the pre-S1-encoded sequence of hepatitis B virus (HBV) envelope were detected by ELISA using a synthetic peptide analogue of preS1 proteins, in different groups of HBV-infected subjects and also in hepatitis B vaccine recipients. Such antibodies were specifically found in only 1% of HBsAg chronic carriers including patients with cirrhosis and primary liver cancer. Anti-preS1 were detected in patients with acute hepatitis; in 13% of the HBsAg+ sera obtained before recovery and in 37% of the sera obtained after recovery. Anti-preS1 antibodies were detected in recipients of a plasma-derived vaccine, but not in those receiving a recombinant vaccine. The results indicate that anti-preS1 is an earlier serum marker of HBV clearance than anti-preS2 and anti-S antibodies.