[Recklinghausen's disease and gastrointestinal stromal tumors]. / Maladie de Recklinghausen et tumeurs stromales digestives.

Gastro-intestinal stromal tumors associated with Recklinghausen's disease should be considered in the current concept of the stromal tumors with reference to recent advances in immuno-chemistry. In this setting, there is an high potential of maluignancy. For the treatment of these lesions, surgery is the main tool. Frequency of malignant digestive diseases associated with Recklinghausen disease should be kept in mind.

Endoscopic management of obstructive jaundice due to portal cavernoma.

This report describes 2 cases of calcified cavernous transformation of portal vein of unknown etiology. In both cases the revealing symptom was jaundice due to extrinsic compression of the common bile duct by the cavernoma. Only 4 other cases have been previously described in the literature. The cause of the jaundice was discovered only during surgery and confirmed by arteriography. Endoscopic retrograde cholangiography allowed both the diagnosis and the palliative treatment of the stricture of the distal common bile duct. Surgical treatment could not be performed.

[Treatment of achalasia by pneumatic dilatation]. / Traitement de l'achalasie par dilatation pneumatique.

Between 1979 and 1988, 60 patients with achalasia were treated by pneumatic dilatation under general anaesthesia, using the Rider-Moeller apparatus. The diagnosis rested on clinical, radiological, manometric and endoscopic criteria. These 60 patients underwent a total of 99 dilatations: 63.3 per cent were dilated once and 37.7 per cent were dilated several times. Forty seven of the 60 patients were followed up for more than 12 months (mean: 44 months): 2 of them (4.2 per cent) had to be operated upon, while 45 (95.7 per cent) are asymptomatic. Immediate complications were perforation in one case and cardial fissure in another; both were treated medically and cured. There was no oesophagitis or peptic stenosis, and no patient died. These results are compared with those found in the literature. The authors underline the simplicity, safety and effectiveness of pneumatic dilatation and suggest that it should be used as first-line treatment of achalasia, surgery being performed only when dilatation fails.

Pneumatic dilatation in the treatment of achalasia.

The results of a European survey on pneumatic dilatation in the treatment of achalasia have been compiled from a questionnaire completed by 18 different surgical teams. The total number of patients investigated was 2,161. Surgical treatment was prescribed by 94% of teams, whereas pneumatic dilatation was only prescribed by 56%. The indications for pneumatic dilatation were: inoperability (28%), drug failure (17%), surgical failure (11%). Nine surgeons believe pneumatic dilatation is indicated in all cases (50%), four consider it ineffective and useless (22%), and one expressed no opinion (6%). The arguments in favour of pneumatic dilatation are the fact that the procedure is minor and cost efficient and that it is relatively safe and effective with good long-term results in 75% of cases. Pneumatic dilatation should be used as the initial treatment in achalasia; surgery is only indicated in cases of failure.

[Retrograde endoscopic cholangiography after biliary surgery]. / La cholangiographie rétrograde endoscopique après chirurgie biliaire.

Retrograde cholangiography was conducted in 310 patients early or late after biliary system surgery. Principal indications for the investigation were angiocholitis (37% of cases), isolated jaundice (30%) or acute hepatic colic (17%). Biliary tract lesions were excluded in 7% of patients while in the remaining 93% it was possible to determine the precise cause of the disorder. In 30% of cases the disorder was unrelated to the previous operation or the lithiasic disease, whereas in 63% it was related to the latter (remaining or reformed stone, odditis) or to the surgical procedure (stenosis, common bile duct ligature or injury to main bile duct). These results, and those reported in the ligature, suggest that retrograde cholangiography can provide a precise diagnosis and ensure adapted therapy after biliary surgery.

[Ajmaline-induced hepatitis. A case report with ultrastructural study]. / Hépatite à l'ajmaline. Présentation d'un cas avec étude ultrastructurale.

The authors report the case of a patient with ajmaline hepatitis. The clinical presentation suggested angiocholitis; serum bilirubin concentration and the activity of alkaline phosphatase were markedly increased; serum transaminase activity was moderately increased; the prothrombin time remained normal. After interruption of the drug, the outcome was favorable, with complete recovery within 2 months. Histologic examination of a liver specimen obtained early after the onset of jaundice showed inflammatory cells in the portal tracts and mild hepatocytic lesions. Electron microscopy disclosed dilatation of the endoplasmic reticulum. The microfilamentous network of the hepatocytes was reduced and disorganized. Biliary canaliculi were enlarged with absent or blunted microvilli. There was evidence for passage of bile products from the biliary caniculi into the space of Disse. These aspects are reminiscent of those observed in animals after the administration of cytochalasin B. It is suggested that ajmaline may, in some patients, trigger an immune response which then alters the microfilamentous network of the hepatocytes, and may, thereby, produce cholestasis.

[Electron microscopic study of the sera of hepatitis B surface antigen (HBs Ag) subjects (author's transl)]. / Apport de la microscope électronique dans l'étude du sérum de sujets Ag HBs positifs.

Electron microscopic observation of sera from 59 subjects(HBs Ag-negative controls, HBs Ag-positive asymptomatic blood donors, and HBs Ag-positive patients with acute viral hepatitis, chronic persistant or active hepatitis and alcohol-induced liver damage) was capable of specifying the morphology of the HB virus (spherical particles, rod-shaped particles and Dane particles) and of correlating the aspect of the observed viral material with the nature and evolution of the liver damage. The viral particles are observed in small amounts in asymptomatic blood donors and in patients with acute viral hepatitis, but are present in very significant quantities in chronic hepatitis. Dane particles and viral particle aggregates are more numerous in chronic active hepatitis than in chronic persistant hepatitis. The detection of HBeAg in the serum, especially found in chronic active hepatitis, correlates with the presence of Dane particles. In most cases, the observed viral particle aggregates do not seem to be associated with an immunological process.

[Inappropriate secretion of antidiuretic hormone: true and false Schwartz-Bartter syndrome. Apropos of 2 cases]. / Sécrétion inappropriée d'hormone antidiurétique: vrai et faux syndrome de Schwartz-Bartter. A propos de deux observations

The authors report two cases and consider the various physiopathological mechanisms of inappropriate hypersecretion of antidiuretic hormone. An exploration including clearance of free water and, in some cases, estimation of ADH before and after a water load, then before and after administration of ethyl alcohol, permits one to determine the mechanism. It seems advisable to reserve the term Schwartz-Bartter syndrome to paraneoplasic syndromes linked to ectopic and autonomous secretion of ADH.