[Agenesis of the right lobe of the liver and portal hypertension]. / Agénésie du lobe droit du foie et hypertension portale.

A case of agenesis of the right lobe of the liver associated with portal hypertension is reported. This uncommon feature was diagnosed by computed tomography which excluded secondary liver atrophy due to cirrhosis or tumour. The main pathophysiological hypothesis for agenesis and portal hypertension, exceptionally associated, is arrest of hepatic development during foetal life.

[Hepatitis induced by alpidem (Ananxyl). Four cases, one of them fatal]. / Hépatite imputable à l'alpidem (Ananxyl). Quatre cas dont un mortel.

Acute hepatitis related to psychotropic drugs has been rarely reported with anxiolytic treatments. Alpidem (Ananxyl) is a new imidazopyridine derivative with anxiolytic properties which was launched in October 1991. Several cases of acute hepatitis, some severe, were described with this drug and its liver toxicity was questioned. Results of a study monitoring drug side-effects caused this drug to be withdrawn from the market for one year. We report four cases of acute hepatitis and discuss the role of alpidem. All but one case were presented as severe acute hepatitis with hepatic failure. One patient ran a fulminant course and died despite liver transplantation. The mechanism of liver toxicity remains unclear.

Alcoholic cirrhosis and cobalamin metabolism.

The cobalamin status of 27 patients suffering from alcoholic cirrhosis and 20 control subjects was analyzed. Plasma cobalamin (p < 0.005), total corrinoids (p < 0.005) and their analogs (p < 0.05) were all significantly elevated in the cirrhosis patients. These differences were due to increased haptocorrin (HC)-bound corrinoid (p < 0.02), which could be explained by a deficient hepatic clearance of cobalamin bound to HC. The increase in the concentration of true cobalamin was greater than that of its analogs. There were positive correlations between cholestasis (serum alkaline phosphatase) and plasma analog concentrations (p < 0.05), HC-bound cobalamin (p < 0.005) and total corrinoids bound to HC (p < 0.005). The plasma concentrations of the indicators of cobalamin deficiency, homocysteine (p < 0.05) and methylmalonic acid (p < 0.001), were increased, which could indicate poor cellular penetration of vitamin B12 or a defect in the activation of the two vitamin-B12-dependent enzymes.

Crohn's disease and vitamin B12 metabolism.

The concentrations of vitamin B12, its analogs, and the haptocorrin and transcobalamin carriers in 21 patients suffering from Crohn's disease and a group of controls (20 adults) were measured. There were no significant differences in the mean values for vitamin B12, total corrinoids (vitamin B12 + analogs), or vitamin B12 or total corrinoids bound to haptocorrin or transcobalamin of the Crohn's and control patients. There was a significant increase in the binding capacity of transcobalamin in the Crohn's patients compared to the controls (P < 0.001), but there was no difference in the binding capacities of haptocorrin. The serum concentrations of the markers of vitamin B12 status, homocysteine and methylmalonic acid, showed an increase (P < 0.01) in homocysteine in the Crohn's disease patients, but no change in methylmalonic acid. As the hyperhomocysteinemia was associated with normal folate concentrations, there may have been a defect in the activation of the enzyme due to altered intracellular vitamin B12 status.