AIDS-related conditions: study of a representative sample of 1203 patients deceased in 1992 in France.

BACKGROUND: Little representative information exists on the frequency of human immunodeficiency virus (HIV)-related diseases among the overall AIDS population. The objective of this research is to assess the nature, frequency and characteristics of these diseases among AIDS patients during their last year of life and to analyse these frequencies according to the mode of transmission and other socio-demographic and medical characteristics. METHODS: To obtain comprehensive data, we conducted an investigation based on retrospective collection of clinical information on a representative sample (1203 deaths) of all AIDS deaths that occurred in France during 1992. RESULTS: The frequency of the diseases was markedly higher than the one described in the AIDS surveillance registers and varied between homosexuals and intravenous drug users (IVDU). After controlling for other variables (age, CD4 counts, survival times) by means of logistic regression, homosexuality remained a significant explaining factor for Kaposi's sarcoma, cytomegalovirus infections, herpes simplex and cryptosporidiosis. In contrast, HIV encephalopathy, hepatitis, mental disorders, invasive candidiasis and cachexia were more frequent in male IVDU. Few differences were observed by sex. CONCLUSIONS: Several factors may explain the differences: variation in exposure to infectious agents, general health status, use of medical care and direct influence of the mode of HIV transmission. These data are of particular value for medical services in planning the magnitude of health care needs among the AIDS population overall, for clinicians and researchers for advancing the understanding of the natural history of AIDS and in the definition of prophylactic strategies against opportunistic infections.

[Peptic oesophagitis and carcinoma of the lower third of the oesophagus: report of 7 cases (author's transl)]. / Oesophagite peptique et cancer du tiers inférieur de l'oesophage. A propos de sept observations.

The authors report seven cases of carcinomas of the lower third of the esophagus developed on lesions of peptic esophagitis. These lesions precede the carcinoma. They can be real precancerous states and even in situ carcinomas whose evolution over several years could be proved indeed. They argue about the therapeutical indications in peptic esophagitis considering not only that such a cancerous transformation is always possible but also the fact that a surgical ablation is always serious.

[Acute primary ischemic enteritis and colitis. Clinico-pathological and physio-pathological findings]. / Entérites et colites ischémiques aiguës primitives. Faits anatomo-cliniques et physio-pathologiques.

By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.

[Intestinal complications during the use of oral contraceptives]. / Les accidents intestinaux au cours de l'emploi des contraceptifs oraux.

PIP: The only intestinal complications of oral contraception, besides occasional diarrhea, are ischemic colitis, intestinal infarction, and acute ulcerative colitis. Ischemic colitis, the most common of the 3, is usually localized in the left colon, is due to intravascular coagulation, and resolves on stopping the pill. Intestinal infarction is rare but sometimes fatal, and usually occurs after thrombosis of the superior mesenteric artery. Acute ulcerative colitis is often severe but clears up on stopping the pill, although the etiologic role of the pill is in dispute. 1 case of severe Crohn's disease in a pill user was observed. This disorder is known to occur in pregnancy, but has not previously been associated with oral contraception.^ieng

[Anatomical lesions of the liver and oral contraceptives (author's transl)]. / Les lésions anatomiques du foie au cours de la contraception orale.

Based on two cases, the authors recall the anatomical lesions of the liver occurring at times in women using oral contraceptives: jaundice, benign tumors, vascular lesions; and they emphasize more particularly the vascular lesions and their relation with oral contraceptives.

PIP: The authors describe 2 observations of anatomical lesions of the liver related to the use of oral contraceptives. They remind of the different forms of lesions of the liver observed in women using oral contraceptives: jaundice (although this form has become relatively rare), benign liver tumors and vascular lesions. Some hepatic alterations provoked by oral contraceptives are very similar to lesions observed during pregnancy. Experiments performed on animals have shown the influence of sex hormones in hepatic tumors: a prolonged administration of high doses of extrogens increases the carcinogenic action of acetylaminofluoren in the female while the occurence of tumors is not increased in males treated in the same fashion. In males as well as females, testosterone has a stimulating effect on the development of hepatic tumors. It is concluded that clinicians should be aware of the hepatic risks carried by oral contraception.

[Lymphatic peritonitis occurring 8 days after right colectomy for Crohn's disease]. / La péritonite lymphatique au 8e jour après colectomie droite pour maladie de Crohn

The authors have observed on two occasions, a diffuse peritoneal syndrome in the post-operative period after right hemi-colectomy for Crohn's disease, and interpret, in the absence of complications at the level of the anastomosis, as peritonitis due to septic lymphorrhea. According to them, it does not seem that this syndrome has the same significance as that described following appendicectomy in children.

[Gall-bladder troubles and oral contraceptives (author's transl)]. / Les troubles vésiculaires au cours de la contraception orale.

On the basis of about one hundred and fifty cases, the authors study the effect of oral contraceptives on the gall-bladder. After having showed their results, they discuss the mechanism of the action of oral contraceptives on the gall-bladder, showing their favouring effect on gallstones and pointing out the delay in gall-bladder emptying induced by them.

[Developed carcinomas of the lower oesophagus with peptic lesions (author's transl)]. / Les cancers développés sur lésions "peptiques" du bas-oesophage.

The authors report seven cases of carcinomas of the lower oesophagus with peptic lesions. Based on clinical, endoscopical and histological criteria, they point out these peptic lesions preceded the carcinoma in all the cases certainly or very probably. They emphasize at last two cases where the peptic lesions after a strict supervision during many years, gave place, in spite of it all, to a cancerous transformation.

[Study of morbidity according to age and sex in adult persons deceased at hospital (author's transl)]. / Etude de la morbidité selon l'age et le sexe, chez les sujets adultes décédés en milieu hospitalier.

Studying morbidity according to age and sex in persons decreased at hospital, the authors point out that many illnesses grow in frequency with age. Very often too, illnesses grow in number with age; but this is not constant. At last, this study allows to state the behaviour of old people before illness and the influence of senescence on the terminal evolution.

[Headache and oral contraceptives (selective study of 159 cases)]. / Les céphalées au cours de la contraception orale (etude sélective à l'aide de 159 observations)

Based on a series of 159 cases of headache during oral contraception, the authors confirm the part plainly favouring and aggravating of oral contraceptives on headaches. They are dominated by the frequency of migraines and happen with predilection at the time of hormonal weaning. We deduct from this, that oral contraceptives generally aggravate or reveal a latent sensitivity to hormonal variations, especially clear with older women.

[Colonic Crohn's disease: diagnostic and therapeutic problems. Apropos of 11 cases]. / Maladie de Crohn colique: problèmes diagnostiques et thérapeutiques. A propos de onze observations

The authors report a few unusual cases of Crohn's disease of the colon and discuss the diagnostic problems which are raised in such cases. They then review the various colonic diseases liable to be considered in a differential diagnosis, and which may be linked to colonic Crohn's disease, e.g. ulcerative colitis, intestinal tuberculosis, carcinoma of the colon, colonic diverticulosis and sarcoidosis. In a chapter on treatment, they emphasize the favourable effect of acexamic acid and the necessity for very wide colonic resection, and they note a complication which they encountered during surgery for Crohn's disease: lymphatic peritonitis on the 8th day after right colectomy.

[Crohn's disease after administration of oral contraceptives. Report of a case (author's transl)]. / Maladie de Crohn iléo-colique après emploi d'un contraceptif oral

PIP: The case of a 20-year-old female patient is which ileo-colic Crohn's disease developed after repeated attempts at contraceptive treatment (no rgestrel-ethinyl estradiol) had resulted in periods of diarrhea, which ceased after stopping treatment, is reported. As a consequence of the severity of the disease, after the 3rd attempt at using oral contraceptives (OCs) a partial removal of the ileum and colon had to be performed. The relation between Crohn's disease and other acute ulcerative colitis in patinets receiving OCs and the role of these drugs as a triggering factor in Crohn's disease are discussed. It is conclude d that, while their causative role is unproven, in view of studies on th e relation between pregnancy and this disease, OCs may favor the development of the disease, and intestinal disorders during OC treatment should be carefully monitored.^ieng