[Ganglio-esophageal fistula revealed by hematemesis: a rare complication of silicotuberculosis]. / Fistule ganglio-oesophagienne révélée par une hématémèse: complication rare d'une silico-tuberculose.

We report a case of fistula between a silicotic mediastinal lymph node and the esophagus with protrusion of a stiff and darkish concretion into the oesophageal lumen. The patient, a 68-year-old coal miner, presented with cough since a few months and the lesion was revealed by haematemesis. The general course was rapidly favourable. Association with tuberculosis was recognized only a few months later.

[Ultrasound study of gallbladder motility in healthy subjects. Reproducibility of the method and effect of alcohol]. / Etude échographique de la motricité vésiculaire du sujet sain. Reproductibilité de la méthode et effet de l'alcool.

The protective effect of alcohol against cholesterol cholelithiasis has been established in several epidemiologic studies. An impairment of gallbladder motility in gallstone disease has been demonstrated in animals and in man. At a daily dose of 39 g, alcohol reduces the lithogenic index of bile, but its effect on gallbladder motility is still debated. To test this potential mechanism, the effect of 20 g of alcohol on gallbladder motility was studied, using an ultrasonographic ellipsoid method in 16 healthy male subjects. The stimulus for gallbladder contraction was a Lundh test meal. Using a cross over method, this meal was ingested by each subject once with water and once with alcohol. A third set of measurements was taken in each subject after ingestion of a Lundh meal and water to test the reproducibility of the sonographic method. The gallbladder kinetics were studied for 90 minutes following ingestion of the test meal and beverage. Alcohol stimulated rapid post prandial gallbladder emptying, and accelerated gallbladder filling. This second action could result from sphincter of Oddi pressure enhancement and, perhaps, decrease of gallbladder absorption by Na+ K+ ATPase inhibition. The reproducibility of the method was good. With a decrease of lithogenic bile index, the protective effect of alcohol against biliary cholesterol cholelithiasis could be due either to stimulation of gallbladder emptying and/or acceleration of gallbladder filling.

[Hepatic brucelloma (pseudotumoral brucellar caseous necrosis of the liver). Study of a case and review of the literature]. / Brucellome hépatique. (Nécrose caséeuse brucellienne hépatique pseudo-tumorale). Etude d'un cas et revue de la littérature.

We report the case of a 43 year-old Portuguese woman, hospitalized for long-standing fever, fatigue and weight-loss. Biologic investigation demonstrated anicteric cholestasis. Abdominal plain film showed a single hepatic calcification; computerized tomography and ultrasonography of the liver led to the discovery of a large mass, centered by the calcification. C. T.-guided biopsy showed caseiform necrosis, surrounded by histiocytic and lymphocytic cells. Brucella agglutination tests were negative at the beginning of the illness but became positive secondarily. The germ was not isolated from the hepatic fragment. The melitine intradermo-reaction was positive. Outcome was rapidly favorable with antibiotic treatment. Analysis of the 14 previously published cases showed that the most constant features were the hepatic calcifications and the epidemiologic context.

[The estrogen-androgen profile is unchanged in men with cholelithiasis]. / Le statut estro-androgénique n'est pas modifié chez les hommes atteints de lithiase biliaire.

It is well established that cholelithiasis is more frequent in women than in men. This difference is usually explained by the effects of estrogens and progesterone on the metabolism of bile acids, biliary cholesterol secretion and saturation, and gallbladder motility. Another explanation could be a protective effect of androgens against cholelithiasis in men. To test this hypothesis, we determined the hormonal, androgenic and estrogenic, status of 15 male patients with asymptomatic gallstone disease and in 15 control patients with normal gallbladder matched for age and body weight. No significant difference in the plasma concentrations and the urinary excretion rate of sex hormones (testosterone, dihydrotestosterone, androstenedione, testosterone and androstanediol glucuronides, estradiol, estrone, total estrogens), as well as in the plasma sex hormone binding globulin, was found between the 2 groups of patients. The development of cholelithiasis in men, therefore, does not appear to be related to modification of sex steroids.

[Acute hepatitis due to carbamazepine (Tegretol). Study of a case and review of the literature]. / Hépatite aiguë due à la carbamazépine (Tégrétol). Etude d'un cas et revue de la littérature.

The case of a 28-year-old epileptic woman, treated for 3 months with carbamazepine and who developed jaundice, fever and exfoliative dermatitis is reported. Biological investigations showed an increase in the activity of serum transaminases and alkaline phosphatases as well as in the blood eosinophilic count. Liver biopsy revealed centrolobular necrosis and cholestasis with portal inflammatory infiltrate. Drug challenge was followed by the rapid recurrence of clinical and biological signs. The definitive outcome was favorable. The analysis of the 12 previously published cases, and particularly the frequency of granulomatous hepatitis, suggests an immunoallergic mechanism for the development of carbamazepine hepatitis.

[Increased fasting gallbladder volume: a new ultrasonic sign of cirrhosis?]. / L'augmentation du volume vésiculaire à jeun: un nouveau signe échographique de cirrhose?

Ultrasound was used to calculate fasting gallbladder volume in three groups of patients: 90 with cirrhosis (alcoholic in 75 cases), 41 with non cirrhotic liver disease (alcoholic in 14 cases), and 38 controls. Gallbladder volume was evaluated according to sex, age, alcoholism, presence of gallstones, time of diagnosis, and biological tests of hepatocellular function. Mean fasting gallbladder volume was significantly higher in cirrhotic patients (45.89 +/- 32.65 ml, m +/- 1 SD) than in patients with non cirrhotic liver disease (25.31 +/- 14.08 ml) and in control subjects (21.28 +/- 10.30 ml) (P less than 0.001), but there was a great overlap between individual results in each group. No relationship was found between gallbladder volume and all clinical and biological tested parameters, except for decreased prothrombin time (P less than 0.02). Further studies are necessary to consider this ultrasound sign as an useful diagnostic tool in cirrhosis.

[Cavernous lymphangioma of the liver. A report of 2 cases and review of the literature]. / Lymphangiome caverneux du foie. Etude de 2 cas et revue de la littérature.

The authors report 2 cases of hepatic lymphangioma observed in a 54-year-old woman, and in a 39-year-old man. These tumors were discovered upon ultrasound examination performed for jaundice due to viral hepatitis, and for abdominal right upper quadrant pain respectively. Computed tomography and angiography showed hypervascularized tumors. Diagnosis was established through surgical biopsy specimens. The clinical course was uneventful, during respectively the 9- and 3-year follow-up periods, respectively. From these and the 40 previously reported cases, the authors describe the different features of this unusual tumor.

[Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis]. / Biopsies d'un rectum et d'un côlon endoscopiquement normaux: une nécessité. Fréquence de la colite collagène et de la colite microscopique.

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.

[Hyperplastic gastric polyposis and familial colonic adenomas. Apropos of a case]. / Polypose gastrique hyperplasique et adénomes coliques familiaux. A propos d'un cas.

A case of gastric hyperplastic polyposis is reported in a 48-year old woman, with iron deficiency anemia. An hyperplastic gastric polyposis was discovered. This patient had been operated 17 years previously for a large adenomatous polyp of the caecum. Her son had also several adenomatous polyps of the right colon. A gastrectomy was performed. Hyperplastic gastric polyposis is very rare, and is quite always associated with colorectal adenomas. The relationship between gastric hyperplastic polyposis and intestinal polyposis is not quite clear.

[Interobserver and intercenter agreement of gastro-esophageal endoscopic signs in cirrhosis. Results of a prospective multicenter study]. / Concordance inter-observateurs inter-centres des signes endoscopiques gastro-oesophagiens au cours de la cirrhose. Résultats d'une étude prospective multicentrique.

Because of the diagnostic and prognostic value of gastroesophageal endoscopic signs in cirrhosis, we studied their interobserver and intercenter agreement. Fifty cirrhotic patients without previous digestive bleeding were included in this study. The gastroesophageal endoscopic examinations of these patients, recorded on video tape, were independently viewed by 12 observers belonging to different hospitals. Agreement was evaluated by the kappa index (k), the values of which were given with p less than 0.001. Agreement was good for the presence (k = 0.40) or the size (k = 0.51) of esophageal varices as well as for red signs on the mucosa overlying esophageal varices, but it was poor for the color (k = 0.10) or the extent (k = 0.20) of esophageal varices. Agreement was poor for all gastric signs: fundic varices (k = 0.35), red spots (k = 0.28), associated lesions (k = 0.27), mosaic pattern (k = 0.27), gastropathy (k = 0.11). The mean diameter of esophageal varices, evaluated without any scale, varied from 3.5 +/- 1.4 to 7.5 +/- 4.0 mm between the 12 observers (p less than 0.001). Agreement was maximum for the more developed grade of a sign and minimum for the intermediate grade. The value of kappa indexes in this intercenter study was compared to that obtained in a previous study from one institution: interobserver agreement was significantly better within one center than between different centers. In conclusion, intercenter agreement is good for the size of esophageal varices and the presence of red signs, and poor for all the other signs. The millemetric measurement of esophageal varices diameter, without any scale, appears to be unreliable.(ABSTRACT TRUNCATED AT 250 WORDS)

[Endoscopic sclerotherapy of hemorrhagic esophageal varices. 86 cases]. / Sclérose endoscopique des varices oesophagiennes hémorragiques. 86 observations.

OBJECTIVES: Haemorrhage due to rupture of oesophageal varices is a major cause of death in patients with cirrhosis. We evaluated retrospectively our results with endoscopic sclerosis in order to evaluate recurrence, compliance and long-term survival. METHODS: Endoscopic sclerosis was performed with a flexible endoscope in 86 patients from 1986 to 1989. Ninety-nine percent of the patients had cirrhosis; they were equally distributed in the 3 Child-Pugh classes. Sclerosis was performed once a week for three weeks then once every 3 weeks until eradication. Sessions was performed during an episode of haemorrhage in 17 patients and begun after bleeding had stopped in 69 others. Mean clinical follow-up was 24 +/- 14 months and mean endoscopic follow-up, 19 +/- 15 months. RESULTS: The mean number of sessions was 5.3 +/- 3.5 (range 1-17) per patient. Haemostasis was obtained in 4 out of 17 patients treated in emergency situations. Eradication was attained in 50 patients (58%). Recurrent varices were observed in 28 of these 50 and recurrent bleeding in 13, leading to 2 deaths. Global mortality over the period studied was 36%: 24 patients died before eradication, 7 after and 2 due to extra-hepatic causes. More than two-thirds of the deaths occurred during the first 2 months, mainly after recurrent bleeding. Global actuarial survival was 70% at 12 months, 62% at 24 months and 56% at 36 months. There was a significant difference in actuarial survival between Child-Pugh classes A and B patients and Child-Pugh class C patients. CONCLUSION: Our experience and the data in the literature indicate that sclerosis can be beneficial in patients with haemorrhagic oesophageal varices, but must be carried out within the framework of comprehensive care and follow-up.