[Epiploic appendagitis: report of a case]. / Appendagite épiploïque primitive : à propos d'un cas.

Primary epiploic appendagitis are considered to be a rare cause of acute abdomen. They are frequently misdiagnosed as either acute appendicitis or acute diverticulitis and the diagnosis is usually made during surgery. We report a case in which computed tomography (CT) suggested the diagnosis and helped in avoiding unnecessary surgery.

Factors predictive of complicated or severe alcohol withdrawal in alcohol dependent inpatients.

OBJECTIVE: In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management. METHODS: Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score. RESULT: The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6+/-10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p=0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1+/-44.4 UI/L versus 78.4+/-11.8 UI/L; p=0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8. In conclusion, severe alcohol withdrawal (Cushman score>or=8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.

[A case of acquired angioedema]. / Un cas d'oedème angioneurotique acquis.

We report the case of a 46 year-old woman presenting an acquired angioedema. Angioedema is an C1 inhibitor deficiency. Patients present recurrent non inflammatory swelling of the head and extremities and recurrent attacks of severe abdominal pain. This clinical presentation is non specific : investigation of complement is useful for diagnosis. Laboratory testing show low serum levels of C4 with normal levels of C3. Low C1 esterase inhibitor confirm the diagnosis. If acquired angioedema, a cause must be searched.

[Chronic diarrhea due to lymphocytic colitis treated with piroxicam beta cyclodextrin]. / Diarrhée chronique secondaire à la prise de piroxicam beta-cyclodextrine associée à une colite lymphocytaire.

BACKGROUND: Lymphocytic colitis is a chronic diarrhea syndrome with no endoscopically detectable anomaly and histological colonic lesions. CASE REPORT: A 52-year-old woman was hospitalized for chronic diarrhea. She experienced 10 to 30 liquid bowel movements per day. Symptoms had begun 8 days after taking piroxicam fl-cyclodextrin. Intraepithelial cell counts on rectum and colon endoscopic biopsies showed more than 20% lymphocytes, giving the diagnosis of lymphocytic colitis. The patient was given 5ASA 3 g/24 h. Symptoms regressed in less than one week. DISCUSSION: Lymphocytic colitis is uncommon. The cause remains unknown but a secondary autoimmune mechanism triggered by drugs has been suggested. This case would implicate nonsteroidal antiinflammatory drugs. Certain authors have demonstrated that they can be involved in the development of collagen colitis.

[Mesenteric cystic lymphangioma]. / Lymphangiome kystique mésentérique.

BACKGROUND: Cystic lymphangioma is an uncommon congenital malformation usually encountered in children and often discovered fortuitously. CASE REPORT: A 46-year-old man was hospitalized for acute alcoholic hepatitis with edematoascitic decompensation. The abdominal and pelvic CT scan showed homogeneous hepatomegaly and a tumoral process involving the terminal ileal loops without signs of occlusion or node enlargement. Pathology reported benign mesenteric multicystic lymphangioma. DISCUSSION: Cystic lymphangiomas account for 7% of all intra-abdominal cystic formations. The ileal localization predominates with little or no clinical expression. Ultrasonography and CT scan provide complementary information on the relations with other organs. Magnetic resonance imaging is currently the gold standard allowing precise diagnosis of the anatomic relations and identifying intracystic hemorrhage. The pathology examination is required to eliminate possible benign multicystic mesothelioma which may occasionally take on an aggressive form. Complete surgical excision provides cure.

[Cystic dystrophia of the duodenal wall with aberrant pancreas. Value of magnetic resonance imaging for diagnosis]. / Dystrophie kystique de la paroi duodénale sur pancréas aberrant. Intérêt de l'imagerie par résonance magnétique pour le diagnostic.

BACKGROUND: Cystic dystrophy of the duodenal wall is characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal wall. Diagnosis is difficult and endosonography is considered as the most useful investigation. CASE REPORTS: A 40-year-old man was hospitalized for abdominal pain triggered by ingestion of alcoholic beverages and for vomiting after food intake. The diagnosis of acute atypical cephalic pancreatitis was initially made. Magnetic resonance cholangiography then magnetic resonance imaging suggested the diagnosis of cystic dystrophy of the duodenal wall in a heterotopic pancreas which was confirmed by endosonography. DISCUSSION: Magnetic resonance imaging evidenced several cystic formations within a thickened duodenal wall leading to the correct diagnosis. MRI appears to provide all the elements necessary for the diagnosis of cystic dystrophy of the duodenal wall, avoiding the need for invasive investigations.

[Diabetes and travel]. / Diabète et voyages.

With the continuing expansion in international air travel, increasing numbers of diabetic patients consult physicians for advice before going abroad. Careful planning is required taking into account climatic and medical conditions at the destination. Diabetic travelers should pack an appropriate treatment kit and contract special insurance coverage for medical evacuation. Precautions are necessary to limit the effects of motion sickness and time differences on diabetes control and especially the risk of hypoglycemia. Special attention is needed to avoid digestive problems and prevent foot injuries which can lead to serious complications in diabetic patients. Diabetic patients cannot forget their health problem during vacation and must be especially cautious when traveling. However with proper training, the risks of foreign travel can be reduced to acceptable levels.

[Diabetes in Cameroon. Classification difficulties in Africa]. / Etude du diabète au Cameroun. Les difficultés de classification en Afrique.

Diabetes is a major health problem in Africa where management is complicated by poor socioeconomic conditions. Atypical presentations of diabetes appear to be common in tropical countries although there is still little accurate data in this regard. We describe 550 diabetic patients treated in Cameroon between December 1990 and July 1994. According to WHO criteria 136 of these patients (24.7%) were classified as insulin-dependent (IDDM), 405 (73.5%) as non-insulin-dependent (NIDDM), and 9 as secondary diabetes (1.6%) related to other diseases. There were no cases of malnutrition-related diabetes but 18 patients (3%) met the criteria for "African diabetes" defined by Cuisinier-Raynal. Study of this cohort revealed several differences with diabetic populations in industrialized countries. Insulin-dependent diabetes was observed in all age groups with a mean age of onset 40.0 +/- 14.8 years which is close to the mean age of onset of non-insulin-dependent diabetes (49 +/- 10.9 years). The overall M/F sex ratio was 1.63 demonstrating a clear-cut male predominance. There was a high incidence of non-insulin-dependent diabetes in young, non-obese subjects. In many cases classification was difficult because insulin requirements fluctuated greatly. The incidence of obesity in non-insulin-dependent diabetic patients was lower than in industrialized countries. These findings suggest the existence of a tropical diabetes syndrome unrelated to malnutrition. Thus African diabetes appears to be another aspect of the disease which has a variety of heterogeneous etiologic features that cannot be classified on the basis of available data. The current WHO system does not take atypical African diabetes into account.