[A case of chronic ischemic erosive gastropathy healed after surgical revascularization]. / Un cas de gastropathie érosive chronique ischémique cicatrisée après revascularisation chirurgicale.

A case of chronic ischemic erosive gastropathy secondary to chronic abdominal vascular insufficiency is reported. This gastropathy healed after revascularization procedure but then recurred after stenosis of the aortomesenteric graft. The clinical picture was characterized by post-prandial abdominal pain, weight loss and an abdominal bruit. The upper gastrointestinal endoscopy showed multiple non hemorrhagic antral erosions with irregular outlines and a pseudomembranous floor. Reduction of the resistance of the gastric mucosal barrier by a chronic decrease of mucosal blood flow probably accounted for the gastric erosions. Although the prevalence is unknown, ischemic injury to the stomach is unexpected, because of the rich collateral circulation of this organ. Increased awareness of the disease and its prognostic implications should lead to suggest abdominal vascular insufficiency based on their clinical and gastroscopic aspects, thus leading to operation before acute mesenteric infarction occurs.

[Therapeutic strategy in the treatment of gastroesophageal reflux]. / Stratégie thérapeutique dans le traitement du reflux gastro-oesophagien.

Management of gastro-oesophageal reflux disease depends on the importance attached by the physician to symptoms and to risk of complications, ie: stricture, haemorrhage, operation- and drug-hazards. A patient who suffers rarely and during short periods could require dietary and postural recommendations and the use of the following drugs: antacids, alginates, prokinetic agents and/or H2-receptor antagonists. We consider that the rarity of stricture rules out the necessity of any change in management, whether or not erosive oesophagitis is observed at endoscopy. Most patients are treated with these drugs. On the other hand, when symptoms are frequent and occur daily and especially at night and when H2-receptor antagonists fail to relieve the pain, a more potent drug such as omeprazole is to be administered. The same applies to patients running the risk of haemorrhage resulting from anticoagulant coexisting therapy, the later condition requiring the lesions to be healed and relapse prevented. In the long run, the choice between a drug (H2-receptor antagonist or omeprazole) taken daily and surgery can be debated. Even when a stricture is present surgery is no longer necessary due to failure of conservative management. The decision depends on the operation-linked risks relative to the patient's condition and on his or her compliance to daily drug-administration. Respiratory or ENT complications are often difficult to alleviate by H2-receptor antagonists and may need to be treated with omeprazole.

[Ultrasound-guided fine-needle punctures of abdominal masses: cytology or histology? Comparative prospective study]. / Ponctions échoguidées de masses abdominales à l'aiguille fine: cytologie ou histologie? Etude comparative prospective.

The aim of this study has been for one part to assess the obtaining of cytological and histological material from the same patients with the minimum amount of injections using a fine needle (diameter less than 1 mm) and also to evaluate the histological and cytological supply, individually and jointly in the diagnosis of abdominal tumors. Seventy lesions of which 58 hepatic have been punctured with fine needles of 20 (0.9 mm) to 22 G (0.7 mm). Material has been obtained in 98.6 per cent of cases for cytology and 54 per cent of cases for histology. Their respective sensitivity in the diagnosis of malignant tumors was 96.8 per cent and 86.8 per cent and was not improved by adjoint analysis. The specificity was 1 for cytology. The differential diagnosis in malignant hepatic tumors between hepatocarcinoma and metastasis was existent in 94.3 per cent of cases for cytology and 90 per cent for histology with no benefit coming from the association of two. In the group having hepatic metastasis without known primary cancer having found histological confirmation of the primary lesion, the cellular type has been revealed in exactitude in 94.4 per cent of cases with cytology and in 63.6 per cent with histology. No complications have been observed. The fine needle cytological aspiration ponction gives very satisfying results, comparable with regard to the diagnosis contribution to results of published studies, obtained with the use of coarse needle biopies. We suggest that fine needle ponction should be used preferentially and that coarse needle biopsy should be restricted to the few cases in which the former does not yield sufficient information.

[A case of Whipple's disease with ankylosing spondylarthritis treated with trimethoprim-sulfamethoxazole]. / Un cas de maladie de Whipple avec spondylarthrite ankylosante traité par triméthoprime-sulfaméthoxazole.

We report the case of a patient, suffering from Whipple's disease and HLA B27 positive ankylosing spondylitis with syndesmophytes and erosive discopathy. Since spinal radiographic aspects of spondylitis due to Whipple's disease are unusual, we are debating on their relation. We, then, took an interest in the treatment given to this patient: trimethoprim-sulfamethoxazole which would now appear to be the best antibiotic for Whipple's disease.