[Acute hepatopathy caused by amiodarone. Study of a case and review of the literature]. / Hépatopathie aiguä due à l'amiodarone. Etude d'un cas et revue de la littérature.

The authors report the case of a non-alcoholic 73-year-old man, treated for arrhythmia with amiodarone for 2 months, and hospitalized because of jaundice and hepatomegaly. There was an important increase in serum alkaline phosphatase activity (4 times the normal value) and a moderate increase in the serum activity of transaminases (3-4 times the normal value). Endoscopic retrograde cholangiography was normal. Serum markers of virus B and tissue antibodies were absent. Histological examination of a liver specimen disclosed portal and periportal fibrosis, mixed inflammatory infiltrate of the portal spaces, and ductular proliferation. Lamellar lysosomal inclusions were demonstrated on electron microscopy. Outcome was favorable after withdrawal of amiodarone. This report, as well as the 7 previously published cases, cannot explain the pathogenesis of amiodarone-induced liver changes.

[Massive hepatic steatosis disclosing adult celiac disease. Study of a case and review of the literature]. / Stéatose hépatique massive révélatrice d'une maladie coeliaque de l'adulte. Etude d'un cas et revue de la littérature.

The authors report the case of a 32-year old woman admitted for hepatomegaly, weight loss, and moderate diarrhea. Liver function tests showed anicteric cholestasis with slight increase in serum level of transaminases. Liver biopsy demonstrated massive steatosis. Biological and radiological investigations of the small intestine showed a malabsorption pattern. Stool fat excretion was 54 g per day. Duodenal biopsies disclosed total villous atrophy. A ten-day treatment with metronidazole (1,5 g per day), followed by a gluten-free diet, resulted in rapid improvement of hepatic and intestinal symptoms. This case report shows that: 1) adult celiac disease may be the cause of severe steatosis; 2) anicteric cholestasis with or without hepatomegaly during the course of adult celiac disease may be secondary to steatosis, as well as primary biliary cirrhosis or malignant infiltration of the liver; 3) bacterial overgrowth should be searched and eventually treated in the case of massive fatty liver occurring in adult celiac disease.

[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.

[Xanthogranulomatous cholecystitis. X-ray computed tomographic study of a pseudotumoral form]. / Cholécystite xanthogranulomateuse. Etude scanographique d'une forme pseudo-tumorale.

The authors report a case of xanthogranulomatous cholecystitis in a 63-year-old woman hospitalized because of a right hypochondrium mass. Ultrasonography, computed tomography, and celiac arteriogram showed a gallbladder tumour. Surgical management allowed subtotal tumour resection. Diagnosis of xanthogranulomatous cholecystitis was established by histological examination. Twenty-two months later, patient is in good health. From this observation and a world-wide literature review (90 previously reported cases), the authors analyse the clinical, pathological, and pathophysiological features of this very unusual entity.

[Nodular regenerative hyperplasia of the liver. Study of 15 cases and review of the literature]. / L'hyperplasie nodulaire régénérative du foie. Etude de 15 cas et revue de la littérature.

The authors report 15 cases of nodular regenerative hyperplasia (NRH) of the liver observed in 10 women and 5 men during a 9 year period. Gastrointestinal bleeding due to ruptured esophageal varices revealed the liver disease in 11 cases. Hepatomegaly and splenomegaly were noted in 9 cases and ascites in 7. Anicteric cholestasis was demonstrated in 10 cases. Another disease, e. g. myelofibrosis and monoclonal gammapathy, was present in 11 patients. In 10 patients, portal diversion was performed; outcome being favorable with a follow-up of one to six years. The analysis of these cases and of the 113 previously published reports calls for the following comments: 1) In most cases, NRH is characterized by small-sized hepatocytic nodules scattered throughout the entire liver with no surrounding fibrosis; however this histological pattern may vary somewhat, with adjacent normal zones being found adjacent to typical cirrhotic fibrosis; although a precise morphometric study was not performed in our patients, obstruction of the tiny branches of intrahepatic portal veins was not observed. 2) Histological diagnosis of NRH is difficult and in most cases requires surgical biopsy specimens and specific coloration of the reticulin network. 3) NRH must be considered as a new cause of intrahepatic (sinusoidal or presinusoidal) portal hypertension and/or of chronic anicteric cholestasis. 4) A number of various conditions may be associated with NRH, the most frequent being Felty's syndrome and myeloproliferative disorders. 5) The pathogenesis of NRH remains unknown. 6) Portal diversion generally has a favorable outcome in this disease.

[Adenocarcinoma of the rete testis. Review of the literature apropos of a new case]. / L'adénocarcinome du rete testis. Revue de la littérature à propos d'une nouvelle observation.

The authors report the case of a 66 year old man with a Boden stage I adenocarcinoma of the rete testis treated by orchiectomy and adjuvant chemotherapy. Lung metastases developed 46 months later and were responsible for death despite further chemotherapy. Adenocarcinoma of the rete testis is an exceptional tumour, as only 23 cases satisfying the criteria defined by Feek and Hunter have been reported in the literature. The prognosis is poor even in the apparently localized forms (5 year survival less than 25%) and local recurrences and lung and/or hepatic metastases are frequent. Radiotherapy and chemotherapy appear to have little value.

[Focal nodular hyperplasia of the liver discovered and biopsied during hysterectomy for fibroids secondarily treated by paramendian bisectoriectomy with cure for more than one year (author's transl)]. / Hyperplasie nodulaire focale du foie traitée par bisectoriectomie paramédiane.

The authors emphasise the necessity for rigourous criteria of histological identification, the basis of the therapeutic decision; the risk on onset of hemoperitoneum suggests radical treatment before the compliction, considering the operative risk, in relation to the site of the lesions and their macroscopic appearance. The notion of rareness and the histogenesis of the disease are also considered.

Reflections on the concept of basic needs and primary health care.

PIP: The notion or concept of need has different meanings according to the individual groups or ages to which it is applied. A need is something which man subjectively feels an urge to satisfy. Basic or primary needs are the minimum vital requirements which must be met to ensure dignified human existence. Basic needs relate both to individuals and communities. Although the needs of individuals and communities are contingent, they are not necessarily in harmony. One of the principal goals of socioeconomic development in general and health care development in particular is the satisfaction of the basic needs of the greatest number of people. Growth-oriented strategies have so far failed to reduce inequalities and physical, mental, and social destitution. Development strategies focusing on basic needs must: 1) eliminate social inequalities; 2) include coherent programs of activities relating to basic needs; and 3) undergo radical structural changes (a social revolution in community health). Promotion of health care for the most underprivileged segments of society necessitate: 1) production of goods necessary for the satisfaction of basic needs such as building materials or essential medicines; 2) construction of country roads; and 3) development of programs of rural health, water supply, literacy, and housing. Primary health care is essential care which is fundamental to basic needs. Policies, strategies, and plans of action should be formulated in order to develop primary health care. An excellent means of implementing primary health care is the choice of appropriate technology for health care. Choosing the appropriate technology for development entails finding the right balance between labor-intensive and capital-intensive technology; it should be the result of combining knowledge and practices which help improve the physical, mental, and social well-being of individuals, families, and communities. In most rural populations of the world, infections and epidemic and endemic diseases are still very much a part of everyday living. Also, 80% of the rural populations are still far removed from health care technology. Now is the time for action because of widespread suffering of so many people.^ieng

[Granulomas caused by animal parasites]. / Les granulomes provoqués par les parasites animaux

Numerous animal parasites, protozoan, metazoan and in particular helminths, may cause a varied range of granulomatous lesions in man. Study of two examples, the leishmaniasis granuloma and the schistomiasis granuloma, would appear to indicate that reactions between the host and the parasite at various stages of its development are dependent upon facilitation or rejection phenomena in which both humoral and cellular mechanisms are involved. The appearance of the granuloma thus depends upon the reactional possibilities of the host. The lesions seen in these granulomas may be related to a certain number of basic processes: phenomenon of necrosis, of fibrosis, specific or non-specific reactions and allergic reactions which are processes also seen under other aetiological circumstances. Certain of them, in particular giant cell or epithelio-giant cell reactions and the tissue eosinophilia associated with helminthic infestations, the role of which is not clearly known, are suggestive of a parasitic aetiology but are in no way pathognomonic. Thee demonstration and identification of the parasite, sometimes difficult or even impossible, should take into account the geographical and epidemiological context, as well as the localisation of the lesions, and often require the pathologist to study serial sections, with special stains. The timely aid of the parasitologist or immunologist is often essential to the aetiological diagnosis of the granuloma.

Liver in obesity.

We report on clinical, nutritional, and hepatic histological findings in 50 non-selected obese subjects (mean overweight +74%; range +21-138%). The pathogenesis of the liver damage was assessed with the help of multidimensional analysis of a number of clinical variables. According to the severity of the hepatic lesions, the patients have been ranged in five groups: O (normal liver) 10%; I (fatty liver) 48%; II (fatty hepatitis) 26%; III (fatty fibrosis) 8%; IV (fatty cirrhosis) 8%. The more severe changes (groups III and IV) were constantly associated with excessive alcohol intake. The multidimensional analysis was unable to find a relationship between obesity and the development of fibrosis and cirrhosis whereas it showed that: (a) there was a highly significant correlation between the daily ethanol intake and the degree of overweight, (b) severe fatty metamorphosis was significantly associated with the degree of overweight, the existence of diabetes mellitus, and the amount of alcohol and fat intake, (c) nutritional factors, in particular deficient protein intake, have only an accessory effect in the development of mild inflammation and fibrosis, (d) the consumption of potentially hepatotoxic drugs, very high in the obese (about five drugs per day) could have a role in the development of cirrhosis. In conclusion in our study, there was no evidence that obesity per se could result in severe liver damage.

Leiomyoblastoma of the stomach: endoscopic treatment.

Since 1960, about 250 cases of leiomyoblastoma of the stomach have been reported. The diagnosis was always made after surgical resection or necropsy. We report the first case of gastric leiomyoblastoma successfully treated by endoscopic resection, in a 76-year-old woman presenting with upper gastrointestinal bleeding. This therapeutic procedure would seem to be the one of choice, in view of the age of the patient, the limited size and the pedunculated form of the tumor. Endoscopic follow-up should be instituted since local recurrence of the tumor and distal metastases have been reported.

[Diffuse inverted micropapillomatosis of the upper excretory tract. Apropos of a case. Review of the literature]. / La micropapillomatose inversée diffuse de la voie excrétrice supérieure. A propos d'un cas. Revue de la littérature.

We have reported diffuse endophytic lesions that we have defined as being an inverted micropapillomatosis. There are benign proliferative lesions that we can classify between the Von Brunn nets and the other proliferative urothelial lesions.

Mucosal bridges of the upper esophagus after radiotherapy for Hodgkin's disease.

A 47-yr-old man presented with dysphagia 4 yr after mediastinal radiotherapy for Hodgkin's disease. X-ray series, fiberoptic endoscopy, and computerized transverse tomography showed mucosal bridges in the upper esophagus. Histologically, these bridges were constituted from normal epithelium overlying a chronic inflammatory lamina propria, without evidence of Hodgkin's disease recurrence or of squamous cell carcinoma. Swallowing was improved by endoscopic electrocoagulation and Eder-Puestow dilatations. Several arguments favor the hypothesis that these mucosal bridges were the late sequelae of radiation esophagitis.

A case/control study of the association between primary liver cancer and hepatitis B infection in Senegal.

A case/control study has been carried out to determine by radioimmunoassay and passive hemagglutination techniques the prevalence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) in patients with primary liver cancer (PLC) and age/sex-matched hospital controls with cancers of other sites (OCC) and similarly matched controls without cancer (NCC). HBsAg was found in 61.2% of 165 cases of PLC as compared to 11.7% of 328 NCC. The frequency of HBsAg in PLC patients was significantly higher (72.2%) in those with detectable alpha fetoprotein as compared to those without (40.3%). There was no difference in the frequency of HBsAg in PLC patients with and without accompanying cirrhosis. No significant difference in potential hepatitis exposure history was found in the three study groups.