[Evaluation by endoscopic biopsies, of the histological criteria of reflux esophagitis]. / Evaluation sur biopsies endoscopiques des critères histologiques d'oesophagite par reflux.

Histologic criteria of esophagitis and/or gastroesophageal reflux have been described in suction biopsy specimens which are easy to orient for perpendicular section of the mucosal surface. The aim of this study was to reassess the currently accepted criteria in guided endoscopic pinch biopsy specimens obtained from esophageal erosions. Epithelium of each sample was stained by Lugol's solution in order to be able to spread the specimen out flat and orient it before fixation. Of 92 biopsies nine were composed of granulation tissue and were excluded from the study. Of the remaining 83 biopsy specimens, 74 (89.2 p. 100) from 66 patients were properly oriented. Of these 74.65 (87.8 p. 100) from 57 patients contained lamina propria. Combination of the 2 epithelial criteria, i.e. papillary height and basal cell zone thickness greater than 50 p. 100 and 14 p. 100 of total epithelial thickness, respectively, were recorded in only 58 p. 100 of 66 patients. Nevertheless, the mean papillary height and the mean basal cell layer thickness were 64 p. 100 and 19 p. 100 of total epithelial thickness, respectively. Infiltration of the lamina propria by neutrophilic and/or eosinophilic granulocytes were recorded in 32 of 57 patients (56 p. 100) and only in 48 p. 100 of biopsy specimens which did not display any epithelial defect. Combination of pathologic changes in epithelium and lamina propria were observed in only 32 p. 100 of the patients and were not more frequent than expected on the basis of a chance association. We conclude that histologic criteria have a low sensitivity even in patients with erosive esophagitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoembryonic antigen in ascites and pleural effusions]. / Antigène carcino-embryonnaire dans les ascites et les épanchements pleuraux.

The purpose of this prospective study was to evaluate the usefulness of carcinoembryonic antigen (CEA) assays in effusion fluids for the diagnosis of cancer. From 1978 to 1981, 63 patients totaling 67 effusions were investigated for malignant cells and CEA concentrations. There were 62 cases of ascites and 5 cases of pleural effusion resulting from 35 cirrhoses and 28 cancers, including 17 adenocarcinomas. Macroscopic examination of serous membranes was possible in 24 patients. CEA concentrations at least 4 times higher than the upper limit of normal laboratory values were required to diagnose malignancy in effusions. The specificity of both cytology and CEA assays was 100 p. 100 in cirrhotic ascites. Malignant cells were present in 14 cases and positive CEA levels in 19 cases. CEA concentrations were highly significant (p less than 0.001) of cancerous effusions due to adenocarcinomas. In cancers other than adenocarcinoma and in hepatocarcinoma, CEA assays did not prove useful, and cytological examination remained the best diagnostic method. Both cytology and CEA levels were positive for malignancy in 11 effusions, and a diagnosis of cancer could be made on these grounds in 22 out 28 cases. Lack of correlation between CEA concentrations in sera and in effusion fluids suggests local production consecutive to invasion of the serous membranes. All 8 adenocarcinoma patients with grossly detectable extension to the peritoneum had high CEA concentrations, but malignant cells were absent in 4 cases. This discrepancy might tentatively be explained by local dissemination via the lymphatic system without disruption of the membrane but resulting in reflux of CEA into the effusion fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

[Protective effect of appendectomy on the development of ulcerative colitis. A case-control study]. / Effet protecteur de l'appendicectomie contre la rectocolite hémorragique.

AIMS: To examine by a case-control study the relationship between appendectomy and subsequent ulcerative colitis development in a French population. METHODS: A total of 150 patients with ulcerative colitis were matched for age (+/- 5 years) and sex, with 150 controls recruited in a preventive medicine center. The following data were collected from medical records and by standardised questionnaire in consultation or by phone: appendectomy and tonsillectomy before the onset of ulcerative colitis, smoking habits and area of residence. RESULTS: The rate of previous appendectomy in patients with ulcerative colitis was 8% (12/150) compared with 30.6% (46/150) in the control group (P=0.001). There was no significant association between ulcerative colitis and tonsillectomy (25.3 and 27.3% in the control and the ulcerative colitis groups, respectively). Smoking was more frequent in the control group (36%) than in the ulcerative colitis group (25.3%) but the difference was not significant (P=0.07). In multivariate analysis, the risk of developing ulcerative colitis was significantly lower after previous appendectomy (odds ratio=0.26; 95% confidence interval: 0.13-0.55; P=7 x 10(-4)). CONCLUSION: Our study confirms the inverse association between appendectomy and subsequent ulcerative colitis, in a French population, after adjusting on smoking.