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Resume L’allergie a l’albumine serique d’origine animale est une affection frequente, nettement sous-diagnostiquee actuellement. Les voies de sensibilisation a cette proteine sont multiples etant donnee sa presence ubiquitaire dans les fluides biologiques. L’allergie a l’albumine contenue dans la viande de bœuf est la plus souvent rapportee et est frequemment croisee avec les autres viandes. Les manifestations cliniques sont variees : diarrhee recurrente, dermatite atopique, syndrome oral, voire angio-œdeme ou choc anaphylactique. L’albumine contenue dans les phaneres des chats ou des chiens peut etre responsable d’une rhinite ou d’un asthme. Les allergies croisees sont frequentes, comme le classique syndrome porc-chat, mais aussi entre les œufs et le lait ou les volailles. Le diagnostic est confirme par tests epicutanes avec l’albumine pure et/ou par la recherche d’anticorps IgE specifiques. Selon la symptomatologie, le traitement pourra consister en la cuisson attentive des aliments, l’eviction des contacts avec les chats ou les chiens ou en un traitement symptomatique.

A duplication cyst of the gastric antrum was diagnosed in a 35-year man after recurring attacks of acute pancreatitis. The patient was operated on with the preoperative diagnosis of cystic dystrophy on aberrant pancreatic tissue of the antrum wall. Diagnosis of duplication was established on pathologic examination of antrectomy specimen. A review of the literature about gastric duplication is performed.

Dos terceras partes de los casos de cirrosis se descubren en el estadio de las complicaciones; un diagnostico precoz permite la instauracion de un tratamiento etiologico y una prevencion eficaz de las complicaciones hemorragicas. En presencia de un higado duro y de una tasa de protrombina (TP) inferior al 85 %, el diagnostico de cirrosis puede confirmarse por la existencia de varices o por la biopsia hepatica.

Recently, we developed a new method to measure collateral blood flow in rats: splenorenal shunt (SRS) blood flow (BF). The aims were to evaluate the reproducibility of SRSBF measurement in different models of portal hypertension, and to investigate the ability of SRSBF to disclose pharmacological changes.Hemodynamics were determined in anesthetized rats with secondary biliary, CCl4 or DMNA cirrhosis and portal vein ligation (PVL) under baseline and pharmacological (octreotide, vapreotide) conditions. The main measurements performed were: SRSBF by the transit time ultrasound (TTU) method and % portosystemic shunts (PSS) by the microsphere method.SRSBF was 6 to 10 times higher in portal hypertensive rats and was similar in the different models of cirrhosis but was higher in portal vein ligated rats than in cirrhotic rats (1.1+/-0.7 vs 0.6+/-0.7 ml x min(-1) x 100 g(-1), p=0.01). SRSBF was correlated with mesenteric %PSS (r=0.61, p0.01), splenic %PSS (r=0.54, p0.05), portal pressure (r= 0.32, p0.05) and the area of liver fibrosis (r=0.33, p0.05). Octreotide significantly decreased SRSBF (-23+/-20%, p0.01 vs placebo: -6+/-8%, NS). Vapreotide significantly decreased SRSBF but not mesenteric or splenic %PSS compared to placebo. The variations in SRSBF (-26+/-32%) and in splenic %PSS (0+/-15%) with vapreotide were significantly different (p0.05) and not correlated (r=-0.1, NS).Determination of SRSBF by TTU is an accurate way to measure collateral blood flow in different models of intra- and extra-hepatic portal hypertension in rats. Its sensitivity provides accurate measurement of pharmacological changes, unlike the traditional estimation of %PSS by the microsphere method.

We report the case of a cirrhotic patient with a hepatocellular carcinoma and a synchronous hepatic metastasis of a colorectal cancer, both visualized on a positron emission tomography (PET) and a CT scanner. We repeat the need for the arterial phase on CT scanner when a possibility of cirrhosis exists, even in the follow-up of a colorectal cancer. We detail the usual pattern of HCC and the present efficacy of the PET in the diagnosis of HCC.

Our aim was to study the antifibrotic and hemodynamic effects of simvastatin (SMV), pentoxifylline (PTX) and spironolactone (SPN), three drugs which may have antifibrotic and/or portal hypotensive properties, in a model of hepatic fibrosis and portal hypertension induced in rats by bile duct ligation. A blind study was performed in five groups of 53 Sprague-Dawley rats: sham, placebo (PL), SMV (2.5 mg x kg(-1) x J(-1)), PTX (50 mg x kg(-1) x J(-1)) and SPN (100 mg x kg(-1) x J(-1)). Drugs were administered by daily gavage over a 4-week period as soon as bile duct ligation was performed. At day 28, the following parameters were evaluated: area of hepatic fibrosis by image analysis after staining collagen with picrosirius and plasma concentrations of hyaluronate, splanchnic and systemic hemodynamics (radiolabeled microspheres).Portal venous pressure (PL: 15.5+/-1.5, SMV: 15.8+/-2.5, PTX: 15.9+/-1.8, SPN: 13.5+/-2.1 mmHg, p0.05) and porto-systemic shunts (PL: 30+/-31, SMV: 18+/-27, PTX: 25+/-24, SPN: 5+/-4%, p0.05) were significantly reduced in the SPN group; other hemodynamic parameters were not significantly altered. There was a significant correlation between portosystemic shunts and portal pressure (r(s)=0.47, p0.01). The area of fibrosis was not significantly different among the four groups of bile duct ligated rats (PL: 8.7+/-3.9, SMV: 7.1+/-3.6, PTX: 7.8+/-2.7, SPN: 6.6+/-3.3%) but was higher than in sham rats (1.5+/-0.5%, p0.001). Hyaluronate was significantly higher in bile duct ligated rats (from 374+/-162 to 420+/-131 microg/l, among the four groups) than in sham rats (52+/-16 microg/l, p0.0001).In this model, none of the drugs prevented hepatic fibrosis. On the other hand, spironolactone decreased portal pressure and prevented porto-systemic shunts. Therefore, this drug may have beneficial effects in patients with early portal hypertension.

Resume Introduction Nous decrivons un cas de lymphome malin non hodgkinien a cellules B apparu chez un malade atteint d'une hepatite chronique virale C traitee par interferon α. Exegese Certains virus pourraient etre a l'origine des lymphomes, tels le virus d'Epstein-Barr et le virus du lymphome malin a cellules T de type I et II. La survenue d'un lymphome a cellules B au cours de l'hepatite chronique virale C a ete rapportee et pourrait etre une consequence du tropisme lymphocytaire du virus de l'hepatite C. Conclusion Cette nouvelle association entre une infection par le virus de l'hepatite C et un lymphome malin non hodgkinien doit inciter a rechercher des signes en faveur d'un lymphome chez les malades atteints d'hepatite chronique virale C.

Objectifs Quantifier le debit sanguin azygos (DSAz) par IRM chez des patients cirrhotiques et evaluer la reponse hemodynamique au traitement pharmacologique par beta-bloquant. Materiels et methodes Les examens ont ete realises avec un imageur 1,5T, en utilisant une sequence 2D cine PC. Une premiere etude a compare le DSAz entre 2 groupes de patients, sans (n = 14) et avec cirrhose (n = 42), avec confrontation aux stades des varices œsophagiennes (VO). Une seconde etude a inclu 40 patients cirrhotiques, sans (n = 20) et avec (n = 20) un traitement par beta-bloquant (Pro-pranolol 160mg/jour). Le DSAz et le gradient porto-sus-hepatique, obtenu par voie trans jugulaire, etaient mesures avant puis 2 mois apres instauration du traitement. Resultats Etude 1 : Le DSAz etait significativement augmente dans le groupe de patients avec cirrhose (309 ± 162 ml vs 96 ± 37 ml, p Conclusion Nous confirmons l’interet de la mesure du DSAz par IRM chez les patients cirrhotiques. L’IRM pourrait etre une methode plus sensible que la mesure du gradient de pression sus hepatique pour l’evaluation des effets pharmacologiques du traitement par beta-bloquant.

Rationale Grass pollen injection immunotherapy (IT) is associated with a suppressive response mediated by IL-10 and TGF-β, inducing respectively IgG4 and IgA production. We assessed the IgA response in patients with severe seasonal rhinitis during a double-blind, placebo-controlled trial of grass pollen IT, and related the findings to TGF-β expression in the nasal mucosa. Methods Serum concentrations of IgA1, IgA2 and joining chain-containing IgA antibodies to grass pollen (GP extract or Phl p 5 ) were measured by ELISA using specific monoclonal antibodies (and expressed as arbitrary units) before treatment and after 2 years of IT. TGF-β mRNA was assessed by in situ hybridization in nasal biopsies taken before and after 2 year IT. Results Serum IgA2 antibodies to GP were significantly increased after 2 years of IT as compared with placebo (median: 35.65, IQ range: 29.4-49.9 versus 8.15, 1-17.78, p U -test), as also observed for IgA2 to Phl p 5 . In contrast, IgA1 antibodies to GP were increased to a much lower extent and only at the peak pollen season. Mucosal-derived, joining chain-containing IgA to Phl p 5 was significantly increased after 2 years of IT as compared with placebo (108, 94.11-151.33 versus 80.22, 54.39-116.47, p=0.02). Moreover, levels of serum IgA2 antibodies to Phl p 5 significantly correlated with TGF-β expression in the nasal mucosa (p=0.01, r=0.60). Conclusions The IgA response to grass pollen immunotherapy is mostly of the IgA2 subclass, and grass pollen-specific serum IgA2 antibodies could be, at least partly, produced within the nasal mucosa and associated with local TGF-β expression.

Effects of Rblockers and nitrates on arterial pressure and renal function are controversial in cirrhosis. Therefore, we studied these factors in 198 consecutive patients divided into 2 groups: Grl: treated patients (n=129); Gr2: apparied untreated patients (n=69). The predictive value of 31 baseline variables and 30 follow-up (FU) variables for the occurence of a decrease in arterial pressure (DAP: SAP l20 ltmol/I) was studied. Results: in Grl, 82% of patients were given propranolol. FU was similar in Grl (25~h24 mo) and Gr2 (30&32 mo, NS). Side effect occurence was 34% (24% were DAP or RD according to the clinician). However, the frequences of DAP and RD were not significantly different between Grl and Gr2. In Grl, independent predictive variables (Cox model) of DAP were: MAP (P=O.O3), and Child-Pugh score (P=O.O7) and that of RD were: body temperature (P=O.OOOl), baseline creatinine (P=O.OOl), diuretics (P=O.OOl), prothrombin index (P=O.O2), serum Na (P=O.O5) and BUN (P=O.O7). In Gr 1+2, the predictive variables were a) for DAP: FU decrease in hemoglobin (P=O.O04) and in body temperature (P=O.O4), baseline serum Na (P=O.O6) and treatment (P=O.O8); b) for RD: BUN (P=O.OOOl), body weight (P=O.O5), FU decrease in prothrombin index (P=O.Ol), diuretics (P=O.O6), and age (P=O.l). Conclusions: Clinicians overestimate the frequence of Bblocker side effects. Bblockers do not alter renal function but could decrease blood pressure. Besides, anemia and infection predict DAP; BUN, prothrombin, diuretics, weight, Na, age and infection predict RD. Ccl,-INDUCED LIVER INFLAMMATION AND NECROSIS IN