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The diffuse biliary or pancreatic papillomatosis is a rare pathology. Reported cases in the literature underscore the difficulties of preoperative diagnosis of these lesions, their extensive nature, their tendency to relapse, and their malignant potential. The case that we report differs by the isolated involvement of the biliary tract and by the increasing role of imaging (MRCP) for diagnosis and follow-up.

From January to December 1991, the portal venous system was evaluated by Doppler ultrasonography in 72 patients with liver cirrhosis. The objectives of this study were to evaluate the prevalence of spontaneous reversal of blood flow in the portal vein and to assess the relationship between Doppler ultrasound investigation and clinical, biochemical, endoscopic (70 patients), and endosonographic (44 patients) features. Reversed flow was quite frequent (alternating: 17%, permanent: 22%) and its prevalence did not differ in relation to age, sex, serum gammaglobulin concentration and Child-Pugh class. In patients with reversed portal venous flow, the prevalence of hepatic encephalopathy was higher (39% vs 13.5%, P0.05), but the prevalence of esophageal or gastric varices was not related to that pattern. Endosonography detected gastric wall abnormalities in a higher proportion of patients with reversed portal flow than in patients without it (P0.05). This study suggests that reversal of flow in the portal vein could play a role in the development of the gastric wall abnormalities in liver cirrhosis, which are detected by endosonography but not by endoscopy.

Samples from 64 consecutive resected colorectal polyps were preserved in liquid nitrogen and analyzed by flow cytometry to assess the nuclear DNA content, which was compared to the histopathologic findings. The frequency of aneuploidy in these nonselected polyps was 17.2%. There was a significant correlation between the diameter of the polyp and the frequency of aneuploidy (P = .04), with all aneuploid polyps being greater than or equal to 10 mm. Similarly, aneuploidy was significantly more frequent for polyps that were both greater than or equal 20 mm and showed at least severe dysplasia (P = .02). On the other hand, there was no correlation between the ploidy and the gross histopathologic type (tubular, tubulovillous or villous), and the proliferation index did not correlate with any of the parameters studied.

A 61-year-old man developed primary adenocarcinoma with skin invasion, at the ileostomy site 33 years after a proctocolectomy for ulcerative colitis. A total of eleven patients with ileostomy adenocarcinoma have been reported in the literature. Ten patients were treated surgically for ulcerative colitis and the other for adenomatous polyposis coli. The diagnosis of stomal malignancy was made 9 to 36 years after the ileostomy (mean interval, 22 years). The pathogenesis of the malignant growth is uncertain and several possibilities are discussed: stasis, severe chronic inflammation, colonic metaplasia and severe dysplasia of the ileal mucosa. When an ileostomy requires late revision for inflammatory changes, careful pathologic examination of the entire stoma and surrounding skin is essential.

This study was carried out in order to compare the accuracy of ultrasound and ultrasonically guided fine-needle aspiration biopsy in screening for tumoral hepatic syndrome in 206 patients. According to their different clinical presentations, patients were divided into 4 groups: 1: Documented cancer, 2: Hepatic cirrhosis, 3: Fortuitous ultrasonic detection, 4: Clinical hepatic tumor. Cytologic findings were divided into 4 types: benign, primary malignant tumor, secondary malignant tumor (with or without etiologic orientation) non significant result. The ultrasonic and cytologic results were retrospectively compared to definitive diagnosis which was known in 199 patients. No early or delayed complications related to fine-needle aspiration biopsy were recorded. Ultrasonic imaging globally suggested the final diagnosis in 116 patients (diagnostic precision: 58.2 percent) while the cytologic result corresponded to final diagnosis in 183 patients (diagnostic precision: 92.5 percent). Improved results by fine-needle aspiration biopsy with regard to ultrasound was recorded in each group, particularly in group 3; its diagnostic sensitivity was 92 percent for malignant lesions with 100 percent specificity and an excellent value in discriminating between their primitive or secondary nature. Fine-needle aspiration biopsy gave an exact etiologic orientation in half of cases with metastasis and helped to discover the primitive tumor in some patients when this was not known previously. We conclude that fine-needle aspiration biopsy is a simple, moderately invasive and accurate procedure in the diagnosis of hepatic lesions. As ultrasound alone is not suggestive, especially in the case of a fortuitous ultrasonic detection, fine-needle aspiration biopsy improves diagnostic precision.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 156 patients with endoscopically proven duodenal ulcers are randomized in a double-blind, multicentre trial comparing rioprostil, 300 micrograms b.d., with ranitidine, 150 mg b.d. With rioprostil, the cumulative healing rate by endoscopy is 73% at 4 weeks, and 87% at 6 weeks. With ranitidine it is 79% and 92%, respectively. There is no difference in the occurrence of pain after the two types of treatment, and the side effects are comparable in the two groups. These results show that rioprostil is probably as effective and safe as ranitidine in the treatment of duodenal ulcer.

This study is a multicentre, double-blind, double-dummy, two-way, parallel group comparison of the efficacy and safety of rioprostil and ranitidine in the treatment of active gastric ulcer. Ninety-one patients with gastric ulcer are randomly allocated to treatment with either rioprostil 300 micrograms b.d., or ranitidine, 150 mg b.d. The duration of treatment is 4 weeks, or 8 weeks for the patients who are improved but not healed at 4 weeks. Clinical, endoscopic and laboratory assessments are made before treatment, and after each treatment period. Therapeutic success is defined as complete endoscopic healing of the ulcer. At the end of the treatment period, either 4 or 8 weeks, healing rates are 69% in the rioprostil group, and 66% in the ranitidine group; this difference is not significant (p = 0.86). After the first 4 weeks of treatment the healing rates are 44% and 55% in the rioprostil and ranitidine groups, respectively. The incidence of adverse effects is 22% in the rioprostil group, and 7% in the ranitidine group (p = 0.036). Diarrhoea is the most common side effect (12%), but is usually intermittent and mild. We conclude that rioprostil, 300 micrograms b.d., for up to 8 weeks is as effective as ranitidine, 150 mg b.d., in the treatment of benign gastric ulcer.

This study was carried out in order to assess the accuracy of ultrasound in a) screening for hepatocellular carcinoma in patients hospitalized for cirrhosis and b) determining the possibility of hepatic resection. From January 1983 to January 1987, 492 patients with cirrhosis were investigated for hepatocellular carcinoma using clinical examination, serum alphafetoprotein measurement and ultrasound study. Four hundred and thirty-seven patients had alcohol-related cirrhosis (88.8 p. 100); ascites was found in 280 cases (56.9 p.100). Ultrasonography-guided aspiration cytology was performed whenever a tumor was found. Four hundred and nineteen patients underwent ultrasonography and alpha-fetoprotein chemistry. The diagnosis of hepatocellular carcinoma was confirmed in 66 of 419 patients (15.8 p. 100). Sixty of the 88 patients diagnosed as having tumor on ultrasound were found to have hepatocellular carcinoma. In 6 out of 66 patients (9.1 p. 100), the tumor was not identified by ultrasonography but the level of alphafetoprotein was high (greater than 1,000 ng/ml). Sixteen cancers (24.2 p. 100) were diagnosed by ultrasonography only. All patients were men with alcohol-related cirrhosis, their ages ranging from 52 to 82 years. The results of ultrasound investigation were: 8 solitary tumors, 5 multicentric tumors, 3 diffuse tumors. Only 2 of the 16 tumors were resectable. We conclude that ultrasound is an accurate procedure in the diagnosis of hepatocellular carcinoma associated with cirrhosis. However, in hospitalized patients, the value of screening for hepatocarcinoma is small because liver resection is often impossible due to the wide spread tumor involvement or advanced liver cirrhosis at the time of diagnosis. On the other hand, screening should be performed in patients with compensated cirrhosis.

In 1982, 13,866 deaths secondary to cirrhosis were reported. Between 1925 and 1982, the number of deaths increased by 163 p. 100. This overall change was observed gradually: profound drop in the cirrhosis mortality rate during the Second World War, increase between 1945 and 1967, stabilization between 1967 and 1975 and more pronounced decline from then on. Cirrhosis mortality rate per 100,000 increased from 9.17 to 28.21 (+208 p. 100) in males and from 3.63 to 10.38 (+186 p. 100) in females from 1945 to 1982. The increase was approximately the same whatever the age. A cohort effect was observed in both sexes. There were two successive waves of increased mortality separated by an interval of non augmentation for the cohorts born between 1906 and 1915 and between 1931 and 1940. Since 1967, mortality due to cirrhosis has stopped increasing in both sexes. These changes may be related to decreasing alcohol consumption in France, certainly one of the major objectives in present day health programs. Abrupt reduction of alcohol consumption should be followed by a dramatic fall in the number of deaths from cirrhosis. Progressive decline of consumption is possibly associated with a decrease in the incidence of the disease. In 2,000, the rate for cirrhosis mortality is expected to be the same as that observed in the middle of the 20th century.

Concerning two cases of biliary distomiasis, the authors describe the sonographic patterns leading to the ultrasonic diagnosis of this parasite. Gallbladder distomiasis appears as an echogenic, oval structure, without acoustic shadow. It characteristically displays mobility and variable shape. The aspect of common bile duct distomiasis is reported for the first time. It is a nonshadowing linear structure and however non specific.

Ultrasonically guided fine needle aspiration biopsy cytologies (external diameter inferior to 1 mm) were carried out in 28 patients with proved hepatocellular carcinoma. In all cases, the diagnosis of malignant involvement of the liver was firmly established by cytological examination. A correct diagnosis of hepatocellular carcinoma was made in 26 of 28 patients (sensitivity = 93%). The specificity of the procedure was 100%. No complications were observed. The present study shows that fine needle aspiration biopsy under ultrasound guidance is a safe and accurate diagnostic procedure in hepatocellular carcinoma even associated with cirrhosis.

The management of malignant colonic polyps removed by endoscopic polypectomy is a controversial subject. We reported a series of 81 patients with 82 malignant polyps removed by endoscopic polypectomy between 1977 and 1984. 15 polyps contained carcinoma in situ and were treated by endoscopic polypectomy alone. 36 polyps contained superficial cancer; 35 were treated by EP alone; 1 was treated by endoscopic polypectomy and colectomy. 26 polyps contained invasive carcinoma and 2 were classified as polypoid adenocarcinomas. 19 had clear resection margins at polypectomy and seven had involved resection margins: 17 were treated by endoscopic polypectomy alone, 9 were treated by endoscopic polypectomy and colectomy. The patients were followed with colonoscopy. Follow-up has been 6 to 74 months (mean 32 months). The patients whose polyps were treated by endoscopic polypectomy alone, had had no evidence of recurrent tumor at the polypectomy site. Of the 12 patients undergoing colectomy, 4 had residual tumor at the polypectomy site. No patients had involved lymph nodes. There was no evidence of recurrence in any of these cases. Polyps containing contained carcinoma in situ and superficial cancer, polyps containing invasive carcinoma and clear resection margins can be treated with endoscopic polypectomy alone. Polyps with invasive carcinoma and involved resection margins should undergo segmental colonic resection. This approach must be weighed against the age of the patient, the medical status and the morbidity and mortality of the surgical procedure.

Recent data concerning the mortality from oesophageal cancer by régions and départements in France are reported (around 5,000 deaths yearly). It was decided to investigate whether any time trend had become apparent and whether the correlation with alcoholism could still be observed. Numbers of deaths from oesophageal cancer for the years 1961-1963 and 1967-1968, and from cirrhosis and alcoholism for 1967 and 1968 were collected as well as the corresponding population from the census figures of 1962 and 1968. A cohort analysis using the data for 5 reference years from (1951 to 1971) is presented. Among European countries, France has the highest mortality rate from oesophageal cancer in males (13.65/100,000) and very high sex ratio (12.88). The rates are particularly high in western areas, especially Basse-Normandie. Over the 20-year period from 1951 to 1971, a progress of 32.7% was observed in males. The increase in mortality in males is greatest in the youngest age groups. In 1967-1968, there is a strong correlation between oesophageal cancer mortality and mortality from cirrhosis and alcoholism, the latter being more significant.

This prospective study was carried out in order to assess the accuracy of ultrasound in the diagnosis of cirrhosis. One hundred and twenty eight alcoholic patients were included. A careful ultrasonographic examination of the liver was performed before liver biopsy (100 patients). In 15 cases, liver histology was normal, steatosis and/or fibrosis, cirrhosis were diagnosed in 13 and 72 cases respectively. Ultrasonic patterns were classified by the same examiner, according to several criteria: volume, irregular outline, coarse and fine bright echo pattern, attenuation of the ultrasound beam, splenomegaly, ascite, portal hypertension. Cirrhosis was diagnosed in 58 out of 72 patients (80.5%). Specificity was 78.5%, positive and negative predictive values were 90.6% and 61% respectively, and global efficacy was 80%. Irregular outline (0.66), hepatomegaly (0.66) and attenuation of the ultrasound beam (0.64) were the best signs. In case of fine bright echo pattern, the diagnosis of cirrhosis would be missed. The results suggest that ultrasonography is a good test for screening alcoholics for cirrhosis. Therefore, it is useful when liver biopsy is contra indicated or refused or when liver is not detected at the clinical examination.