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Unlabelled: The pathogenic mechanisms of hepatic encephalopathy remain to be elucidated. It has been suggested that a digestive motor disorder could promote the absorption of toxins produced within the lumen and thus enhance hepatic encephalopathy., Aim: To evaluate oro-cecal transit time in cirrhotic patients with and without hepatic encephalopathy., Methods: Hospitalized patients with alcoholic cirrhosis without encephalopathy and with spontaneous grade I and II encephalopathy were included. Severity of hepatic encephalopathy was assessed clinically and the Child-Pugh score was used to describe cirrhosis severity. Nine healthy volunteers constituted a control group. Oro-cecal transit time was measured with the sulfasalazine test., Results: Twenty-eight patients (mean age 62.5 +/- 8.5 years) were included. Ten had hepatic encephalopathy of unknown cause and 18 were free of hepatic encephalopathy. Oro-cecal transit time was significantly longer in patients with hepatic encephalopathy (641 +/- 350 min) compared to patients without hepatic encephalopathy (298 +/- 96; P<0.05) and to controls (354 +/- 90; P<0.05). Oro-cecal transit time was comparable for each Child-Pugh score and was not different between the two grades of hepatic encephalopathy., Conclusion: Oro-cecal transit time is longer in alcoholic cirrhosis patients with hepatic encephalopathy. This digestive motor disorder provides a partial explanation of hepatic encephalopathy of unknown etiology.

Objective: Potential cardiac sources of embolism may promote ischemic colitis. The aim of this study was to evaluate their role in segmental, nongangrenous ischemic colitis and to determine the usefulness of routine cardiac evaluation in patients with this disease., Methods: Sixty case and 60 control patients matched for age and gender were included and questioned regarding treatment and prior cardiovascular history or risk factors. Potential cardiac sources of embolism, classified as "proven" or " still debated," were screened using an electrocardiogram, rhythmic Holter monitoring over 24 h, and transthoracic echocardiography., Results: Sex ratio (male:female) was 1:2, and mean age was 70 +/- 14 yr. Case and control patients had similar drug use, prior cardiovascular history, and risk factors. A potential cardiac source of embolism was found in 26/60 case (43%), compared with 14/60 control patients (23%) (p = 0.02; OR = 2.5, 95% CI = 1.2-5.5). Excluding the "still debated," 21/60 case (35%), compared with 8/60 control patients (13%), had a "proven" cardiac source of embolism (p < 0.01; OR = 3.5, 95% CI = 1.4-8.4). Electrocardiogram alone misdiagnosed 72% of the "proven" cardiac sources of embolism, whereas the combination electrocardiogram plus Holter monitoring detected 71%, and electrocardiogram plus echocardiography 62%. Twelve of 21 case patients with at least one proven cardiac source of embolism, were previously unknown. Anticoagulant therapy was required in 32% of case patients and antiarrhythmic therapy in 25% of cases., Conclusions: Potential cardiac sources of embolism were more common in patients with segmental, nongangrenous ischemic colitis than in control patients. Therefore, these patients should undergo a routine electrocardiogram, rhythmic Holter monitoring, and transthoracic echocardiography. Anticoagulant therapy should also be considered for this patient population.

The aim of this study was to evaluate the prevalence of cardiac arrhythmia and intracardiac embolic process in ambulatory ischemic colitis. From November 1994 to November 1997, 33 consecutive cases of ambulatory ischemic colitis were detected. This study included 21 women and 12 men with a mean age of 71 years. All patients underwent a cardiovascular investigation including questioning, electrocardiogram, 24-hr ambulatory electrocardiography and transthoracic echocardiography. A prior history of ischemic colitis was found in four cases (12%). Cardiac arrhythmia was detected in eight cases. Transthoracic echocardiography showed an intracardiac process, potentially responsible for a peripheral embolism, in four cases. In conclusion, the aggregate, in 33% of the patients, there was potential cardiac etiology. This suggests that when ambulatory ischemic colitis occurs, it is necessary to perform an exhaustive cardiovascular evaluation similar to those performed in other ischemic diseases.

Plasmocytic variants of Castleman's disease are uncommon. We report a new case of abdominal location with a rapidly fatal outcome. Another particularity of that case was the negativity of Kaposi's sarcoma associated herpesvirus, a virus recently implicated in human immunodeficiency virus associated Castleman's disease.

Aims of the Study: The 5-year survival rate of gastric cancer is less than 20% in cancer registries. The prognosis of early gastric cancer is much better but this diagnosis is rare in Europe. The aim of the study was to evaluate the prognosis and trends in the incidence of early gastric cancer in the area of Calvados (France) during a 13-year period., Methods: Between 1978 and 1990 the Digestive Cancer Registry of Calvados recorded 1,160 new cases of gastric cancer. The diagnosis of early gastric cancer was defined according to the Japanese Gastroenterological Society criteria. Prognostic factors were determined with univariate and multivariate analysis., Results: One hundred patients had early gastric cancer (8.6%). This rate did not change significantly during the period. The mean age was 64.2 +/- 1.5 in males and 64.8 +/- 2.2 in females and 39% of patients were older than 70. A precancerous condition was present in 56% of cases on the surgical specimen. A total gastrectomy was performed in 23% of cases and a subtotal gastrectomy in 72% of cases. The postoperative mortality was 5% and the 5-year relative survival was 86.8% +/- 4.6. Univariate and multivariate analysis found a better prognosis in patients younger than 75 or in patients with a superficial or excavated gross appearance compared with those older than 75 or with a protruded type. Lymph node metastasis, depth of invasion, size of the tumor and histologic differentiation did not influence significantly the outcome., Conclusion: According to the data of the Cancer Registry of Calvados the proportion of Early Gastric Cancer was low and did not change between 1978 and 1990. The prognosis of EGC is good, mainly altered in elderly and in cases with a protruded type.

Objectives: The aim of this study was to determine the epidemiological characteristics of hepatocellular carcinoma in a non-selected population., Methods: Between 1984 and 1990, all cases of hepatocellular carcinoma were registered at the Registry of Digestive Tumors of Calvados. Standardized incidence rates were calculated for males and females. Prognostic factors were determined by the Cox multivariate method., Results: 213 patients with hepatocellular carcinoma were registered. Standardized incidence rates were 7.5/100,000 in men and 0.4/100,000 in women. Sex-ratio was 18.3. Mean age was 66.4 years; hepatocellular carcinoma was uncommon (3%) before the age of 50. Cirrhosis was associated in 85.9% of patients. The cause of cirrhosis was known in 150 cases: alcoholic: 73.3%, cryptogenetic: 8.7%, viral B or C: 7.3%, alcoholic and viral B or C: 5.3%, and genetic hemochromatosis: 4.7%. The overall survival rate in 203 patients was 21%, 8% and 3% at 1 year, 3 years and 5 years, respectively. The multivariate study identified 4 prognostic factors: number of tumors < or = 2, lack of ascites, serum alpha-fetoprotein < or = 10 mg/mL, and hepatocellular carcinoma revealing a well-compensated liver disease until the time of diagnosis., Conclusion: The occurrence of hepatocellular carcinoma seems to be linked to cirrhosis, male sex, and age > 50, which could be used as the main selection criterias for the screening of hepatocellular carcinoma.

To assess the portal contribution to liver perfusion, we carried out quantitative sequential scintigraphy in 110 patients with alcoholic cirrhosis (22 Child-Pugh class A, 39 class B, 49 class C) and 15 normal subjects. Duplex Doppler ultrasound found a type of intrahepatic circulation that made the standard scintigraphic procedure inaccurate in four cases of cirrhosis, which were reevaluated. Portal contribution to liver perfusion was lower in cirrhotics than in normal subjects (48.7 +/- 29% versus 78.4 +/- 6%; p < 0.001). The sensitivity of scintigraphy in detecting portal hypertension, based on portal contribution < or = 66%, was 61.8% (with a 100% specificity) compared with 66.7% for endoscopy (diagnosis based on existence of varices). The overall sensitivity of the two tests together was 86.1%. Portal contribution to liver perfusion was inversely correlated to Child-Pugh score (r = 0.53; p < 0.001), to prothrombin time (r = 0.52; p < 0.001), and to hepatic venous pressure gradient (r = 0.43; p < 0.001) and positively correlated to albuminemia (r = 0.42; p < 0.001). Concurrent alcoholic hepatitis and the existence of large portosystemic collaterals were related to a decrease in portal contribution to liver perfusion. We conclude that quantitative sequential scintigraphy, which shows a direct relationship between portal contribution to liver perfusion, on the one hand, and the amount of portosystemic shunting, the progression of liver disease, and/or acute liver injury, on the other, could serve as a diagnostic test for portal hypertension. The addition of scintigraphy improves the overall sensitivity of endoscopy.

Hyperplasia of Brünner's glands is a dysembryoplastic or hyperplasic lesion with an elective location of the proximal duodenum. Symptoms are often non-specific but severe manifestations can occur (haemorrhage, duodenal obstruction). Two cases of hyperplasia of Brünner's glands were reported due to their particularly large size and a misguiding clinical appearance. Difficulties in diagnosis due to this rare benign entity were discussed.

The aim of this study was to evaluate the diagnostic usefulness of percutaneous liver biopsy and screening for hepatitis C virus antibodies with 1st and 2nd generation ELISA in asymptomatic blood donors with persistent (> 1 year) and moderate elevation (> 1.5 times the upper limit of normal) of serum alanine aminotransferase. The diagnosis was established from clinical, biological and ultrasound data before biopsies were obtained, then compared to the histological diagnosis. Thirty one of 56 blood donors who satisfied the preceding criteria accepted liver biopsy and were subsequently included in the study. An accurate diagnosis was proposed before biopsy in 20 cases. This was in agreement with the histological results in 19 cases but in 2 of these, unexpected lobular hepatitis was associated with the expected steatosis. Positive hepatitis C virus tests corresponded to chronic hepatitis in all cases (n = 5). No accurate diagnosis could be proposed in the 11 remaining cases owing to the lack of evidence of any etiology (n = 4) or because several potential etiologies were possible for the same subject (n = 7). Histological diagnoses were: isolated steatosis (n = 12), steatosis associated with lobular hepatitis (n = 7) or with chronic persistent hepatitis (n = 1), chronic active (n = 2) or chronic persistent hepatitis (n = 3), alcoholic hepatitis (n = 2), hemochromatosis (n = 1), and normal liver (n = 3). Liver biopsy is essential to the accurate etiological diagnosis of persistent and moderate elevation of aminotransferases despite hepatitis virus C tests which are associated with the correct diagnosis of chronic hepatitis in 16% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to compare gastroesophageal 99mTc scintiscanning (GES), the pH reflux test (TRA) and esophageal manometry in the assessment of gastroesophageal reflux (GER). GES was performed after oral intake of sulfur colloid labeled with 99m technetium and 300 ml of water. Calculation of an index of reflux gave a semi-quantitative assessment of the GER. Sixty patients with symptoms of GER (typical in 51 cases, atypical in 9 cases) had the three tests. A GES was also performed in 17 normal volunteers and in 12 patients of the series after fundoplication. The diagnostic specificity of GES was 1.0 in GER. GES was less frequently positive than the pH reflux test in GER (68.6 p. 100 versus 80.4 p. 100) but the difference was not significant. These two tests were more sensitive than manometry. The index of reflux was higher in patients than in control subjects (p less than 0.0005) and returned to normal values after fundoplication. A correlation between the index of reflux and the stage of pH-reflux test was observed. It is suggested that GES can be used in the initial assessment of GER as an alternative to TRA and performed repeatedly during the follow-up of patients treated surgically.

A new case of assumed parasitic cardiac disease is reported once more; a 67 year old woman with a trematode injection presenting with mitral incompetence and left ventricular failure. Biventricular endomyocardial fibrosis predominating at the apex was diagnosed at angiography and confirmed at surgery. Mitral incompetence was related to retraction of the papillary muscles which were surrounded by fibrosis, the rest of the mitral apparatus being normal. There was no indication for endocardectomy and so, mitral valve replacement alone was performed. There are few previous reports of parasitic cardiac disease: one case of left ventricular endomyocardial fibrosis, one case of biventricular fibroplastic parietal endocarditis and one case of cardiomyopathy. This report emphasises the need for cardiac examination in patients with parasitic diseases.

Isaxonine phosphate is known to induce acute hepatitis which in most cases is reversible after withdrawal of the drug. The authors describe 4 new cases of hepatitis which differ from those previously reported by their evolutive and pathological features. In 3 cases, the outcome was fatal within a delay of 15-40 days despite discontinuation of the drug, and was associated with hepatic encephalopathy and ascites. In the 4 cases plasma concentration of alanine- and aspartate-aminotransferases were initially increased (up to 33 X upper normal range) and decreased to normal values in 2 cases. Plasma bilirubin levels were also elevated at first and continued to increase during the first 15 days of evolution. Pathological examination of the liver showed mild necrosis, sometimes with a piecemeal or a bridging aspect, marked fibrosis infiltrated with mononuclear and neutrophil polymorphonuclear cells and a conspicuous biliary neogenesis. In these particular cases of hepatitis due to isaxonine phosphate, occurrence in women, increased serum immunoglobulin levels, presence of autoantibodies, clinical and pathological aspects resembling those observed in iproniazid hepatitis may be suggestive of an immunological, or even autoimmune, mechanism.

Twenty-one patients with hepatic metastases were treated by chemoembolization over a 2-year period, the technique consisting of selective injection of a mixture of Spongel powder and Adriamycin plus 5-FU into the hepatic artery. Indications and results are discussed as a function of clinical, biologic and radiologic criteria.

175 Chronic HBs Ag carriers have been discovered in the blood donors of the Calvados blood transfusion center from 1971 to 1979. 72 of them (41%) gave their consent for a clinical and biological study at the end of 1979, after receiving a convocation letter. This work had two aims: - to study the epidemiological factors in this population. - to evaluate the clinical and biological consequences of persistent antigenemia. 1. Epidemiological Study. Most results agree with the literature (higher prevalence in male, age, stay in endemic countries) but some results disagree for several reasons: our donors are all volunteers, HBs Ag prevalence is low in our region, most of the patients are caucasian and with life conditions and habits which may explain some particularities in contagion. Furthermore, the relative number of blood donors found every year as chronic HBs Ag carriers, does not increase in our country. 2. The Clinical and Biological follow-up of 62 HBs Ag carriers (alcoholics excluded) was carried out for 4,3 years on average. No patients developed clinical and biological features of chronic liver disease. After a mean term follow-up, we conclude that the asymptomatic HBs Ag carriers state seems not to be of bad prognostic. Since long term complications cannot be excluded, the follow-up of these patients must be maintained.

A retrospective review was made of 1 400 cases of cancer of the esophagus treated at the Centre "Francois Baclesse" between 1964 and 1975. The disease appeared at an earlier age and more frequently in men (95%) than in women. The lesions were located predominantly in the middle third of the esophagus. There was a high frequency of local, regional and general extension of the disease due to late diagnosis. Less than one-third of the patients were eligible for surgery--which was excluded in the other cases because of age or the presence of associated pathology or secondary neoplasm--and only 10 per 100 of this group were potentially curable.