[Acute cholecystitis with gallbladder perforation treated by transpapillary endoscopic drainage].
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Biomedical subjects
Publications and source records attributed to P Hastier.
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The authors describe the case of a female patient who presented with recurrent rectorrhagia of unexplained origin. The diagnosis was wirsungorrhagia complicating advanced calcifying chronic pancreatitis. Analysis of the surgical specimen led to fortuitis discovery of a pancreatic neuroendocrine tumour.
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We sought to measure cystic duct diameter in patients without biliary calculi and in those with cholelithiasis or choledocholithiasis. Using endoscopic retrograde cholangiopancreatography (ERCP), we visualized the cystic duct in 168 patients referred to our unit. These patients were distributed into three groups based on findings at ERCP: Group I (N = 57), no calculi in the gallbladder or common bile duct; group II (N = 27), stones found in the gallbladder but absent from the common bile duct; and group III (N = 34), stones present in the common bile duct with or without gallbladder stones. The diameter of the cystic duct was measured at its widest and narrowest dimensions. The largest diameter measured was greater in group III (7.72 +/- 2.29 mm) than in groups I (2.63 +/- 0.67 mm) and II (4.59 +/- 1.13 mm) (P < 0.001). The same differences were found in measurement of the smallest diameter (5.00 +/- 0.99 mm, 3.10 +/- 0.62 mm, and 1.83 +/- 0.53 mm, for groups III, II, and I, respectively) (P < 0.001). Maximal and minimal cystic duct diameter show a progressive increase at each level of disease. This increase in cystic duct size may facilitate the migration of gallstone fragments after lithotripsy and facilitate the instrumentation of the cystic duct during ERCP and laparoscopic cholecystectomy.
After describing two cases of Hashimoto's thyroiditis associated with chronic hepatitis C, we set up a prospective study to assess the prevalence of thyroid autoantibodies (thyroglobulin and thyroid microsomal autoantibodies) in 72 chronic hepatitis C patients (43 men and 29 women; mean age = 51 +/- 2.1 yr) before interferon therapy admitted between January and December 1991 to our liver unit. Thyroid autoantibodies were systematically assayed in 60 chronic HBsAg-positive patients (34 men and 26 women; mean age = 50 +/- 2.2 yr), who served as controls. Antibody to hepatitis C virus was detected with a second-generation enzyme immunoassay and then confirmed with a recombinant immunoblot assay and a supplemental enzyme immunoassay using two beads. In chronic hepatitis C patients, no men had thyroid autoantibodies. Nine of 29 women (31%) had thyroid autoantibodies. Among them, six (20.7%) had high titers of thyroid autoantibodies, and two had hypothyroidism. In all nine of these women, hepatitis C virus viremia was detected on nested polymerase chain reaction (with primers located in the 5' untranslated region). One year later, titers of thyroid autoantibodies had increased in one patient. Three other patients progressed to hypothyroidism. We judged four of 29 patients (13.8%) to have Hashimoto's thyroiditis on the basis of their high titers of thyroid autoantibodies and biological features of hypothyroidism. In the control group, only one man had thyroid microsome autoantibodies, at a very low titer (1:100). The association between chronic hepatitis C and presence of thyroid autoantibodies is clearly confirmed (p = 0.021) by this study.
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During an 8-year period, 35 patients aged over 60 and presenting with idiopathic thrombocytopenic purpura were observed. At the time of diagnosis, 51.5 percent had haemorrhages which were major in 26 percent of the cases. Response to various treatments, notably corticosteroid therapy, was weak (43 percent). During the course of the disease, 2 patients (5.7 percent) died of cerebral haemorrhage. This series confirms the importance of haemorrhagic syndrome and the resistance to treatment of the elderly as opposed to younger subjects. This is probably due to the heterogeneity of purpura in old age: in a number of patients purpura corresponded to refractory chronic thrombocytopenia or to chronic thrombocytopenia associated with carcinoma.
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BACKGROUND: To evaluate the diagnostic accuracy of endosonography (ES) in a prospective series of cancer of the cardia. METHODS: Thirty-five patients with cancer of the cardia were investigated by ES; 29 underwent surgery. ES staging for the surgery patients was compared with histopathologic findings. Tumors were staged according to the 1987 TNM classification. RESULTS: ES had a diagnostic accuracy of 79% for the T category, 79% for the N category, 89% for the M category, and 72% for prognostic TNM staging. CONCLUSION: ES is an excellent paraclinical modality for the staging of local-regional spread of cancer of the cardia and a useful complement to computed tomography for evaluation of these tumors.