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[Echo-guided percutaneous drainage of abscesses and abdominal fluid collections].

Abdominal abscesses are pathologies characterized by an high decree of mortality and morbidity. The pathology was once dealt with surgery evacuation the percentage of success reaches 60% while mortality runned around 24%. Today this technic has been substituted by the echo-guided treatment. The minimal invasive approach reduced dramatically the cases of complications (4-6%) and mortality (4%); it is highly suggested in the majority of the cases of visceral or endoperitoneal abscesses. Our study case counts 57 echo-guided drainages due to multiply surgery pathologies. The number of successful ends runs on 93%, this perfect agrees with the data given by literature that states a decree of success around 90%. We did no test an higher or lower decree of complications nor mortality. According to our opinion the echo-guided drainage is a primary technic in abdominal septic collections. Surgery drainage has to be aside for patients with general good health or for collections accompanied with divertcular disease of the large intestine, crohn disease, rectocolitis ulcerosis and periappendix abscess.

Abdominal Abscess↗

[W27 HL-A antigen. Diagnostic value in rheumatology].

The authors studied the tissue groups in a first series of patients with properly diagnosed rheumatic disorders. They found HL-A W27 antigen in 84 percent of 50 cases of primitive ankylosing spondylarthritis in adults, in 33 percent of the 50 cases of Fiessinger-Leroy-Reiter syndrome, in 20 percent of the 40 cases of psoriatic polyarthritis (50 percent of the 12 cases with radiological sacroiliac involvement) and in 66 percent of the 6 cases of spondylarthritis associated with haemorrhagic rectocolitis. In a second series of 45 patients with unclassifiable inflammatory rheumatism, only the W27 antigen tested for and it was found in 33 percent of the patients. On the basis of these observations, which were compared with those in other publications, the authors confirm the absence of a clear correlation between the pathological picture and the presence of the W27 antigen. They discuss the significance of the association between the W27 antigen and the disease, and underline the diagnostic and sometimes the prognostic value of the W27 test in rheumatology.

Adolescent↗

Gastro-intestinal lesions induced by non-steroidal anti-inflammatory drugs.

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with serious and sometimes fatal side effects as gastrointestinal ulcers, bleeding and less frequently kidney and liver damage. These side effects are caused primarily by the reduction of prostaglandin synthesis, which in turn deprives the stomach's self-protection mechanism. NSAIDs prevent prostaglandin formation by inhibiting the enzyme cyclooxygenase. Recent research has shown that there are two types of cyclooxygenase, one that produces the form of prostaglandin involved in the gastric protection and the other that produces the form of prostaglandin involved in inflammation. Current NSAIDs inhibit both forms of cyclooxygenase. Gastrointestinal lesions associated with NSAIDs are predominantly observed in the stomach and are defined under the term of "NSAID gastropathy". Intestinal lesions secondary to the ingestion of NSAIDs were only recently described. Rectocolic lesions induced by NSAID are frequent and severe. The noxious effect of NSAID on preexisting low pathologies can be differentiated from "de novo" induced acute and chronic lesions.

Anti-Inflammatory Agents, Non-Steroidal↗

[Analysis of the results of 1221 colonoscopies in the hospitals of Burkina Faso, 1994-1997].

The authors report the results of 1221 colonoscopies. It appears from their analysis that whereas functional diseases of the colon remain predominant and topical, organic diseases appear to be increasing in frequency (polyps, polyposis, rectocolic cancer, parasitical colitis, diverticulis). Inflammatory bowel diseases are also beginning to be seen. The reported cases of Crohn's disease and ulcerative colitis are, so far as they know, the first in their country.

Burkina Faso↗

[Toxic megacolon].

Reference to the literature dealing with idiopathic rectocolitis and its complications, with particular attention to megacolon, is followed by the presentation of two cases of ulcerous colitis complicated by toxic megacolon and a picture of acute abdomen. Emphasis is placed on the clinical features of such complications and the surgical treatment required in accordance with the degree of seriousness of the case.

Colitis, Ulcerative↗

Colitis cystica profunda of the rectum: report of a case and review of the literature.

Colitis cystica profunda is a rare intestinal lesion. Because of its clinical expression (rectorrhagia, mucorrhea and abdominal pain) and the way it appears to current imaging techniques this disease presents features which can be associated with colon neoplasm. Its diagnosis has to be confirmed histologically, and its etiology remains unclear. The following is a case report of colitis cystica profunda recurring 20 years after a first episode in a white woman, who had had an anterior resection of the sigmoid colon and upper rectum to deal with a colitis cystica profunda-induced stenosis of the sigmoid colon and at 41 underwent the transanal removal of a polypoid lesion. A review of 20 cases in the literature showed that colitis cystica profunda has a predilection for the male and generally affects the medial and lower rectum and the sigmoid colon. The literature also confirmed the association with ulcerative rectocolitis, Crohn's disease and rectal prolapse. The type of treatment varies from surgical, medical, and endoscopic to no treatment at all.

Adult↗

[Topical beclomethasone dipropionate (BDP) in intestinal inflammatory diseases: the results of a multicentre trial].

The authors assessed the efficacy and tolerability of BDP in an open protocol using rectal enemas and suppositories and in a double-blind protocol vs mesalazine using rectal enemas. A total of 47 patients suffering from ulcerous rectocolitis were enrolled in the study and treated for 42 days while undergoing endoscopic, histologic and clinical controls. In conclusion, the authors affirm that BDP may represent a useful new therapeutic instrument in the treatment of slight to moderately severe forms of inflammatory intestinal disease.

English Abstract↗

[A recto-sigmoid lesion due to trans-anal aspiration. Apropos of a case].

A three year old boy presented a transanal evisceration of the rectum after sitting over a non covered drain site of a swimming pool. Peritonitis led to laparatomy 24 hours later. The high rectum was found to be necrotic and perforated. A protecting sigmoïd loop colostomy was performed with out any rectocolic resection. Five months later, resection of the fibrosed high rectum and end to end anastomosis between sigmoïd and low rectum was done. The colorectal function was quickly restored. Continence is now normal with a follow-up of 18 months. Pathogenesis of transanal suction may be as follows: relaxation of perineal muscles and anal sphincter during sitting position permit transanal evisceration by suction. Such lesions are rare (less than 10 cases reported). The therapeutic choice, between initial reparation and drainage associated, with protecting colostomy is discussed.

Anal Canal↗

[Phagocytosis of human erythrocytes by Entamoeba histolytica. Quantitative study].

The degree of eythrophagocytosis of two recently isolated strains of E. histolytica was measured by microscopic examination. Amebas isolated from a patient with amebic rectocolitis (strain HM22:IMSS, monoxenic) ingested human red blood cells faster and in larger numbers than trophozoites isolated from an asymptomatic carrier (HM27:IMSS, monoxenic). The results suggest that an increased rate of phagocytosis could be one of the surface properties characteristic of the invasive strains of E. histolytica.

Dysentery, Amebic↗

[Analysis of the distribution of HDL-cholesterol and (VLDL + LDL)-cholesterol in hepatic and intestinal disorders].

Total cholesterol (Ch-T), HDL cholesterol (Ch-HDL) and (VLDL + HDL) cholesterol (Ch-(VLDL + LDL) were evaluated in 78 cases of various hepatodigestive diseases (11 icterus, 14 hepatitis, 30 chronic alcoholisms, 8 Crohn's diseases and 15 haemorragic rectocolitis (RCH], and in 76 control subjects. High cholesterol levels were found in icterus, but its distribution between lipoproteic fractions remained unchanged. In the group of hepatitis, a deficit in Ch-(VLDL + LDL) was elicited by a significant decrease of Ch-(VLDL + LDL)/Ch-T ratio. The same was observed in chronic alcoholism. In Crohn's disease the levels of every cholesterol fraction were low, while in RCH they were not significantly different from those of the control group. But, in RCH, the Ch-HDL/Ch-T ratios showed significant low values with concommitant higher values of Ch-(VLDL + LDL)/Ch-HDL ratios, suggesting that, in RCH, the metabolism of cholesterol is unbalanced with a deficit of Ch-HDL. In conclusion, the evaluation of cholesterol in lipoproteic fractions by a simple assay may contribute to specify the diagnostic of these disorders.

Adolescent↗

[Pyoderma gangrenosum and pelvispondylitis without patent intestinal disease. Apropos of a case].

The authors report a case of pyoderma gangrenosum associated with a positive B27 pelvispondylitis. The search for a hemorrhagic rectocolitis, possible link between the two syndromes, revealed to be negative. Pelvispondylitis is an unusual complication of pyoderma gangrenosum. Review of the literature shows only one case of sacroiliitis, beside seronegative polyarthritis unrelated to HLA B27.

Adult↗

[Caval thromboses and systemic diseases].

Sixty-five patients presenting with a vena cava syndrome have been examined over a 7 years period; incidence of systemic diseases as an etiologic factor has thus been studied. A systemic disease was diagnosed in 17 cases, that is 25 p. 100 of cases. This incidence is higher in inferior vena cava syndromes (15 cases out of 45). Two diseases appear as the main factors: on one hand, Behçet disease, liable for 8 vena cava thrombosis, 7 inferior and 8 superior thrombosis; on the other hand, severe disseminated erythematous lupus liable for 5 cases of inferior vena cava thrombosis. Other etiologies are mentioned such as: Churg and Strauss disease (1 case), Horton disease (1 case) and hemorrhagic rectocolitis (1 case). In the patients presenting with lupus, two died from various pulmonary embolisms; a vena cava clip was required in 3 cases. As for lupus, the immuno-hepatologic exploration did demonstrate a thrombopenia in 5 cases, an hemolytic anemia with a positive Coombs test in 2 cases, and a circulating anti-coagulant (antiprothrombinase type) in one case. Though high frequency of systemic diseases in this series may depend on the patients' recruitment, systemic lupus as well as Behçet diseases are to be researched in case of vena cava thrombosis, above all if diagnosed in a young patient and failing to be explained by a congenital abnormality of hemostasis.

Adult↗

Specific technical note concerning the preparation of distal rectal anastomoses.

The present increase of distal conolorectal anastomoses is certainly due to the desire of surgeons to conserve the natural routes of intestinal transit. With the exception of unusual, and in some cases debateable indications, such as haemorrhagic rectocolitis or Crohn's disease, most distal anastomoses involve cancer. At present, the main interest in distal rectal anastomoses is focussed on the choice of operating technique: manual or mechanical. In the opinion of the author, the decisive factor in favour of the use of Staplers was the substantial reduction of the incidence of dehiscence from 16 to 5 percent.

Colectomy↗

Influence of buthionine sulfoximine and misonidazole on glutathione level and radiosensitivity of human tumor xenografts.

We have studied the effect of buthionine sulfoximine (BSO; a gamma-glutamylcysteine synthetase inhibitor) administration, either alone or combined with misonidazole (MISO), on five human tumor xenografts (three melanomas: Bell, Mall, and Nall; and two rectocolic adenocarcinomas: HT29 and HRT18) transplanted into mice. Two criteria were used, the nonprotein bound sulfhydryl (NPSH) level (glutathione (GSH) and cysteine (CYS] and the fraction of surviving tumor cells after gamma irradiation. GSH and CYS were estimated by HPLC and cell survival by in vivo-in vitro clonogenic assay. Administration of BSO alone (three injections of 10 mumol/g) prior to irradiation always produced a significant reduction in the GSH level while MISO administration (1 mg/g) did not consistently influence the NPSH level. While BSO had little or no radiosensitizing effect, MISO always induced radiosensitization (enhancement ratio between 1.6 and 1.8). This effect did not depend on the fraction of surviving hypoxic cells. An increase in MISO-induced radiosensitization produced by BSO was cell-line dependent. Results do not seem to support the hypothesis of a relationship between the GSH level at the time of irradiation and the radiosensitization induced by BSO or BSO + MISO. However, BSO treatment may not have been able to reduce endogenous thiols to a low enough level to test the hypothesis.

Adenocarcinoma↗

[Solitary ulcer syndrome: anatomo-clinical aspects].

The clinical, radiological, endoscopic and histological aspects of a case of Isolated Ulcer Syndrome (IUS) of the rectum are examined. For over a decade and on the basis of its clinical, radiological, endoscopic and histological features, this condition was considered Ulcerous Rectocolitis and treated as such. The case presented serves to highlight the possibility of confusing this ulcer with other inflammatory colorectal conditions if only the clinical, radiological and endoscopic pictures are taken into consideration. The importance of histological examination of numerous bioptic samples is emphasised as essential for accurate diagnosis.

Biopsy↗

[Pregnancy and enterostomy].

The authors describe the difficulties and possible complications of pregnancy in colonostomized women. In the neoplastic forms, generally appearing in advanced age, the knowledge of the basic disease discourages any possible attempt at pregnancy. In the chronic inflammatory diseases (ulcerous rectocolitis and Crohn's disease), typical of young age, pregnancy, if opportunely followed and programmed, can get an absolutely favourable course. The authors report their own experiences and some other authors' ones.

Colitis, Ulcerative↗

[Body illness and changes in verbal communication. Study of the alexithymic phenomenon in somatic disease].

The Schalling--Sifneos Personality Scale was administered to several groups of subjects (patient suffering from chronic hepatitis or from ulcerative colitis, patients undergoing chronic periodic haemodialysis, encephalopathic patient and healthy subjects) in order to assess the presence of alexithymia in healthy subjects, in patients suffering from chronic organic pathologies and in psychosomatic patients. The results obtained permit one to distinguish the psychosomatic patients from other groups of subjects: compared to healthy subjects, patients suffering from ulcerous rectocolitis obtained higher average scores, while compared to patients suffering from other organic pathologies their scores showed a wider scatter. A distinction is therefore proposed between primary alexithymia, of a distinctive cognitive-affective kind which predisposes towards psychosomatic pathology, and secondary alexithymia which is associated with stressful situations, such as illness, and which is essentially defensive in origin.

Adult↗