Cirrhosis and renal insufficiency influence of the value of creatinine on prognosis

Renal failure in cirrhosis has multiple etiologies and numerous aggravating factors with evidence of worsening of prognosis. Our study was performed on 130 cirrhotic patients hospitalized in HDF between January 1st, 1994, and December 31st, 1999. We have evaluated the causes of renal failure and the relation of different aggravating factors with the onset of renal failure. Causes of renal failure included drug-induced renal failure, organic nephropathy, pre-renal azotemia, acute tubular necrosis and hepato-renal syndrome. Among the aggravating factors, lactulose was found to alter renal function [p = 0.0175]. We studied the survival with respect to the serum creatinine levels and to the severity of liver disease. Three-year survival was respectively 59% and 42% in case of Child A and Child B patients with creatinine lower than 90 micro mol/L. No three-year survivors were noted in these subsets of patients when creatinine level was higher than 90 micro mol/L [p = 0.0247 and p = 0.0121 respectively]. No difference in survival was noted in Child C cirrhosis The occurrence of renal failure is a factor of bad prognosis in cirrhotic patients irrespective of Child's classification. In patients with Child A and Child B cirrhosis, a serum creatinine level higher than 90 micro mol/L is a bad prognostic factor with a significantly decreased survival rate. This factor does not affect survival in Child C cirrhosis because of mortality related to cirrhosis complications

Interest of endoscopic biopsy in the management of gastritis: about 250 consecutive cases

Background The practical role of gastric biopsy in the management of gastritis is controversial. Aim To estimate the yield of endoscopic biopsies in the clinical, endoscopic and pathologic approach of gastritis. Material and methods: Prospective study of 250 consecutive patients who underwent an upper G.I. endoscopy between July 1996 and January 1997, for upper G I symptoms, miscellaneous manifestations requiring an upper G.I. endoscopy or presenting a gastritis on EGD performed for other indications. Every patient had 6 biopsies: 2 in the antrum, 2 in the corpus, and 2 in an intermediate zone. Results After defining the abnormal elemental endoscopic and pathologic patterns, gastric mucosa was endoscopically normal in 57 cases [22.8%] and abnormal in the remaining of the 250 cases [77.2%]. The pathologic findings were normal in 69 cases [27.6%] and abnormal in the remaining 181 cases of 250. H pylori was found in 126 cases [50.4%], 10 cases of which [7.9%] had normal pathology. There was no significant correlation between clinical symptoms, endoscopy and pathology. There was a correlation between endoscopic abnormalities and tobacco use [P = 0.0073], NSAIDs use [P 0,0001] and the presence of H. pylori [P < 0,0001]. There was also a correlation between pathologic findings, tobacco use [P = 0.0015], NSAIDs use [P = 0.0022] and the presence of HP [P < 0.0001] On the other hand, there was a correlation between the presence of an inflammatory infiltrate in H. pylori gastritis [P 0.0007] and its absence in NSAIDs use [P = 0.0003]. The correlation between endoscopy and pathology existed only for certains patterns: erosion and ulcerations [P = 0.0002], purpuric [P = 0.033], congestion [P < 0.0001] and mosaic [0.0095]. Conclusion: Gastric biopsy brings no important practical supplement to endoscopic examination except in revealing the presence of H. pylori. It adds nothing to endoscopy in helping explain the clinical symptoms. But it is obvious that it may reveal some serious pre-malignant dysplasia or malignant gastric lesions [maltoma, linitis plastica]. This did not occur during our study

Recherche d'helicobacter pylori chez 244 patients par le test al'urease

The authors report the results of the detection of helicobacter pylori [HP] in gastric mucosa by the urease test, in 244 patients between January 1989 and August 1991. the overall prevalence of HP was 38.1%. it was 19.5% in patients with normal upper gastrointestinal endoscopy [UE], 61% in duodenal ulcer [p < 0.001] and 68.7% in congestive antritis [p < 0.001], significantly higher than in controls. There was no significant difference between controls and patients with erosive antritis or healed duodenal ulcers. The prevalence of HP rises with age in all patients and in those with lesions at UE but not in those with normal UE. A rise of this prevalence seems to exist in the months of June and December. The authors conclude by pointing out the rise of the overall prevalence of HP in congestive antritis compared with erosive antritis, the similarity of prevalence in normal subjects and those with healed ulcer and the lack of influence of age on this prevalence in subjects with normal UE. These conclusions are in need of confirmation by further studies on much more longer series

cas de trichinose revele par une diarrhee prolongee et des signes neurologiques

We report a case of trichinosis presenting with a subacute persistent diarrhea and neurologic complications. Gastrointestinal endoscopic as well as digestive and neurologic signs were observed. The mainstay of treatment was glucocorticoids associated with thiabendazole. The patient responded well to this regimen. A literature review to explain the gastrointestinal and neurological manifestations of trichinosis as well as their management was done