[Hepatitis B and pregnancy]

Chronic Hepatitis B infection can lead to liver cirrhosis and hepatocellular carcinoma. In women, these viral infections can be responsible for transmission to the husband and to the child during delivery. The purpose of this review is to analyze from the literature the mechanism of mother-to-child transmission and the consequences. We conducted a review of the literature through the interrogation of the MEDLINE database using a query documentary by combining the Boolean [AND] keywords [MeSH] as follows: [hepatitis B]; [Vertical transmission; [Pregnancy]; [Delivery]. Hepatitis B virus transmission by sexual contact in low prevalence areas and infection occurs during either the perinatal period or early in childhood in moderate or high prevalence areas. In Tunisia, the prevalence of Antigen HBS [HBs Ag] with pregnant women is 3 to 4%. The risk of maternal-infant contamination is high, from 20 to 90 per cent according to the viral load in the mother. Mother-to-child transmission can be avoided by serovaccination of the newborn .The women with very high viral loads may receive lamivudine treatment at the end of pregnancy to diminish viral load and thus the risk of chronic carriage in the child; however the role of this drug in this situation is not yet clearly defined

[Helicobacter pylori and gastric adenocarcinoma]

Accumulating evidence for considering HP as a causal factor for gastric cancer comes from recent epidemiologic studies, the advent of an animal model of gastric cancer and from new insights in to the biological mechanisms for gastric carcinogenesis. The purpose of this review is to analyze recent data from the literature on this relationship and try to define what kinds of preventive measures could be proposed. We conducted a review of the literature through the interrogation of the MEDLINE database using a query documentary by combining the Boolean [AND] keywords [MeSH] as follows: Helicobacter pylori, stomach neoplasms. HP infection, host genetic background, food regimen are known to be involved in this cancer. There is no definite clinical evidence of the benefit of eradication on cancer risk in humans due to the lack of randomized controlled studies in large populations. Therefore HP should be eradicated in selected patients, such as patients' relatives with documented gastric cancer as well as patients having another gastrointestinal cancer

[Crohn's disease: influence of age at diagnosis on clinical type of disease]

The aim of the study was to examine the influence of age at diagnosis of Crohn's disease on disease site and course in Tunisian patients

Methods: All hospital patients for Crohn's disease between 1993 and 2002 were included. They were segregated by age at diagnosis as follows: younger than 20 years, 20-39 years, and 40 years or older. And all patients were classified at the time of the latest visit into one of three subtypes of disease [non complicating, stricturing, and fistulizing] according Vienna's classification. Crohn's disease was devised also by site [ileum, ileocecal, colon and higher site]

Results: Sixty one patients [50,4%] were 20-39 years old and 43 patients [35,5%] were 40 years and older. Colonic involvement was significantly more common [46,5%] in the 40 years and older group compared with 20-39 years group [24,6%] [p=0,01]. The subtype without complication was significantly more common [58,1%] in the 40 years and older group compared with 20- 39 years group [39,3%] [p=0,05]. The frequency of the need for surgery for any indication for Crohn's disease didn't differ significantly according to age

Conclusion: In this study, Crohn's disease diagnosed in tunisian patients that were 40 years and older had often a colonic site and a less severe phenotype supporting the concept of genetic heterogeneity

Predictive factors of surgery in severe attacks of ulcerative colitis

The purpose of our study was to determine clinical, biological or endoscopic factors that predict surgery after a glucocortico steroid treatment failure in severe attacks of ulcerative colitis. Sixty one patients were analyzed. A therapeutic response for glucocorticosteroid was defined as the absence of resort to surgery within the first 30 days after hospitalization. Predictive factors were assessed using univariate and multivariate analysis. Fifteen patients [24,6%] had a medical response. In univariate analysis, predictive factors of surgery were: male sex, tobacco, number of colitis attacks in case history, temperature over 38°C, ery-throcyte sedimentation rate over 30 mm, systolic blood pressure below 11, deep and wide ulcers. During the course, bowel movements/ day over 7, pulse over 90/mn, temperature over 38°C on day 3 after treatment initiation as well as passage of blood on day 5 were identified as predictors of surgery. In multivariate analysis, bowel movements over II day on day 3 of hospitalization was independently predicted a surgery. Bowel movements/ day over 7 on day 3 of hospitalization was the only independently predictive factor of surgery after glu-cortico steroid treatment failure

Stromal tumors of the digestive tract: three small bowel localisation

Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified as stemming of [pace-maker] cells of Cajal related to the immunohistochimical characterization of the phenotype. Report three new cases. We report three observations of the small bowel stromal tumors reveal by anemia in one case and mass formation in two cases. The aim of this study was to discuss the anatomo clinical, prognosis and management of these tumors

[Epidemiologic profile of gastric carcinoma: study of 140 cases]

The authors make a retrospective study of a series of 140 patients aged 59 years in average, followed up from 1995 to 2002 for adenocarcinoma of the stomach. Surgical resection was performed in 79 percent of the patients with total gastrectomy in 15.4%, partial gastrectomy in 50.6%. Resection was considered as curative in 66%. Lymph node metastases were present in 42, 9 percent of the patients. Margins of resection were involved in 24, 5% of the specimens. The mean survival rate was 26.5 months, 13 months and 5 months after curative resection, palliative resection and without resection

[Importance of vaccination chronic hepatitis B]

Weak therapeutic responses and weak immune cytotoxic CD8 and CD4 response in chronic hepatitis B emphasize the necessity to find new therapeutic strategies especially as specific immunotherapy. Vaccination, whose principle was to widen immune repertoire, was used as a curative treatment of chronic hepatitis B. It would be the therapeutic procedure with the lowest cost and the potentially greatest benefit. Our purpose was to enhance the interest of therapeutic vaccination in chronic hepatitis B in order to debate later its usefulness in developing countries

Identification des patients a haut risque de rechute de la maladie de Crohn

The aim of this study is to determine the factors associated with high risk of recurrence of Crohn disease. Patients and methods: During 12 years period from January 1987 till December 1999, 98 patients treated for crohn's disease were included in this study. The risk of recurrence was studied using the Kaplan -Meier method. The possible predictive factors of recurrence were studied using the LOG-RANK test. During the follow-up period, 50 [66%] patients developed a recurrence of Crohn's disease. The factors associated with a high risk of recurrence of the diseases were female [p=0,03], long delay before the diagnosis of the disease [p=0,03] and the presence of extra-intestinal lesions [p=0,05]. Concerning other factors such as the age, smoking, inflammatory syndrome and ano-perineal lesions, the study showed no relationship between these factors and the recurrence of the disease. This study showed that the group of patients treated for crohn's disease and who have predictive factors of recurrence should have prophylactic medical treatment to prevent recurrence of the disease

Utilisation de l'octreotide dans le traitement des hemorragies digestives aigues par rupture de varices oesophagiennes

Aims To asses the value of octreotide in the control of acute bleeding esophageal varices in a retrospective study Methodology: Fourty two patients admitted for esophageal voriceal bleeding confirmed at endoscopy were recruired.An initial 50 micrograms bolus of octreotide followed by a two day continuous infusion of 25 micrograms/h were evaluated for the control of bleeding. Twenty nine patients were endoscopic stigmata of recent bleeding and thirteen were active bleeding at emergency endoscopy. Octreotide was found to be effective regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. 30 day mortality was 1 1,9%. Echec of octreotide was significativement associated with severity of cirrhosis [p<0, 03]. Conclusion These results suggest that octreotide is effective in the treatment of esophageal variceal bleeding and it is a valuable adjuvant treatment in association with endoscopic menagement