[Hypertransaminasemia in an adolescent]. / Macrotransaminasémie chez un adolescent.

CASE REPORT: An adolescent admitted to hospital because of an obvious convulsion seizure presented with a high level of serum macroaspartate aminotransferase. This macroaspartate aminotransferase was discovered by chance when blood tests were made. DISCUSSION: Macroaspartate aminotransferase is a persistent, benign phenomenon, probably not congenital, discovered either in healthy patients, or in adults suffering from malignancies or autoimmune diseases. Macroenzymes have been identified as a cause of benign increase in a number of serum enzymes, like macroamylase serum levels. The macroenzyme is often an immunoglobulin G-complexed enzyme. CONCLUSION: It is important for clinicians to be aware of their existence in order to avoid unnecessary procedures. It is important that the patient is informed of the macroaspartate aminotransferase and that the same is stated in his health record.

Epidermoid carcinoma complicating chronic osteomyelitis of the femur.

A case of epidermoid carcinoma of the femur that arose in an area affected with chronic osteomyelitis for over 40 years is reported. The incidence of this rare complication has been estimated at 0.23% to 1.6% of all cases of chronic osteomyelitis. Although cases of sarcoma, adenosarcoma, plasmocytoma, and malignant fibrous histiocytoma have been reported, epidermoid carcinoma is the most common cancer type. This tumor develops after 20 to 40 years of chronic infection with a discharging fistula. Epithelialization of the fistulous tract has been demonstrated. The cancer arises in the metaplastic epithelium and can secondarily spread to the bone. Despite the low grade of malignancy of many of these epidermoid carcinomas, pulmonary metastases are not rare. Amputation meeting criteria for oncologic surgery is the only means of ensuring a good prognosis.

Propranolol reduces the rebleeding rate during endoscopic sclerotherapy before variceal obliteration.

In patients treated with sclerotherapy, most rebleeding episodes are observed before variceal obliteration. This prospective randomized study aimed to assess if propranolol together with sclerotherapy could reduce the rebleeding rate before variceal obliteration. Seventy-five patients (59 male, 16 female; mean age, 54 +/- 15 years) with cirrhosis (from alcohol abuse in 91%) admitted with upper gastrointestinal bleeding, which was endoscopically proven to originate from ruptured esophageal varices, were included. After initial control of bleeding, the patients were randomized into the following two groups: group 1 treated with sclerotherapy alone (36 patients) and group 2 treated with sclerotherapy plus propranolol (39 patients). They were followed up to variceal obliteration. In group 2, 7 patients rebled as compared with 14 patients treated with sclerotherapy alone (P less than 0.005). When considering only rebleedings from esophageal varices, 4 patients rebled in group 2 vs. 10 in group 1 (P less than 0.10). The total number of rebleeding episodes was lower in group 2 than in group 1 whether considering all causes (8 vs. 17; P less than 0.07) or variceal rebleedings alone (4 vs. 13; P less than 0.01). Mean total blood requirement per patient was lower in group 2 than in group 1 (1.4 +/- 3.4 vs. 2.79 +/- 6.4 units of blood, respectively; P less than 0.01). Mortality was similar in both groups of patients (14% vs. 13% in groups 1 and 2, respectively, NS). It is concluded that patients treated with sclerotherapy should be given propranolol before variceal obliteration.