[Pancreatic-portal fistula. A rare complication of chronic pancreatitis]. / La fistule pancréatico-portale. Une complication rare de la pancréatite chronique.

We report a 40-year-old patient with complication of chronic pancreatitis as a pancreatico-portal fistula. The patient had subcutaneous nodular fat necrosis of the lower limbs resembling Weber-Christian syndrome, and amylasic ascitis. The diagnosis was established with retrograde endoscopic cholangio-pancreatography which found three pancreatic pseudocysts and a communication with the portal venous system. A portal thrombosis with cavernum was studied with color echo-Doppler and arteriography. The echo-endoscopy was performed for the first time in this complication and its significance estimated. The evolution was quickly and spontaneously favourable. That is a very rare complication of chronic pancreatitis and an expectant conservative management can be adopted.

[Endoscopic exploration of the small intestine]. / L'exploration endoscopique de l'intestin grêle.

The development of Japanese enteroscopes, mot of which are still prototypes, has made it possible to explore the entire small bowel. These instruments are either introduced into the jejunum like an ordinary endoscope, or pushed along a guidewire, or weighted with mercury, like a Miller-Abbott probe. A simplified study of the adult malabsorption syndrome can be performed by proximal jejunoscopy, usually carried out in Europe with a paediatric colonoscope. Perendoscopic forceps biopsy of the jejunum can replace probe sampling and is well suited to measurements of disaccharidase activity. In cases with "blind loop syndrome", bacteriological examination of the intestinal juice, endoscopically collected in sterile conditions, usefully supplements the visual and bioptic information. Since several investigations can be performed during one single enteroscopic examination, this method will be increasingly used in the study of small bowel diseases.

Early changes in blood-brain barrier permeability after porto-caval shunt and liver ischaemia.

The brain oedema, distribution space (DS) and brain uptake index (BUI), of L-glucose, inulin, B12 vitamin and of three polypeptidic hormones of increasing molecular weight (angiotensin-I, gastrin and insulin) were measured in the rat after sham operation, porto-caval shunt (PCS) or liver ischaemia. At an early stage following PCS or liver ischaemia brain oedema was not constant, and was only demonstrable after liver ischaemia in a large number of animals. Substances without an active transport and with a low diffusion coefficient such as L-glucose and inulin had a very low BUI, unchanged even if the 3H2O brain content or the DS were modified. B12 vitamin, DS and BUI were very high and did not change after liver ischaemia or PCS. Insulin DS and BUI were low in the three groups of animals, whereas it decreased after PCS for gastrin. A significant increase of BUI and DS (without any cerebral oedema) was demonstrated for angiotensin-I, a polypeptidic hormone of molecular weight 1300. This polypeptidic marker is in the same range of MW as the preliminary recently recognized medium-sized molecules which may be involved in the pathogenesis of encephalopathy during experimental acute liver failure. However, not only the MW, but the nature of such polypeptides may be of importance in the genesis of this limited impairment of BBB permeability.