[Viral hepatitis A with prolonged course in adults]. / Hépatite virale A d'évolution prolongée de l'adulte.

OBJECTIVE: The aim of this study was to determine the clinical and virological characteristics of patients with type A viral hepatitis and a protracted course. METHODS: Twenty-seven patients with hepatitis A virus and elevated serum ALT levels for more than 6 months were studied. Patients were tested for hepatitis C and E virus using conserved serums. RESULTS: A biological relapse was defined by a decrease of the serum ALT levels > or = 50% followed by a > or = 50% increase in the minimal value. Biological relapses occurred in all patients. The median time between the onset of the disease and the first relapse was 87 days. During relapse, jaundice and ascites were present in five and one patients, respectively. All patients recovered. Serum aminotransferase activities returned to the normal range in a median of 230 days. None of the 17 tested patients had hepatitis C virus antibodies. Sixteen patients were tested for hepatitis E virus antibodies; 8 were positive for IgG and one for IgM. Sixteen control patients with acute hepatitis A of short duration, matched for date and country of contamination, were also tested for antibodies to hepatitis E virus; 11 were positive for IgG and none for IgM. CONCLUSION: A protracted course of type A viral hepatitis is characterised by relapses with or without symptoms. The high frequency of a positive test for hepatitis E IgG associated with a negative test for IgM in patients with and without a protracted course does not suggest that hepatitis E virus plays a role in patients with a protracted course. These positive results might be due to either false positive results or to past contamination.

[Markers of viral hepatitis B and D and levels of alanine aminotransferase in military blood donors: a profile of 30,000 blood donations in 1989]. / Marqueurs des hépatites virales B et D et taux des alanine aminotransférases chez les donneurs de sang en milieu militaire: bilan sur 30,000 dons de sang en 1989.

Serologic data for B and D viral hepatitis are studied on 30,000 military blood donors. Because of legal norms of blood products for transfusion 761 donations (2.53% have been destroyed). Exclusion criteria for viral B hepatitis and ALT are independent. In this study the prevalency of HBV infections is significantly lower than for other blood centers: probably in account of the young age of military blood donors.

[Acute icteric viral hepatitis type A, B, D and non-A non-B. Etiologic, clinical and developmental aspects in the young man. Apropos of 423 cases]. / Hépatites virales aiguës ictérigènes A, B, D et non-A non-B Aspects étiologiques, cliniques et évolutifs chez l'homme jeune. A propos de 423 cas.

In the light of the present serological tests, the etiology, clinical features and course of acute viral hepatitis were reviewed in 423 consecutive male patients. Follow-up started less than 15 days after the onset of jaundice and continued until recovery or for at least six months if recovery did not occur before them. The incidence of type A viral hepatitis decreased in France but remained high in North Africa and tropical areas. During the acute phase it differed from hepatitis type B by a lower aminotransferase level. Relapse, however, was more common, as was protraction of longer than six months. Recovery ultimately occurred. The specific IgM antibody persisted throughout the condition. Type B hepatitis differed from type A hepatitis by a mean quicker normalization of the biochemical disturbances. In the absence of superinfection by delta hepatitis virus or by a non-A, non-B virus, the progression to chronic liver disease was rare. The course of non-A, non-B hepatitis was very dissimilar according to the circumstances of occurrence. In epidemic cases rapid recovery occurred and no progression to chronicity was noted. In the other cases, relapse and chronicity were more frequent than for type A or B hepatitis. Type D hepatitis was characterized by more pronounced biochemical disturbances during the acute phase and by more frequent progression to chronicity in case of superinfection.

[Colonic cancer. Indications and results apropos of a continuous series of 223 patients]. / Les cancers coliques. Indications et résultats à propos d'une série continue de 223 patients.

The authors report a retrospective study of 223 surgical colonic carcinoma (1978-1987), the rectal carcinoma left out of them because of disparity in technical aspects. The total post-operative mortality rate was 9.4 per cent, made of great mortality in emergency (31 per cent) and in palliative surgery (17 per cent). Out of emergency, the mortality of curative surgery is 3.7 per cent. Surgical procedure was mechanical in 96 per cent with incidence of leakage in 3.9 per cent. The total survival rate is 53 per cent after 5 year follow-up, 70 per cent after curative surgery and 89 per cent for the first level (A) in DUKE'S classification. There is only a problem for the choice in size of resection for the sigmoid side (50 per cent of the cases). Contrary to recent studies, in our experience the post-operative mortality rate and survival rate are different with sigmoidectomy or left colectomy. Then the authors think that every model of resection has to be choice according age of patient and classification of carcinoma.

[Acute epidemic non-A, non-B hepatitis: clinical study of 38 cases seen in Chad]. / Hépatite aiguë non-A, non-B épidémique: étude clinique de 38 cas observés au Tchad.

An epidemic of acute non-A, non-B hepatitis (NANBH), observed in 38 young French soldiers in Chad, presumed to be waterborne, allowed to describe the clinical picture of the disease. The main features of this entity were compared with those observed during previously described outbreaks of waterborne NANBH encountered in North Africa and in Asia as well as with 85 cases of viral type A hepatitis of various other geographical origins, observed during the same period of time. Similarities between the clinical features of the disease within every water-transmitted NANBH epidemic center were suggestive of a particular nosologic entity among the non-parenterally transmitted cases of NANBH. In young male subjects, the course of the disease proved to be milder than that of type A viral hepatitis. A 5 ml dose of non-specific French-prepared human immunoglobulins had no prophylactic effects on the disease.

[Hepatic amebiasis: study of 152 cases]. / L'amibiase hépatique: étude de 152 observations.

The purpose of this study was to describe and analyse retrospectively the clinical, serological, anatomical and evolutive features of 152 cases of hepatic amebiasis in young adults, treated and followed up in France from 1969 to 1983. The disease was revealed 3 times out of 4 by tender hepatomegaly with fever, but only in 6 cases by complications. Serological tests (immunofluorescence or hemagglutination) were always positive for amebiasis, whereas Entamoeba histolytica was absent from stools in 96.7 p. 100 of the cases. Hepatic amebiasis always caused a hepatic abscess: in these cases, the superiority of ultrasonography over all other diagnostic methods was confirmed, especially concerning the detection of multiple abscesses (47 p. 100). Complete recovery was obtained by medical treatment in 117 cases, either alone (98 cases), or combined with needle aspiration (19 cases). Nitro-imidazoles are the simplest treatment, but nevertheless in 5 cases they were not effective. These patients were then treated with dehydroemetine, associated in 2 cases with surgery. Four patients relapsed at mid or long-term after apparent recovery, in the absence of any obvious reinfection. A significant correlation between the course of the treated disease and the size and number of abscesses was demonstrated: it was possible to define a group characterized by a slow and/or complicated course (with single abscess of the right lobe whose diameter is equal to or greater than 10 cm, or multiple abscesses). The pathogenesis of hepatic amebiasis is not yet fully understood.

[Hepatic amebiasis in France. Apropos of 152 case reports]. / L'amibiase hépatique en France. A propos de 152 observations.

The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.

[Changes in HBs antigen and anti-HBs antibody in 77 patients with acute B-virus hepatitis]. / Evolution de l'antigène HBs et de l'anticorps anti-HBs chez 77 patients ayant une hépatite aiguë due au virus B.

Serum HBs antigen (HBs Ag) and anti-HBs antibody (anti-HBs), as determined by radioimmuno-assay or ELISA methods, were studied in a group of 77 patients with acute icterogenic viral hepatitis over a period of at least three months and correlated to the evolution of the disease either to return to good health or to a chronic state. The cumulative rate of patients in whom HBs Ag had disappeared (n = 53) was a linear function of time during the first sixteen weeks. Correlation seemed even stronger in the subgroup of patients restored to good health before the third month. Time of HBs Ag disappearance ranged from 5 days to 5 months in common forms of hepatitis. There was no evident correlation between the time of disappearance and the normalization of ALAT levels. Among the four cases of chronic persistent hepatitis, three had no detectable antigenemia six months later. Development of anti-HBs preceded the loss of HBs Ag in one case, was simultaneous or posterior to it in all other cases; the absence of any serologic HBV marker could last up to 4 months. No chronological link was found between seroconversion and normalization of ALAT levels. The correlation between time and HBs Ag disappearance from the blood could be specific for a given group of patients placed under specific conditions; its determination might help in understanding the factors that influence the course of the disease.