Liver cirrhosis in histiocytosis X.

Cirrhosis of the liver was diagnosed in an 18-year-old man with histiocytosis X. Electron microscopy and immunohistochemistry revealed infiltration of the liver by the typical cellular elements of histiocytosis X. Endoscopic retrograde cholangiography showed alterations resembling those of sclerosing cholangitis. Sixteen months later, the patient died of recurrent variceal bleeding and cholangiosepsis. Autopsy confirmed that cirrhosis was the main manifestations of the underlying disease. Thus, cirrhosis of liver can be a main and potentially fatal manifestation of histiocytosis X beyond the pediatric age range. Histiocytosis X may lead to parenchymal infiltration of the liver and to changes of the major bile ducts resembling sclerosing cholangitis. The diagnosis of hepatic histiocytosis X can easily be missed without relying on appropriate electron microscopic and immunohistochemical investigations.

[Bladder substitute realized by means of an ileal segment]. / Vessie de substitution réalisée au moyen de l'iléon replié.

An internal urinary diversion after radical cystoprostatectomy has been performed in 24 male patients. The bladder substitute was made from an ileal segment, opened along its antimesenteric border and folded twice, according to Goodwin's "cup-patch technique". After an observation time of 3 months to 3 years, the results are in general good: no signs of pyelonephritis or metabolic changes, necessitating a substitution, have been observed. The increase of the bladder substitute's capacity is parallel to the improvement of urinary continence. In general, the latter is achieved after 1-3 months during the day, and after 2-6 months during the right. According to our experience, preservation of the neurovascular bundles responsible for erection, helps to regain continence. However, loss of several drops of urine may occur, reason why half of our patients wear a safety pad later than 6 months after surgery, at least during the night.

[Biological availability of digoxin and beta-methyl-digoxin administered in the fasting state or after meals]. / Biologische Verfügbarkeit von Digoxin und beta-Methyl-Digoxin bei nüchterner und postprandialer Einnahme.

Ten healthy volunteers were given 0.75 mg digoxin and 0.5 mg beta-methyl-digoxin (BMD) in tablet form in the fasting state or after breakfast. Serum concentrations and 24-hour urine excretion of glycoside were measured by radioimmunoassay. Neither the mean area under the serum concentration curve nor the mean cumulative urinary excretion was significantly changed by postprandial administration. Peak serum concentrations were higher when the subjects took the tablets while fasting than when they took them postprandially, but the difference was significant only for BMD. After BMD in the fed state the peak serum concentration was reached earlier and with less variation than after digoxin, but -- as after administration in the fasting state -- the differences were not significant. The peak serum concentration and the time when it is achieved are, as parameters for the rate of absorption, only of secondary importance for treatment with cardiac glycosides in medical practice. They suggest faster absorption of BMD compared with digoxin. Both the glycosides can be given equally well before, during or after food, a fact which facilitates prescription.