[Hepatic inflammatory pseudotumor regressing with antibiotic therapy]. / Pseudo-tumeur inflammatoire hépatique régressant sous antibiothérapie.

INTRODUCTION: Inflammatory hepatic pseudo-tumors are rare, non-neoplastic lesions, and their diagnosis is usually made on hepatectomy samples. OBSERVATION: The general health of a 77 year-old patient was suddenly altered and clinical examination (and scan) revealed a hepatic tumor. Diagnosis of inflammatory hepatic pseudo-tumor was evoked by analysis of a biopsy. In view of the age and the general state of the patient we chose prolonged antibiotic therapy rather than hepatic surgery. Nine months later, the tumor had regressed. COMMENTS: Because they are rare (100 cases described), hepatic pseudo-tumors raise two questions: can diagnosis be made simply by biopsy or should one always analyze the complete sample and, if hepatectomy is contraindicated, is non-surgical treatment effective? The progression of our patient permits us to reply positively to both questions.

[Hepatic manifestations in Still's disease]. / Manifestations hépatiques au cours de la maladie de Still.

In children, as in adults, Still's disease usually presents with a hectic fever, a characteristic rash and arthralgia or arthritis. Visceral involvement is however classical; the hepatic manifestations were studied with respect to two cases. Biochemical changes are common, often mild: the commonest abnormality is cytolysis. Jaundice is less frequent and hepatic involvement may in exceptional cases be life threatening, usually in cases of serious polyvisceral disease often with disseminated intravascular coagulation. These manifestations may be spontaneous or secondary to salicylate therapy; the anatomical changes are the same; the salicylate would therefore seem rather to unmask and aggravate an underlying hepatic abnormality.

[Relapse of an amebic abscess of the liver after treatment with metronidazole]. / Rechute in situ d'un abcès amibien du foie après traitement au métronidazole.

The authors report the observation of a twenty four years old soldier; subsequent to a stay in an endemic amoebic area, he showed several successive dysenteric episodes which were treated with metronidazole despite the absence of amoeba in the coprological examination. During one of these episodes, he presented a single rectal ulceration, then a hepatic abscess was observed four months later. The patient was treated with metronidazole and by contact amoebicides. In spite of that, amoeba were disclosed after a parasitological stool examination.

[Hemolytic anemia and the digestive system]. / Anémies hémolytiques et appareil digestif.

Haemolytic anemias are less frequently encountered in gastro-enterology than hyposideremic hypochrome anemias, or megaloblastic anemias. In our country, migrant's pathology has become increasingly important and congenital haemolytic anemias are part of this pathology. These and their main digestive complications require an early diagnosis, which is the best sign of an effective treatment. A severe haemolytic anemia occurring during a chronic liver disease often represents an evolutive turning point.

[Plummer-Vinson syndrome or related syndrome in 3 black African women]. / Syndrome de Plummer-Vinson ou syndrome apparenté chez trois africaines de race noire.

The Plummer-Vinson syndrome or "sideropenic dysphagia" is exceptional among Blacks. One case was recently reported in a female patient from Guadeloupe. This study pertains to three cases observed in Senegalese Black women aged 28, 27, and 41 years. These three women were admitted for a dysphagia, in fact in evidence 10, 4, and 7 years respectively before the diagnosis was made. A clinical anemia was noted twice in addition to mucocutaneous disorders (cases 1 and 2). The laboratory tests showed in all three cases a hypochromic microcytic sideropenic anemia (serum iron levels at 32, 14, and 31 mcg 100 ml respectively). Barium swallow films showed esophageal rings in front of C5-C6 (case 1) of T2-T3 (case 2) and a web of fine mucosal folds in front of C5-C6 (case 3). These films were confirmed cineradiographically by esophagoscopy. The treatment consisted of blood transfusions (cases 1 and 2) and administration of iron by injections and or per os. The endoscopic exams were repeated two or three times. Medical treatment rapidly changed the course of disease for the better. No cause for bleeding was found. A chemical achlorhydria (case 1), a provoked hypoachlorhydria (cases 2 and 3) can be retained as associated factors. In light of the frequency of esophageal membranes in the general population and the incidence of sideropenic anemias among African women, the Plummer-Vinson syndrome should be more often detected in Black Africa.

[Practical use and interpretation of viral hepatitis B markers and hepatic biopsy in HBs Ag carriers and at the chronic hepatitis stage]. / Utilisation pratique et interprétation des marqueurs de l'hépatite à virus B et de la biopsie hépatique chez le porteur d'Ag HBs et au stade d'hépatite chronique.

Practical significance of serologic markers for hepatitis B virus and interpretation according to clinical stage and liver biopsy pattern in HBs Ag positive patients with or without chronic liver disease. Vidarabine is the treatment of choice actually available for patients with chronic persistent or chronic active hepatitis who demonstrate active replication of the virus. The authors review the technics actually necessary: to diagnose chronic hepatitis, to screen for hepatitis B virus, to demonstrate active replication of the virus. They report that these actually routine technics can be available in any biochemistry or pathology laboratory including those in tropical areas.

[Indications for laparoscopy in an internal medicine department in Dakar as indicated by echotomography]. / Indications de la laparoscopie dans un service de médecine interne à Dakar à l'heure de l'échotomographie (E.C.T.).

A real time ultrasonography was set up in a senegalese hospital, resulting in a decrease of laparoscopy indications. Laparoscopy is given up for the diagnosis of liver abcess, jaundice and "abdominal masses". It must no more be included in the first step check up for hepatocellular carcinoma, because ultrasonography and cytology after puncture are enough to confirm the diagnosis. Laparoscopy remains essential for peritoneal diseases. Hepatic needle biopsy under laparoscopy control remains necessary to ensure with certainty the diagnosis of cirrhosis and especially chronic hepatitis, provided that no countraindications are found.

[Hemorrhagic rectocolitis or ulcerative colitis in the black Senegalese. Apropos of 14 cases]. / La rectocolite hémorragique ou colite ulcéreuse chez le sénégalais de race noire. A propos de 14 cas.

Ulcerative colitis is exceptional in Africa South of the Sahara. The first case was described in 1964: up to 1982, 46 cases were reported. We report on 14 cases (6 females and 8 males) observed in black Senegalese for three years and a half. The medium age of patients was 30 years. All of them had a high social standard of living. Four patients showed intestinal amebiasis in their previous medical history. Clinical and evolutive patterns of ulcerative colitis in Africa present few differences in comparison with the classical ones. The diagnosis is established by endoscopy (rectosigmoidoscopy and/or colonoscopy) and histopathology. Cryptic abscesses were found in only 2 out of 14 cases. Rectal dysplasia was noted in 2 cases. The course of the disease developed on a fulminating acute mode in one case, on a continuous chronic mode in another case and on a chronic mode with relapses in 11 cases. Irrespective to the clinical form observed, intestinal amebiasis represents the most pressing differential diagnosis. Treatment appears to be difficult in severe acute forms out of an intensive care department, as well as in advanced extensive chronic forms. For the later in black Africa endoscopic and histopathological surveillance appears to be preferable to a total colectomy, made necessary by the important rectal lesions, because the functional sequelae of an ileostomy.

[Esophagogastroduodenal endoscopy in diagnosis in tropical areas. Apropos of 3000 studies performed in adults]. / Apport de l'endoscopie oesogastroduodénale au diagnostic en zone tropicale. A propos de 3.000 examens réalisés chez des adultes.

The authors report on the results gained from 3000 peroral endoscopies (10% as urgent cases) carried out in adults at the Dakar General Hospital within a period of 30 months. They emphasize the low cost of such an exam, and they underline: a) the young age of examined patients b) the number of examinations on out-patients, demonstrating that oesogastroduodenoscopy is now well accepted by Africans. Digestive hemorrhages are mainly caused by duodenal ulcers, oesophageal varices, hemorrhagic gastritis. A new pathology is raising up: volontary ingestion of caustic pro ducts. The most frequent lesions observed are duodenal ulcers, oesophagic and gastric cancers, gastritis. The interest of endoscopic control of healing of cancers is confirmed. Revealing of oesophageal varices often take place before an hepatopathy is discovered. Therapeutic endoscopy and monitoring endoscopy should be developed. Through improved technics, diagnostic endoscopy has been efficient.