ABSTRACT
BACKGROUND: Epidemiological data concerning hepatitis B are scarce in France. AIM: To describe epidemiological, clinical, virological and histological features of HBsAg-positive patients followed at non-academic hospitals in France. METHODS: Clinical, biological, virological and histological data of all HBsAg-positive consecutive patients observed from April 1, 2001 to May 31, 2002 in participating centres were recorded prospectively. Multivariate analyses of factors associated with significant fibrosis and cirrhosis were performed. RESULTS: Nearly 1166 HBsAg-positive patients were seen in the 58 centres: 671 males and 495 females from metropolitan France (32%) and from outside metropolitan France (68%); mean age 41 +/- 15 years. Twenty-nine percent of patients were probable HBsAg inactive carriers, while 50% had chronic hepatitis; 43% of these were HBeAg-positive and 57% HBeAg-negative. Liver biopsy had been performed in 558 (51%) patients; 205 (17.6%) patients had cirrhosis. By multivariate analysis, factors associated with significant fibrosis were: age >40 years (P < 0.05), HBeAg-negative status (P < 0.02) and histological activity (P < 0.0001). Factors associated with cirrhosis: age (P < 0.0001), platelet count <150 000/mm(3) (P < 0.0001) and viral co-infection (P < 0.03). CONCLUSION: HBV infection represents a significant workload for hepatogastroenterologists at non-academic hospitals in France.
Subject(s)
Hepatitis B, Chronic/epidemiology , Adult , Female , France/epidemiology , Hepatitis B e Antigens/blood , Hepatitis B virus/isolation & purification , Hepatitis B, Chronic/blood , Humans , Liver Cirrhosis/epidemiology , Male , Prevalence , Risk Factors , Sex FactorsABSTRACT
The authors report a case of a primary melanoma of the esophagus, which is a rare neoplasm with poor prognosis. The diagnosis of malignant melanoma was suggested, on endoscopic biopsies, because of the presence of large malignant cells with abundant cytoplasm containing melanin pigment positive in the Fontana-Masson's reaction. These cells were immunoreactive for S100 protein while they did not show staining for antiepithelial membrane antigen and anti-keratin antibodies. Moreover ultrastructural study of the tumor cells revealed cytoplasmic aberrant premelanosomas. An important histological feature of the present case, which confirmed the primary oesophageal nature of the tumor was the presence of foci of melanosis (benign melanocytes) within the oesophageal epithelium which was adjacent to the melanoma. The variation in the histology of malignant melanoma may provide difficulties in diagnosis especially if one is limited to study a small biopsy specimen. In such cases other diagnoses including epidermoid carcinoma with prominent spindle-cell features and sarcomas should be eliminated by means of immunohistochemical and ultrastructural studies. The particular feature of our case, which apparently has not been reported previously, is the identification of the melanosis two years prior to the diagnosis of the malignant melanoma. The present study indicates that the identification of this lesion is of important diagnostic interest and might lead to the follow-up surveillance of the melanosis by multiple biopsies.
Subject(s)
Esophageal Neoplasms/pathology , Melanoma/pathology , Melanosis/pathology , Esophageal Neoplasms/analysis , Esophageal Neoplasms/ultrastructure , Humans , Male , Melanoma/analysis , Melanoma/ultrastructure , Microscopy, Electron , Middle AgedABSTRACT
The authors report of a case of caecal perforation in a patient with Sezary syndrome who was submitted to systemic corticosteroids a few days before that complication. Caecal perforations during corticosteroid treatment appear to be rare, the known causes being essentially carcinoma, ischaemia and colectasia in inflammatory colitis. In the case reported, there was no associated intestinal lesion. The prognosis is usually severe, mainly on account of the lack of explicit symptoms.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Cecal Diseases/chemically induced , Sezary Syndrome/complications , Adrenal Cortex Hormones/therapeutic use , Aged , Humans , Male , Sezary Syndrome/drug therapyABSTRACT
A 70-year-old patient developed a bone marrow aplasia following the onset of an apparently infectious hepatitis. During the course of his illness he experienced episodes of severe sepsis, that were treated with antibiotics and leucocyte transfusions. The authors suggest that lithium therapy might be of benefit for such patients because of his granulopoïetic properties.
Subject(s)
Bone Marrow Diseases/etiology , Hepatitis, Viral, Human/complications , Lithium/therapeutic use , Aged , Bone Marrow Diseases/drug therapy , Hepatitis, Viral, Human/drug therapy , Humans , MaleABSTRACT
A study of thyroid function was undertaken in 53 patients with chronic alcoholism the following tests were performed: T3 RIA, T4 RIA, T3 test and I.V. TRH-test. The patients were divided into 3 groups according to the degree of liver injury: histologically documented fibrosteatosis (group 1), cirrhosis (group 2); group 3 consisted of severe cirrhosis with coagulation defects precluding liver biopsy. 32 healthy subjects served as controls. Free thyroxine index was normal in the 3 groups of patients; on the contrary, serum T3 RIA was significantly reduced in the 2nd and the 3rd group. The decrease of T3 correlated with the degree of hepatocellular failure. TRH test was almost always normal. If patients are separated into two groups according to their circulating T3 levels, it appears that subjects with low T3 show a TRH-induced increase in TSH lower than in the other group, but not significantly different from normal subjects, suggesting an inadequate hypothalamic reactivity.
