[Pseudomyxoma of the peritoneum. Apropos of 4 cases]. / Maladie gélatineuse du péritoine. A propos de quatre cas.

Peritoneal pseudomyxoma is a rare disease (400 published cases). In 60% of all cases, an ovarian tumor is the cause of the disease. The second cause is appendicular mucocele. We report about four personal cases after a longer time lapse. No clinical or biological sign is specific. Ultrasonography associated to CT may allow establishing the preoperative diagnosis. Peritoneal pseudomyxoma has several main features: it is insidious, recurrent, obstinate and severe. Recent work has shown that peritoneal pseudomyxoma is secondary to malignant mucosecretory tumors, mainly of ovarian (cystadenocarcinoma) or appendicular origin, with intraperitoneal cell implants. Surgery is the only treatment with proven effectiveness. The effectiveness of chemotherapy and radiation therapy has not been established.

[Clinico-immunological profile of hepatic and extrahepatic diseases accompanied by anti-mitochondrial antibodies]. / Profil clinico-immunologique des affections hépatiques et extra-hépatiques s'accompagnant d'anticorps anti-mitochondries.

In a 13 year retrospective study mitochondrial antibodies were found in 1.71 p. 100 of patients about 60 years old with a strong female predominance. The presence of these antibodies was associated with a significantly increased level of the three classes of immunoglobulin and a marked cholestatic syndrome. In 76.9 p. 100 of cases the antibodies were associated with hepatic disease, mainly of immunological origin (67.7 p. 100). Primary biliary cirrhosis was the most frequent with significantly increased levels of mitochondrial antibodies, immunoglobin M, alkaline phosphatase and cholesterol. However, there was no correlation between the antibody levels and the clinical, biological and histological stages, thus ruling out any prognostic significance. The use of human cultured cells in the antibody detection assay increased the positivity of antinuclear antibodies compared with assays using classical rat liver substrates. Six sera were positive for anticentromere antibodies: 5/6 showed signs of the CRST syndrome with a primary biliary cirrhosis in 3/5 cases. The frequency of the association of primary biliary cirrhosis and other autoimmune diseases supports the results of previous reports as well as the finding of an association between mitochondrial antibodies and other auto-antibodies. In 3 cases primary biliary cirrhosis was associated with a chronic pancreatitis, suggesting a pluriglandular sicca syndrome, and in 3 other cases with a monoclonal IgA gammopathy. Mitochondrial antibodies are associated with other auto-immune non-hepatic diseases in 15.4 p. 100 of cases. The presence of increased levels of mitochondrial antibodies without any other auto-antibody associated with a chronic non-surgical cholestasis and an increased level of immunoglobulin M is still strongly suggestive of primary biliary cirrhosis.

[Crohn's disease of the colon. History]. / La maladie de Crohn du côlon. Historique.

During the 18th, 19th, and at the beginning of the 20th century, various observations of inflammatory lesions of the colon and small intestine were published, which were different of tuberculosis to which was at that time attributed every chronical small intestinal inflammatory disease. It was only in 1932, that in a very important paper, Crohn, Ginsburg and Oppenheimer defined the terminal ileitis, afterwards called regional enteritis, and finally more simply Crohn's disease. Twenty years later, in 1952, Crohn's disease of the colon, confused until that date with colonic tuberculosis and with ulcerative colitis, was also identified as a separate entity. Since that time, the number of reported cases has tremendously increased through its is impossible to state whether the incidence of the disease has really increased or whether the diagnosis is done earlier and more precisely. Even today, the exacts limits of the disease are difficult to precise, since the causal agent of the disease is unknown, and that no biological test is completely secure. The present work reports 60 observations of chronic colitis, associated or not with small intestinal inflammation.

[Findings by baryum enema in granulomatous colitis and ileocolitis. A review based upon 60 cases (author's transl)]. / Les signes fournis par le lavement baryté dans les colites et les iléocolites de Crohn. A propos de soixante observations.

Radiological aspects of colonic involvement in 60 patients whose disease has been followed up during several years are described. The typical radiological findings have been observed with their usual frequency. This study also confirmed the persistancy of the radiological findings in the chronic stage and the frequency of recurence in the two first years after surgery. Extension of disease has not been uncommon in the series, even without surgery. This progression was different, according to the initial location of disease: in the case of initial ileal lesion, extension occurred towards the adjacent caecum and right colon in sequence; in the case of initial colitis or ileocolitis lesion, extension occurred at a distance in other colonic segments.

[Haematologic disorders in Crohn's disease (author's transl)]. / Les signes hématologiques de la maladie de Crohn.

Anemia is the most commonly haematologic disorder observed in Crohn's disease. Secondary megaloblastic anemia related to a nutritional deficiency of vitamin B 12 and/or folic acid is a rare condition as well as auto-immune haemolytic anemia. Iron lack microcytic hypochromic anemia is far more frequent. It is probably due to several causes as microscopic or macroscopic haemorrhages, inflammatory syndrome, disturbance of iron absorption. Hyperleucocytis, hypereosinophilia, hypoprothrombinemia related to the inflammatory syndrome and/or lesions of the bowels are frequently observed in such patients. Anyhow, heamatologic disorders seem markedly correlated with the activity of the disease and should be useful in the follow up patients with Crohn's disease.

[Medical mangement of Crohn's disease (author's transl)]. / Traitement médical de la maladie de Crohn.

Medical management of Crohn's disease is above all symptomatic. According to the severeness of the case, treatment varies and may be simple (regimen, antidiarrheic agents and sulfamid drugs) or more sophisticated (continous parenteral alimentation). Sulfamids and antibiotics have a definite although temporary action. Pathogenic medication includes: 1) steroid therapy who is active, but its effects are not long stand; 2) immunosuppressors who allow for the reduction of steroid therapy dosages; 3) immunostimulants as proposed by Geffroy. Among those presently studied are Calmette-Guérin vaccine, either given orally or by scarification, and two anti-parasitic drugs, metronidazole and levamisole. Short term results are good but they worsen with time. The main problem is to know when to discuss surgery. As need be, resection although mutilating, should be timely indicated.

[Surgical treatment of Crohn disease of the colon. (38 cases) (author's transl)]. / Le traitement chirurgical de la maladie de Crohn colique. A propos de 38 observations.

From 1959 to december 1972 thirty-eight patients out of sixty having Crohn disease of the colon alone or with ileal and/or rectal involvement were operated upon. We had four post-operative deaths and one a long time after the intervention, but in relation with the initial Crohn disease. These thirty-eight patients had sixty-seven operations. Only fifty-five per cent of the operated on patients did not have any complications. Twenty-three patients had recurrence of the disease, seven of them were re-operated for this first recurrence, two of them for a second recurrence and one of these two last patients had a third recurrence. That makes twenty-seven recurrences out of forty-three resections. Among these twenty-seven recurrences, in at least seventeen cases, resection was not large enough or was not radical. Three quarters of the recurrences appear during the first year. The more exposed interventions to recurrences are left hemi-colectomies (two out of two) and total colectomies with ileo-rectal anastomosis (six out of eight). The ones that give less recurrences are total colo-protectomies or subtotal colectomies (one recurrence out of nine). Indications for the different types of interventions are analysed. Management of the rectum in Crohn disease of the colon is difficult. Procedures applied for toxic megacolon are equally very critical.

[Extra intestinal manifestations of Crohn's disease (author's transl)]. / Manifestations extra-intestinales de la maladie de Crohn.

The extra intestinal manifestations of Crohn's disease (CD) are not devoid of interest. They can, by themselves, aggravate the CD. Some of them have to be searched systematically (urinary complications, spondylarthritis and sacro-iliac arthritis). Amongst our 60 cases of Crohn's disease of the colon or of the ileon and colon, articular manifestations were the most frequent: arthralgias 25 cases (42%), true arthritis 17 cases (28%), spondylarthritis 5 cases, aacro-ileitis 9 cas (13%), finger hippocratism 11 cases (18%). In second cause, the cutaneous manifestations: 29 cases (48%) among which 6 cases (10%) of erytheme nodosa and 9 cases of allergic troubles (15%). Then came ocular troubles (5 cases), jaundice (5 cases). We observed 4 renal lithiasis and an hepatic sarcoïd granuloma revealed by the liver biopsy. Some complications were the local consequence of a local disease (hydronephrosis). Others represented the distant repercussion of a severe chronical intestinal disease. Some were true extra-intestinal localisations of the disease (perineal ulcerations and para-stomal ulcerations). Finally some complications, though non specific of Crohn's disease, evolued in parallel to it (some articular, ocular; dermatologic complications). In some cases they were anterior by several months or years to the intestinal symptoms of Crohn's disease, which suggests the existence of common etiological factors, especially genetical.

[Barium granuloma of the rectum]. / Granulome baryté du rectum

The authors report a case of barium granuloma of the rectum. This complication of barium enema is exceptional. During enema, the cannula may ulcerate the mucosa which is blown up secondarily by the barium. Clinically, the granuloma presents like a hard polyp which is suggestive in certain cases of a malignant tumour. The precise diagnosis is made by careful examination of the abdominal films before administration of barium taking in the whole of the pelvis.

[Experimental autograft of the small intestine in the pig. Histological, histoenzymological and ultrastructural study]. / Autotransplantation expérimentale de l'intestin grêle chez le porc. Etude histologique, histoenzymologique et ultrastructurale

In order to form an opinion of the value of certain precocious rejection tests with a view to ulterior intestinal allograftings, the authors intend first of all to determine the consequences of the operation itself and of the possibility resulting anoxia on the function of the intestinal mucosa. A concomitant biological (xylose test meal, quantitative analysis of the enzymes of the mucosa) and morphological study (lipid test meal, histologic, enzymologic and ultrastructural study of biopsic specimens) was carried out at various intervals after orthotopical intestinal autografting in 22 pigs. Most of the biological tests were strongly perturbated on the 7th day and some of them did not resume their initial value until the 15th day. The morphological and especially ultrastructural studies showed up to that time an important inflammation apparently caused not by the anoxia but by the lymph stasis. Solely conventional histology was only sightly modified (absence of ulcerations and of denudation of the villi) and this relative integrity, contrasting with the known severity of the lesions in case of precocious rejection, allows to consider this examination the only valuable until the 15th day, for the detection of immunologic incompatility reactions in allograftings.

[Effect of autotransplantation on various functions of the small intestine in swine].

The effects of anoxia on orthotopic small bowel autotransplantation were studied in 22 pigs respectively on the operative day (before and after transplantation) and post-operatively (on the 1st, 3d, 5th, 7th and 15th day). Absorption of D-xylose (as evaluated by xylosemia curve) and several brush border enzyme activities were compared with histological and histoenzymological data. After transplantation D-xylose test, enzymatic assays and to a lesser degree histoenzymology showed some impairment until the 15th day. By contract mucosal morphology as evaluated by optical microscopy was normalized as soon as the 3d post-operative day. From these data it may be assumed that in allotransplantations, optical microscopic abnormalities seen after the fourth post-operative day are no longer due to anoxia but may be related to early rejection. Other functional tests could be of some value only after the 15th day.