Development of JAK2V617F-positive polycythemia vera after chemotherapy-induced remission of primary central nervous system diffuse large B cell non-Hodgkin's lymphoma: a case report and review of the literature.

The coexistence or the development of Philadelphia chromosome-negative myeloproliferative neoplasms after a lymphoproliferative disease in the same patient is an extremely rare event. We report the case of a 72-year-old man who developed JAK2V617F polycythemia vera 3 years after the diagnosis and treatment of primary diffuse large B cell non-Hodgkin's lymphoma of the central nervous system. We also review the literature regarding the pathogenesis underlying the association of myeloproliferative and lymphoproliferative chronic disorders.

[Acute necrotizing hepatitis: an unusual side effect of oral anticoagulants]. / Akute nekrotisierende Hepatitis: eine ungewöhnliche Nebenwirkung oraler Antikoagulantien.

We report the case of a severe relapsing phenprocoumon-induced hepatitis. The first episode of hepatitis was thought to be caused by another drug (Verapamil). The anticoagulation with Phenprocoumon was therefore continued after healing of liver inflammation. The relapse typically developed after a shorter exposition-time supporting the hypothesis of an allergic etiology. Fortunately we didn't find any cross-reaction between Phenprocoumon and Acenocoumarol. The patient could thus be anticoagulated orally without complications. If long term anticoagulation is absolutely essential, it is reasonable to prescribe a different Coumarin-derivate. In the case of a cross-reaction, the therapy should be continued with low-molecular weight heparin.

[Usefulness of bile analysis collected via endoscopy in the diagnosis of microlithiasis and biliary sludge]. / Utilité de l'analyse de la bile prélevée par endoscopie dans le diagnostic de la microlithiase et de la boue biliaire.

The search for cholesterol crystals in the bile, drawn during the endoscopy, represents a simple and reliable method in the diagnosis of the symptomatic biliary sludge. In our patients it was present in 82% of the cases. The injection of cholecystokinin appears to us absolutely necessary in order to obtain vesicular bile. The sensitiveness of abdominal sonography in the diagnosis of biliary sludge is weak, 13% of our cases. The clinical evolution with ursodeoxycholic acid treatment has been favourable in 83% of the treated patients.

[Retroperitoneal fibrosis and portal hypertension]. / Fibrose rétropéritonéale et hypertension portale.

A patient is described in whom retroperitoneal fibrosis manifested itself by bleeding from ruptured varices and pain in the left flank and lumbar region. The clinical diagnosis was confirmed by axial computerized tomography and MRI, while the histology from a mesenteric biopsy taken during splenectomy was considered insufficiently consistent with the diagnosis of retroperitoneal fibrosis. Treatment with prednisone resulted in relief of lumbar and flank pain a well as in prevention of further digestive tract hemorrhage. A review of the literature since 1966 shows 16 articles describing the association of retroperitoneal fibrosis and portal hypertension manifesting itself by hemorrhage from bleeding varices.

[A difficult diagnosis]. / Un diagnostic difficile.

We describe the case of a patient suffering from relapsing abdominal pain and vomiting over 4 years, in whom various radiological and endoscopic examinations remained normal. CT scan and MRI eventually showed a mesenteric mass corresponding to metastasis of an ileal carcinoid; this tumor was diagnosed only at laparotomy as well as his mesenteric and hepatic metastases. The different localization and clinical manifestations of carcinoid tumours as well as the difficulties of radiological diagnosis of tumours of the small bowel are mentioned; the diagnostic value of sonography. CT-scan and MRI in the diagnosis of hepatic metastasis is discussed.

[Lymphocytic gastritis]. / Gastrite à lymphocytes.

Lymphocytic gastritis is characterised by an accumulation of lymphocytes in the epithelium of the gastric mucosa. This form accounts for 4.5% of chronic B-gastritis and manifests itself by dyspepsia, anorexia and weight loss. The course is benign, as 12 of 19 patients recovered within 24 to 36 months in Haot's studies. Macroscopically it appears with nodules, erosions, thickened mucosal folds, or diffuse varioliform pattern. The gastric corpus is preferentially involved. The etiology is unknown. Some authors have hypothesized an abnormal immune response to a local antigen, i.e. Campylobacter pylori.

[Study of gallbladder emptying using 99m Tc-HIDA in acalculous cholecystopathy]. / Etude de la vidange vésiculaire à l'aide de 99mTc-HIDA dans la cholécystopathie sans calculs.

So-called acalculous gallbladder disease is an ill-defined entity, mainly seen in young women, which could be due to a motility disorder of the biliary tract. Seven young women with relapsing pain in the right upper quadrant of the abdomen or in the epigastrium, with cholesterol crystals in the bile and with normal sonographic and radiologic findings as well as normal gastroscopy, were investigated by hepato-biliary scintigraphy with 99mTc-HIDA. This first group was compared with a second group of 6 young women suffering from irritable colon, and with a third group of 6 asymptomatic control subjects. The half emptying-time of the gallbladder after cholecystokinin injection was 104.36 +/- 43.93 minutes in the first group, 17.92 +/- 23.57 minutes in the second and 20.42 +/- 23.67 minutes in the third group (p less than 0.005). After 6 weeks of ursodeoxycholic acid treatment, regression of pain and a significant reduction in the half emptying-time from 104.36 +/- 43.93 to 74.35 +/- 52.79 minutes (p less than 0.01) was observed in the first group. These results, which need to be confirmed by further studies, show that in acalculous gallbladder disease there is a delay in gallbladder emptying which could explain the formation of cholesterol crystals by bile stasis as described by various authors.

Gastric ulcer: a double-blind comparison of 100 mg pirenzepine plus antacid versus 800 mg cimetidine plus antacid.

Fifty-five patients with endoscopically confirmed gastric ulcers received either cimetidine (28 patients) or pirenzepine (27 patients) in a randomized double-blind manner. Fifty-seven per cent of the patients treated with cimetidine and 48% of those treated with pirenzepine presented with endoscopically healed ulcers after 4 weeks of treatment. By 8 weeks complete healing had occurred in 83% of the patients taking cimetidine and 76% of those taking pirenzepine. These differences were not statistically significant. Severity of pain on entering the study was correlated with slower healing of the ulcer. Side effects occurred in 5 of 27 patients in the pirenzepine group and 3 of 28 in the cimetidine group. They were mostly mild and did not differ from side effects observed in other studies.

[Correlation between endoscopy and histology of 48 cases of superficial stomach cancer]. / Corrélation endoscopie-histologie dans 48 cas de cancers superficiels de l'estomac.

The relationship between different endoscopic (gross appearance, diameter, localization, morphological type according to the Japanese Endoscopic Society) and histological parameters (type of cancer according to Lauren, tumor infiltration, association with metaplastic chronic gastritis) were analyzed retrospectively in 48 patients operated on for early gastric cancer. Endoscopy and histology provided a preoperative diagnosis of malignancy in 89.6% of the cases. With endoscopy alone the results were 23% malignancy, 44% suspicious and 33 benign. The antrum was the preferential site and type III the most frequent form. 62% of early gastric cancers were of the intestinal type and the average age of the patients was higher than for the diffuse type. Metaplastic chronic gastritis was associated in 67% of the intestinal type and in 21.5% of the infiltrating type. The degree of tumor infiltration was related to the diameter of the lesion, irrespective of the histological type. Since a malignant or suspicious lesion was diagnosed in only 67% by endoscopy alone, it is imperative to perform several biopsies of all gastric lesions, including even the smallest: 11 cancers of type III and IIc in this series had a diameter inferior to 1 cm and had been classified endoscopically as benign.

[Treatment of stomach ulcers with cimetidine and pirenzepine]. / Traitement de l'ulcère gastrique par la cimétidine et la pirenzépine.

37 patients with endoscopically confirmed gastric ulcers received either cimetidine (19 patients) or pirenzepine (18 patients) in a double-blind trial. At 4 weeks, 53% of the patients treated with cimetidine and 44% of those treated with pirenzepine had endoscopically healed ulcers. At 8 weeks, complete healing had occurred in 83% of the patients taking cimetidine and 71% of those taking pirenzepine. These differences are not statistically significant.

[Dissolution of gallstones based on 6 months treatment with a single daily dose of ursodeoxycholic acid]. / Dissolution de lithiase vésiculaire après 6 mois de traitement par dose journalière unique d'acide ursodésoxycholique.

51 patients with radiolucent gallstones of diameter less than or equal to 15 mm were treated for 6 months with a new form of ursodeoxycholic acid (UDCA) in a single dose of 450 mg at bedtime. This new form has 3 components with fractionate liberation. The rate of partial and complete dissolution after 6 months was 63.4%, reaching 85% for gallstones of less than 5 mm diameter. The results show that a single dose of 450 mg UDCA at bedtime is as effective as UDCA at mealtimes in the dissolution of radiolucent gallstones. Administration of the drug once a day should be more acceptable to patients.

[Treatment of reflux esophagitis with ranitidine. A multicentric prospective study]. / Behandlung der Refluxösophagitis mit Ranitidin. Eine multizentrische prospektive Studie.

Thirty-eight patients with erosive-ulcerative reflux esophagitis were treated in an open trial with the histamine-H2-receptor antagonist ranitidine (150 mg twice daily). At endoscopy after 6 weeks there was evidence of complete healing of all epithelial defects in 20 of 38 patients (53%). Continuation of treatment for another 6 weeks in 13 patients was followed by healing in 6 additional patients as judged by endoscopy. Although the symptoms of the group as a whole improved significantly during treatment, there was no correlation between the degree of symptomatic improvement and healing of esophagitis. Also, the healing rate did not depend on age, sex, smoking and drinking habits or on the severity of esophagitis. It is concluded that medical treatment of reflux esophagitis with ranitidine is promising, even in severe cases previously considered candidates for surgery.

[Treatment of dyspeptic disorders, lithiasis and biliary dyskinesia with ursodeoxycholic acid. Analysis of a controlled multicenter study]. / Le traitement des troubles dyspeptiques, de la lithiase et de la dyseinésie biliaires avec l'acide ursodésoxycholique. Analyse d'une recherche multicentrique contr$olée.

The effect of ursodesoxycholic acid (UDCA) on dyspeptic symptoms and pain in cholelithiasis and biliary dyskinesia has been investigated in a double blind trial. The results obtained in 661 patients investigated after 7 and 14 days of treatment show a significantly superior effect of UDCA compared with placebo.

[Postoperative reflux gastritis]. / Réalité de la gastrite postopératoire par reflux.

Postoperative reflux gastritis is generally considered a definite clinical syndrome. It is the possible sequel to any gastric surgery suppressing pyloric continence. Incidence of this complication is still difficult to evaluate, whereas enterogastric reflux is often seen during endoscopy. 75 patients were studied clinically and endoscopically, and their gastric mucosa histologically, after gastric surgery. Results were compared to those in a 2nd group of patients whose reflux induced symptoms had been brought under control by endoscopically confirmed surgical correction of reflux. Enterogastric reflux is common (80%), but its effect on the gastric mucosa is observed endoscopically only when it is relatively marked (69%). Clinical suspicion of reflux gastritis is most often confirmed by endoscopy, but endoscopic reflux gastritis is symptomatic in only half of patients undergoing surgery. Foveolar hyperplasia is the only histological criterion related to reflux gastritis.