[Clinical case of the month. Hepatitis B reactivation in an Ag HBs negative patient]. / Le cas clinique du mois. Un cas de réactivation virale B chez un patient Ag HBs négatif.

A 66-year-old man, Ag HBs negative, suffering from glomerulonephritis was treated with prednisone. Hepatitis B reactivation was observed after increasing and regression of corticotherapy. Pathogenesis, efficient therapy and prevention of reactivation of hepatitis B will be reviewed.

[Epidemiological aspects, risk factors, and detection of pancreatic cancer]. / Epidémiologie, facteurs de risque et dépistage du cancer du pancréas.

The incidence of pancreatic cancer (PC) is increasing in developing countries. Smoking, reduced consumption of fruits and vegetables, chronic pancreatitis appear to be the best established risk factors. PC is often diagnosed at a late stage. We have to look for it when dyspepsia with weight loss, pancreatic pain or impaired glucose tolerance occurs. Tumor markers are briefly exposed and we discuss the place of endoscopic retrograde cholangiopancreatography (ERCP) after non invasive imaging techniques.

[Endoscopic ultrasonography in the diagnosis and staging of pancreatic and ampullary cancer: influence on patient management]. / Apport de l'échoendoscopie (EE) au diagnostic et à la stadification des cancers pancréatiques et ampullaires: influences sur la prise en charge du patient.

Accurate preoperative staging is now more prerequisite in the management of cancer of the pancreas and ampulla in order to orientate the patient toward the best selected treatment: either a curative or a palliative surgery associated or not with a pre- or postoperative multimodal therapy, or an endoscopic palliative technique which does not require surgery. Endoscopic ultrasonography (EUS) appears to be a highly accurate diagnostic procedure in the assessment of local resectability because it enables detailed visualization of the pancreatic gland, the depth of infiltration into the surrounding tissue and organs and visualisation of regional lymph nodes involvement. EUS-guided fine needle aspiration for cytology will provide a tissue diagnosis. The likelihood of successful resection for palliative or cure can be predicted before surgery. The following overview will point out the clinical impact of EUS on diagnosis, staging and management of these tumors.

[Clinical case of the month. Rupture of Salmonella mycotic aneurysm of the infrarenal abdominal aorta]. / Le cas clinique du mois. Rupture couverte d'un anévrysme infectieux post-typhique de l'aorte abdominale sous-rénale.

Mycotic aneurysms are uncommon but remain one of the most challenging clinical problems for the vascular surgeon. They are associated with high morbidity and mortality, and the clinical signs and symptoms are non specific. We report here the case of an abdominal aorta mycotic aneurysm due to salmonellosis treated by insertion of an arterial homograft.

Ultrasonically guided fine-needle biopsy in focal intrahepatic lesions: six years' experience.

We report the results of 322 ultrasonically guided percutaneous fine-needle biopsies of focal intrahepatic lesions. The technique is original in several respects; it is an aspiration of both the lesion and normal-looking liver, and it includes both cytology and histology when the tiny cores are obtained. Cytology included Papanicolaou and Giemsa staining and other special staining when necessary. Sensitivity was 88.6% and specificity was 100% in the diagnosis of malignancy. Out of 141 metastases, 14 false negatives, 5 misclassifications, and 122 correct diagnoses were obtained. Out of 69 hepatomas the correct diagnosis of malignancy was made in 63 patients and of these the correct classification in 49. Complications occurred in six patients and marked hemorrhage in four. This technique is a simple, accurate, safe method for the diagnosis of focal intrahepatic lesions.