[Intraductal mucinous tumor of the pancreas: report of a clinical case]. / Tumore intraduttale pancreatico mucinoso: a proposito di un caso clinico.

A 49-year-old diabetic patient with abdominal pain was found at ultrasonography and computed tomography to have a cystic mass in the head of the pancreas with dilatation of the main pancreatic duct. The head of the pancreas and the duodenum were removed surgically. Examination of the operative specimen showed chronic pancreatitis, dilatation of the main pancreatic duct, and impacted mucus in the secondary ducts with villous proliferation of the ductal epithelium, thus allowing a diagnosis of intraductal adenomatosis. There was no evidence of malignancy. The resection margin was involved, and consequently the remainder of the pancreas was removed six months after the initial surgical procedure. A review of the literature showed that intraductal adenomatosis tends to spread and carries a high risk of malignant transformation. Surgery is required because of the risk of pancreatic duct obstruction and pancreatic cancer. Intraductal papillary tumour of the pancreas shares many characteristic with other adenomatous proliferation of the gastrointestinal tract (colorectal villous adenoma, bile duct adenomatosis) including the presence of villous structures with increased mucus production, a tendency to spread massively, and a high risk of malignant transformation.

[Diagnosis and treatment of spleen rupture during pancreatitis].

A 31-year old man was admitted for acute pancreatitis. His condition deteriorated progressively and he developed an acute anemia followed five days after admission by an hemorrhagic shock consecutive to splenic rupture. A 45-year old woman was admitted because of an acute episode of chronic pancreatitis. She improved progressively but developed eleven days after admission an hemorrhagic shock consecutive to the rupture of a subcapsular haematoma of the spleen. Splenic rupture, an infrequent complication of acute or chronic pancreatitis, is responsible for anemia and hemorrhagic shock. Abdominal ultrasonography and CT scan are necessary to make the diagnosis of splenic rupture and to look for risk factors of splenic rupture, i.e. necrosis in the spleen hilium, left pancreatic pseudocyst, splenic vein thrombosis, segmental portal hypertension, splenomegaly and intrasplenic collection. When possible, embolization of the splenic artery can stop bleeding. Splenectomy with distal pancreatectomy seems to be the appropriate treatment of splenic rupture.

[Acute acalculous cholecystitis associated with primary antiphospholipid antibody syndrome. Cure with low-molecular-weight heparin and antivitamin K]. / Cholécystite aiguë alithiasique associée à un syndrome primaire des anti-phospholipides. Guérison sous héparine de bas poids moléculaire et anti-vitamine K.

We report the first case of acute acalculous cholecystitis associated with primary antiphospholipid-antibody syndrome. The diagnosis was serological and was based on positive tests for lupus anticoagulant or anticardiolipin antibodies. The treatment was exclusively medical. Cholecystitis was cured with low-molecular weight heparin and oral anticoagulants. A rapid diagnosis can prevent lack of therapeutic errors such as surgery, antibiotherapy or corticotherapy, and long-term anticoagulant treatment can be proposed to prevent recurrent thrombosis.

[Ulcer of the esophagus disclosing probable malignant histiocytofibroma of the posterior mediastinum]. / Ulcère suspendu de l'oesophage révélant un probable histiocytofibrome malin du médiastin postérieur.

We report the case of a 72-year-old woman hospitalized for dysphagia and odynophagia due to an ulcer of the esophagus. Thoracic CT-scan and esophageal endosonography revealed a tumour of the mediastinum which invaded the esophagus. Per-operative biopsies concluded to a probable malignant fibrous histiocytoma.

[Pancreatic involvement, ascites and diarrhea in idiopathic hypereosinophilic syndrome]. / Atteinte pancréatique, ascite et diarrhée au cours d'un syndrome hyperéosinophilique idiopathique.

We report a new case of idiopathic hypereosinophilic syndrome with multivisceral digestive failure. After an erroneous diagnosis of pancreatic cancer, the pathological examination of pancreaticoduodenectomy specimen demonstrated pancreatic fibrosis with eosinophilic infiltration without gastritis or duodenitis. The diagnosis of idiopathic hypereosinophilic syndrome was made three months later upon the classical criteria: a) blood eosinophilia of 1.5 G/L or more, persisting for more than 6 months; b) lack of evidence for any other recognised cause of eosinophilia: c) multiple organ systemic involvement: rheumatologic, cutaneous and digestive (pancreatitis, ascites and diarrhoea): d) previous history of allergic disease and increased plasmatic IgE levels; e) absence of leukemic markers. This case emphasises the difficulty in classifying eosinophilic infiltration of the gut and the possibility of transitional forms between eosinophilic gastro-enteritis and idiopathic hypereosinophilic syndrome. We argue that in case of eosinophilic infiltration of the gut, systematic research of multiple organ systemic involvement is mandatory.

[Value of rectosigmoidoscopy with bacteriological culture of colonic biopsies in the diagnosis of post-antibiotic hemorrhagic colitis related to Klebsiella oxytoca]. / Intérêt de la rectosigmoïdoscopie avec culture bactériologique de biopsies coliques dans le diagnostic des colites hémorragiques post-antibiotiques associées à Klebsiella oxytoca.

UNLABELLED: We report 7 cases of antibiotic-associated and hemorrhagic colitis due to Klebsiella oxytoca. The diagnosis was performed by sigmoidoscopy with bacteriological biopsy culture. PATIENTS AND METHODS: Nine patients, aged 25-83 years, were hospitalized from February 1993 to October 1995 with hemorrhagic acute diarrhea following antibiotic treatment: amoxicillin (n = 3). amoxicillin-clavulanic acid (n = 4), cephalosporine (n = 2). All patients have had two stool samples cultures including Clostridium difficile toxin detection. Sigmoidoscopy with collection of biopsy specimens for bacteriological cultures was performed routinely. RESULTS: Endoscopic findings established the diagnosis of colitis in all cases: rectitis (n = 1), diffuse left colitis (n = 4), segmental left colitis (n = 4). The lesions were erythematous and purpuric (n = 5) or ulcerative (n = 4). Stool culture was normal in all cases but Klebsiella oxytoca was isolated in 7 cases (78%). CONCLUSIONS: Sigmoidoscopy and bioptic microbiology ensured the diagnosis of antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca.

[Value of proctosigmoidoscopy with bacteriological culture of colonic biopsies in the etiological diagnosis of post-antibiotic acute diarrhea in adults. Prospective study in 24 patients]. / Intérêt de la rectosigmoïdoscopie avec culture bactériologique de biopsies coliques dans le diagnostic étiologique de diarrhée aiguë post-antibiotique de l'adulte. Etude prospective sur 24 patients.

The aim of this study was to analyse the interest of proctosigmoidoscopy and biopsies microbiology in antibiotic-associated acute diarrhea in adults. Between February 1993 and October 1995, we have studied prospectively 24 patients with antibiotic-associated acute diarrhea. Ages ranged from 17 to 83 years. They had taken antibiotics: amoxicillin (n = 8) amoxicillin-clavulanic acid (n = 11), cephalosporinia (n = 3), cotrimoxazole (n = 1), macrolide (n = 1). For each patient, 2 stool cultures with Cytotoxin assay for Clostridium difficile and 3 fecal samples for parasitic enteropathogens were collected. Proctosigmoidoscopy with biopsies microbiology was carried out in all patients. Stool culture was always negative but colonic biopsies cultures were positive with Klebsiella oxytoca in 7 patients. Cytotoxin assay of C. difficile was positive in 11 patients. Proctosigmoidoscopy permitted also diagnosis of 2 pseudomembranous colitis without cytotoxin assay of C. difficile. Proctosigmoidoscopy permitted diagnosis of 83% of antibiotic-associated acute diarrhea. Complementary to Cytotoxin assay of C. difficile, it should be necessary in antibiotic-associated acute diarrhea in adults.