[Stenosing and perforated ulcers of the small intestine related to potassium chloride in enteric-coated tablets. Apropos of 11 cases]. / Ulcères sténosants et perforés de l'intestin grêle liés au chlorure de potassium en comprimés sous enrobage à délitement entéral. A propos de 11 cas.

The enteric coated KCl tablet formulation generates complications that affect selectively the small intestine. A novel 1 g KCl tablet preparation proved to be accountable for the development of a specific type of intestinal disease. 11 cases of stenotic ulcers of the proximal ileum have been treated at the Clinique chirurgicale "C" (CHRU, Nancy) since January 1986, 9 of them presenting with perforations. These 11 patients required potassium replacement, which was being supplied by the same tablet formula. A study of these 11 cases focusing on the patients history and clinical characteristics was carried out, that included both macroscopic and microscopic examinations of the lesions. Arterial and venous networks were visualized by X-ray in two surgical tissue specimens, respectively, following injection of contrast material. The authors were thus able to bring forth evidence of the clinical uniqueness (prodromal pain reminiscent of König's syndrome and peritonitis characterized by asthenia); to identify the main risk factor (i.e., reduced bowel movement); as well as describe the basic lesion (pylorus-like stenosis), and propound a novel theory concerning the etiology and the pathology of this condition. The observation of the aforementioned cases initiated a nation-wide, post-marketing pharmacological survey, which resulted, as did a similar investigation which had been carried out in the States, in the discontinuation of any treatment by this type of galenic form of the product.

[Peritoneal actinomycosis. A rare disease. 2 cases]. / L'actinomycose péritonéale. Une affection rare. 2 observations.

We report two cases of peritoneal actinomycosis, a rare localization of an uncommon disease (27% of the 212 cases previously published). The disease presents with tumoral symptoms. It is exceptionally diagnosed before surgery which usually consists of a safety excision. The true nature of the tumour is revealed by pathological examination, and its consequence is an antibiotic treatment. In the 2 cases reported here the patients had an old, uncontrolled intra-uterine device which might have been the portal of entry of the infection.

[Surgical treatment of villous tumors of the rectum and sigmoid. Apropos of 79 cases]. / Traitement chirurgical des tumeurs villeuses du rectum et du sigmoïde. A propos de 79 observations.

The authors analyse a series of 79 villous tumors of the rectum and sigmoid. These tumors are observed more often in men at an average age of 65. They distinguish benign tumors (44 cases), premalignant (21 cases) and malignant tumors (14 cases). The histology of the whole piece has a greater value than a preoperative biopsy. There are many clinical symptoms and the forms with electrolyte depletion are not rare (6 cases). Tumors with wide implantation need a surgical treatment. It will be conservative in benign cases, but the excision will be wide in cases of invasive malignancy. The indication are based upon the localisation of the tumor on the rectum. Mortality of wide excision is quite important (10) because of the bad general feature of the patients. Recurrences must be detected early by regular endoscopic follow-up.

[Persistence of thrombopenia induced by heparin despite replacement with low molecular weight heparin]. / Persistance d'une thrombopénie induite par l'héparine malgré le relais par une héparine de bas poids moléculaire.

A 42 year old man, treated for phlebitis with subcutaneous heparin, developed vascular occlusion in both legs with thrombocytopaenia. After surgery, heparin was discontinued and replaced by low molecular weight heparin (CY 216 Choay) without any success. Both commercial heparin and CY 216 Choay produced platelet aggregation in vitro. Heparin was stopped and replaced by dextran 40,000 with anti-aggregating drugs (flurbiprofen) followed by antivitamin K drugs. Thrombocytopaenia resolved three days later and the patient was discharged without sequelae. It therefore appeared necessary to carry out aggregation tests both with heparin and low molecular weight heparin if thrombocytopaenia occurs whilst heparin is being used.