[Intra-digestive fermentation in intestinal malabsorption syndromes: relations with elevated serum activity of gamma-glutamyl-transpeptidase]. / Fermentation intra-digestive au cours des syndromes de malabsorption intestinale: relations avec l'augmentation de l'activité sérique de la gamma-glutamyl-transpeptidase.

UNLABELLED: The aim of this prospective study was to examine the relationship between gastrointestinal ethanol production ("Mei-Tei-Sho" syndrome described in Japan) and biological liver dysfunction associated with intestinal malabsorption syndromes. METHODS: Sixty-five patients with malabsorption-diarrhea underwent 98 simultaneous measurements of plasma gamma-glutamyl-transpeptidase and of faecal ethanol concentrations; in 5 cases, ethanolemia and faecal ethanol concentrations were measured after a 250 g rice-meal; in 1, ethanol concentration was measured in a sample of caecal liquid in hours following local instillation of fructose (40 g). RESULTS: Faecal ethanol was detected at least once in 60/65 patients (74/98 measurements, maximum 3.50 g*L-1), more often (98.0%, P < 0.001) in 51 patients with gamma-glutamyl-transpeptidase above 38 IU/L. Eating rice increased the faecal ethanol concentration in 5 patients, 2 of whom had measurable ethanolemia (0.20 and 0.47 g*L-1). Ileo-caecal ethanol concentration following local fructose instillation was 11.8 g*L-1. CONCLUSION: Endogenous gastrointestinal ethanol production contributes to elevated gamma-glutamyl-transpeptidase activity observed during malabsorption syndromes.

[Measurement of energy expenditure at rest in nutritional disorders. Study in 229 patients]. / Mesure de la dépense énergétique de repos au cours de désordres nutritionnels. Etude chez 229 patientes.

Resting energy expenditure was measured by indirect calorimetry, and body composition was evaluated by electrical body impedance analysis in 229 female patients with anorexia nervosa, cancer, non tumoral disease, obesity, and 42 healthy women. Results were compared with theoretical formulas based on anthropometry, and expressed by kilogram of body weight and lean body mass. Each group was compared with each other and with controls. Resting energy expenditure of controls is quite identical with the theoretical value; it is very low for anorectic patients, high for obese patients, high during non tumoral diseases, and higher during neoplastic diseases. Respiratory quotient shows catabolism of carbohydrates in anorectic patients, and lipid catabolism in other patients. Results are compared with literature data, and pathophysiological mechanisms and clinical use of the method are discussed.

Primary malignant tumors (lymphoma excluded) in patients with chronic lymphocytic leukemia. A series of 22 cases from a retrospective study of 248 patients.

This retrospective study was conducted to evaluate the incidence of primary malignant tumors in patients with chronic lymphocytic leukemia (CLL). Between 1974 and 1994, 313 patients were hospitalized for CLL. Patients lost to follow-up were excluded (n = 65). Among the remaining 248 patients (167 men and 81 women), 22 patients (8.8%) developed primary malignant tumors (17 males, 5 females; age range 48 to 90 years); those who developed Richter's lymphoma (n = 9) or basal cell epithelioma (n = 5) were excluded from the cohort of the cancer patient. There were 18 epithelial tumors (3 lung adenocarcinoma) and 4 parenchymal tumors. We observed only one cancer of the prostate, and no breast cancer. The malignant tumor occurred at the same time as CLL in 8 cases and after a delay of 3 to 11 years in the 14 other cases. There was no particular features in the stage of duration of CLL before diagnosis of cancer. Outcome was particularly unfavorable, 20 deaths, compared with mortality in the other 226 patients (53.5%). These findings, together with the data in the literature, emphasize the importance of careful follow-up in patients with CLL.

[Prognostic value of nutritional parameters in gastrectomy for cancer: a study of 203 cases]. / Intérêt pronostique des paramètres nutritionnels lors de la gastrectomie pour cancer: étude de 203 patients.

Two hundred and three patients underwent a gastrectomy for 1981 to 1985, as a treatment for gastric carcinoma. This retrospective study focuses on survival and the prognostic value of oncological features as topography, local involvement and size of the tumour, and nutritional features as albuminemia, prealbuminemia and weight loss. Although prealbuminemia and weight loss have a prognostic value, albuminemia has not this classical value. These results show the great importance of the peri-operative nutrition, and lead to criticisms about albuminemia, which is modified by deshydratation and extra-vascular diffusion.

[Gastropericardial fistula. Review of the literature apropos of an original case]. / Les fistules gastro-péricardiques. Revue de la littérature à propos d'un cas original.

The authors present a case of pneumopericarditis consecutive to a perforating gastric ulcer complicating a left, post-traumatic diaphragmatic hernia, evolving favorably after radical surgery. 52 cases of gastro-pericardial fistulas were reported in the literature, 42 of which related to benign pathology. The overall mortality rate for this disease was 85%, although the course was favorable in one patient out of two, whenever radical surgery had been resorted to. In order to ensure these patients the best chances for survival, treatment should combine pericardial drainage and case-adapted gastro-intestinal surgery in an intensive care setting.

[Isolated cervical intramedullary metastasis from breast cancer. Value of magnetic resonance imaging]. / Métastase intra-médullaire cervicale isolée d'un cancer du sein. Apport de l'imagerie par résonance magnétique.

A metastasis from a breast carcinoma developed in the cervical cord. The localisation and nature of the lesion were easily diagnosed by a contrast MRI study with Gadolinium DTPA.

Multiple myeloma in two brothers. An immunochemical and immunogenetic familial study.

When multiple myeloma was diagnosed within 6 months in two brothers a family study was carried out in 34 relatives to assess the genetic factors involved. The monoclonal immunoglobulin isotype identified was identical for the two brothers (IgG kappa) as well as their genotype (a = A2B12BfSDR4 GIo2/d:A9B27BfSDR2GIol). Blood protein electrophoresis and the major histocompatibility complex markers (HLA A, B, DR, Bf, glyoxalase phenotypes) were also determined in the other family members. The immunochemical study revealed no other case of monoclonal gammapathy, but 12 cases of low gamma-globulin and three cases of polyclonal hypergammapathy were found. The immunogenetic study showed that no other family member had the a/d genotype of the two brothers, whereas nine family members were semi-identical for haplotype a and five for haplotype d. It is unlikely that a double immunochemical and immunogenetic identity in two siblings with multiple myeloma would be due only to random encounter, rather this finding suggests that, besides environmental factors, genetic factors may be involved in the pathogenesis. Systematic immunochemical and immunogenetic studies in familial multiple myeloma are proposed as a method to further elucidate an eventual genetic background in multiple myeloma.