[Satellite vasculitis of B or non-A non-B hepatitis. Diagnostic value of a provocation test by intradermal injection of histamine]. / Les vascularites satellites des hépatites à virus HB ou non-A non-B. Intérêt diagnostique d'un test de provocation par injection intradermique d'histamine.

The histo-pathological lesions of hypersensitivity vasculitis (HV) consist in an inflammatory reaction to circulating immune complexes deposited on the vascular endothelium. A provocation test by intradermal injection of histamine was used to demonstrate HV in patients with chronic hepatitis. Three groups of patients were studied: 16 with chronic hepatitis and HV, 22 with chronic hepatitis without HV, 4 control subjects. Skin biopsy was performed before and 3 hours after intradermal histamine. The following markers were looked for in the serum, skin and liver of all patients with chronic hepatitis: HBV (HBs Ag and HBe Ag, anti-HBs, anti-HBe and anti-HBc in the serum, HBs and HBc Ag in the liver); non-A non-B (non-A, non-B Ag and antibody, anti non-A non-Bc in the serum, non-A, non-Bc Ag in the liver). Viral antigens were found in healthy skin in 2 cases (1 chronic A hepatitis, 1 vasculitis), and after injection of histamine in 9 cases (4 chronic A hepatitis, 5 vasculitis). Viral antigens were found on skin biopsy in 2 patients with negative sera. Significant skin changes after histamine were detected only in HV (75 p. 100) even in the absence of cutaneous vasculitis (6/12 positive cases). An intradermal histamine provocation test is a simple, non-invasive method for diagnosing HV.

[Hepatic anomalies in Mediterranean boutonneuse fever]. / Anomalies hépatiques au cours de la fièvre boutonneuse méditerranéenne.

We report 3 cases of rickettsial hepatitis observed in the Lyon area which were secondary to boutonneuse fever. The temperature was elevated and clinical signs were an often painful hepatomegaly and digestive disorders. These signs are only indicative when accompanied by atypical pneumonopathy or exantherma. Indeed, if the inflammatory syndrome is clear, hepatic function is little perturbed. Diagnosis is sometimes influenced by the epidemiological situation, and depends on serologic tests and histological evidence of granulomatous hepatitis (2 of the 3 cases here). The successful antibiotic treatment shows that patients presenting febrile granulomatous hepatitis should be tested for rickettsiosis.

[Acute hepatitis caused by cyclofenil (Ondogyne). Apropos of 2 cases]. / Hépatite aiguë due au cyclofénil (Ondogyne). A propos de deux cas.

We report the cases of two adults suffering from acute hepatitis due to cyclofenil (Ondogyne), a drug proposed for the treatment of dysovulation and scleroderma. Hepatitis developed 30 and 102 days after the beginning of discontinuous administration of the drug. A challenge test was positive in both cases. The course of hepatitis was reversible after withdrawal of the drug. Hepatitis induced by cyclofenil is likely to be due to an hypersensitivity mechanism.

[Effects of a postpituitary extract and lysine vasopressin on portal and systemic hemodynamics in the cirrhotic patient]. / Effets d'un extrait de post-hypophyse et de la lysine vasopressine sur l'hémodynamique portale et systémique chez le cirrhotique.

The purpose of this work was to study the hemodynamic effects of a pituitary extract (Post-Hypophyse, Choay, EPH) and of lysine vasopressin (Diapid, Sandoz, VP). Cardiac, pulmonary and liver hemodynamics were measured in 50 cirrhotic patients before and during intravenous infusion (0.45 IU/kg/h) of EPH (24 patients) or VP (26 patients). EPH and VP did not have identical consequences in cardiac output and systemic resistances. EPH significantly increased cardiac output and significantly decreased systemic resistances while VP significantly and increased systemic resistances. Both vasoactive drugs similarly decreased myocardial performances. EPH and VP had a moderate influence on WHV/IVC pressure gradient. This was variable from one patient to another. The decrease of WHV/IVC pressure gradient observed during EPH infusion was mainly related to an increase of IVC pressure. Since the effects of both drugs on WHV/IVC pressure gradient are slight and unpredictable and they exert an important effect on cardiopulmonary hemodynamics, caution should be taken in administering EPH or VP to cirrhotic patients. The clinical use of EPH or VP should be undertaken only when cardiac and liver hemodynamics monitoring are available.

[Prognostic value of HBe antigen and anti-HBe antibody in viral hepatitis B (author's transl)]. / Evolution des hépatites chroniques à virus B. Valeur pronostique de l'antigène et de l'anticorps HBe.

HBe antigen (Ag) and anti-HBe antibody (Ab) were detected in 50 patients with chronic hepatitis due to virus B. In 19 cases of non-specific hepatitis and 15 cases of chronic persistent hepatitis, there was a significant correlation (p less than 0.01) between biochemical disturbances and the presence of HBe Ag. In 13 cases of HBs Ag-positive chronic persistent hepatitis (9 with HBe Ag and 4 with anti-HBe Ab) followed up for a mean period of 15 months, the biochemical disturbances were associated with the presence of HBe Ag and they subsided when the anti-HBe Ab appeared. In 4 cases of persistent chronic hepatitis and 16 cases of chronic active hepatitis followed up biochemically and histologically for a mean period of 22 months, aggravation of hepatic lesions was observed in the 8 cases where HBe Ag persisted. Conversely, histological improvement and return to normal of biochemical values were noted in 8 of the 12 remaining cases (5 seroconversions HBe Ag/Ab, 1 seroconversion HBs Ag/Ab, 3 HBs Ag and HBc Ab, and 3 HBs Ab). The results of treatment with corticosteroids alone or combined with azathioprine appeared to correlate with changes in HBe serology rather than with the pharmacological effects of the drugs. It would therefore seem that the disappearance of HBe Ag is a prerequisite of improvement of hepatitis B and that the HBe Ag/anti-HBe Ab system is an excellent prognostic index, as it closely reflects the evolutive potential of the disease, which in turn governs all therapeutic measures.

[Association of retroperitoneal fibrosis with ankylosing spondylitis. Report of a case (author's transl)]. / Association fibrose rétropéritonéale-spondylarthrite ankylosante: une nouvelle observation.

A case of retroperitoneal fibrosis associated with ankylosing spondylitis is reported. Five similar cases have been reported in the published literature. Certain etiological factors and anatomical locations suggest an analogy between the two affections, with conditions predisposing to fibrous changes, one result of which being the presence of HLA-B27 antigen.

[The interaction of cellular immunity and of viral factors in the pathogenesis and the resolution of HB virus infections in hemodialysis (author's transl)]. / Pathogénie et résolution des infections à virus HB de l'hémodialysé. Interaction de l'immunité cellulaire et des facteurs viraux.

A study of delayed cutaneous hypersensitivity (DC) was carried out in 50 chronic hemodialysis patients divided into 3 groups according to their serological response to the HB virus (HBV): 31 chronic carriers of Ag HBs (13 HBe positive and 18 HBe negative and 19 having eliminated Ag HBs, antiHbs positive). The results of DCH testing were compared in relation to the 3 patient groups. The number and sum of indurations were reduced, this being more marked in the women, in all the uraemic patients tested. Male hemodialysis patients who were carriers of Ag HBe had the weakest responses, significantly more depressed than those of the HBe positive HBe negative or anti-HBs carrier patients. The presence of Ag HBe was correlated with persistently raised transaminases. In chronic carriers of Ag HBe, hepatic cytolysis was always absent when DCH reactions were negative, and was seen only in the presence of a cellular immune reaction. These results suggest the interaction, in the hemodialysis patient, of virological factors related to Ag HBe and cell mediated immunological factors in the pathogenesis of hepatic lesions related to HBV.

[Demonstration of a serum and liver antigen in acute or chronic non A-non B viral hepatitis]. / Mise en évidence d'un antigène sérique et hépatique au cours des hépatites virales non A-non B aiguës ou chroniques.

A new precipitating antigen-antibody system possibly was demonstrated by immuno-diffusion in the serum of patients suffering from non A-non B hepatitis. The antigen appears during the first four weeks of transaminases elevation. In acute cases was transient antigenemia (average 3 weeks). Antibodies appeared rapidly after the disappearance of antigen. The same antigen was also detected, by immunodiffusion and by immunofluorescence, in the liver nuclei of infected hepatocytes. This antigen specific appears for non A-non B hepatitis since it is neither found in the serum of normal subjects nor in that of patients with cirrhosis toxic or viral that hepatitis A or B. The hypothesis of a virus associated antigen is the most likely explanation.

[Franklin's disease associated with chronic active hepatitis and hypothyroidism. One case (author's transl)]. / Maladie de Franklin associée à une hépatite chronique active et à une hypothyroïdie. Une observation.

The authors report on a new case of Franklin's disease; the originality of which lies in the fact that it was associated with hypothyroïdism and mainly with B virus chronic active hepatitis. It seems likely that chronic antigenic stimulation during active hepatitis played role in the pathogenesis of the monoclonal gammapathy.

Controlled trial of chenodeoxycholic therapy for radiolucent gallstones. A multicenter study.

134 patients with radiolucent gallstones were randomly allocated to receive either placebo or 1 of 3 different doses of chenodeoxycholic acid (CDCA); 750, 1,500, or 3,000 mg). The initial dose was lowered if not well tolerated. 107 patients were treated for more than 3 months. Among them, stones dissolved in 21 and were smaller in 25 patients. Partial or complete dissolution occurred in 4 of the 13 receiving 375 mg/day, 14 of 37 receiving 750 mg, 24 of the 38 receiving 1,500 mg and 4 of 8 receiving 3,000 mg/day. The number of responders to the therapy was significantly greater in the groups of patients receiving 1,500 mg/day or 17-24 mg/kg body weight than in any other group. However, side effects, i.e., diarrhea and transaminase increase, are also dose related. It appears from this study that the optimal dose of CDCA may be between 17 and 20 mg/kg body weight.