[Effect of enprostil on the healing and the recurrence of duodenal ulcer. Comparison with ranitidine]. / Effect de l'enprostil sur la cicatrisation et la récidive des ulcéres duodénaux. Comparaison à la ranitidine.

Enprostil, a synthetic prostaglandin E2, has been shown to exert both antisecretory and mucoprotective activity. It is effective in duodenal ulcer healing. OBJECTIVE--This study was performed to compare the frequency and the delay of spontaneous duodenal ulcer relapse during a two-year follow up period after initial healing by enprostil (35 micrograms, twice a day) or ranitidine (300 mg per day). METHODS--This multicentric, double-blind, randomized study included 642 patients (324 in the enprostil group and 318 in the ranitidine group). Patients included in the follow up period were evaluated by an endoscopy at 6 months, one and two years after healing. RESULTS--After a 6 weeks treatment period, healing rate was 85% for ranitidine and 70% for enprostil, respectively (P < 0.001). Adverse effects, especially digestive ones, occurred more often with enprostil than with ranitidine (P < 0.001). After initial healing, there was no significant difference between the 2 groups concerning the cumulative rate of relapse, despite a non significant trend for a milder rate of relapse in the enprostil group (P = 0.08). Twenty-seven % of the patients randomized to treatment (intend-to-treat analysis) in the enprostil group and 29% in the ranitidine group had no ulcer recurrence 6 months after ulcer healing, and respectively 12% and 13% at 2 years (difference not statistically significant). CONCLUSIONS--It is concluded that a) ranitidine is more effective and has less adverse effects than enprostil for duodenal ulcer healing, b) after duodenal ulcer healing by enprostil, there is a non significant trend for a lower rate of relapse than after healing with ranitidine, c) there is the same proportion of patients without ulcer in the 2 groups after 6 months and 2 years.

[Variations of plasma gastrin (basal and postprandial) in ththtreatmentof duodenal ulcer with either enprostil or ranitidine. Correlations with rates of relapse]. / Variations de la gastrine plasmatique (basale et post-prandiale) au cours de traitements de l'ulcère duodénal par l'enprostil ou la ranitidine. Corrélations avec les taux de rechute.

Enprostil, a synthetic E2-prostaglandin efficacious for duodenal ulcer healing, presents both antisecretory and antigastrinic effects. This is at variance with the elevation of plasma gastrin observed with ranitidine. OBJECTIVE--This leads us to compare enprostil and ranitidine on the following points: a) variations of plasma gastrin (basal and postprandial) parameters over a 6-week conventional treatment; b) correlation studies between ulcer relapses (frequency and temporal evolution) after treatment discontinuation and various gastrinic criteria. METHODS--Among a group of 642 patients followed for ulcer relapse, 165 were considered for gastrin (78 of the "Enprostil" group and 87 of the "Ranitidine" group). RESULTS--Initially, both populations were comparable for clinical and plasma gastrin parameters. After 6 weeks of treatment, the increases in the various gastrin parameters (basal, postprandial, peak, integraded) were significantly greater and the absolute values higher (Wilcoxon, P < 0.001) with ranitidine than with enprostil. No correlation was found between relapse occurrence after drug discontinuation and these gastrin parameters. CONCLUSIONS--Ranitidine hypergastrinemia seems directly related to gastric hyposecretion whereas its absence with enprostil is likely more dependent upon a specific antigastrinic activity than on a reduced antisecretory activity. Those differences in mechanism of action have no consequence on the stability of ulcer obtained by either drug.

[Acute form of primary bilharziasis]. / Formes aiguës de primo-invasion bilharzienne.

Acute schistosomiasis is observed in subjects with primary infestation, Schistosoma mansoni and S. japonicum being the responsible parasites in the vast majority of cases. The disease occurs between 2 weeks and 6 months from the first infesting bath and presents as fever with cutaneous, pulmonary and gastrointestinal manifestations. Eosinophilia is frequent. The diagnosis is made by serological tests. Myelopathies are rare and may leave severe sequelae. Treatment rests on praziquantel combined with a short course of corticosteroid therapy.

[Viral hepatitis in patients over 60 years of age. Clinical, etiologic and developmental aspects]. / Les hépatites virales après 60 ans. Aspects cliniques, étiologiques et évolutifs (78 cas).

The authors report a retrospective study of 78 cases of acute viral hepatitis observed from 1971 to 1985 in patients over 60. Viral hepatitis involved males as often as females. A, B, delta and non-A, non-B viruses were responsible for 11.5, 23.1, 5.1 and 60.3 p. cent of cases, respectively. From 1975 on, the frequency of non-A non-B viral hepatitis has reached 85 p. cent while blood transfusions appeared as the most important route of transmission. Outcome was severe in 10.3 p. cent of cases. Early in the course of disease, the risk of progression to cirrhosis was obvious and concerned 12 patients (1 out of 18 with B hepatitis, 3 out of 4 with D hepatitis, 8 out of 47 non-A non-B hepatitis). The long term prognosis (from three to five years) was not as poor as stated in previous studies.

[Aspects of viral hepatitis in patients over 60 years of age]. / Aspects des hépatites virales chez les malades de plus de 60 ans.

78 acute viral hepatitis (VH) cases were seen from 1971 to 1985 in patients over 60. Virus A, B, B-Delta and non-A, non-B are, respectively, responsible for 11.5, 23.1, 5.1 and 60.3% of the cases. Severe outcome occurs in 10.3%. Early in the course of VH, the risk of progression to cirrhosis concerns 1/18 VHB, 3/4 VHD, 8/47 VH NA NB. But the long-term prognosis is not so poor as stated in previous studies.

[Yellow nail syndrome with chylous effusions]. / Syndrome des ongles jaunes avec épanchements chyleux.

Yellow nail syndrome is characterized by a yellow discolouration of the nails associated with idiopathic lymphoedema and pleuropulmonary manifestations. Pleural effusions are usually of the exudate type with a normal lipid content. The case reported here of a 74-year old man who had yellow nails together with chylothorax and chylous ascites provides an opportunity to discuss the origin of these rare effusions which, like the syndrome itself, were most probably due to primary abnormalities of the lymphatic system.

[Hepatic manifestations in Still's disease]. / Manifestations hépatiques au cours de la maladie de Still.

In children, as in adults, Still's disease usually presents with a hectic fever, a characteristic rash and arthralgia or arthritis. Visceral involvement is however classical; the hepatic manifestations were studied with respect to two cases. Biochemical changes are common, often mild: the commonest abnormality is cytolysis. Jaundice is less frequent and hepatic involvement may in exceptional cases be life threatening, usually in cases of serious polyvisceral disease often with disseminated intravascular coagulation. These manifestations may be spontaneous or secondary to salicylate therapy; the anatomical changes are the same; the salicylate would therefore seem rather to unmask and aggravate an underlying hepatic abnormality.

Mononeuritis in acute viral hepatitis.

We describe the cases of 4 adults with acute viral hepatitis A or B in whom mononeuritis affecting a cranial nerve or a nerve of a limb developed. The features of this neuropathy were the following: (a) the prevalence of mononeuritis in patients with acute viral hepatitis was low; (b) this complication developed in the early phase of acute viral hepatitis in most of our patients; (c) the onset of mononeuritis was sudden in most of them; (d) the course of mononeuritis was protracted. Mononeuritis might be the consequence of ischemia resulting from vasculitis.