[Well's cellulitis: A case report]. / La cellulite de Wells : à propos d'une observation.

INTRODUCTION: Wells's cellulitis is a rare eosinophilic dermatose characterized by an inflammatory erythematous eruption, often associated with eosinophilia, and suggestive histologic features. The differential diagnosis with other eosinophilic dermatitis is problematic. The treatment is typically based on systemic steroids. CASE REPORT: We report a 63-year-old patient with an extensive pruritic maculo-papular eruption of the limbs and the trunk, forming large indurated and painful erythematous patches. Blood analysis revealed eosinophilia. Histologic examination showed perivascular eosinophilic inflammatory infiltration, also disposed around collagen fibers. The symptoms disappeared with topical corticosteroids. CONCLUSION: The diagnosis of Well's cellulitis is difficult because of the lack of specific sign; it is based on suggestive clinical, biological and histological features. Topical corticosteroids are efficient and well-tolerated, and should be used as first treatment.

[Celiac disease and pregnancy. A case report]. / Maladie coeliaque et grossesse. A propos d'une observation.

The authors report a case of coeliac disease occurring during the pregnancy. The occurrence of coeliac disease during a pregnancy is an unusual pathology needing an early diagnostic and specific therapeutic so that the life of the child is not at stake. The diagnostic is suggested by the duodenoscopy visualizing the typical mosaic appearance of the mucosa. It's confirmed by the results of biopsy that shows a total villous atrophy. The gluten-free diet changes the foetal and maternal prognostic. The clinical result increases in few days, the biologic normalisation within few weeks. The growing up of the villous happens a few months later.

[Comparative study of the data of fine-needle aspiration biopsy and echographic aspects of hepatic tumors as a function of the circumstances of discovery. Apropos of 206 patients]. / Etude comparée des données de la cytoponction à l'aiguille fine et des aspects échographiques des formations tumorales hépatiques en fonction des circonstances de découverte. A propos de 206 patients.

This study was carried out in order to compare the accuracy of ultrasound and ultrasonically guided fine-needle aspiration biopsy in screening for tumoral hepatic syndrome in 206 patients. According to their different clinical presentations, patients were divided into 4 groups: 1: Documented cancer, 2: Hepatic cirrhosis, 3: Fortuitous ultrasonic detection, 4: Clinical hepatic tumor. Cytologic findings were divided into 4 types: benign, primary malignant tumor, secondary malignant tumor (with or without etiologic orientation) non significant result. The ultrasonic and cytologic results were retrospectively compared to definitive diagnosis which was known in 199 patients. No early or delayed complications related to fine-needle aspiration biopsy were recorded. Ultrasonic imaging globally suggested the final diagnosis in 116 patients (diagnostic precision: 58.2 percent) while the cytologic result corresponded to final diagnosis in 183 patients (diagnostic precision: 92.5 percent). Improved results by fine-needle aspiration biopsy with regard to ultrasound was recorded in each group, particularly in group 3; its diagnostic sensitivity was 92 percent for malignant lesions with 100 percent specificity and an excellent value in discriminating between their primitive or secondary nature. Fine-needle aspiration biopsy gave an exact etiologic orientation in half of cases with metastasis and helped to discover the primitive tumor in some patients when this was not known previously. We conclude that fine-needle aspiration biopsy is a simple, moderately invasive and accurate procedure in the diagnosis of hepatic lesions. As ultrasound alone is not suggestive, especially in the case of a fortuitous ultrasonic detection, fine-needle aspiration biopsy improves diagnostic precision.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of ultrasound-guided cytopuncture in the diagnosis of hepatocellular carcinoma]. / Valeur de la cytoponction écho-guidée dans le diagnostic du carcinome hépatocellulaire.

Ultrasonically guided fine needle aspiration biopsy cytologies (external diameter inferior to 1 mm) were carried out in 28 patients with proved hepatocellular carcinoma. In all cases, the diagnosis of malignant involvement of the liver was firmly established by cytological examination. A correct diagnosis of hepatocellular carcinoma was made in 26 of 28 patients (sensitivity = 93%). The specificity of the procedure was 100%. No complications were observed. The present study shows that fine needle aspiration biopsy under ultrasound guidance is a safe and accurate diagnostic procedure in hepatocellular carcinoma even associated with cirrhosis.

[Echographic detection of hepatocellular carcinoma in patients hospitalized for cirrhosis]. / Dépistage échographique du carcinome hépatocellulaire chez les patients hospitalisés pour cirrhose.

This study was carried out in order to assess the accuracy of ultrasound in a) screening for hepatocellular carcinoma in patients hospitalized for cirrhosis and b) determining the possibility of hepatic resection. From January 1983 to January 1987, 492 patients with cirrhosis were investigated for hepatocellular carcinoma using clinical examination, serum alphafetoprotein measurement and ultrasound study. Four hundred and thirty-seven patients had alcohol-related cirrhosis (88.8 p. 100); ascites was found in 280 cases (56.9 p.100). Ultrasonography-guided aspiration cytology was performed whenever a tumor was found. Four hundred and nineteen patients underwent ultrasonography and alpha-fetoprotein chemistry. The diagnosis of hepatocellular carcinoma was confirmed in 66 of 419 patients (15.8 p. 100). Sixty of the 88 patients diagnosed as having tumor on ultrasound were found to have hepatocellular carcinoma. In 6 out of 66 patients (9.1 p. 100), the tumor was not identified by ultrasonography but the level of alphafetoprotein was high (greater than 1,000 ng/ml). Sixteen cancers (24.2 p. 100) were diagnosed by ultrasonography only. All patients were men with alcohol-related cirrhosis, their ages ranging from 52 to 82 years. The results of ultrasound investigation were: 8 solitary tumors, 5 multicentric tumors, 3 diffuse tumors. Only 2 of the 16 tumors were resectable. We conclude that ultrasound is an accurate procedure in the diagnosis of hepatocellular carcinoma associated with cirrhosis. However, in hospitalized patients, the value of screening for hepatocarcinoma is small because liver resection is often impossible due to the wide spread tumor involvement or advanced liver cirrhosis at the time of diagnosis. On the other hand, screening should be performed in patients with compensated cirrhosis.