Francois Paraf

A simple biological index for detection of alcoholic liver disease in drinkers

To make liver biopsy unnecessary in certain cases, PGA (P, prothrombin time; G, gamma-glutamyl transpeptidase; A, apoliprotein AI), a simple biological index combining a specific test for severe liver disease (prothrombin time), a sensitive test of alcoholic liver disease (serum gamma-glutamyl transpeptidase), and a test for liver fibrosis (serum apolipoprotein AI), was evaluated in a training sample of 333 drinkers and validated in 291 other drinkers. All patients underwent an intercostal liver biopsy, and the specimen was independently read by two pathologists. The PGA index varied from 0 to 12. When PGA was less than or equal to 2, the probability of cirrhosis was 0% and the probability of normal liver or minimal changes 83%. Conversely, when PGA was greater than or equal to 9, the probability of normal liver or minimal changes was 0% and the probability of cirrhosis 86%. These values did not vary between training and validation periods, between asymptomatic vs. symptomatic subjects or between PGA at admission vs. PGA 1 week later. This index could be useful for general practitioners in identifying subjects at high risk for severe alcoholic liver disease.

Miliaire hépatique métastatique d'un mélanome malin : deux observations

Resume Le melanome malin cutane ou choroidien est une maladie a fort potentiel metastatique soit d’emblee, soit apres une longue periode de latence. Le foie est l’organe le plus souvent concerne par les metastases. Neanmoins l’atteinte hepatique sous la forme d’une miliaire metastatique est rare. Dans ce cas, les examens morphologiques sont normaux et seules les anomalies biologiques associant une cholestase icterique et une insuffisance hepatocellulaire peuvent faire evoquer le diagnostic. Nous rapportons deux cas de miliaire metastatique hepatique diagnostiques par ponction biopsie hepatique.

Laparoscopic approach for colorectal polyps unresectable under laparoscopy

When colonoscopic polypectomy has an unacceptable risk of perforation due to the size or location of the polyp, it is usual to proceed to colectomy through a laparotomy. The laparoscopic approach provides an alternative method of managing these polyps unsuitable for colonoscopic polypectomy. The aim of the present study was to evaluate the laparoscopic approach for treatment of colorectal polyps. Patients and method : From September 1996 to May 1999,20 patients (7 women, 13 men) underwent laparoscopic surgery for polyps of the colon or rectum. The mean age was 63 years (ranged from 34 to 77). In 15 patients, colonoscopic resection appeared to be unsafe (sessil polyps: 6 ; pedunculated polyps> 2 em : 3 ; number of polyps> 3 : 5 ; pedunculated polyp associated with diverticular disease: I). In 5 patients, secondary colectomy was necessary because of discovery of carcinoma on colonoscopic resection specimen (muscularis mucosae invasion : 4 ; involved margin of resection: I). Polyps were tattooed during pre-operative colonoscopy in one case. Colonoscopy during laparoscopy was performed in 5 patients in order to landmark the polyp. The laparoscopically surgical procedure performed were: 9 sigmoidectomies, 4 sigmoido-rectal resections, 2 left colectomies, 2 right colectomies. I caecal wedge resection and 2 polypectomies through a colotomy. Three to five ports were used. Specimen were removed through a 5 em laparotomy with protection of the wedges. Resected polyps were removed through a port in a bag. Results : There was one conversion due to a mesocolic artery bleeding. There was no mortality. Three complications occured : I wound abcess, I small bowel occlusion, I reversible paralysis of the fibularis communis nerve. No reoperation was necessary. There was no anastomotic leak, no blood transfusion. The median duration of postoperative morphinic analgesia was 2 days (1-5 days). Oral feedings began on the third post-operative days (2-5 days). The median length of hospital stay was 9 days (4-16 days). On pathologic examination, there were 6 in situ carcinomas and 3 Dukes A carcinomas. In one case, a secondary right colectomy was performed because of an involved margin of a wedge caecal resection. All nodes were free of disease. There were no cancer recurrence and no port site recurrence. Conclusion : Laparoscopic approach for colorectal polyps allowed safe and complete resection of colonoscopically unresectable polyps without mortality and with a low morbidity in our study.