Michel Melange

Etude anatomoclinique d’une série de gastrites chroniques caractérisées par une infiltration lymphocytaire intraépithéliale

RésuméParmi les gastrites chroniques, un petit groupe de lésions se distingue par une importante composante de lymphocytes intraépithéliaux. Au cours des dernières années, nous avons pu sélectionner 46 cas de ces gastrites lymphocytaires qui nous ont servi à une étude de corrélation anatomoclinique basée sur les éléments du dossier médical. L’ensemble des données recueillies montre que la gastrite lymphocytaire correspond à une entité particulière. Les caractéristiques en sont: du point de vue clinique, une perte de poids fréquente, souvent rapide et importante parfois accompagnée d’anorexie; du point de vue endoscopique, les lésions se localisent de façon préférentielle au fundus avec extension possible à l’antre. L’element de base est le nodule aphtoïde, surélevé, érodé au sommet; ces nodules sont Ie plus souvent disposés en chapelet le long de plis épaissis.Les auteurs s’interrogent sur les relations éventuelles entre la gastrite lymphocytaire et la gastrite varioliforme.SummaryAmong the chronic gastritis, a small group of lesions are distinguishable by their important component of intraepithelial lymphocytes. During the last two years, we could select 46 cases of these lymphocytic gastritis which were used to study the anatomoclinical correlations on base of medical records. The collected data show that lymphocytic gastritis corresponds to a peculiar entity. The characteristics of this entity are: from the clinical point of view, a frequent, rapid and important weight loss sometimes accompanied by anorexia; from the endoscopical point of view, the lesions are localized in the body; the basic component is an aphtoid nodule, surelevated, exulcerated, most often disposed in strings along thickened folds.The authors discuss the possible relations between lymphocytic and varioliform gastritis.

Foregut cyst of the mediastinum: fluid re-accumulation after transbronchial needle aspiration

Cysts arising from embryonic remnants of the primitive foregut include bronchogenic cyst, oesophageal duplication and neurenteric cyst (Kirwan et al, 1973). The place of computed tomography (CT) and needle biopsy in the diagnosis and the management of foregut cysts of the mediastinum has been demonstrated (Schwartz et al, 1985, 1986; Kuhlman et al, 1988). We report a case of a foregut cyst diagnosed and treated by these methods, but without long-term symptomatic relief inasmuch as symptoms recurred 3 years later with re-accumulation of fluid. In 1986, a 27-year-old man complained of vague right thoracic pain. A right mediastinal mass was discovered on chest radiographs (Fig. la, b). A CT scan showed a tubular cystic mass (internal density + 30 HU). This had regular and smooth borders and was located on the right side of the entire thoracic oesophagus (Fig. lc, d). There was no subdiaphragmatic extension and a CT scan of the upper abdomen did not show any abnormality. In particular, no pancreatic lesion wa...

Focal Nodular Hyperplasia in Association With Spontaneous Intrahepatic Portosystemic Venous Shunt

We report a case of focal nodular hyperplasia in an adolescent with a spontaneous intrahepatic portosystemic venous shunt. Diagnosis was established by duplex and color Doppler ultrasound, computed tomography, magnetic resonance imaging, and histology. This association further supports the hypothesis that focal nodular hyperplasia is a response to a preexisting vascular abnormality.

CT findings of perforated duodenal diverticulitis.

The diagnosis of duodenal diverticulitis is rarely made preoperatively by upper gastrointestinal series or plain abdominal films. We describe a case of perforated duodenal diverticulitis diagnosed by CT.

Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis.

The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur.

Regenerative nodules in hepatic cirrhosis. Value of gradient-echo MR imaging with a surface coil.

To evaluate the accuracy of surface coil gradient-echo (GRE) imaging in the detection of regenerative nodules of hepatic cirrhosis, 53 patients with diffuse liver disease, among whom 31 had cirrhosis, were prospectively investigated. Three GRE sequences acquired with a surface coil were used in the study: a T2*-weighted, a T1-weighted, and a gadopentetate-enhanced sequence. ROC analysis showed that two surface coil GRE sequences were superior to conventional T2-weighted spin-echo imaging acquired with a body coil for the detection of regenerative nodules. The detection of regenerative nodules was also more accurate for the diagnosis of cirrhosis than the measurement of the caudate-to-right lobe ratio. These results suggest that there could be a potential for surface coil GRE imaging in the assessment of the characteristic macroscopic alterations of cirrhosis.

Distomatose des voies biliaires. Intérêt de la cholangiographie rétrograde. Efficacité du triclabendazole.

A case of chronic biliary fascioliasis is reported, which was confirmed by endoscopic retrograde cholangiography. After unsuccessful attempts of treatment with classic antiparasitic drugs, cure was obtained with triclabendazole the absorption of which was studied.

Alcoholic liver disease: Value of the left-to-right portal vein ratio in its sonographic diagnosis

A study group of 50 patients in whom the left portal vein diameter was equal to or greater than the right portal vein diameter (LPVD≥RPVD) was prospectively compared on ultrasonography with a control group of 50 patients with LPVD < RPVD. Clinical and laboratory data indicating chronic alcoholic liver disease (CALD) were observed with a significantly higher frequency in the study group than in the control group. It emerges from this study that LPVD ≥ RPVD represents a useful ultrasonographic sign of CALD, corresponding to a relative enlargement of the left hepatic lobe compared with the right.

Regenerative Nodules in Hepatic Cirrhosis

To evaluate the accuracy of surface coil gradient-echo (GRE) imaging in the detection of regenerative nodules of hepatic cirrhosis, 53 patients with diffuse liver disease, among whom 31 had cirrhosis, were prospectively investigated. Three GRE sequences acquired with a surface coil were used in the study: a T2*-weighted, a T1-weighted, and a gadopentetate-enhanced sequence. ROC analysis showed that two surface coil GRE sequences were superior to conventional T2-weighted spin-echo imaging acquired with a body coil for the detection of regenerative nodules. The detection of regenerative nodules was also more accurate for the diagnosis of cirrhosis than the measurement of the caudate-to-right lobe ratio. These results suggest that there could be a potential for surface coil GRE imaging in the assessment of the characteristic macroscopic alterations of cirrhosis.

Gastric carcinoid tumour and hypergastrinaemia.

We report a case of gastric enterochromaffin-like carcinoid tumour associated with fundic chronic atrophic gastritis and hypergastrinaemia of antral origin. The clinical and pathological features of this association are reviewed. The probable causal relationship between these argyrophil carcinoids and hypergastrinaemia is also discussed.