Importance of vaccination chronic hepatitis B

Weak therapeutic responses and weak immune cytotoxic CD8 and CD4 response in chronic hepatitis B emphasize the necessity to find new therapeutic strategies especially as specific immunotherapy. Vaccination, whose principle was to widen immune repertoire, was used as a curative treatment of chronic hepatitis B. It would be the therapeutic procedure with the lowest cost and the potentially greatest benefit. Our purpose was to enhance the interest of therapeutic vaccination in chronic hepatitis B in order to debate later its usefulness in developing countries.     

Epidemiologic profile of gastric carcinoma: study of 140 cases

The authors make a retrospective study of a series of 140 patients aged 59 years in average, followed up from 1995 to 2002 for adenocarcinoma of the stomach. Surgical resection was performed in 79 percent of the patients with total gastrectomy in 15.4%, partial gastrectomy in 50.6%. Resection was considered as curative in 66%. Lymph node metastases were present in 42, 9 percent of the patients. Margins of resection were involved in 24, 5% of the specimens. The mean survival rate was 26.5 months, 13 months and 5 months after curative resection, palliative resection and without resection.     

Treatment of primary and secondary malignant tumor of the liver. Opinion of the surgeon

Hepatocellular carcinoma is the most frequent primitive cancer of the liver. This tumor mainly develops in cirrhotic liver that is a true precancerous state. Treatment can be surgical or not surgical. Orthotopic liver transplantation is the only treatment that definitively address both the metachronous occurrence risk of hepatocellular carcinoma and the underlying disease. Liver metastases from colorectal carcinomas are the most frequent secondary tumors. Only complete resection offers the potential for curative treatment of these metastases.     

Predictive factors of intestinal stenosis in Crohn's disease

The aim of our study was to determine demographic, clinical, biological or endoscopic factors that predict intestinal stenosis in Crohn's disease. PATIENTS AND METHODS: One hundred and twenty one patients were retrospectively analyzed during 10 years. The diagnosis of stenosis were determined by morphologic and endoscopic exams independently of appearance of symptoms. The studied characteristics were age at appearance of symptoms, sex, geographical origin, tobacco addiction, symptoms revealing Crohn's disease, extra-digest and auto-immune signs associate and seat of disease. Biological values studied were: haemoglobin, white cells, platelet, erythrocyte sedimentation rate, C- reactive protein and albumin. Predictive factors were assessed using univariate and multivariate analysis. RESULTS: Forty-seven patients (38,8%) had a stenosis. In univariate analysis, predictive factors of stenosis were a young age and ileum site of Crohn's disease. In multivariate analysis, none of these variables was independently associated of appearance of stenosis in Crohn's disease. CONCLUSION: This study didn't identify the presence of predictive factors of intestinal stenosis in Crohn's disease that could allow an early specific therapy.     

Congenital cystic dilatation of bile ducts

Congenital cystic dilatation of bile ducts is a rare condition. We report a retrospective study about 18 patients having congenital bile duct cysts. According to Todani's classification, 11 cases were type I and 7 were type V. Six patients from the first group had a pancreatobiliary maljunction. A total resection of the cyst was conducted in the type I cysts. Anatomopathologic examination showed an adenocarcinoma of a common bile duct cyst. In one case, a cancer of the gall bladder associated to a common bile duct cyst in another case. Three patients with segmental dilatation of intrahepatic bile ducts (type V) underwent liver resection. Four patients had a diffuse form, one of them was treated by percutaneous drainage, and in the other cases a hepatojejunostomy was performed. Postoperative course was complicated with acute cholangitis in these four cases. Percutaneous drainage and antibiotics allowed a positive outcome in most of the cases. In one case, secondary biliary cirrhosis occurred as a long-term complication. Congenital cystic dilatation of bile ducts is considered to be a precancer state. Enterocystic anastomosis is proscribed and the resection has to be as complete as possible.     

Étude thérapeutique prospective randomisée des entorses latérale de la cheville. Apport de l’échographie

In case of a lateral sprain of the ankle, the clinician has to estimate its gravity and to propose the most adapted treatment. The contribution of the ultrasounds in our series determines the type and the number of worn-out bundles. It also informs about the articular effusion and so contributes to the diagnosis of less frequent hurts involving the lower tibio-fibular joint, the medio-tarsal joint, the sinus tarsi.The purpose of this prospective and randomized work is to compare at three months the clinical result of the functional treatment alone versus orthopaedic treatment associated to a functional treatment. An echography is practiced in the middle and at the end of processing to check the ligamentary healing of the ligaments.In the third month, no recurrence was reported. It was not highlighted by significant difference as regards: the pain in the initial site or somewhere else, the anterolateral sensibility, the subjective instability, the sensation of disturbance, and the insecurity in the running. An objective instability was not found in our series.We suggest for any severe lateral ankle sprain to confirm the lesional balance sheet by an ultrasound, which according to the hurts ligament isolated or associated to prescribe the type of fixed immobilization, the duration of the treatment, to individualize the reeducation and to plan the incapacity. The followed by the ligament healing and by the lesional recovery is assured by repetitive ultrasounds     

Salivary duct carcinoma

INTRODUCTION: Salivary duct carcinoma is a very rare tumor of the salivary glands that has been principally reported in the parotid gland. It displays histologically a striking similarity to ductal carcinoma of the breast. OBSERVATION: We report the case of a salivary duct carcinoma arising in the parotid gland of a 62 year-old man. The fact that the tumor was confined to the parotid gland has allowed a radical treatment. After two year follow-up, there was no evidence of recurrence. DISCUSSION: This tumor is characterized clinically by local aggressiveness, frequent metastatic evolution and poor prognosis. This case report illustrates both the clinicopathological features and the prognostic factors of this entity.