Cryoglobulinemia in chronic hepatitis C virus infection. About 76 cases

Cryolobulines are immunoglobulins that persist in the serum, precipitate with cold temperature and resolubilize when rewarmed. There are 3 types of cryoglobulinemia. Type II and III define mixed cryoglobulinemia. 40% approximately of patients with chronic hepatitis C virus (HCV) infection had cryoglobulinemia. OBJECTIVE: To evaluate the frequency of cryoglobulinemia in a chronic hepatitis virus (CHV) infection group and determine the characteristics of positive cryoglobulinemia patients. RESULTS: 76 patients were included. There were 53 women an 23 men. The mean age was 59.45 years. Mixed cryoglobulinemia was detected in 65 patients (85.5 %). Cirrhosis, old age and the long duration of CHV infection were the 3 factors associated with cryoglobulinemia positivity. CONCLUSION: Mixed cryoglobulinemia is a frequent manifestation during chronic hepatitis C infection virsus especially in patients with cirrhosis.     

Liver regeneration after major hepatectomy. Evaluation of dogs hepatectomy

OBJECTIVES: The aim of our study is to evaluate anatomic regeneration and metabolic derangement of the liver after major resection in dogs. METHODS: This is an experimental study on 9 dogs; we divided the dogs in two groups: the first group (5 dogs) underwent at one go major hepatectomy (90% of the liver).The second group (4 dogs) underwent successively a resection of 75% of the liver and a second resection of 90% of the restored liver six months later. All dogs underwent a metabolic and morphologic studies of the liver and of their kidney function. RESULTS: In the first group; all dogs which underwent 90% hepatic resection died 48 hours after the surgical resection of hepatic insufficiency. The ultra microscopic study showed the role of portal hypertension in hepatic degeneration on the first group. In the second group, the dogs survived the first resection, and our study shows a regeneration of the liver after resection and sub normal hepatic function. CONCLUSION: The liver is able to regenerate after minimally resection but major resection must be done by successively resection to avoid hepatic dysfunction, but the time between resection must be evaluate later.     

Cholangitis revealing an intrahepatic Osler's disease

Osler Weber Rendu Disease is an hereditary haemorrhagic télangectasia habitually revealed by reccurent bleeding (epistaxis). Hepatic involvement in Osler disease is found in 8 to 31%, manifested by cholestasis. We report an original observation of a cholangitis revealing Osler disease.     

Mature cystic teratoma of the fallopian tube. A case report

Primary teratomas of the fallopian tube are extremely uncommon. To date, only about 50 cases have been reported in the literature. They occur usually in the fourth decade. There association with nulliparity and reduced parity has been noted. Many have been discovered incidentally and none has been diagnosed preoperatively. The majority are cystic, show great variation in size and are commonly located in the ampulla or the isthmus. They can be intraluminal, attached to the serous surface by a pedicule and rarely intramural. Histologically they are similar to teratoma of the ovary and elsewhere. We describe a mature cystic teratoma of the fallopian tube found incidentally in a 35-year-old woman operated for suspicion of ectopic tubal pregnancy. The feature of benign teratoma of the fallopian tube is discussed.     

French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease

BACKGROUND: The aim of this study was to compare in-hospital morbidity and mortality rates after elective laparoscopic and open colorectal surgery for sigmoid diverticular disease (SDD). METHODS: This prospective national multicentre observational study included all consecutive patients undergoing open or laparoscopic elective colectomy for SDD in a 4-month period between June and September 2002. Postoperative in-hospital mortality and morbidity in the two groups were compared. RESULTS: Three hundred and thirty-two consecutive patients undergoing either laparoscopic (163 patients) or open (169 patients) colectomy for SDD were analysed. Overall postoperative mortality and morbidity rates were 0.3 and 23.8 per cent respectively. The morbidity rate was significantly higher in the open than in the laparoscopic group (P < 0.001), leading to a significantly longer hospital stay (P < 0.001). The morbidity rate remained significantly higher in the open group when the patients were matched for age (P = 0.015) or American Society of Anesthesiologists score (P = 0.028). An open procedure (relative risk (RR) 2.13 (95 per cent confidence interval (c.i.) 1.29 to 3.45)), age over 70 years (RR 1.62 (95 per cent c.i. 1.14 to 2.30)) and intraperitoneal contamination (RR 2.54 (95 per cent c.i. 1.18 to 5.50)) were identified as independent risk factors for morbidity. CONCLUSION: A laparoscopic approach to elective treatment of SDD may be associated with reduced postoperative morbidity and hospital stay. A randomized study is required to confirm these results.     

Abecedary of the "Annales". Part 6

The terms included and detailed in the present part are: cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, proportional hazards (Cox) model, inclusion criteria, endpoints or outcomes.     

Epithelioid hemangioendothelioma of bone complicated by femoral fracture

A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.     

How to approach major surgery where patients refuse blood transfusion (including Jehovah's Witnesses)

Jehovah's Witnesses do not permit the use of allogeneic blood products. An increasing number of patients are refusing blood transfusion for non-religious reasons. In addition, blood stores are decreasing, and costs are increasing. Transfusion avoidance strategies are, therefore, desirable. Bloodless surgery refers to the co-ordinated peri-operative care of patients aiming to avoid blood transfusion, and improve patient outcomes. These principles are likely to gain popularity, and become standard practice for all patients. This review offers a practical approach to the surgical management of Jehovah's Witnesses, and an introduction to the principles of bloodless surgery that can be applied to the management of all patients.