Biliary Involvement in Type 2 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) is a rare condition classified in 2 subtypes. Their distinction relies on a combination of clinical, serological, morphological and histological features. Type 1 is a pancreatic manifestation of IgG4-related disease characterized by multiorgan infiltration by IgG4 plasmocytes. In this condition, hepatobiliary infiltration is frequent and often mimics cholangiocarcinoma or primary sclerosing cholangitis. On the other hand, type 2 is commonly limited to the pancreas. Herein, we describe the case of a patient who presented a type 2 AIP associated with cholangiopathy, a condition not described in the established criteria. He first developed a pancreatitis identified as type 2 by the typical histopathological features and lack of IgG4 in the serum and tissue. Despite a good clinical response to steroids, cholestasis persisted, identified by MR cholangiography as a stricture of the left hepatic duct with dilatation of the intrahepatic bile duct in segments 2 and 3. Biliary cytology was negative. Evolution was favorable but after steroid tapering a few months later, the patient suffered from recurrence of the pancreatitis as well as progression of biliary attempt, suspicious for cholangiocarcinoma. As the investigations again ruled out neoplastic infiltration or primary sclerosing cholangitis, azathioprine was initiated with resolution of both pancreatic and biliary attempts

Role of ERCP for the diagnosis of indeterminate biliary stenosis and the treatment of benign (non-neoplastic) biliary stenosis in adults

In the first part of this thesis, the diagnostic role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in suspected malignant biliary stenosis) is reported. Sophisticated techniques have been proposed to optimize the diagnostic accuracy of this procedure. We report the major contribution of a simple and safe procedure: bile cytological analysis performed during ERCP in combination with cytological brushing illustrated by our experience detailed in 2 publications. The role of ERCP with a single operator cholangioscopy (SOC) for the diagnosis of indeterminate biliary stenosis and its significant impact on patient management is reported in a third publication. In the second part, the role of therapeutic ERCP is detailed for the treatment of benign biliary stenosis. The role of cSEMS for biliary post-operative stenosis is reported along with our local experience. In addition, ERCP stenting is suggested as an alternative therapy for the particular case of biliary stenosis of alveolar echinococcosis. These two aspects are illustrated by publications. ERCP remains essential in 2021 for the diagnosis of indeterminate biliary stenosis and the treatment of benign biliary stenosis. In the concluding chapter, we focus on current challenges for teaching ERCP to trainees and standards of performance for practitioners after initial training for this demanding endoscopic technique</p

Intérêts des méthodes microbiologiques rapides d'identification et de dénombrement dans un laboratoire de contrôle (exemple le chemscan RDI)

STRASBOURG ILLKIRCH-Pharmacie (672182101) / SudocSudocFranceF

Contribution à l'étude de l'écologie d'Aphyllanthes monspeliensisL. - 1) Place et rôle dans la végétation du Sud-Est français

In this first part of a comprehensive study about the ecology of Aphyllanthes monspeliensis the authors analyse the groupings and facies of vegetation where this species is present in the South-East of France. They emphasize the fact that Aphyllanthes monspeliensis can be found in various ecological environments : grasslands related to the Aphyllanthion ; grasslands non related to the Aphyllanthion ; grasslands and garrigues the largest part of which being related to the dynamics of the forests of Que reus pube seen s. The study of the abundance-classes of Aphyllanthes monspeliensis shows up variations related to the composition of the groupings and especially some clear relationships between Aphyllanthes monspeliensis and some other taxa.Dans cette première partie d’un travail d’ensemble sur l’écologie d’ Aphyllantes monspeliensis, les auteurs répertorient les groupements et faciès de végétation ou l’espèce est présente dans le Sud-Est français. Ils soulignent son appartenance â différentes entités écologiques : les unes se rapportent à des pelouses se rattachant ou non à l’ Aphyllanthion les autres à des pelouses et garrigues arborées dont la plupart relèvent de la dynamique de la chênaie à Qu2Ac.uA pubcAccnA . L’examen des classes d’abondances d’Aphyllanthion monspeliensis permet de discerner une variation du cortège floristique au sein d’un même groupement ou de groupements affines ainsi que quelques relations privilégiées entre cette espèce et certains autres taxons.Bichard D., Bonin Gilles, Vedrenne Gérard, Vidal Philippe. Contribution à l'étude de l'écologie d'Aphyllanthes monspeliensisL. - 1) Place et rôle dans la végétation du Sud-Est français. In: Ecologia mediterranea, tome 8 n°4, 1982. pp. 177-199

Esophageal pulmonary fistula – a rare complication of radiation therapy: a case report

Abstract Background Esophageal respiratory fistulae are abnormal communications between the esophagus and the respiratory system. They are either congenital or acquired. Most acquired esophageal respiratory fistulae are of the esophageal tracheal and esophageal bronchial type and are caused by infections or malignant neoplasms, whereas esophageal pulmonary fistulae are rare. Case presentation We report a case of a 72-year-old Caucasian man with squamous cell carcinoma of the lung presenting with abrupt-onset dyspnea during localized mediastinal radiotherapy. His laboratory test results suggested major respiratory infection. A chest x-ray revealed left apical lung radiopacity along with excavated lesions, consistent with secondary tumor infection. No clinical improvement was observed despite antibiotic treatment. A contrast-enhanced computed tomographic scan of the chest confirmed persistent lung infection with unfavorable progression and air in the mediastinum; the latter suggested a fistula from the upper third of the esophagus to the upper left pulmonary lobe. Videofluoroscopy confirmed the diagnosis of an acquired esophageal pulmonary fistula. The patient underwent endoscopy, and an esophageal self-expandable metallic stent was deployed. Conclusions Esophageal pulmonary fistulae must be suspected whenever patients undergoing local mediastinal radiotherapy present with acute pulmonary complications, particularly pneumonia resistant to antibiotic treatment. Esophageal pulmonary fistulae are diagnosed by means of radiological imaging. Because esophageal respiratory fistulae are acute life-threatening conditions, prompt treatment with an endoscopically placed covered stent proves vital

Dissection sous-muqueuse endoscopique : avancées et perspectives

Endoscopic submucosal dissection (ESD) is a mini-invasive technique allowing to resect superficial lesions of the digestive tract and maintaining organ function. High technical expertise is required as well as a network approach with referring physicians, pathologists, radiologists, surgeons and oncologists. Rigorous selection of cases as well as endoscopic management of potential complications (hemorrhage, perforation) is mandatory. Therefore, ESD should preferably be performed in expert centers with high volumes of cases, in order to maintain competency and offer optimal patient's management. Most frequent indications in the Western world are early cancers of the esophagus, stomach and colon as well as non-non-lifting polyps and gastrointestinal stromal tumors (GIST).La dissection sous-muqueuse (DSM) est une technique permettant la résection des lésions superficielles du tube digestif, de façon mini-invasive, afin de conserver la fonction de l’organe atteint. L’expertise technique aboutissant à ce geste doit s’accompagner d’un travail en réseau associant médecins référents, pathologistes, radiologues, chirurgiens et oncologues. Elle nécessite une sélection rigoureuse des indications, ainsi que la maîtrise des complications éventuelles (hémorragie, perforation) et doit préférablement être réalisée en centre expert, avec un volume suffisant de cas afin de maintenir la compétence. Les indications les plus fréquentes en Occident concernent les cancers super­ficiels de l’œsophage, de l’estomac et du côlon ainsi que les polypes ne se soulevant pas lors de l’injection sous-muqueuse et les tumeurs stromales gastro-intestinales (GIST)

Epidémiologie, prise en charge et suivi des polypes colorectaux

Colorectal polyps are frequent in the general population. The diagnostic is made by endoscopy. Polyp's characteristics determine the technic to be used to remove them. Transanal endoscopic microsurgery offers an alternative to radical surgery for large rectal polyps or rectal tumors with low risk of node invasion. One peace resection is necessary to evaluate the resection margins. Lymphatic invasion, ≥ 1 mm submucosae invasion, tumor budding and poorly differentiated tumor are the four main risk factors for node invasion. In case of high risk of lymph node invasion a radical surgery is recommended. Surveillance must be adapted to the polyp type, their number, size, presence of a carcinomatous component as well as age and clinical status of the patient

Cancers superficiels de l’œsophage : épidémiologie, diagnostic et traitement

In Europe, oesophageal cancers are diagnosed at an early stage in less than 10% of the cases. They are superficial tumours whose invasion is limited to the mucosae and the submucosa. Synchronous node invasion is the most important prognosis factor. Oesophagectomy is the benchmark treatment. Nowadays, endoscopic resection is a validated curative therapeutic alternative. Accurate endoscopic evaluation using chemical or virtual colouring as well as an echoendoscopy, followed by an expert pathological review, must be conducted beforehand. It can be realised for good prognosis tumours after evaluation of the synchronous node invasion or its risk. After completion, regular endoscopic follow-ups are compulsory to detect local relapse

Prise en charge multidisciplinaire du cancer localisé du rectum

Rectal cancer remains a frequent pathology, with a good prognosis, according to a proper management. During the last decades, we have been confronted with important improvements, notably regarding the diagnosis and the treatment. In the era of highly specialized medicine, it is clear that the management must be multidisciplinary, incorporating not only the surgeon, the oncologist and the radiation oncologist, but also the radiologist, the gastroenterologist, and the pathologist. We aim to review the recent concepts and the future developments in the management of rectal cancer