Role of endoscopic ultrasound in the management of submucosal tumours in the esophagus and stomach

Les tumeurs sous-muqueuses œso-gastriques constituent une pathologie rare et de découverte souvent systématique. Elles sont parfois source de complications graves (hémorragie, obstruction) ou peuvent être malignes. L'échoendoscopie apparaît aujourd'hui comme la méthode de choix pour affirmer l'existence d'une lésion sous-muqueuse, et donner des éléments d'orientation sur sa nature, et son pronostic. Elle doit donc prendre place d'emblée après l'examen qui évoque le diagnostic (en général la gastroscopie). Une fois le diagnostic de tumeur sous-muqueuse affirmé. la décision thérapeutique dépend des symptômes, de la localisation et des données échoendoscopiques (taille supérieure à 3 cm, caractère régulier ou non des contours périphériques, homogénéité). Pour des lésions suspectes ou symptomatiques, l'attitude doit être chirurgicaie. En cas de lésion régulière, homogène, de petite taille et asymptomatique, une simple surveillance peut-être proposée. Dans les autres situations, il faut favoriser la résection chirurgicale de type énucléation ou la résection endoscopique

Les méthodes de travail de Gersonide et le maniement du savoir chez les scolastiques

Collaboration et aide de Ph. BOBICHO

Olmesartan-associated enteropathy: results of a national survey

BACKGROUND: Recently, a new enteropathy has been described: olmesartan-associated enteropathy. However, the association has been questioned: a phase 3 trial and a cohort study found no association between gastrointestinal events and olmesartan. AIM: To collect French cases of sartan-associated enteropathy to describe further this entity, confirm or refute causality, and determine if the association exists with other sartans. METHODS: French gastroenterologists were invited to report cases of sartan-associated enteropathy and collect clinical, biological and histological data. Patients with diarrhoea and histological duodenal abnormalities were included. RESULTS: Thirty-six patients with olmesartan-associated enteropathy were reported, including 32 with villous atrophy and four without. There was only one patient with irbesartan-associated enteropathy. None of the patients died. Patients with villous atrophy had diarrhoea, vomiting, renal failure, hypokalaemia, body weight loss and hypoalbuminaemia. Thirty-one patients were hospitalised; four required intensive care. Anti-transglutaminase and anti-enterocyte antibodies were negative; anti-nuclear antibodies were positive (9/11). Endoscopic duodenal biopsies showed villous atrophy (32/32) and polyclonal intra-epithelial CD3+CD8+ lymphocytosis (11/11). Exactly, 14/15 patients responded to steroids and/or immunosuppressants, prescribed because of suspected autoimmune enteropathy. Ten olmesartan interruptions were followed by reintroductions before steroids or immunosuppressants. Interruptions were followed by remissions (9/10), but reintroductions were followed by relapses (9/9). Twenty-nine patients were in remission since olmesartan interruption, including 26 without immunosuppressants. Patients with normal villi had similar clinical characteristics, but mild histological abnormalities (intra-epithelial lymphocytosis and lamina propria lymphocytic infiltration). CONCLUSIONS: Olmesartan causes a severe and immune-mediated enteropathy, with or without villous atrophy. Enteropathy associated with other sartans seems to be very rare

Updates on the epidemiology of dermatophyte infections.

The spectrum of dermatophytes isolated from skin lesions had changed in last 70 years. Before the Second World War in Germany, Microsporum audouinii and Epidermophyton floccosum ranked the first, whereas Trichophyton rubrum is the most common dermatophyte since the fifties of last century, accounting for 80-90% of the strains, followed by T. mentagrophytes. This evolution is typical for Central and North Europe and it needs to be connected with the increase in the incidence of tinea pedis. In contrast, in Southern Europe and in Arabic countries, zoophilic dermatophytes, such as Microsporum canis or Trichophyton verrucosum, are the most frequently isolated. In Europe, especially in Mediterranean countries, the incidence of M. canis infection has strongly increased during the recent years and this dermatophyte is now the most prevalent in tinea capitis in children. An analysis of the frequency and distribution of tinea pedis in different occupations and leisure-time activities as well as the routes of infection are reported. The spreading of this disease in most developed countries of the world represents a considerable economic problem, since it was accompanied by a parallel increase in the frequency of onychomycosis which implies, as tinea pedis, large financial charges. In poor developing countries, mycoses appear endemically, primarily with children, and their treatment often fails because of the lack of efficient antifungals. The particular epidemiological situations of dermatophytoses and the pathogenic spectrum of dermatophytes are examined at the example of numerous countries