Acute cholangitis complicating a chronic alveolar echinococcosis: an unusual therapeutic cholangioscopy

International audienceA 71-year-old man with a history of chronic alveolar echinococcosis presented with acute cholangitis and severe sepsis. Echinococcosis had been diagnosed 38 years previously. At this time, a left hepatectomy, associated with distal gastrectomy and gastro-jejunal anastomosis (Finsterer) was performed. Afterwards, despite parasitostatic therapy, the infection progressed slowly with chronic biliary compression, causing secondary biliary cirrhosis and episodes of recurrent acute cholangitis. Several endoscopic retrograde cholangiopancreatographies (ERCPs) with insertion of biliary plastic stents had been performed in another hospital.Magnetic resonance cholangiography showed extrinsic compression of the main bile duct by a multicystic parasitic pseudotumor, associated with an intrahepatic necrotic parasitic cavity, in communication with dilated intrahepatic bile ducts, and containing gallstonesOur management consisted of retrograde access of the major papilla, using an adult gastroscope, after going up the short afferent loop. The dilation of the main bile duct by the previous biliary stent procedures made it possible to perform cholangioscopy with the gastroscope. After crossing a relative extrinsic compression of the main bile duct, the endoscope accessed the necrotic cavity filled with biliary debris, into which multiple bile ducts flowed ([Fig. 2]). Sludge and gallstones were removed with endoscopic baskets. A second cholangioscopy was then performed to complete the cleaning of the bile ducts with an exploration of each biliary branch with a balloon ([Fig. 3]). At the end of this procedure, a biliary metal stent was positioned to treat the compression of the common bile duct ([Video 1]).Video 1 Magnetic resonance cholangiography showing extrinsic compression of the main bile duct by a parasitic pseudotumor and an intrahepatic necrotic parasitic cavity. Cholangioscopy with a gastroscope allows removal of the gallstones and the sludge from the cavity, which is followed by exploration of the dilated bile ducts with a balloon.Alveolar echinococcosis is a parasitic disease caused by Echinococcus multilocularis. The development of this parasitic infection causes the progressive appearance of intrahepatic pseudotumors. Radical surgery and liver transplantation are the only curative treatments. In 70 % of cases, the treatment consists of a combination of parasitostatic therapy and the punctual treatment of complications, such as biliary stenosis or intrahepatic gallstones. Current recommendations advise the use of endoscopic biliary drainage instead of surgery, even if iatrogenic cholangitis is more frequent with this (10 %). Placement of several plastic biliary stents optimizes drainage through the stenosis by decreasing stent occlusion [1]

L'Abri n°1 de l'Aulp du Seuil (Isère, Chartreuse, St-Bernard-du-Touvet): synthèse des résultats préliminaires et discussion sur les modalités d'exploitation territoriale au Mésolithique et au Néolithique ancien

Situé à 1700 m d'altitude, au fond d'un vallon creusé dans un synclinal perché urgonien, isolé et difficile d'accès, ce site a livré six abris sous bloc et une station de plein air. Nous présentons ici les résultats préliminaires des fouilles en cours de l'abri no 1. La stratigraphie a permis de reconnaitre quatre couches bien individualisées et calées chronologiquement. La couche A correspond à la période médiévale, la couche B au 1er Âge du Fer et au Néolithique final, la couche C1 au Néolithique ancien et au Mésolithique récent, alors que les couches C2, C3 et D1 se rapportent au Mésolithique moyen. Les espèces chassées les mieux représentées sont le bouquetin, le chamois et le cerf. Les données de la paléobotanique indiquent un environnement caractéristique de l'étage montagnard, un paysage boisé mais ouvert avec, au Mésolithique, une représentation des feuillus aujourd'hui absents du site indiquant des conditions climatiques plus tempérées. Les résultats préliminaires des études sur les matières premières, qui mettent en évidence des zones d'approvisionnement plus ou moins éloignées, témoignent de la mobilité des groupes mésolithiques, de leur connaissance et de leur exploitation du milieu montagnard

Paradoxical articular manifestations in patients with inflammatory bowel diseases treated with infliximab

International audienceIntroduction Articular involvement is the most common extraintestinal manifestation associated with inflammatory bowel diseases (IBDs). Manifestations are `paradoxical' when they occur during treatment, notably with anti-tumor necrosis factor (anti-TNF) drugs, which are expected to prevent or treat them. The aim of this study was to assess the frequency, characteristics, and associated factors of paradoxical articular manifestations in patients with IBD treated with anti-TNF. Patients and methods In this prospective single-center study, an examination by a rheumatologist was systematically offered to all patients with IBD treated with infliximab (IFX) to assess the prevalence of articular manifestations and distinguish between those related to treatment and those associated with intestinal disease. Paradoxical manifestations were defined as the occurrence of articular manifestations (excluding induced lupus and hypersensitivity reactions) during anti-TNF therapy in patients with intestinal remission. Measures of biological inflammatory, immunological markers, HLA-B27 allele, IFX trough levels, and anti-IFX antibody (Ab) were performed for all patients. Results Between May 2013 and April 2014, 65 patients with Crohn's disease and 15 with patients ulcerative colitis treated with IFX were included. The median duration of anti-TNF therapy was 66 months [quartile (Q) 1=23 months-Q3=81 months]. Articular manifestations were observed in 50 (62%) patients treated with IFX. Eleven percent (n=9) were considered to be associated with IBD and 16% (n=13) to be associated with anti-TNF therapy. Among articular manifestations associated with anti-TNF therapy, nine (11%) patients were considered paradoxical, two (2%) as drug-induced lupus, and two (2%) as a hypersensitivity reaction. Among the nine patients with paradoxical manifestations, all had Crohn's disease in clinical remission, three patients presented a spondyloarthropathy, and three developed associated paradoxical psoriasis. No patient discontinued anti-TNF because of the articular manifestations. Methotrexate was effective on articular symptoms in two of the three treated patients with paradoxical manifestations. No clinical or biological factors, including IFX trough levels, were associated with the occurrence of paradoxical manifestations. Conclusion Paradoxical articular manifestations in IBD patients treated by anti-TNF are common, affecting more than 10% of patients. These events are generally mild and do not need discontinuation of anti-TNF therapy. Eur J Gastroenterol Hepatol 28:876-881 Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

Membres du comité d’organisation scientifique et logistique

SPEEAGESTADAGROSUPMembres du comité d’organisation scientifique et logistique. 23. Conférence du COLUMA - Journées Internationales sur la Lutte contre les Mauvaises Herbe