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Tuberculosis of the pancreas is unusual and often secondary to generalized tuberculosis. In most cases clinical presentation is obstructive jaundice due to pancreatic mass lesion. Although diagnosis is usually obtained after resection of the mass lesion, endoscopic procedures might avoid non-necessary surgical procedure. We report a clinical case of pancreatic tuberculosis diagnosed by endoscopic ultrasound guided fine needle aspiration biopsy and treated by biliary stenting.

An unusual form of adenoma of left lobe of liver was detected fortuitously in a young woman with an inflammatory syndrome and an anicteric cholestasis. In this case, a positive correlation existed between the adenoma and the treatment with estrogens, the disappearance of the biologic anomalies after exeresis of the adenoma being suggestive of an increased production of fibrinogen by hepatocytes. The cholestasis was probably the result of pressure exerted by the adenoma. Excision of the adenoma was justified by the risk of hemorrhagic complications and the possibility of malignant changes in the tumor.

Hemoptysis is not considered as an hemorrhagic complication of portal hypertension. We report a patient with liver cirrhosis and portal hypertension who developed a hitherto unreported porto-pulmonary transdiaphragmatic collaterality many years after splenectomy. Life threatening hemoptysis complicated this unusual shunt after banal bronchitis. A proximal splenorenal shunt was performed and was completely effective at 26 months.

The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma of the liver managed without surgery under CT guidance. This attitude--which does not exclude surgery as a later resort--requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans.

The influence of intravenous infusion of branched-chain amino acids (BCAAs) on brain function in patients with liver cirrhosis and acute hepatic encephalopathy was examined using a double-blind, randomized study design. Five medical centers in France and Sweden participated, and 50 patients were studied. The patients received either BCAAs (40 gm per day) in 5% glucose or 5% glucose alone (placebo) for 5 days or until "wake up". Nutritional support was provided with equal proportions of carbohydrate and fat. During BCAA administration, plasma concentrations of aromatic amino acids and methionine fell (20 to 40%, p less than 0.05 to 0.01), and the ratio of BCAAs to aromatic amino acid concentrations increased significantly. Clinical improvement was seen in 14 of 25 BCAA-treated patients and in 12 of 25 patients receiving placebo (N.S.). EEG responses were similar in the two groups during treatment. In the BCAA group, 10 of 25 patients died in the course of the study, compared to 5 of 25 in the placebo group (N.S.); six patients died from encephalopathy in the BCAA group as compared to three among placebo-treated patients. It is concluded that BCAA administration, in the dose and composition employed in the present study, reduces the concentrations of aromatic amino acids but neither improves cerebral function nor decreases mortality in patients with hepatic encephalopathy.

There is an increasing number of patients who have lad massive resection of the small intestine, and they pose a problem of how to readapt their nutrition. This has to take into account their malabsorption syndrome due to the extent and site of the resection. Other factors which may affect their nutritional status are whether the caecum has been left in place, the functional capacity of the remaining small intestine and the hepatic and pancreatic functions. This process of readaptation is luckily helped by the compensating hyperplasia of the remaining small intestine especially clearcut in the ileum. This organ and this process is closely related to the presence of food and biliary pancreatic secretions in the intestinal lumen. This is a strong argument in favour of early oral feeding of these patients. It should start two to three weeks after the operation with at the same time intravenous feeding being continued until such time as the intestine can adequately take over. Nevertheless at the beginning simple food is used, which can be absorbed directly (glucose, amino acids, medium chain triglycerides--MCT). These are given slowly and continuously by a silicon nasogastric tube. After some time when the patient has become used to this, he can be fed orally to a slightly greater extent, with the food divided into five or six meals.

The authors define the management of a patient following emergency admission for the ingestion of a caustic liquid: immediate assessment by fibroscope oesophagoscopy; avoidance of all corticosteroid therapy and of the insertion of a gastric tube; parenteral alimentation. The frequency of early deaths has considerably decreased since the applications of this method, either as a result of shock or of the inhalation of caustic liquid.

This study was carried out in order to assess the value of ultrasonography in the diagnosis of cirrhosis. One hundred patients were studied within 2 weeks of the histological diagnosis of the liver disease (cirrhosis 49, acute or chronic hepatitis: 23, fatty liver: 16, normal liver: 12). Ultrasonic patterns were classified by a second examiner according to 5 hepatic criteria (volume, outline, echogenicity, attenuation of the ultrasound beam, enlargement of caudate lobe) and 3 extrahepatic criteria (dilatation of the portal vein, ascites, splenomegaly), leading to a ultrasonic diagnosis. Cirrhosis was diagnosed in 36 out of 49 patients (73 p. 100) by the echographist whereas clinical and biological data lead to diagnosis in only 27 out of these 49 patients (P = 0.057). Hepatocellular carcinoma was diagnosed only in 2 out of 5 patients. Splenomegaly (0.60) and caudate lobe enlargement (0.59) were the signs whose predictive value was the best for this group of patients. The ratio thickness of caudate lobe/global hepatic thickness (as measured on a sagittal cut through the inferior vena cava) allowed for easy assessment of caudate lobe size. The mean value of this ratio was significantly different (P less than 0.001) in the cirrhotic group (0.38 +/- 0.07) when compared to the non-cirrhotic one (0.28 +/- 0.06). Ratios greater than 0.35 were not seen in subjects with normal livers, nor were ratios greater than 0.40 seen in non-cirrhotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The therapeutic approach to the management of corrosive burns of the upper gastrointestinal tract leaves a considerable morbidity and a heavy mortality rate. This work evaluates the effectiveness of a new therapeutic approach given to 94 consecutive patients. The management has been based on three major points: (1) the definition of extent of upper gastrointestinal lesions by immediate fibroendoscopy; (2) immediate protection of the upper gastrointestinal tract by total parenteral nutrition in cases with serious burns (41 cases), normal oral nutrition being allowed for minor burns (35 cases); (3) reparative surgical procedures for any of the sequelae of such burns during the fibrosing phase. The results were as follows: (a) healing, depending upon the degree of burn, occurred between eight to 90 days; (b) the frequency of subsequent local complications was small with total parenteral nutrition started a few hours after ingestion of the corrosive product; (c) after reconstructive surgery no serious complications occurred; (d) the overall morbidity stayed at a very low level (four patients). We conclude that the general prognosis of a severe burn of the upper gastrointestinal tract, without other trauma, is appreciably improved by the very early institution of total parenteral nutrition.