[Endoscopic ultrasonography of the digestive tract]

Endoscopic ultrasonography of the digestive tract provides for a precise ultrasonic study of the accessible gastrointestinal walls (oesophagus, stomach, duodenum, rectum) and, through these walls, of the adjacent organs (lymph node clusters, posterior mediastinum, pancreas, extrahepatic biliary ducts and perirectal environment). This method is better than computerized tomography to evaluate the local and regional extension of oesophageal and cardial carcinomas producing little or no stenosis and of gastric and rectum carcinomas and lymphomas. It is the examination of choice to detect a peri-anastomotic recurrence of these cancers and to evaluate submucosal tumors of the digestive tract. This method, without morbidity is better than computerized tomography or ultrasonography in the aetiological diagnosis of obstacles in the biliary tract and in the diagnosis and pretherapeutic assessment of pancreatic cancers or endocrine tumors.

[Endoscopic ultrasonography in the preoperative evaluation of rectal cancer. A prospective study in 31 patients]

Endoscopic transrectal ultrasonography (EUS) is performed with an ultrasonic transducer (7.5 mHz or 12 mHz) situated in the tip of a side viewing endoscope. Its accuracy to assess the depth of rectal cancer invasion was studied prospectively in 31 patients. The ultrasonic examination was complete in 26 cases; in 5, the stricturing tumour could not be passed by the probe. The depth of invasion was correctly evaluated in 27 of the 31 patients (accuracy: 90 per cent). The 7 superficial lesions were all correctly detected with EUS. EUS appears to be a very promising method for the pretherapeutic staging of rectal cancer.

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.

[Epithelial gastric polyps in a series of 13000 gastroscopies]

The frequency and characteristics of epithelial gastric polyps were studied over a 4-years periods. In a series of 13,000 gastric fibroscopies, 191 patients (1.3 per cent) were fund to have a "polypous lesion". Among these, 48 had hyperplastic polyps, 19 had fundic gland polyps and 6 had adenomatous polyps. The remaining patients had either lesions of interstitial gastritis (118) or normal histology (34). Hyperplastic polyps were 5 mm large in 87 per cent of the cases, and 7 out of 10 were solitary. They were equally distributed between fundus and antrum and associated with atrophic gastritis in 9 out of 22 cases. In 2 cases, they were accompanied with gastric cancer. Fundic gland polyps were less than 5 mm large in 84 per cent of the cases and solitary in 5 out of 19 cases. Adenomatous polyps were associated with hyperplastic polyps in 4 patients, including 1 mixed polyp (hyperplastic containing adenomatous areas). Follow-up with regular endoscopic examinations is accepted for adenomatous polyps; it seems to be justified in patients with hyperplastic polyps, and lesions bigger than 10 mm should be removed in view of the as yet imperfectly evaluated risk of malignant degeneration.

Endosonography: promising method for diagnosis of extrahepatic cholestasis

Endosonography, ultrasonography, and computed tomography (CT) were carried out prospectively in 52 patients with extrahepatic cholestasis. 35 patients had extrahepatic biliary obstructions (21 tumorous, 14 non-tumorous) and 17, with recent gallstone migration within the bile duct, had no extrahepatic obstruction at the time of investigation. The definitive diagnosis was established by surgery (in 39 patients), by transendoscopic sphincterotomy (11 patients), or by retrograde biliary opacification (2 patients). Endosonography was significantly more sensitive than ultrasonography or CT (100% vs 80% and 83%, respectively) in making a positive diagnosis of obstruction. Endosonography was also significantly more accurate than ultrasonography or CT (97% vs 49% and 66%) in diagnosing the cause of the obstruction and more effective in the assessment of the locoregional spread of tumorous obstructions (75% vs 38% and 62%). Thus, endosonography was superior to ultrasonography and CT in the diagnosis and staging of biliary obstructions.

[Endoscopic ultrasonography of the digestive tract]

Endoscopic ultrasonography of the digestive tract provides for a precise ultrasonic study of the accessible gastrointestinal walls (oesophagus, stomach, duodenum, rectum) and, through these walls, of the adjacent organs (lymph node clusters, posterior mediastinum, pancreas, extrahepatic biliary ducts and perirectal environment). This method is better than computerized tomography to evaluate the local and regional extension of oesophageal and cardial carcinomas producing little or no stenosis and of rectal carcinomas. It is the examination of choice to detect a perianastomotic recurrence of these cancers and to evaluate submucosal tumours of the digestive tract and thick fold stomach diseases. Its use in the aetiological diagnosis of obstacles in the biliary tract and in the pretherapeutic assessment of pancreatic and biliary tract cancers seems to be very promising.

[Primary rectal lymphoma: value of rectal endosonography]

The authors report a case of primary rectal lymphoma characterized by dyspareunias and a raised erythematous rectal mucosa visible at rectoscopy. They stress the difficulty of the diagnosis, requiring deep biopsies, and the advantage of endorectal sonography. Its efficacy in defining the parietal and depth spread is evaluated between 90-95 p. cent, while it is lower (72%) regarding node invasion.

[Cystic dystrophy on aberrant pancreas. Contribution of ultrasound-endoscopy]

Cystic dystrophy of aberrant pancreatic tissue without chronic pancreatitis is a rare disease described by Potet and Duclert in 1970. Clinical diagnosis is possible by endoscopy and intraluminalsonography; we report the first case diagnosed by intraluminalsonography.

[Digestive lymphomatous polyposis: study of a case diagnosed by rectal biopsy]

We report a case of gastrointestinal lymphomatous polyposis revealed by a rectal tumor. Numerous polypoid lesions, 5 to 20 mm in diameter, were found at various levels of the gastrointestinal tract. Microscopic examination of gastric, duodenal, colic and rectal specimens led to the diagnosis of small cleaved-cell type lymphoma. The immunohistochemical study showed a monotypic surface staining of the lymphomatous cells with anti-IgM, IgD, kappa, C3b, and CD5 antibodies. This type of lymphoma is rare and presents as multifocal polyposis of the gastrointestinal tract. Only histologic and immunohistologic studies can establish diagnosis. Gastrointestinal lymphomatous polyposis is classified as a low-grade malignant lymphoma, with frequent nodal, hepatosplenic, bone marrow, and blood involvement. Chemotherapy is the appropriate treatment.

Length of the distal esophageal sphincter and competency of the cardia

Pressure and abdominal length of the distal esophageal sphincter are important factors in maintaining competency of the cardia against challenges of intraabdominal pressure. Some patients with normal distal esophageal sphincter pressure and position may have reflux which could be due to the inability of the cardia to overcome challenges of intragastric pressure. Three experimental studies and one clinical study were designed to evaluate this problem. The results showed that the resistance to flow through the cardia is related to the integrated effect of distal esophageal sphincter pressure and length; the ratio of distal esophageal sphincter to intragastric pressure necessary to maintain competency is inversely related to the length of sphincter present; gastric dilatation has an adverse effect on the degree of competency achieved by a given distal esophageal sphincter length; and patients with an overall distal esophageal sphincter length of 2 cm or less measured at rest in the fasting state are subject to reflux caused by gastric dilatation, increased intragastric pressure independent of intraabdominal pressure, or both.

Isolation of human T-lymphotropic retrovirus (LAV) from Zairian married couple, one with AIDS, one with prodromes

A Zairian married couple had been living in France since 1981. The man had acquired immunodeficiency syndrome (AIDS) and his wife had prodromes of the disorder. Infection with a human T-lymphotropic retrovirus (lymphadenopathy-associated virus) was demonstrated in both by isolation of the virus from their cultured lymphocytes and the detection of specific antibodies in serum samples. Since this virus has been isolated from patients in other AIDS risk categories, the finding of the virus in AIDS patients from the African group adds further support to the hypothesis that this human retrovirus is the AIDS aetiological agent.