Possible zoonotic transmission of hepatitis E from pet pig to its owner

Hepatitis E is transmitted mainly by water or food, but in industrialized countries, all routes of transmission have not been identified. We describe possible zoonotic transmission of hepatitis E virus that involved direct contact between a pet pig and its owner.

Painful jaundice revealing Kawasaki disease in a young man

Liver involvement is usually a minor manifestation of Kawasaki disease and includes hepatobiliary dysfunction or gallbladder hydrops. We describe here an unusual case of jaundice revealing an adult onset Kawasaki disease. An 18-year-old man presented with abdominal pain and jaundice associated with cholestasis as the initial manifestation of Kawasaki disease. Abdominal evaluation (ultrasonography and CT-scan) did not find abnormality. Other signs typical of the Kawasaki disease occurred a few days later and permitted diagnosis. With aspirin and intravenous immunoglobulins, outcome was favorable without any cardiovascular complication. Our case suggests that Kawasaki disease should be added to the etiological list of painful febrile icterus in young patients.

[Deteriorating choledochal cyst. A case]

Choledochal cysts have an increased risk of biliary tract malignancy, induced by reflux of pancreatic juice and anomalous pancreatobiliary ductal junction. We report one case of congenital choledochal cyst in a 68-year-old female whose malignancy was revealed by history of pain and jaundice. Pancreatico-duodenectomy was performed and the patient was alive 6 months later.

[Lymph node-hepatosplenic hemangioma in an adult with consumption coagulopathy and fatal cardiac insufficiency]

Hemangioendothelioma is seldom seen in adults. Its severe evolution is due, not so much to the exceptional transformation into hemangiosarcoma, but mainly to haemorrhagic complications by rupture or consumption coagulopathy and to severe cardiac insuffficiency secondary to arteriovenous shunts. The case reported here concerns a 64 year-old woman presenting pain in the left hypochondrium and splenomegaly. A splenectomy was performed and the histological findings were compatible with the diagnosis of hepato-splenoganglionic hemangioendothelioma. The evolution was unfavorable. The patient died a few months later in a picture of haemorrhagic syndrome and cardiac insufficiency. Histological findings on autopsy specimens indicated a cavernous hemangioma. The treatment of these diffuse hemangiomas is a difficult one. Hepatic artery ligation has been advocated in certain desperate situations. Nevertheless, because of a collateral circulation, recurrences are frequent.

[Porphyria variegata. Apropos of a new familial case]

With reference to an observation of porphyria variegata, which was complex and unusual as all such observations are, the direct responsibility of rifampicin is underscored. Porphyria variegata should be considered in two situations. The first of these is a dramatic acute neuroabdominal picture: the diagnosis of acute hepatic porphyria is established by the measurement of urinary porphyrins; the second step is to distinguish between the three acute hepatic porphyrias by looking for cutaneous manifestations and determining the respective proportions of coproporphyrins and protoporphyrins in the stools. In porphyria variegata, fecal protoporphyrins are significantly increased. The second situation is cutaneous involvement suggestive of late-onset cutaneous porphyria: porphyria variegata as well as hereditary coproporphyria in the cutaneous phase must be considered. Diagnosis can be established only through measuring fecal porphyrins. Porphyria variegata is a genetic enzymatic disorder inherited on an autosomal dominant basis. A study of the family is required in all cases, but the conventional methods for detecting heterozygotes for porphyria variegata are not satisfactory. Carriers will be unequivocally distinguished from healthy subjects only through measuring the defective enzyme activity.

[Physiological basis of enteral nutrition]

The authors discuss the various recent discoveries and fundamental data on absorption from the digestive tube and the digestive hormones. The practical applications of these data in oral feeding are underlined.