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Biomedical subjects

A Pages

Publications and source records attributed to A Pages.

At least 19 recordsLinked to original sources

[Surgical treatment of ruptures of the Achilles tendon. Apropos of 42 cases treated by Bosworth's technique].

PURPOSE OF THE STUDY: There is no consensus on the treatment of acute ruptures of the Achilles tendon. We have chosen surgical technique with early muscle stimulation. This study analyses possibilities of functional recovery and complications in Athletes. MATERIALS AND METHODS: Between 1983 and 1994, we treated surgically 42 Athletes who had Achilles tendon ruptures with early musculo-tendinous stimulation. The 39 male and 4 female patients had a mean age of 41 years (range, 15 to 70). We have always used Bosworth's technique with gastrocnemius flap procedure. Immediately after surgery, weightbearing with below-the-knee cast was initiated for 6 weeks followed by rehabilitation. RESULTS: There was no local major complication, deep vein thrombosis or pulmonary embolism. Only one patient suffered from a traumatic rerupture one month after surgery. Mean value of the calf atrophy was less than 1 cm. 93 per cent of patients returned to previous activity levels and 78.5 per cent of patients returned to their usual sport activity. DISCUSSION: Like this study recent results confirm the low complication and recurrence rate of the surgical treatment. Percutaneous technique and conservative treatments seem to be worse for rerupture and sportive functional recovery. Early muscle stimulation decrease morbidity and calf atrophy. Our protocol with weightbearing in ankle neutral position reduces calf atrophy. CONCLUSION: A rigid and stable reconstruction, allowing early weightbearing without equinus position seems to be a rational treatment for Achilles tendon rupture in athletes.

Achilles Tendon

Thyroid spindle epithelial tumor with thymus-like differentiation (the "SETTLE" tumor). An immunohistochemical and electron microscopic study.

An intrathyroid primary epithelial spindle-cell tumor with mucous cysts is described in a 9-year-old child. Histologically, this well-circumscribed tumor exhibited a nodular pattern, a prominent spindle cell component with minimal pleomorphism, and well-differentiated mucinous glands within fibrous bands. The spindle cells demonstrated diffuse immunopositivity for cytokeratin and vimentin. Electron microscopy of tissue sections demonstrated that cells contained bundles of cytoplasmic tonofilaments and numerous desmosomes. The light and electron microscopic features and immunohistochemical profile of this tumor were similar to those of recently described thyroid tumors that have been called "SETTLE" tumors (i.e., spindle epithelial tumor with thymus-like differentiation). These uncommon tumors can be considered intrathyroid thymoblastomas and must be regarded as potentially malignant lesions.

Child

Cathepsin D immunostaining in paraffin-embedded breast cancer cells and macrophages: correlation with cytosolic assay.

High cathepsin D (cath-D) concentration in breast cancer cytosol is associated with increased risk of metastasis. To specify the relative contribution of the different cells types responsible for cath-D level in cytosol, we validated semiquantitative cath-D immunoperoxidase staining on formalin-fixed, paraffin-embedded sections, using the M1G8 monoclonal antibody, one of the two antibodies of the cytosolic assay. Using computer-aided image analysis, cath-D level in cancer cells was estimated by integrating both staining intensity in each cell and proportion of stained cells. We confirmed on 41 primary breast cancers a higher expression of cath-D in cancer cells compared with peritumoral mammary glands. Cancer cell staining was mostly in lysosomes and for some invasive ductal carcinomas in large vesicles corresponding to phagosomes. Lymphocytes and fibroblasts were not or were only weakly stained. Macrophages also were stained for cath-D, generally on the periphery of the tumor area. The cytosolic cath-D level was correlated with cath-D expression in cancer cells (r = .76; P = 1 x 10(-4)) rather than with the number of macrophages in the tumor (r = .29; P = .09), as determined by use of the specific anti-CD68 antibody. There was a significant increase in the tissue cath-D level in tumors containing large vesicles compared with tumors without large vesicles. This approach provides a means to separately estimate the prognostic significance of cath-D expression in cancer cells and macrophages when evaluating risk of metastasis.

Breast Neoplasms

[Natural history of cardiac rhabdomyoma. Presentation of 2 cases with immunohistochemical study and review of the literature].

Two cases of cardiac rhabdomyoma have recently been observed in foetuses. The cardiac and muscular nature of the cells was confirmed by immunohistochemistry using monoclonal antibodies. A review of the literature shows that cardiac rhabdomyomas are usually considered to be hamartomas which are composed of primitive myocardial cells. Their spontaneous regression is often observed and apoptosis has been proposed as a possible mechanism of such a phenomenon. We propose that cardiac rhabdomyomas should be better considered as developmental vestiges rather than as true hamartomas. These vestigial structures would result either from a defect in differentiation, or from a defect in regression of primitive myocardial cells.

Abortion, Therapeutic

Prenatal diagnosis of diastematomyelia.

Fetal diastematomyelia, a malformation due to a longitudinal split of the cord, was diagnosed during the third trimester. Diagnosis was based on the visualization of a sagittal bony spur in the thoracolumbar spinal canal, associated with enlargement of the canal, hemivertebrae and spina bifida without a meningocele.

Adult

Immunostaining of cathepsin D in breast cancer: quantification by computerised image analysis and correlation with cytosolic assay.

Cathepsin-D (cath-D) was quantified in 34 breast cancer specimens by immunohistochemical staining of frozen sections with a computer image analysis and the results were compared with the corresponding cytosolic assay. Cath-D concentrations varied from 0 to 420 arbitrary units (AU). Tumour cells were more intensely stained than peritumoral tissue with the D7E3 mouse monoclonal antibody than with rabbit polyclonal antibodies. There was a good correlation (r = 0.80) between cath-D values obtained either by immunohistochemistry with D7E3 antibody or by cytosolic immunoenzymatic assay. However, with a cut-off of 50 AU, 3 out of 25 patients had higher immunohistochemical values and 2 had higher cytosolic values. Therefore, quantification of cath-D concentration in tissue section by immunostaining and a computerised image analyser, which is the only technique available for small tumours, should provide similar prognostic information to that obtained by assaying cath-D in the cytosol.

Animals

Lysosomal enzymes and severity of saphen varicosis.

The severity of the varicosis estimated clinically and histologically is well correlated with the seric levels of beta-acetylglucosaminidase and beta-glucuronidase. No correlations are observed with the arylsulfatase level in serum nor with the levels in venous tissue for the three enzymes.

Acetylglucosaminidase

Early prenatal diagnosis of congenital cystic adenomatoid malformation of the lung (Stocker's type I); a case report.

A congenital cystic adenomatoid malformation was diagnosed by ultrasound examination at 20 week's gestation. The entire right lung was cystic and elements of poor prognosis such as hydrops fetalis and polyhydramnios were present. After verification of the karyotype, abortion was performed and autopsy confirmed prenatal findings and Stocker's type I. Cystic congenital adenomatoid malformation of the lung is a rare form of congenital pulmonary disease. Our case shows that this malformation can be accurately diagnosed during the midtrimester of pregnancy by ultrasound examination. Ultrasound examination permits an evaluation of the three types described by Stocker and may reveal certain lesions associated with poor prognosis, such as anasarca or polyhydramnios. Also, it offers the possibility to save some fetuses by surgical decompression in the immediate postnatal period, or to terminate earlier pregnancies by abortion.

Adult

[Neuroendocrine tumors of the mammary gland. Current evaluation apropos of a case].

The authors report a case of infiltrating non-mucinous neuroendocrine breast tumor of both nesidioid and carcinoid type, exclusively composed of argyrophil cells and showing estrogen receptors. By comparing it to those published in literature, they conclude that there are two types of breast tumors with argyrophil cells: one very rare, exclusively composed of neuroendocrine cells, which may present all of the morphological, functional, evolutive aspects and particularly the carcinoid pattern of diffuse endocrine system tumors; the other is more common, composite, reminiscent according to the abundance of their neuroendocrine components, either of the features of diffuse endocrine system tumors, or of those of conventional adenocarcinomas. Their findings help to explain that the combined hormonoreceptive and hormonosecreting nature of these tumors is the particular property of their neuroendocrine cells comparable to that of the pituitary gland. In the composite tumors, these cells are associated in symbiosis with the epithelial glandular cells which are of ectodermal origin. Such an association, also observed in other parts of the body, is not fortuitous but functional and thus could contra-indicate antiestrogen hormonetherapy.

Aged

[Association of a pheochromocytoma and a homolateral clear cell renal carcinoma].

A 61 years old man had a clear cell type carcinoma of the right kidney and a small asymptomatic homolateral adrenal pheochromocytoma. A von Hippel-Lindau disease suggested by this association was not confirmed in this case. However the measurement of plasma and urinary catecholamines, VMA and Iodine 131 MIBG (meta-iodo-benzyl-guanidine) scans are usefull in case of clinical doubt in patients with renal adenocarcinoma. This observation and others in medical literature demonstrate the interest of resection of adrenal glands during a nephrectomy for adenocarcinoma.

Adrenal Gland Neoplasms

Expression of the progestin-induced fatty acid synthetase in benign mastopathies and breast cancer as measured by RNA in situ hybridization.

We have shown previously that fatty acid synthetase (FAS) is specifically induced by progestins in human breast cancer cell lines. To test the potential value of FAS as a clinical marker in breast diseases, we measured FAS expression in frozen sections of 22 benign and 27 malignant mammary tumors using in situ hybridization with the [35S]UTP alpha S-labeled FAS anti-sense mRNA. The hybridized RNA was quantified with an IMSTAR computerized image analyzer. We found FAS RNA in epithelial cells, but no labeling was detected in the connective tissue. In breast cancer, we found no correlation between FAS expression and estrogen receptor and progesterone receptor concentrations or status. However, the level of FAS was significantly (P less than .02) higher in premenopausal than in post-menopausal patients and increased with the grade of tumor differentiation (P less than .005 between the poorly and well-differentiated tumors). In benign mastopathies, high levels of FAS RNA were found in some cysts (mostly with apocrine metaplasia). In lobules, the FAS RNA level increased proportionally to the degree of proliferation determined by histological examination (P less than .015) and correlated with the H4 histone level measured in an adjacent section using in situ hybridization (r = 0.85, P less than .001). In ductal structures, a lower correlation (r = 0.64, P less than .01) was found between FAS and H4 RNA levels. We conclude that FAS RNA is overexpressed in some mammary tumors and may be useful in predicting high-risk mastopathies and less aggressive breast cancers.

Breast Diseases

Cathepsin-D in human endometrium: induction by progesterone and potential value as a tumor marker.

Using an immunoenzymatic assay, cathepsin-D concentrations were measured in the cytosol of human endometrium biopsies. The level of cathepsin-D was higher in the luteal phase than in the follicular phase (P less than 0.01), suggesting increased accumulation by progesterone. Induction by progestin was confirmed by immunoprecipitation of cathepsin-D from a lysate of epithelial endometrial cells previously treated in primary culture with R5020 (10 nM); estradiol (10 nM) had no effect. Immunohistochemistry showed that cathepsin-D is mainly localized in the epithelium and that its level is higher in the luteal phase. The plasma level of cathepsin-D was stable during the menstrual cycle, ranging between 2.5-10 pmol/mL, but increased slightly during pregnancy. The mean level of cathepsin-D was higher in 19 endometrial carcinoma than in 20 normal endometrium, but was not correlated with steroid receptor status. However, using 15 pmol/mg protein as a cut-off level, the cathepsin-D status (high or low) was correlated with the degree of myometrial invasion (greater than or equal to one third) by adenocarcinoma cells, whereas steroid receptor status was not. We conclude that cathepsin-D is induced by progesterone in human endometrium, as it is in normal rat uterus, and we suggest that a low concentration of cathepsin-D in the cytosol of endometrial adenocarcinoma may indicate a favorable prognosis, since it is correlated with low myometrial invasion.

Biomarkers, Tumor

Regulation of fatty acid synthetase ribonucleic acid in the human endometrium during the menstrual cycle.

Fatty acid synthetase (FAS) is induced by progesterone in MCF7 and T47D breast cancer cell lines. We studied a possible in vivo regulation of expression of this gene by looking for FAS RNA in human endometrial biopsies at various periods of the menstrual cycle, using a cloned cDNA FAS probe. By Northern blot analysis, we detected the 8-kilobase FAS RNA throughout the cycle in 7 uterine samples. RNA in situ hybridization analysis of frozen sections from 22 endometrial biopsies showed that FAS RNA was present during follicular and luteal phases of the menstrual cycle in stromal and epithelial cells. RNA levels were quantified by counting autoradiographic silver grains using a computer-aided image analyzer. FAS RNA levels were significantly higher in epithelial cells than in fibroblasts (P less than 2 x 10(-5]. Furthermore, in both cell types, mean FAS RNA concentrations were higher in biopsies removed during the luteal phase than the follicular phase of the menstrual cycle (P = 2 x 10(-3) and 9 x 10(-5), respectively). A 2- to 3-fold increase in FAS RNA levels between days 8-14 and days 22-24 was detected in 2 normal patients who had previously undergone 2 successive biopsies. This increase was not observed in 2 patients with low plasma estradiol and progesterone concentrations, indicating a probable dysovulation. We conclude that FAS normally increases in both stromal and epithelial endometrial cells during the luteal phase. This increase is probably due to progesterone, which implies that FAS is induced in normal endometrium, as demonstrated in breast cancer.

Adult

[Hemorrhagic necrosis of the mesenteric lymph nodes in adult celiac disease. Physiopathologic interpretation of 1 case].

The authors report the case of a 35 year old woman dead of cachexia in the course of a refractory adult coeliac disease. The autopsy revealed multiple lymphadenopathies exclusively found in the small intestinal mesentery; all these lymph nodes were destroyed by an extensive haemorrhagic necrosis. There was neither lymphoma nor cavitation. These original findings are interpreted as the consequence of a localized intravascular coagulation, and probably a step towards cavitation or atrophy.

Adult

[Congenital mesoblastic nephroma (Bolande's tumor). Prenatal diagnosis].

The authors report a new case of the antenatal ultrasound diagnosis of a congenital mesoblastic nephroma (also called Bolande's tumor) at 33 weeks of amenorrhea. This tumor was found to be associated with acute hydramnios involving premature labor and fetal death by respiratory embarrassment. Congenital mesoblastic nephroma is a very rare entity but is the predominant renal neoplasm in the immediate neonate period. The differential diagnosis between Bolande's tumor and nephroblastoma (Wilm's tumor) is now clear since histopathological features have been precisely described by Bolande. Clinical and pathological features of the renal disease are discussed. The prognosis is excellent for most cases requiring only surgical treatment (nephrectomy).

Acute Disease

[Prostaglandins and the uterine cervix. Immunofluorescence study].

The authors, using immunofluorescence, studied the effect of different prostaglandins (F2 alpha, E1, dimethyl PGE1) on cervical connective tissue. They analysed 80 biopsies which were carried out before and after the prostaglandins had been applied locally, both in pregnant and in non-pregnant women. The method showed that there were changes in the collagen fibres but not in fibronectin. On the other hand, there does not seem to be any difference in the collagen effect with the methods used: 1) between pregnant and non-pregnant women, and 2) between the different types of prostaglandin that were studied.

Adolescent

Immunohistochemical study of rhabdomyosarcoma. Unexpected staining with S100 protein and cytokeratin.

The immunohistochemical study of 60 cases of rhabdomyosarcomas made it possible to test eight different antibodies currently used in tumour pathology: i.e., antisera to vimentin, desmin, myoglobin, cytokeratin, epithelial membrane antigen, S100 protein, neurofilaments, and leukocyte common antigen. Vimentin was found in 58 cases (97 per cent), desmin in 49 cases (82 per cent), myoglobin in 23 cases (38 per cent), S100 protein in 7 cases (12 per cent), and cytokeratin in 3 cases (5 per cent). Other markers were negative. S100 protein was present in large round tumour cells with abundant eosinophilic cytoplasm (round rhabdomyoblasts), whereas cytokeratin was present in small tumour cells similar to those observed in rhabdoid sarcoma. This unexpected staining should become common knowledge for the correct interpretation of the immunohistochemical study of small cell tumours in the young.

Adolescent