Biomedical subjects
Publications and source records attributed to A Suhler.
Tendinopathies, essentially involving the Achilles tendon, which tendon rupture, can be secondary to treatment with fluoroquinolones, and facilitated by corticosteroid therapy, renal failure and sport. Fluoroquinolone treatment must therefore be prescribed cautiously and patients must be advised to stop treatment at the slightest warning signs of tendinitis.
Reporting their experience of these seldom described fistulas, the authors specify their etiological modalities, mainly the infected stones, the multiple clinical symptomatology and specify the various locations between the ureter and the enteral duct from the duodenum to the anal channel at any point.
The authors report the various locations (ileal, appendicular, colic, rectal and through Meckel diverticulum) of the fistulas between the bladder and the digestive tract and specify the mainly inflammatory etiologies and specifically those due to the Crohn disease or those caused by tumors aggravated by irradiation and repeated surgery.
Reporting 7 new observations of prostatic or urethro-rectal fistulas, the authors insist on their etiological modalities specially of traumatical, inflammatory, post-irradiation, cancerous and congenital origin. The diagnosis methods and surgical techniques are also mentioned.
Malignant entero-vesical fistulas are uncommon. Colonic malignancy is the main cause although fistula are present in just 1%. Pneumaturia and fecaluria are pathognomonic for entero-vesico-fistula and are present in half of cases. By combining the results of cystoscopy, barium enema and urine culture, fistula can be identified in almost all the cases. Escherichia coli, Streptococcus faecalis and Proteus mirabilis are very often isolated from the urine cultures. The management of entero-vesical-fistula depends of the etiology. The treatment requires in most of the case resection of the diseased bowel with partial cystectomy and primary anastomosis. But sometimes, is necessary to perform a diverting colostomy and urinary diversion.
As the authors point out the uncommon occurrence of these fistulas between the calicopyelic cavities with the colon, the duodenum and still more unusually with the stomach and the jejunum, they report the etiological and clinical features found in the published cases. Usually the only solution is a nephrectomy.
Eight cases of benign mesothelial tumors of the bladder are reviewed (7 leiomyomas and 1 fibroma). The authors describe the pathological and clinical features and the various possibilities of diagnosis of these uncommon tumors. The treatment is exclusively surgical and the prognosis is good in every case.
Malakoplakia is a granulomatous disease. We report 3 cases of this condition. This disease is characterized by its rarity, the nonspecific revealing signs, histological studies being the only method providing a positive diagnosis, and the possibility of healing with a simple medical treatment.
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Several factors contributed to the impact of Ms. Scott's testimony on the judge and thereby on the case. Most obvious was the degree of her expertise; just as important was the way in which she presented her testimony. She maintained a moderate tone throughout and never gave the impression that what she was saying was anything but mainstream or that she was speaking from zealotry. Her greatest strength, as for any LC's testimony, is that she spoke in terms of what was best for the child. In any initial custody case the judge must decide what is in the child's best interests or some small variation on that theme. By its very nature, breastfeeding and all the information provided about it speaks to the same issue. In that sense, the testimony is not offered on behalf of one of the parents, but on behalf of the welfare of the child. It is this nonpartisan aspect of an LC's testimony that can make it so powerful.
The authors report their experience of rare non-germ-cell tumours of the testis over a period of 10 years. The criteria of benign disease, justifying testicular preservation in 5 out of 7 cases of epidermoid cysts, are defined. Four cases of Leydig cell tumours, including 3 with gynaecomastia, are described. Three cases of adenomatoid tumours with conservative surgery, 3 lymphomas, 2 mature teratomas and 2 cysts of the rete testis are also reported. The place of ultrasonography is defined and the possibility of conservative surgery is discussed in relation to a review of the recent literature.
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The authors report 5 cases of urogenital tuberculosis where examination of the urine failed to reveal any B.K. The diagnosis was suggested by the history of tuberculosis and the radiological appearance by intravenous pyelography. However, it was not possible to start an antituberculosis therapy in the absence of bacteriological proof. Forceps biopsy for histological examination provides an additional argument: the highly typical tuberculosis granuloma.
The authors report a case of renal lymphoma which secreted a monoclonal Ig M kappa immunoglobulin (immunocytoma) and which was diagnosed on the basis of its secretion. They analyse the problems posed by the indication for surgery, the histological nature, the management and the prognosis.
The authors report a case of malignant breast tumour induced by oestrogens in a patient treated for 7 years for carcinoma of the prostate. They review the literature on the subject and stress the important diagnostic and prognostic role of hormonal receptor assays. These allow the much more numerous cases of mammary metastases of prostatic cancer to be distinguished and, in cases of primary malignant tumour, they permit the choice of the best possible hormone therapy available.
The author reports an exceptional case of 12 years survival in a case of prostatic carcinoma with bone metastases. He notes the high degree of hormone dependence of this tumour which was seen particularly clearly following bilateral orchidectomy. Certain bone metastases disappeared completely whilst others regressed. A precise immunological study demonstrated the preservation of immune potential despite the presence of metastases.
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