Coronary lesions in young HIV-positive subjects at necropsy.
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Adult↗
Biomedical subjects
A Tabib
Publications and source records attributed to A Tabib.
[Chronic cardiac rejection. 20 anatomico-clinical cases].
Twenty anatomico-clinical cases of chronic cardiac rejection (accelerated coronary disease in heart transplant) consecutive to heart transplantation were studied with the view of obtaining detailed information on the anatomical features of coronary lesions, such as histopathological alterations, modalities of their diffusion to the 3 epicardial trunks and to distal intramyocardial branches, thrombotic complications and their consequences: massive (infarct) or disseminated myocardial ischaemia. The lesions observed were correlated with the corresponding coronary angiographic images, and an interpretation of the aetiopathological factors was attempted. Within a few months or years, the coronary lesions are found to progress towards very diffuse circumferential atherosclerous alterations where the plaques are clearly less individualized than in common atherosclerosis but thrombosis is frequent and multifocal in 50 percent of the cases. This produces a restrictive type of ischaemic cardiopathy which is painless since the heart is denervated, resulting in cardiac failure (11 cardiectomies for retransplantation, 9 autopsies) with coronary angiography tending to underestimate the importance of coronary damage. The most original aetiopathological factors seem to be arterial inflammation of immune origin, viral infections facilitated by immunosuppression and platelet hyperactivity, but their respective importance could not be accurately determined in this study.
Adult↗
Cardiomyoplasty does not preclude heart transplantation.
Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. Heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of cardiomyoplasty. Cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of cardiomyoplasty in humans.
Assisted Circulation↗
[Anatomoclinical study of 100 cases of hypoplasia of the right ventricular muscle (including 89 unexpected sudden deaths). Relation with Uhl's anomaly].
The authors present the pathologist's view of Uhl's anomaly based on 100 cases recorded over 31 years, 89 of which came from medico-legal autopsies following sudden unexpected death in young subjects. The anatomic diagnosis is made by macroscopic examination of the whole heart in diffuse forms (parchment heart) and from transverse sections of the mid third of the ventricle in incomplete forms, showing absence of myocardium in the juxta-septal anterior wall of the right ventricle. The wall entirely made up of adipose tissue, may retain its normal thickness. On microscopy, normal adipose tissue is observed between the epicardium and endocardium, sometimes with islets of myocardium dispersed in the subendocardial layer and with, in about half the cases, subendocardial bundles of non-hyalinized collagen without any inflammatory cellular infiltration. Other structural histopathological lesions may complicate the malformation, involving the intraseptal arterioles or the conductive system. In addition to the 89 cases of sudden and unexpected death before the age of 50 (preceded by some modification of the patient's life style in 29 cases), 11 cases were symptomatic and 5 were transplanted with a good result. The clinical diagnosis of Uhl's disease is important because of its consequences: ventricular tachycardia and possible sudden death, more rarely cardiac failure with age. Histological analysis should take into account the constant presence of adipose tissue in the right ventricle, and should only interpret excessive quantities with associated myocytic aplasia as pathological.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[An unusual cause of sudden death: spontaneous dissection of coronary arteries. Apropos of 2 cases].
The authors report two new cases of spontaneous dissection of the coronary arteries in women under 50 years of age without any predisposing factors and responsible for sudden death. One patient had dissection of the left anterior descending artery and the other had dissection of the left anterior descending and right coronary arteries. Special histological stains allow demonstration of abnormalities of the elastic tissue of the media in both cases. In the first case, a plaque of atheroma was present opposite the site of dissection but did not seem to be causal. In the second case, severe periadventitial cellular, infiltration of unknown origin was observed. This pathology of the young woman, often occurring in the postpartum period, is as rare as it is unpredictable.
Adult↗
[Localized pleural fibrous mesothelioma (submesothelial pleural fibroma). Anatomo-clinical study of 25 cases].
We studied a retrospective series of 25 sub-pleural fibromas (benign localized pleural mesotheliomas) of which 23 where excised, collected over a period of 20 years. The current series confirms the excellent prognostic of these rare tumors. They are sometimes bulky, but not infiltrating and discovered by systematic chest X-ray. Modern imaging using CT-Scan and nuclear magnetic resonance can suggest their diagnostic which is confirmed by histopathologic analysis of the usually pediculate and easily removed tumor. Transthoracic needle aspiration is generally of little help for diagnosis. The histopathologic diversity of the tumor is rather confusing but characteristic features can be found with fusiform cells ans collagen stroma. Immuno-histochemistry is more helpful for diagnosis and histogenesis recognition than electron microscopy.
Adult↗
Autoradiographic distribution of TRH binding sites in the human hypothalamus.
Using in vitro quantitative autoradiography and [3H]3MeTRH, a selective high affinity radioligand, we examined the rostrocaudal distribution of TRH binding sites in both the infant and the adult human hypothalamus. The saturation curve shows that the [3H]3MeTRH binds with high affinity to a single class of TRH binding sites and is saturable, the apparent constant of dissociation is in the namomolar range. TRH binding sites showed a wide distribution, principally in the anterior and mediobasal levels of the hypothalamus. TRH binding site concentration was highest within the diagonal band of Broca, the lateral preoptic area, the infundibular and the tuberal nuclei. TRH binding site concentration was moderate in the ventromedial nucleus and the medial preoptic area, whereas we observed low densities in the periventricular, paraventricular and mammillary nuclei. The distribution in the infant and the adult is generally similar. However, it is noteworthy that the infant tuberal nuclei displayed a lower binding site density when compared to the adult. On the other hand, the diagonal band of Broca is relatively more labeled in infant. The analysis of the whole hypothalamus allows us to ascertain the absence of lateral asymmetric distribution both in the infant and the adult. No significant difference is noticed when considering as parameters of variation age, sex or post mortem delay.
Adult↗
[Varicella myocarditis and junctional ectopic tachycardia].
We report the unexpected occurrence of a lethal arrythmia in an 11 month-old boy who presented varicella. The disorder was found to be a junctional ectopic tachycardia due to a zosterian myocarditis confirmed at autopsy. This exceptional association of varicella, myocarditis, and junctional ectopic tachycardia gives us the opportunity to discuss on the diagnosis and treatment of this uncommon and serious arrythmia (regular tachycardia with normal QRS morphology, ranging 200-250 per min, with atrioventricular dissociation or retrograde conduction to the atria).
Chickenpox↗
[Coronary lesions of a cardiac transplant. (Chronic cardiac rejection). Study of 15 retransplantations].
In order to precise the pathologic aspects of coronary lesions observed in the accelerated coronary disease after heart transplantation, 15 cases of explanted hearts have been studied, and compared to the findings of previous coronarography. Histopathological aspects, modes of diffusion involving the three main coronaries and distal branches, thrombotic complications and their ischemic consequences showed that coronary lesions result in a few months or years to diffuse circumferential atheromatous like lesions. Localized lesions are less frequently encountered than in common atheromatous coronary disease, but multifocal thrombosis is frequent, found in 40% of the cases. This feature leads to ischemic cardiopathy expressed by cardiac failure, indolent because of the denervation of the heart. Correlations with coronarographies showed that this method underestimated the importance of coronary lesions, for which retransplantation represents the only hope. Risk factors include vascular immunological inflammation, viral infection enhanced by immunosuppression, increased platelet aggregation but we still ignore the respective importance of these factors at the present time.
Adult↗
[Sudden death of the sportsman. Apropos of 23 cases with autopsy].
The results of a series of 930 coroner's autopsies were analysed retrospectively with the aim of determining the incidence and cause of sudden death during sports activities. Twenty three cases are reported (2.57%) of autopsies of individuals who otherwise had no traumatic lesion and no cerebral or abdominal pathology. Family history revealed no factor likely to favourise sudden death. The sports involved corresponded with various standard activities in France. Patients aged under 35 had a wide range of cardiac diseases. Almost all those aged over 35 died as a result of coronary diseases. This study shows the relative rarity but also the difficulty of preventing such accidents, in particular in the young individual.
Adolescent↗
[Histopathologic study of cardiac myxoma. Apropos of 80 surgical cases].
The histological features of eighty cardiac myxomas removed by surgery between 1959 and 1988 were evaluated by the usual staining techniques and also by identification of immunohistological markers (vimentin, desmin, factor VIII, actin). Myxoma cells present various forms (polygonal, round, spindle, stellate) when isolated but are characterized by their tubular angioid structures: cellular masses, elementary tubes, organoid formations with several parietal layers and abundant "myxoid" matrix, denser around the angioid structures. Sometimes they are located on the surface forming crypts and vegetations, replaced in old myxomas by hyalinization. Other constituents such as vascular spaces, fibrinous exudate, hemosiderosis pigments, necrobiotic areas, various calcifications, plasma cell infiltrates are also frequently found. The insertion on the endocardium is usually an interesting structure. The presence of mucous epithelial structures and clusters of smooth muscle cells is uncommon but constitutes an additional argument in favour of the present explanation concerning its histogenosis i.e. a tumor derived from vestigial cells, usually confined to the floor of the fossa ovalis. On the basis of these various characteristics, myxomas can be classified as being active or inactive (more or less mummified), poorly differentiated or mature, which may correspond to the duration of the lesion prior to its resection. A precise histological examination of myxoma avoids confusion with more malignant myxomatous cardiac tumors.
Heart Neoplasms↗
[Myocardial bridging on the left anterior descending coronary artery and sudden death. Apropos of 19 cases with autopsy].
In order to determine the relationship between myocardial bridging and sudden death, the authors analysed retrospectively the macroscopic and histological features of 19 cases of myocardial bridging of the left anterior descending artery (LAD) out of a series of 930 medicolegal autopsy studies. The patients (15 men and 4 women) had an average age of 39.2 years. A potentially lethal cardiac abnormality was found in addition to the myocardial bridge (ischaemic, cardiomyopathy, conduction tissue lesion) in 11 cases; in the other 8 cases, 7 had minor abnormalities and 1 heart was absolutely normal (a 47 year old woman who died while swimming but not of drowning). All hears had fresh, microscopic, ischaemic lesions in the territory of the LAD artery, demonstrated by LIE staining (basic fuschin). The anatomical lesions of the coronary arteries at the site of bridging were varied: 11 dense collagen fibrosis of the adventicia, 16 intimal fibroses of varying degrees of thickness (10 circumferential), 2 atherosclerotic plaques (a 40 and a 54 year old man), 2 recent thromboses (1 at the site of the bridge in a 50 year old man, and the other just distal to the bridge in a 25 year old man). In only 1 case (39 year old woman) there were no microscopic changes of the LAD artery at the site of the myocardial bridge. The hypothesis of the responsibility of the myocardial bridge in the occurrence of sudden death, either during an acceleration of the cardiac rhythm (milking effect) or by thrombotic or spastic phenomena, cannot therefore be excluded.
Adolescent↗
Bone marrow metastases in small cell lung cancer: detection with magnetic resonance imaging and monoclonal antibodies.
The detection of bone marrow involvement might be of prognostic value and may influence therapeutic decisions in small cell lung cancer. By unilateral bone marrow aspiration and biopsy, evidence of bone marrow metastases is seen in 15-30% of patients with this disease. Since magnetic resonance imaging of the lower body and immunostaining with monoclonal antibodies have recently been shown to be very sensitive detection methods, we investigated the value of these two techniques in detecting bone marrow involvement in 35 consecutive patients with small cell lung cancer. The results were compared to those obtained with conventional cytohistological analysis. In all cases when cytology and/or bone marrow biopsy were positive, monoclonal antibodies immunostaining and magnetic resonance imaging also detected malignant cells. Furthermore, evidence of bone marrow involvement was shown with magnetic resonance imaging and/or immunostaining in 10 of 26 cases (38%) where routine procedures were unable to detect malignant cells. In one of these 26 patients, magnetic resonance imaging and immunostaining provided the only evidence of metastatic disease. These data suggest that the rate of bone marrow metastases is underestimated by routine procedures. Further investigation is needed to determine whether or not these new non-invasive methods have prognostic value or affect therapeutic choices in small cell lung carcinoma.
Antibodies, Monoclonal↗
[Pulmonary contusions. Anatomo-radiologic aspects].
Simultaneous use of pathologic and microangiographic methods in 47 patients with lung contusions due to a closed chest injury with no parietal lesions differentiated between: early traumatic lesions consisting in alveolocapillary ruptures and hematomas distributed at random throughout both lungs, with immediate disseminated intraalveolar hemorrhage as a result; and secondary lesions, known as "shock lung", which are mainly the result of intraalveolar hemorrhage. All these lesions explain the usual development of various forms of fibrosis, responsible clinically for refractory hypoxia.
Adult↗
[Establishment of a transformed line of arterial smooth muscle cells].
Biology of the vascular cells is widely studied by means of cell culture techniques. In the present work the description of a transformed cell line of arterial smooth muscle cells is presented. The cell line, named V8, has been established from cells of adult rat aortic media. The cells presented proliferation characteristics in vitro, in soft agar, and in vivo in nude mice demonstrating a tumorigenic ability. This cell line provides an interesting model for the study of growth regulation of arterial smooth muscle cells specially in the areas of hypertension and atherosclerosis.
Animals↗
[Technics for the exploration of pulmonary arteriovenous shunts in liver cirrhosis. Apropos of 2 cases].
Pulmonary arterio-venous shunts represent a rare cause of hypoxia in cirrhosis. We present two cases, the first was an alcoholic cirrhotic with anthracosilicosis. This patient rapidly developed a picture of significant hypoxaemia with a raised alveolar-arterial oxygen gradient. The presence of this shunt was confirmed by a scintigraphic analysis. A porto-pulmonary localisation was excluded by a changing angiographic picture. Death supervened after refractory hypoxaemia. Post mortem microangiographic studies confirmed the pulmonary nature of the shunt and its pre-capillary localisation. The second patient was alcoholic, with a compensated cirrhosis and developed severe hypoxaemia which progressed to death in less than two months, when he was being treated effectively with corticosteroids for a diffuse interstitial pulmonary fibrosis confirmed histologically. The pulmonary localisation of the shunt was confirmed by an analysis of the angioscintigraphs. The different techniques for the investigation of intra-pulmonary shunt are discussed, as well as the patho-physiological mechanisms involved. The hormone levels measured (sex hormones, serotonin, prostaglandins, intestinal hormones) remained normal. The therapeutic trials tried out (oestrogen, CPD Choline, indomethacin) were ineffective.
Humans↗
Mitral valve prolapse, Wolff-Parkinson-White syndrome, His bundle sclerosis and sudden death.
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Adult↗
Renal autotransplantation versus bypass techniques for renovascular hypertension.
From 1972 to 1983, 78 patients underwent surgical treatment for renovascular hypertension caused by a lesion limited to the trunk of the renal artery. Forty-five of these patients underwent aortorenal bypass (24 saphenous grafts and 21 arterial hypogastric grafts); 36 patients (80%) had either a relief of the hypertension or were improved. Graft closure occurred in five cases. Thirty-three patients were treated by autotransplantation of the kidney. After resection of the lesion, the renal artery was anastomosed end-to-end to the hypogastric artery or end-to-side to the common iliac artery and the renal vein and side-to-side to the iliac vein or the origin of the vena cava. In this group all patients but one (97%) had relief of the hypertension or were improved. No thrombosis was observed. Late angiography was performed 5 years after surgery in 19 patients (nine autotransplantations and 10 bypass operations): patients who underwent autotransplantation had no alteration of the renal vessels whereas four patients who underwent bypass operations had dilatation of the saphenous vein bypass. Renal autotransplantation was superior to the bypass technique in the surgical treatment of renovascular hypertension caused by lesions of the trunk of the renal artery and may represent a better alternative in the surgical treatment of this condition.
Adolescent↗