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Biomedical subjects

A Tabib

Publications and source records attributed to A Tabib.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Late anatomical lesions after cardiac transplantation. Study of 44 autopsies beyond 6-months survival].

The aim of this study was to attempt to determine which anatomical lesions were found late after cardiac transplant and could be fatal. A series of 44 autopsies, beyond a 6 month survival time, revealed the types of cardiac and extra-cardiac lesions encountered. They were viewed in the context of clinical findings. Three lesion patterns accounted for more than 9 cases out of 10: coronary disease affecting the transplant (accelerated atherosclerosis or chronic cardiac rejection: 48% of cases), infectious lesions (29%), more than half of which were due to aspergillosis, and neoplasia (14%), favourised by immune-depression. Three results show that graft coronary disease is currently the essential long term problem in the many patients who survive the early postoperative period of cardiac transplant.

Adult↗
PubMed1993

[Intravascular echographic imaging: experimental validations and limits. An in vitro study].

Intravascular ultrasound is a new method of visualizing details of vascular pathology, providing (real time) high resolution images of vascular walls. Most of the research on the technique has explored its qualitative and quantitative capabilities to improve the assessment of atherosclerotic vascular disease in vivo. Intravascular ultrasound differs from angiography and angioscopy in its ability to penetrate below the surface of the vessel lumen, demonstrating specific appearances of the distribution and composition of plaque. Image analysis is operator dependent. Although this technology is very promising limitations such as artefacts and loss of image quality in heavily calcified vessels hinder its use. There is hope that this imaging technique may ultimately improve the results of endovascular interventions.

Arteries↗
PubMed1993

[Anatomoclinical diversity of bronchiolitis obliterans after lung transplantation. Anatomical study of 16 cases among 64 transplantations].

The aim of this study was to define the presence, histological types and extent of bronchiolitis obliterans (BO) after lung transplantation and to discuss the place of bronchiolitis obliterans in the progressive obstructive ventilatory disorder observed in some patients and considered to correspond to "chronic lung rejection". The histological lesions were studied in 16 subjects surviving for more than one month after lung transplantation or heart-lung transplantation: 12 autopsies, 3 surgical biopsies and one lung explanted for retransplantation. Thirteen subjects presented lesions of bronchiolitis obliterans: 5 cases of granulomatous BO, 6 cases of proliferative BO, one acute necrotising BO and one tuberculous granulomatous BO. Three of these patients presented an obstructive ventilatory disorder: one death on the 213rd day (acute necrotising BO), one retransplantation on the 672nd day (granulomatous BO), one death 53 days after surgical biopsy on the 247th day (proliferative BO). Two patients undergoing surgical biopsies with lesions of proliferative BO are still alive (cases 15 and 16) and do not present any signs of obstructive ventilatory disorder. This study suggests the existence of various histological types of BO in transplanted lungs, which is not exclusively of immunopathological origin, that infections and various inhalations also play a role and that alterations of pulmonary structures other than bronchioles are also involved in the pathogenesis of the obstructive ventilatory disorder (functional destruction of the transplant), corresponding to "chronic lung rejection".

Adolescent↗
PubMed1993

[Unexpected sudden death and coronary lesions. Apropos of 407 cases out of 1000 deaths in patients under 65 years of age].

In order to determine the responsibility of coronary artery disease in unexpected sudden death (without known or treated cardiac disease), the authors studied 1,000 cases of "natural" unexpected sudden death in subjects under 65 years old in whom the autopsies were performed in Medico-Legal Institutes and in whom all non-cardiac causes had been excluded. Macro- and microscopic examination of the heart detected 848 potentially lethal lesions (152 autopsies failed to show the cause of death) of which 407 cases corresponded to coronary disease (atherosclerosis in 340 and other disease in 67 cases). The atherosclerotic lesions could be classified in 3 anatomical groups: 75 isolated recent coronary thromboses; 75 recent coronary thromboses associated with multivessel stenoses; 190 coronary stenoses (> 75%) without thrombosis (139 triple vessel, 31 double vessel and 20 single vessel diseases). The presence of a recent myocardial infarct, the cardiac mass and the circumstances of sudden death were determined in all cases with respect to the three pre-defined anatomical groups. This study, though confirming the high prevalence of coronary artery disease, evaluates it at a lower level than previous reports in the literature which takes into consideration "unexpected sudden death" of known and treated coronary patients, and also has allowed identification of other potentially lethal lesions (such as structural abnormalities of the His-Purkinje system) which are undetectable even with sophisticated paraclinical investigations.

Adult↗
PubMed1993

[Early fatal lesions after cardiac transplantation. Results of 100 autopsies].

The results of 100 consecutive autopsy studies performed since the introduction and use of cyclosporine (1984 to 1991) in patients who died less than 2.5 months after cardiac transplantation were analysed to try to prevent this type of lethal damage. The lesions were complex but the causes of death may be classified as follows: 44 infections (20 aspergillosis, with 13 septicaemias and 7 predominantly pulmonary complications, 15 severe lung infections, 9 other infections including 7 pyogenic mediastino-pericarditis), 12 acute myocardial rejects, 14 pulmonary arteriolitis reflecting the fact that pulmonary resistances affect the results of cardiac transplantation, 13 non-infectious pericarditis, 17 immediate postoperative deaths (incompetent graft, DIVC). In the discussion, the authors underline the importance of pericardial damage, the direct cause of death in 13 cases but also present in most cases of infection when sometimes clinically confused with the diagnosis of "acute reject". Acute pancreatitis (over 10% of cases) were often labelled "septicaemic shock". Pulmonary involvement is one of the commonest complications related to infection and changes due to passive pulmonary hypertension related to the causal preoperative disease, by silent pulmonary embolism during the 3 months of cardiac failure before surgery and DIVC. Infection was the cause of death in nearly half of the early fatalities, and aspergillosis was particularly common whereas systematic prevention with sulfadoxine-pyrimethamine has eliminated pneumocystosis for example. The management of immuno-depression varies from centre to centre and this is also a factor in the incidence of anatomical complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Aspergillosis↗
PubMed1993

[Cytomegalovirus arteriolitis: gangrene of the feet and early coronary disease after heart transplantation].

Peripheral arteriolitis of the legs from the 4th postoperative day after cardiac transplantation caused ischemia of the feet and required bilateral transmetatarsal amputations on the 28th postoperative day. The causal condition was cytomegalovirus infection, confirmed by rising IgM antibody titres, the detection of a viraemia on the 33rd postoperative day, and, above all, the presence of cytomegalic inclusion bodies in many endothelial arteriolar cells of the amputated limbs. The patient died four months after transplantation and autopsy revealed major lesions in all the distal coronary vessels of the graft which occluded over 4/5ths of the coronary lumens. An aspergillus septicemia was the direct cause of death.

Coronary Disease↗
PubMed1993

[Fatal aspergillosis after cardiac transplantation. About 26 cases].

Complications due to infection by aspergillus and favorized by therapeutic immunodepression are a significant cause of mortality after cardiac transplantation, but are only rarely diagnosed before autopsy. A detailed description of the anatomical lesions and their localisation might help the interpretation of symptoms observed in vivo. In a series of 147 autopsies subsequent to cardiac transplantation, aspergillosis appeared as the cause of death in 26 cases. Three anatomoclinical presentations could be identified: early post-operative septic pyohaemia (14 cases), delayed septic pyohemia (7 cases) and forms with predominantly pulmonary involvement (5 cases). In the first category, cardiac lesions are the most evident with myocardial micro-abscesses and intracardiac masses of aspergillus presenting a variable risk of embolism. Pulmonary << target lésions >> (infarctus associated with a variable degree of aspergillus arterial thrombosis) were present in all cases. Visceral involvement completes the picture; the more frequent lesions being acute pancreatitis (9 cases), infarctogenic aspergillus emboli of the kidneys (11 cases), the spleen (9 cases) or the brain (6 cases). In 8 subjects, microscopical examination revealed other germs associated with aspergillus. The serious consequences of aspergillus infection after cardiac transplantation imply that every preventive precaution should be taken, especially in avoiding possible contamination of the air of the operating room by the installation of filters and the regular control of airways and air conditioning systems.

Abscess↗
PubMed1992

[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↗
PubMed1992

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↗
PubMed1992

[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↗
PubMed1992

[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↗
PubMed1992

[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↗
PubMed1991

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↗
PubMed1991

[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↗
PubMed1991

[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↗
PubMed1991

[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↗
PubMed1991

[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↗