[Suspected pulmonary embolism. Concept of care to be given].
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Biomedical subjects
Publications and source records attributed to B Parent.
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Recently there has been renewed interest in hysteroscopy which, since its discovery a century ago, has been in a state of uncertainty. Classical hysteroscopes all require the dilatation of the uterine cavity by the injection of a fluid under pressure. With contact hysteroscopy, the image is obtained by the applciation of the end of the apparatus against the uterine mucosa. This simplifies the equipment and opens up new possibilities. The results of more than 1,000 contact hysteroscopies done in the various circumstances of gynecology and the pathology of pregnancy are presented. The facility of this technique should contribute to the increased use of visual exploration of the uterine cavity, the advantages of which have already been shown.
Two anatomoclinical observations of lymphomatoid granulomatosis are reported. The first case concerns a patient presenting a cutaneous localisation and a severe pulmonary infection with acute febrile dyspnea and macronodular opacities seen in pulmonary radiographs. The treatment associating cortisone and chlorambucil led to a complete remission. Five years later a pulmonary recurrence was treated successfully with the same association. The second patient presents dyspnea upon progressive effort, a radiologic and functional syndrome of interstitial involvement. In the absence of precise diagnosis after pulmonary biopsy, the patient was treated with corticosteroids. Four months later, encephalitic damage led to death. In the 2 observations, the biopsies or autopsic samples from the lungs or brain showed necrotic nodular lesions. Bordering on the necrosis, the small arteries and veins are strictured or obstructured by an infiltrate of lymphocytes, plasmocytes, histiocytes, and large cells with atypical nucleus. The ultrastructural examination of the 2 pulmonary biopsies shows the reactional polymorphic nature of the lymphoid infiltrate, the generally imprecise nature of atypical large cells and the modifications of vascular elastic limitations. The blades of elastine are surrounded by microfibrillar material. These different data are compared with those in the literature.
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The authors try to define the criteria for the diagnosis of this unusual variety of bronchio pulmonary adenocarcinoma. They studied only 9 patients, 8 of whom had surgery which allowed to make a correlation between X-ray and morphological findings. The pathologist encountered the usual problems in the diagnosis of a primitive tumor since some metastasis have the same macroscopic and microscopic aspect. The relation between the radiographic image and the anatomical findings is emphasised. From a symptomatic and radiological point of view, the most frequent distinction was between the opaque round intra-pulmonary image and the chronic alveolar opacity. Other radiological types occurrence less frequently, such as the nodular or the hollowed type. The authors emphasize the pronostic importance of distinguishing the localized form, with a generally good prognosis following surgery, form the diffused form, which have a very poor prognosis. Even under the best of conditions, a radiological study must be supported by both surgery and pathology to be sure that the tumor in question is, in fact, strictly localized. The histogenesis of bronchio-alveolar carcinoma is briefly discussed in a study of histology and pathology.
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If diagnosis of chronic thromboses of pulmonary arteries is usually easy at the stage of confirmed chronic pulmonary heart, it is not so when dysponea is the only symptom of the disease. The authors report 30 cases of chronic thrombosis and remark that if respiratory alkalosis is very frequent, hipoxemia is often missing. On the other hand they observe 27 times out of 28 an increase of CO2 alveoloarterial difference; measuring the CO2 difference appears a safe and reliable test for detecting chronic thrombosis. It should take place in every systematic complete examination of unexplained dyspnoea.
The authors report the case of a patient with severe alveolar hypoventilation, with a large emphysematous bulla in the upper part of the right pulmonary field. The drainage aspiration of the bulla as a life saving technique greatly improved the respiratory function. Blood gases reverted to normal and the bullae disappeared. Literature reviewing. Discussion of radiological and functional criteria of compressing the pulmonary parenchyma around the bulla.
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