Biomedical subjects
C Bernardi
Publications and source records attributed to C Bernardi.
Autologous fat injection for treatment of fecal incontinence: manometric and echographic assessment.
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Follicular neoplasms of the thyroid: diagnostic and operative management.
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[Papillary carcinoma of the thyroid. A uni- and multivariate analysis of the factors affecting the prognosis inclusive of surgical treatment].
METHODS: A total of 463, out of 677 patients operated on for papillary thyroid carcinoma between 1967-1995, were selected, on the basis of a 5-year minimal follow-up (max 28, mean 11.15 +/- 5.29), for uni and multivariate analysis of survival curves. Patient sex, age over and under 45 years, tumour size smaller and larger than 15 mm, stage, any TNM parameter, histological variety, surgical procedure on the thyroid and nodes were the factors assessed in order to express the prognosis. RESULTS: Male:female ratio was 1:3, the mean age 42.2 years; only 25.9% of patients presented with smaller than 15 mm tumor, about 57% with positive nodes and 8.85% with distant metastases; total or near total thyroidectomy was performed in 86% and nodal dissection in 70% of patients. The 5, 10, 15, 20 year survival rate resulted to be 96.94%, 94.36%, 91.38% and 88.69%; 23 patients, but none aged less than 45 years, died (poorly differentiated and locally advanced carcinoma). Age over 45 years, T4 and M+ stages resulted of high prognostic importance while nodal involvement, interrelated with T and M, showed no independent impact; stage gradually worsened but no difference was found between stage I and II. Adverse effect of male sex resulted from its interrelation with more advanced stages. The relapse rate was found higher in male sex and in patients aged over 45 years, interrelated with T and N extension: no tumor smaller than 15 mm recurred and no relation was found between recurrence and surgical procedure. CONCLUSIONS: Longer follow-up is needed to compare the higher curative effectiveness of total thyroidectomy and nodal dissection versus more conservative treatments.
Guidelines for the diagnosis of thyroid carcinoma.
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Blotting patterns of IgG anti-(U1)RNP antibodies in mixed connective tissue disease.
Serum reactivities towards individual U1 snRNP proteins were determined by immunoblotting in 32 patients with mixed connective tissue disease (MCTD). Time persistence of immunoblot profiles and clinical significance of anti-(U1)RNP antibody specificities were also investigated. IgG anti-(U1)RNP antibodies were found in the sera of 29 out of 32 patients (90.6%): 21 (65.6%) reacted with the 70-kD protein, 25 (78.1%) with A, 23 (71.9%) with C and 20 (62.5%) with B/B' proteins. None were reactive with the Sm-D peptide. Seventy kilodalton antibody specificity was strongly associated with a higher antinuclear antibody titre (> 160) and slightly associated with disease activity; anti-B/B' specificity was associated with lymphadenopathy. Anti-A, -C and -B/B' antibodies were negatively associated with systemic lupus erythematosus (SLE) skin rashes. Two types of anti-(U1)RNP blotting patterns were selected: "full spectrum" (53.1% of cases) and a "partially/no reactive" one (46.9%). Such patterns were unchanged over time in 14 out of 16 cases prospectively examined (87.5%), while the pattern shifted from "full spectrum" to "partially/no reactive" in 2 cases (12.5%): in 1 after a prolonged clinical remission (> or = 4 years) and in the other following immunosuppressive therapy. The anti-(U1)RNP antibody immunoblot profile in MCTD patients consisted of various reactivities and remained unchanged over time in most cases. Antibody reactivity against the 70-kD protein represented the major U1 snRNP specificity. The various anti-(U1)RNP specific reactivities demonstrated poor clinical significance within MCTD. Thus, MCTD seems to be characterized by a longstanding serological heterogeneity whose reactivities do not apparently correspond to distinct features within the broad clinical spectrum of MCTD.
[Laparoscopically-prepared vaginal hysterectomy. Our personal experiences (apropos of 35 cases)].
We report our personal experience with 35 laparoscopically prepared vaginal hysterectomies performed over a 3 year period, for January 1990 to January 1993. We give our indications for this new technique present our results. We compared our results with those reported in the literature evaluating indications, technique and complications and demonstrate the numerous advantages of this new technique. Finally, a decision protocol has been prepared in order to chose the optimal approach according to the preoperative work-up.
[Prenatal diagnosis of hepatic hemangioendothelioma. Apropos of a case].
An antenatal echography performed at 32 weeks of amenorrhoea revealed a formation in the liver. Other tests during the antenatal period were unable to provide an exact diagnosis which was only established after exploratory laparotomy after birth. A review of the literature showed that this hepatic tumour has been diagnosed in 3 reported cases antenatally. Haemangioendothelioma occurring during the antenatal period is difficult to diagnose and the severe forms discovered by echography have a poor prognosis.
Microglandular adenosis of the breast: fine-needle aspiration biopsy of two cases.
Microglandular adenosis (MGA) recognizes a benign proliferative lesion of the breast that can mimic adenocarcinoma histologically. We describe the fine-needle aspiration (FNA) biopsy cytology of MGA in two female patients. Smears were characterized by sparse cellularity, and the harvest consisted of a monotonous population of medium-sized cells, with vacuolated clear cytoplasm and round and uniform nuclei with small nucleoli. Clear cells appeared isolated or clustered with spindly fibroblasts. No naked nuclei of myoepithelial origin were present in the background. The differential diagnostic considerations included several breast lesions composed of clear cells. Subsequent surgical histology of lumpectomy revealed MGA. Further studies are needed to determine whether these cytologic features permit the specific identification of MGA, but our observations show that FNA is a sensitive method in recognizing the benign nature of the lesion.
[Chronic idiopathic enterocolitis and pregnancy. Reciprocal repercussions and treatment].
The authors having studied retrospectively 23 pregnancies that were complicated by haemorrhagic proctocolitis or Crohn's disease, try to define by following the literature as well, how these diseases react on fertility and on pregnancy, and how pregnancy reacts on the diseases and the treatments that are available during pregnancy. As far as we know at present, the patients are sub-fertile in cases on ulcerative colitis and normally fertile in cases of Crohn's disease. These illnesses are not exacerbated by pregnancy, but pregnancies are affected by flare-ups of the condition, and therefore should be planned if possible for when the illness is in remission. Previous bowel resection does not alter the course of the pregnancy nor change the methods of delivery. These is no abnormal effect on the fetus or infant due to the treatment, but it is wiser to avoid using Azathioprine during embryogenesis.
[Medullary aplasia during treatment for congenital toxoplasmosis in a twin pregnancy].
The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.
[The ovaries, the immune system, cytokines: physiology].
Sevellar cellular types are involved together in the cyclical functioning of the ovary. Regulating this co-operation between cells are intercellular systems of communication both autocrine and paracrine. The immune system that is present in the ovary seems to have an important role among the regulatory factors. Cytokines are the vectors of intercellular communication. The authors after studying the recent literature show how the immune system elements undergo cyclical variations corresponding to the ovulatory cycle. Reciprocal co-operation between the different cells is brought in to play at all stages of growth and of atrophy of the follicle. The knowledge of these networks for regulation make it possible to understand what is going on better and to work out a more appropriate treatment for certain pathologies such as premature menopause and unforeseen responses to certain forms of stimulation of ovulation.
[Partial 12q trisomy and chylothorax].
The authors present a case of partial trisomy 12q associated with chylothorax, diagnosed at 30 weeks of pregnancy. Cordocentesis for the karyotype as well as thoracocentesis were carried out. In spite of the administration of tocolytic drugs the patient delivered a girl with multiple clinical abnormalities, who died at 7 days of age. From this case, the authors report 6 other cases of partial trisomy 12q in the literature, and, in the discussion they suggest the management after the diagnosis of hydrothorax has been made by ultrasound.
[Anti-Tja (PP1Pk) isoimmunization. A case, a review of the literature].
AIM: A review of the literature concerning the very rare anti-PP1Pk isoimmunisation with a personal case. CLINICAL MATERIAL: Anti-PP1k antibody gives rise to the high risk of abortion in the first and the second trimester (in a different series the risk is 50-70%). A 19-year-old patient who had this antibody was helped by a plasmaphoresis repeatedly between the 6th and the 25th week of pregnancy. Cordocentesis was carried out to estimate fetal haemoglobin from the 25th week onwards. A set caesarean section was carried out at 36 weeks because of intrauterine growth retardation and the development of fetal anaemia. DISCUSSION: The authors suggest research based on the known immunohaematological factors concerned with this isoimmunisation and on the main treatments available (plasmaphoresis, cordocentesis, and delivery at a set time). CONCLUSION: Until now there have been very few cases and only four similar cases to ours have been reported in the literature. That is why it is so difficult to suggest a well defined strategy for treating these patients.
[Laparoscopic treatment of extra-uterine pregnancy. Results apropos of a series of 109 cases].
We report our experience concerning the laparoscopic treatment of ectopic pregnancy (EP). One-hundred and nine women with EP were treated in our department over a 4 year period, between February 1988 (date of our first laparoscopic surgery for EP) and December 1991. Twenty-two of these women underwent laparotomy and the remaining 87 laparoscopic surgery alone. Four therapeutic failures were noted in women treated by laparoscopy. Our results are compared with those of other series and the indications, as well as the modalities of laparoscopic treatment are detailed. It is concluded that laparoscopic surgery of EP is a reliable method which must always be considered, except for a few rare indications.
[Outcome of pregnancies obtained by fertilization in vitro. Experience at the V. Olivier Ward (department of Professor Monnier, Lille University Hospital Center) and review of the literature].
The outcome of 87 pregnancies obtained by fertilisation in vitro and progressing beyond 20 weeks of amenorrhea monitored in the Victor-Olivier Ward (Prof. Monnier, Lille Teaching Hospital Group) was analysed. Results were compared with those in the literature. The group was characterised by three features: age, the number of primipara and above all the multiple pregnancy rate. One quarter of FIV pregnancies are multiple pregnancies and almost two newborn out of live are the result of multiple pregnancies. Almost 70 per cent of clinical pregnancies progressed beyond six months. Pregnancy pathology was represented by a marked worsening of the prematurity rate and by a slightly increased risk of fetal under-development. The cesarean section rate was very markedly increased. Sex ratio, and perinatal mortality, malformation and chromosomal aberration rates were similar to those for spontaneous pregnancies. Results are reassuring overall, the pathology being encountered in pregnancies of this type being only partially explained by age, the number of primipara and the multiple pregnancy rate. This pathology could possibly be explained by the underlying situation in which sterility occurred.
[Immunologic aspects of endometriosis].
Endometriosis is thought to result from implantation of endometrial tissue swept back into the pelvic cavity during menstruation, or from coelomic metaplasia of the peritoneum. Yet not all women with menstrual reflux develop endometriosis. The authors present and analyse the arguments in favour of immune system involvement in the physiopathology of this frequent disease. A knowledge of the antigens that have been recognized and of the operative mechanisms will probably make it possible to understand better the repercussions of endometriosis on fertility, to develop diagnostic methods less traumatic than those available at present and to modulate treatments and improve their effectiveness.
[Severe fetomaternal anti-Duffy allo-immunization].
The authors report a case of severe post-transfusion anti-Duffy (Fya) allo-immunization which required a treatment of four intrauterine exchange transfusions. The child was born at 32 weeks of amenorrhoea and he benefited from an exchange perfusion at birth. The outcome was fully satisfactory. On the basis of this case, the authors present a review of immuno-haematology concerning the Duffy system. This system holds fourth rank, after the ABO, rhesus and Kell systems, on the clinical importance scale of group systems. It concerns two alleles, Fya and Fyb, located on the first chromosome. The anti-Duffy antibodies are IgG immune antibodies; they may be responsible for haemolytic accidents, sometimes lethal, during transfusions, and they are an occasional cause of haemolytic disease of the newborn. A review of the literature yielded only 25 cases of haemolytic disease of the newborn, thereby showing that this allo-immunization is very rare, and it demonstrated its potential danger. Finally, the authors present the therapeutic methods used to treat the haemolytic disease of the newborn caused by anti-Duffy antibodies. Plasmapheresis and intrauterine exchange perfusion have dramatically improved the prognosis of this disease.