Pathology of pulmonary vasculitis.
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Biomedical subjects
Publications and source records attributed to F Capron.
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This study concerns 37 cases of Pneumocystis carinii pneumonia in AIDS patients. The time elapsed between human immunodeficiency virus (HIV) seropositivity and the onset of pneumocystosis has been established. Three clinical types are individualized. In cases with normal X-ray films of the chest, measurement of carbon dioxide transfer capacity, always reduced, has led to a bronchoalveolar lavage which provided an early diagnosis. In spite of good response to treatment, the prognosis of pneumocystosis is poor owing to the frequency of associated diseases.
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Fine needle transthoracic aspiration (FNTA) of pulmonary opacities under guidance of computerized tomography (CT) is a simple procedure yielding conclusive results in many patients with malignant lung tumours. The small caliber of the needles utilized and the CT control make this increasingly popular procedure both accurate and safe. Yet a number of complications have occurred; most of them were benign (e.g. pneumothorax) but some were potentially dangerous (e.g. pulmonary haemorrhage), so that the pros and cons of the procedure must carefully be weighed. We report the case of a patient in whom FNTA was complicated by copious haemoptysis and a pulmonary haematoma clearly visible at CT. The literature concerning the potential complications of transthoracic puncture is reviewed.
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Eighteen dogs were studied to determine the presence, extent and evolution of tissue lesions related to extracorporeal lithotripsy of the gallbladder under conditions similar to those encountered in clinical practice (electrohydraulic generator, ultrasonographic localization, prone positioning and 2,500 shocks delivered per session). Twelve dogs underwent lithotripsy 14 days after implantation of a 9 to 14 millimeter human stone in the gallbladder. The dogs were sacrificed one, 14 and 28 days after lithotripsy (four dogs at each date). Two dogs underwent implantation of stone but not lithotripsy and were sacrificed 14 days later. The last four dogs received only shock wave therapy and were sacrificed one (two dogs) and 14 (two dogs) days later. All calculi were completely fragmented into pieces less than 5 millimeters. Increases in leukocyte count (11 +/- 3.7 10(9) per liter) and alanine and aspartate aminotransferase levels (206 +/- 139 and 156 +/- 164 international units per deciliter, respectively) were seen after lithotripsy (p less than 0.05), but returned to normal during the next four weeks. Macroscopic hemorrhages were noted only in the dogs having undergone lithotripsy and were exclusively located in the organs lying in the path of the shock wave. Macroscopic hemorrhages were found in all six dogs sacrificed the day after lithotripsy and in two of the six dogs sacrificed 14 days later; one dog of the four sacrificed 28 days after lithotripsy still showed a large hemorrhage in the wall of the gallbladder. Microscopic abnormalities included congestion and hemorrhage of the same organs; although more discrete, congestion and hemorrhage were still present one month after shock wave therapy. Early and localized pulmonary fibrosis at the hypercellular stage was noted in two of the four dogs sacrificed at 28 days. The clinical implications for biliary lithotripsy upon humans include the necessity for intact coagulation parameters, strict avoidance of the bases of the lungs in targeting the stone and performing an ultrasonographic assessment of the wall of the gallbladder before repeating lithotripsy sessions, month apart.
Diffuse pulmonary hemorrhages may occur in pulmonary vasculites, including Wegener disease, systemic lupus erythematosus, Behçet disease, and other systemic vasculites. The pulmonary bleeding is often the first manifestation of the disease and frequently denotes a severe form. The etiologic diagnosis can be established only by performing a surgical lung biopsy, which is often a difficult decision. Leukoclastic capillaritis of the alveolar septa is the common features shared by all the vasculites responsible for pulmonary hemorrhage.
We reported the morphologic, phenotypic and functional characteristics of leukemic cells with natural killer (NK) properties in a case of T chronic lymphocytic leukemia with large granular lymphocytes. These cells were cytologically and cytochemically characterized as phosphatase acid positive large granular lymphocytes (LGL), and presented parallel tubular arrays at the ultra structural level. They displayed a CD2, CD3, CD8, CD11, Leu 7, and Leu 11 positive phenotype while they lacked B cell markers including surface immunoglobulins. In addition, they expressed human leukocyte antigens (HLA) Class I, but no Class II antigens. These phenotypic studies were also performed after cells were cultured in vitro with 12-0-tetradecanoyl phorbol 13-acetate, gamma interferon, 5-azacytidine, sodium butyrate, phytohemagglutinin, and interleukin 2 (IL2). The cell surface markers underwent several significant changes. Among them we noted a higher percentage of labeled cells with anti-CD6 and CD7 monoclonal antibodies (moAbs), and a positivity with an anti-CD19 (B4) moAb. The leukemic LGL spontaneously developed a NK activity on K 562 tumor cells, which was not affected under the various T and B cells growth factors because they became more sensitive to IL2; but they were also stimulated by a 50-kilodalton (KD) B cell growth factor (BCGF) factor devoid of any T cell proliferation activity. Together these results gave a better characterization of azurophilic granules containing T chronic lymphocytic leukemia, and enabled the documentation of the differentiation of LGL with NK activity.
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Three hundred and four cases of small cell lung cancer diagnosed histologically were included in a randomised multi-centre trial (23 centres) from 1st January 1983 to the 30 September 1985, with no clinical criteria for exclusion. The clinical and laboratory data were taken from the initial assessment of the patients in the trial, and were compared with those in the literature. The sex ratio was 10:1, only 27 were women (9%) and all were less than 70. The mean aged was 60 +/- 10 (extremes 33 to 84 years) and 80% of the population was from 40 to 70 years. Tobacco consumption was virtually constant, only 7 were non-smokers and 7% of patients smoked less than 20 packs/year; indeed consumption was very heavy with a mean of 44 +/- 23 packs/years. 14% of cases were discovered on systematic radiological examination, but 39% of these asymptomatic patients already had disseminated disease. For the 304 patients overall, despite a very variable degree of dissemination from one patient and one centre to another, 163 (54%) had disseminated disease at the outset and 141 (46%) were apparently localised. The initial metastases were often multiple: extra-thoracic nodes (21%), hepatic (23%), osseous (20%), bone marrow (23%), cerebral (9%), and others (9%); these frequencies are underestimated in view of the fact that the investigations were not over-extensive. The serum carcino embryonic antigen levels were abnormal in 32% of cases. Fibroscopy remains the main diagnostic method to provide the histological proof for 90% of patients, but 4% had thoracotomies (of whom 3% were diagnostic thoracotomies).(ABSTRACT TRUNCATED AT 250 WORDS)
A canary breeder with Waldenström's macroglobulinemia developed a pulmonary disease related to an interstitial infiltration by malignant B cells secreting a monoclonal IgM K. The serum monoclonal IgM was shown to possess an antibody activity to some canary's droppings antigen. This finding may help elucidate the natural course of lymphoid malignancies and the pathogenesis of rare visceral localizations.
A case of Pneumocystis carinii pneumonia is presented. Following presentation a chronic alveolitis was uncovered, which was due to ultimately repeated and prolonged inhalation of sweets containing gum arabic. The diagnosis was confirmed by a trans-bronchial biopsy and by chemical analysis of centrifugation of the alveolar lavage deposit. After cessation of the inhalation the progress was satisfactory both in terms of clinical status and lung function measurement.
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The author presents a quick review of the pulmonary lesions due to ARC, mainly the pulmonary lymphoid hyperplasias. The most frequent pulmonary complications of the disease are summarised (opportunistic infections and Kaposi sarcoma) the practical conditions of their pathological diagnosis are illustrated.
Actinomycosis of the lung is rare and difficult to diagnose. Its good prognosis after medical treatment contrasts with the high frequency of surgical excision, due to the fact that pre-operative diagnosis is exceptional. Following a review of the recent bacteriological, radiological and therapeutic data available in the literature, 4 personal cases are presented. In all 4 cases actinomycosis was diagnosed post-operatively on the presence of yellow grains in the histological specimens. In 2 cases surgical excision proved impossible, but an almost complete radiological recovery could be obtained after prolonged treatment with co-trimoxazole. This shows how important it is to be aware of the disease, to improve its diagnostic approach and to remember its sensitivity to antibacterial agents, even in well organized forms.
The authors present the results of a histopathological study on the lymph-nodes taken from 45 subjects suffering from either an AIDS or from a chronic adenopathy corresponding to the definition of AIDS related complex (ARC). The various aspects observed were classed as type I to type IV. The lymph-node modifications observed in the 29 patients with an ARC could be divided into three principle groups: an extensive follicular hyperplasia associated with other elementary lesions or type IA (25 lymph-nodes from 23 patients); changes resembling a multicentric Castleman syndrome or type IB (1 case); angioimmunoblastic-like (AIL) lesions or type II (2 cases) and an association of lesions of type II (7 lymph-nodes from 6 patients). During AIDS, the adenopathy usually disappears, and the small lymph-nodes removed, especially on autopsy, show an extensive lymphoid depletion (type III) with systematic sclerosis (15 lymph-nodes from 14 patients). When adenopathy persists, it is due to infections complications (tuberculosis, cryptococcosis, avian mycobacteriosis and Whipple's disease like lesions). Of the 10 patients in whom a Kaposi's sarcoma was observed, only 6 showed lymph-node involvement, or type IV. The different histopathological lesions seem to appear according to an evolving succession, proven by certain association of lesions and by successive biopsies. In our series, 17% of subjects with an ARC evolved to AIDS. Lymph-node biopsy allows a possible ARC to be implicated on the association of the following simple lesions: follicular hyperplasia with partial or total destruction of the perifollicular lymphocytic cisterna, infiltration of the germinative centres by streams of small lymphocytes, evolving to an aspect of a "burst" germinative centre and various sinusal reactions with, in particular, the presence of neutrophilic polynuclear cells. The biopsy also allows the forms with bad prognosis to be recognized: those with AIL-like aspect or multicentric Castleman-like syndrome, which seems to represent a particular evolutive form. Finally, it also detects, in certain cases, the localization of a Kaposi syndrome, signalling the passage to AIDS. The immunopathological studies present a double interest. Firstly, they offer arguments in favour of the diagnosis: increase in the number of T8 lymphocytes in the germinative centres with the formation of small clusters and disruption of the network of dendritic reticular cells, and the inversion of the T4/T8 ratio in the extra-follicular cortical regions, by either a decrease in T4 lymphocytes or by an increase in T8 lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)
A case of lymphomatoid granulomatosis arising in a patient with a long history of dysimmunity is reported. The autopsy reviewed the final evolution into a high grade malignant lymphoma with IgM K immunoglobulin production and discovered in deep lymph nodes modifications similar to angio-immunoblastic lymphadenopathy.