[Is there a NZB syndrome in the human?].
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Biomedical subjects
Publications and source records attributed to G Lelièvre.
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The retrospective review of 115 case-histories of patients with acute renal failure (ARF) seen over the last two years showed that etiologies were distributed as follows: acute tubular necrosis in 65% of cases, urinary tract obstruction in 16%, acute glomerulonephritis in 3,5%, acute interstitial nephritis (AIN) in 8% and acute microvascular nephropathy in 3,5%. The diagnostic value of renal biopsy in ARF is discussed. In spite of recent advances in the treatment of ARF, the mortality rate remains as high as 48%. This is mainly due to current etiologic circumstances, to the age of the patients and to the complications of ARF, with infectious complications being the most serious. Urea nitrogen accumulation is not a poor prognosis factor. Furosemide in high doses does not alter the prognosis but reduces the total number of dialysis indications (81% in 1970, 60% in 1980), the number of dialysis sessions per patient (1 only in 62% of patients), and the duration of the ARF episode (mean duration: 10,7 days).
In approaching the question as to which test preparations are most suitable for patch testing of metals, 25 chromium sensitive patients were tested with 0.5% potassium dichromate either in water or petrolatum. The aqueous solution proved better than the petrolatum preparation at a 48 h reading with Neodermtest Roc. No difference in sensitivity was recorded between 4 hexavalent chromium salts. 3 patients who were only sensitive to chromium solution in water also reacted positively to a 1% cobalt chloride solution and a 5% nickel sulfate solution in petrolatum.
Diabetic ketoacidosis is an extremely rare manifestation of glucagonoma. We report such a case in a 72-year-old woman known to be diabetic for seven years. The patient was admitted with diabetic ketoacidosis and associated necrolytic migratory erythrema which suggested the diagnosis of glucagonoma. Plasma glucagon levels were increased (569 to 2298 pg/ml). A vascular tumor of the head of the pancreas without obvious hepatic metastases was visualised by angiography. Duodeno-pancreatectomy including the head of the pancreas led to complete recovery of the mucocutaneous lesions and the plasma glucagon level fell (229 pg/ml). The tumor had several histological characteristics suggesting malignancy and a high glucagon content on extraction. Electron microscopy showed multiple A cells and a few isolated B cells. Most of the cells showed immunoreactivity with anti-glucagon and anti-glicentine antibodies. Three months after surgery, the diabetes was again required treatment with insulin. Plasma glucagon level was again increased and chemotherapy with dimethyltriazenimidazolecarboxamide was undertaken.
The author reports two cases of severe rheumatoid arthritis (RA) where the manifestations of necrosis vasculitis consisted of extensive and bullous gangrene of the lower limbs. In one case, the laboratory picture was that of major complement consumption (CH50 unmeasureable, marked fall in various compounds including C3 and C4) with very high levels of circulating immune complexes. An attempt at treatment by plasmapheresis, immunodepressants and corticosteroids led to moderate stabilisation of the vasculitis (regression of purpura) but remained incapable of resolving the local problem of gangrene. The severity of the lesion led to amputation of both legs. In the other case, there as a fall in CH50 with the presence of circulating immune complexes. Similar treatment led to stabilization of the lesions but final amputation could not be avoided to deal with the residue. Interruption of treatment was followed by an inflammatory exacerbation which was satisfactorily dealt with by further sessions of plasmapheresis. The authors discuss the value of such immunodepressant therapy in severe RA in the light of these cases.
Two cases of lymphoedema of penis and scrotum are reported: lymphanogiography is useful to distinguish between primary or secondary lymphoedema. In the first case, this is a primary tarda lymphoedema of penis and scrotum with hypoplastic lymphatics of the right leg. In the second case the lymphoedema follows repeated infection and paraphimosis. This infection may have worsened an already compromised lymphatic circulation. These genital elephantiasis are quite different from penile venereal edema, which disappears quickly after sexual abstinence. The operative treatment of lymphoedema is lymphangiectomy.
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Between December 1982 and October 1986, 131 patients with stage II-III-IV squamous cell carcinoma of the oropharynx or oral cavity were randomized to induction chemotherapy, consisting of bleomycin (10 mg/m2/day in continuous infusion from day 1 to day 5), methotrexate (120 mg/m2 on day 2) followed by folinic acid, 5-fluorouracil (5 FU) (600 mg/m2 on day 2), and cisplatin (120 mg/m2 on day 4) every 4 weeks for a total of three cycles followed by definitive locoregional treatment versus locoregional treatment alone. The modalities of definitive treatment (radiotherapy +/- surgery) were chosen prior to randomization. A total of 116 patients were evaluable. Of 55 patients in the chemotherapy arm, four (7%) had a complete response (CR) and 23 (42%) a partial response (PR) following the induction regimen. At the completion of locoregional treatment, 76% (42 of 55) of patients in the experimental group were in CR compared to 89% (54 of 61) in the control group. There was no difference in survival, cause-specific survival, and pattern of relapse between both groups. The median survival was 22 months in the chemotherapy group and 29 months in the control group. Responders to chemotherapy did not fare better than nonresponders. Chemotherapy-related toxicities were few and most of them related to cisplatin which was reduced to 100 mg/m2 for 35 patients. There were no treatment-related deaths and, in the experimental arm of the trial, no increased morbidity from locoregional treatment. This induction regimen does not offer any advantages over standard treatment.