Biomedical subjects
Publications and source records attributed to G Mantion.
The authors report a case of hypernephroma revealed by an acute surgical abdomen. The laparotomy found a stercoral peritonitis. A review of the literature shows that this observation is exceptional.
Pelvic arterio-venous fistulae are rare. They can be congenital or acquired. If the latter they are nearly always iatrogenic following surgery for prolapsed intervertebral discs or following gynaecological or obstetrical surgery. Diagnosis is difficult because the symptoms and signs are not specific ore are deceptive. Clinical examination shows that this "tumour" is vascular in nature. Up till recently treatment was disappointing, consisting as it did of surgery which was often difficult and dangerous and possibly carrying a poor prognosis, and in most cases resulting in recurrences. Since intra-arterial embolisation techniques have been developed, either by themselves or before surgery, the results have been better. They cannot be carried out without a preliminary precise and complete arteriographic assessment.
An extremely dense fibrosis is responsible for the main complications of alveolar echinococcosis (AE), a severe parasitic disease due to the development in the liver of a larval form of the cestode Echinococcus multilocularis. Immunotyping of collagens present in fibrous, granulomatous, and normal areas of the liver was performed in nine patients with AE. Immunofluorescent labelling of collagen types showed that dense fibrosis was entirely composed of thick bundles of type I and type III collagens, surrounding old parasitic vesicles with an autofluorescent laminated layer. In granulomatous areas, collagens were labelled as clusters consisting mainly of type III procollagen and collagen. Concentric bundles of type III collagen surrounded active parasitic vesicles. An enhancement of the normal labelling in portal spaces of the intact liver was present in all the patients. These results suggest that irreversible acellular keloid scar-like fibrosis observed in AE is the ultimate result of cytotoxic and fibrogenetic events related to the immune response of the host which are taking place initially in the granulomatous area surrounding the young parasite larvae.
Whilst investigating 26 members of the same family, we discovered 5 cases of multiple endocrine neoplasia type II a. The present report demonstrates the diagnostic value of basal plasma thyrocalcitonin (TCT) assays, before and after stimulation with pentagastrin, and of plasma carcinoembryonic antigen (CEA) assays. Some of the clinical features encountered were novel--e.g. in one patient the phaeochromocytoma was revealed by a haemothorax with cardiovascular collapse--and others were peculiar; thus, in 4 cases the medullary thyroid carcinoma (MTC) was less than 2 cm in diameter and without lymph node or visceral metastases, even in patients aged 87, 59 and 56. More classically, MTC, always multifocal, was clinically silent, as were the two cases of phaeochromocytoma and hyperparathyroidism. Phaeochromocytomas were difficult to diagnose. Ultrasonic tomography did not prove very helpful and the disease was transmitted as an autosomal dominant trait. Finally, MTC secreted a variety of substances (TCT, CEA, beta-endorphin, somatostatin), and HLA A2-B15 antigens were found in 3 patients.
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Pathological prognostic factors of rectal adenocarcinoma were studied retrospectively in 173 patients who underwent curative resection between 1970 and 1980. Analysis was mono- and multifactorial. Minimal and median follow-up were 24 and 66 months respectively. Three factors had a favorable influence on the local failure (LF) and distant metastasis (DM) risks: length of the tumor less than 2 cm; polypoid aspect; Astler-Coller's stage A. Four factors increased the LF risks: perineural invasion (LF = 57 p. 100); poorly differentiated or colloid tumors (LF = 50 p. 100); lymph node metastasis (LF: 43 p. 100); lymphatic invasion (LF = 36 p. 100). Two factors increased the DM risks: perineural invasion (DM = 43 p. 100); lymph node metastasis (DM = 37 p. 100). The multifactorial analysis showed that the risk factors were the same for LF as for DM. Perineural invasion (p less than 0.001), lymph node metastasis (p less than 0.002), level of extension of the tumor in the rectal wall (p = 0.005) were the most important factors for local recurrences. Lymph node metastasis (p less than 0.001), perineural invasion (p = 0.03) and level of extension in the wall (p = 0.05) were the most important factors for DM. These data suggest that a failure risks scale may be established and can be of help in stratifying patients in adjuvant treatment studies.
The authors report a case in which hyperparathyroidism recurred after total parathyroidectomy and autogenous parathyroid graft into the fore-arm musculature, in a patient with chronic renal failure. Light and electron microscopic studies of the grafted tissue show a severe, nodular hyperplasia. This case report illustrates the rapid "tumour-like" growth of the hyperplastic parathyroid grafted tissue; according to some authors, the hyperplastic parathyroid tissue displays an increased propensity to become malignant.
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Among congenital dilatations of the common bile duct, a congenital diverticulum of the common bile duct may remain clinically latent for a long period. One case is reported in a 77 year old subject. Precise diagnosis of the disease is often made at operation and on pathological examination. The diverticulum is cured in most cases after surgery which consists of simple removal, but which may sometimes require reconstruction of the common bile duct.
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The increasing use of computed tomography in evaluating patients with acute abdominal pain has revolutionized the diagnosis of small bowel obstruction in adults. Computed tomography is incontestably the most useful and powerful tool to make positive, topographic, and etiologic diagnoses of small bowel obstruction. Good knowledge of some key signs and rigorous analysis of computed tomographic images by radiologists should lead to improved diagnosis and appropriate treatment.
Extrarenal sorbitol clearance was measured in liver transplant patients after a steady-state perfusion. Four measurements were performed in 3 patients with various liver diseases (beginning or patent acute rejection, cytomegalovirus hepatitis, hepatic metastasis). The mean (+/- SD) extrarenal sorbitol clearance was 14.8 +/- 0.1 ml/min.kg. In 5 patients with minimal or no liver abnormalities, the mean from 5 measurements of extrarenal sorbitol clearance was 18.9 +/- 5.0 ml/min.kg. Extrarenal sorbitol clearance values in this later group were higher than the values previously reported in healthy subjects.