Biomedical subjects
Publications and source records attributed to H Noel.
We report the case of a widely invasive thymoma non-associated with myasthenia gravis which responded only to high doses of corticosteroids. We review the other few reported cases of complete response achieved by this treatment and we stress the possible use of high doses of corticosteroids in the management of recurrent invasive thymoma.
In 15 hips with typical signs of avascular necrosis of the femoral head on plain radiographs and magnetic resonance (MR) images, gadolinium-enhanced spin-echo and fat-suppressed MR images were obtained and compared with nonenhanced T1- and T2-weighted images. Both enhanced and nonenhanced areas were consistently detected in the abnormal femoral heads. Enhanced areas showed a low signal intensity (SI) on T1-weighted MR images obtained before contrast material was administered and an intermediate to high SI on T2-weighted images. Nonenhanced areas showed an SI either identical (pattern 1) or hypointense (pattern 2) to that of fat on both sequences. Histologic correlation (six resected femoral heads) helped confirm that enhanced and nonenhanced areas corresponded respectively to viable and necrotic tissue. In most cases, SI analysis of nonenhanced T1- and T2-weighted images allows the differentiation of hypervascularized viable tissue from hypovascularized necrotic tissue of the sequestrum.
To test the possibility that interleukin-9 (IL-9), the human homologue of the mouse T-cell growth factor P40, may be involved in the pathogenesis of human lymphomas, we examined IL-9 expression in a variety of tumors both by Northern blot analysis and by in situ hybridization. Of 18 B-cell non-Hodgkin's lymphomas and 11 peripheral T-cell lymphomas, none expressed IL-9 message. By contrast, IL-9 message was found in two of six cases of large cell anaplastic lymphoma (LCAL) and in 6 of 13 cases of Hodgkin's disease (HD). In HD the strongest signals were observed in Hodgkin (H) and Sternberg-Reed (SR) cells, but IL-9 mRNA was also detected in small lymphocytic cells. A search for IL-9 message in a panel of 20 cell lines derived both from hematopoietic and nonhematopoietic tumors confirmed the unique association of IL-9 expression with HD and LCAL in as much as the only two cell lines with IL-9 message were derived from cases of HD and LCAL. These results suggest that IL-9 is not involved as an autocrine growth factor in the pathogenesis of most B- and T-cell lymphomas, but that it may play a role in HD and LCAL.
A new case of congenital nonunion of the clavicle is reported with a histological description. Medullar drilling and bone grafting "in loco" was performed during the surgical procedure. The etiologic hypotheses are discussed. The authors compare congenital nonunions between the pathologies associated with the necessity of medullar drilling for consolidation.
A woman suffering from primary Sjögren's syndrome developed sensitive neuropathy. The disease was further complicated by follicular lymphoma, an unusual albeit already described complication of Sjögren's disease. The clinical data suggest that mononuclear infiltration of the dorsal root ganglions could be at the origin of a sensitive neuropathy, inducing an axonal degeneration of the nerves.
We report two patients with non-Hodgkin's lymphoma in whom hypercalcemia and elevated 1,25 dihydroxyvitamin D (1,25-(OH)2D3) levels developed in the absence of any lytic bone lesions. Hypercalcemia responded only transiently to glucocorticoids which were ill tolerated. Intravenous APD administration was needed to circumvene hypercalcemia. Humoral hypercalcemia of malignancy is discussed. Our cases confirm that hypercalcemia associated with elevated 1,25-(OH)2D3 may occur in malignant lymphoma.
The histological demonstration of beta 2-microglobulin (B2M) amyloidosis in a 75-year-old man treated exclusively by continuous ambulatory peritoneal dialysis (CAPD) for 87 months is reported. Amyloid deposits were detected in all joints from which synovial specimens were obtained at autopsy. It is of note that the patient had never undergone hemodialysis and had suffered only one episode of peritonitis. Both features are of interest, as the few reports of dialysis-related amyloidosis (DRA) in CAPD include patients who have been hemodialyzed and have suffered repeated episodes of peritonitis, both conditions being incriminated in the genesis of B2M amyloidosis. We conclude that DRA may develop in the absence of artificial membranes or frequent peritonitis episodes.
We report three cases of spontaneous healing of aneurysmal bone cysts (ABC). In one case histological material was obtained after resection of the already ossified expansile mass discovered as a lytic lesion seven months previously. In the two other patients, spontaneous ossification of a radiologically presumed ABC in the lytic and expansile phase was observed after nine and seven months respectively. The healed lesions have remained stable at 12, 32, and 36 months respectively. These findings suggest that when the diagnosis can be made with confidence, and the lesion is in a location and at a stage that does not entail any risk of fracture or compression, expectant management should be considered. Our three patients were aged 22, 19 and 18 years, older than usual for developing ABC. This is also true for many of the few other reported cases of spontaneous or almost spontaneous healing and suggests that ABC has a greater tendency to stabilise in older patients.
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In connection with a recent observation of laryngeal lymphoma, we have looked through the literature and listed 79 cases. Preferentially, these are male subjects over fifty years of age. The symptoms are slowly progressive dyspnea and unilateral otalgia. Laryngoscopy shows a smooth-surfaced tumour, regular in shape and pinkish grey in colour, generally localized at the supra-glottic level. Therapeutic strategy is closely linked with histologic investigation and the stages of progression. Treatment is based on radiotherapy to the affected area, associated with chemotherapy in the case of extralaryngeal lymphomatous involvement. While prognosis remains good in the case of an isolated laryngeal attack, it is less so in the case of multiple localization.
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A 43-year-old man suffered from migrating then additive arthralgias associated with macroscopic and microscopic cutaneous lesions compatible at first sight with reticular erythematous mucinosis. After nine months, the cutaneous picture evolved into a papular mucinosis. The patient developed "multiple frozen joints" with heterotopic bony deposits around the hips. To our knowledge, such articular problems have not yet been described in this condition. Severe systemic complications prompted the authors to treat the patient with plasma exchange and melphalan.
This paper reports the case of cardiac tumor which had been diagnosed as a left atrial myxoma but which later on was identified as being a primary cardiac liposarcoma. The clinical characteristics of cardiac liposarcomas, the problems of differential diagnosis, the prognosis and therapy are reviewed.
It appears that miconazole is highly effective in reducing the incidence of systemic mycosis in patients suffering from malignant haemopathy and bone marrow failure. Three clinical infections (one stomatitis and two septicaemias due to candida) were easily cured. Autopsy findings never disclosed mycosis as the cause of death. The drug was completely atoxic and seems to offer major help in the treatment of malignant blood disease.
The authors report a case of a large oral tumour. On the basis of classical histological and histochemical techniques, the diagnosis was oriented towards an angiosarcoma though it was not possibile to eliminate an achromic melanoma. Ultrastructural studies demonstrated the presence of premelanosomes and established the diagnosis of an achromic malignant melanoma. The clinical interest of this approach isthus emphasised.