Biomedical subjects
Publications and source records attributed to J Fraga.
We present four cases of lip carcinomas which have been extended to the mandible in between of one to four years through the mental nerve with peripheric neuropathy which was multiple in one of the cases.
Hepatic abscess is a rare complication of Crohn's disease. The present report describes an additional case diagnosed by CT scanning and successfully treated by surgery. Recognition of this complication is important because early therapy could improve the prognosis.
Uvulopalatopharyngoplasty is the treatment of choice for selected patients with obstructive sleep apnea, although the response to surgery is variable. We measured, in addition to obstructive apnea, the frequency of sleep-related partial upper airway obstruction in 11 patients with the obstructive sleep apnea syndrome both before and after uvulopalatopharyngoplasty. Partial obstruction was detected indirectly by recording the secondary hemodynamic changes and respiratory stimulation with the static charge sensitive bed. The frequency of obstructive apnea episodes was reduced from 56.3% to 18.4% by the operation, while the episodes of increased respiratory resistance rose from 3.6% to 20.4%. The various breathing anomalies decreased significantly, although they were still present during 75.6% of the recording time. The results suggest that uvulopalatopharyngoplasty substantially reduces the frequency of obstructive apnea, some of which persists as partial obstruction. The persistent partial obstruction may be the key factor contributing to further pharyngeal narrowing and a recurrence of obstructive sleep apnea syndrome.
Spontaneous umbilical fistula developed in two young women with Crohn's disease. This peculiar complication of Crohn's disease has been rarely reported. In view of the complete closure of the fistulas with medical treatment, we recommended conservative medical management, at least initially, in such patients.
Since 1975, 375 patients with inflammatory bowel disease (IBD) in Oporto have been studied; 180 had ulcerative colitis (UC) and 195 had Crohn's disease (CD). The steady rise in the number of patients observed suggests that the incidence of IBD is rising in the north of Portugal. At diagnosis UC was mild or moderate in 75.5% of patients, and 40.5% had rectal affection only. Colectomy was done only in two cases. The mortality was 1.1%. Clinical experience suggests that the behaviour of UC in this community may be milder than that reported at other centres. In CD patients ileitis was the commonest form (44.1%), and at diagnosis surgery was required for an acute condition of the abdomen in 22.5% of cases. The main complications were abdominal fistulae (22.1%) and perianal fistulae (21.5%). Colitis-related extraintestinal complications were present in 33.3% of IBD patients.
The validity of reference values for vertebral bone mineral density (BMD) reported in the literature has frequently been questioned. The introduction of dual-energy methods, new calibration systems, and automated image evaluation algorithms, has also made it necessary for us to re-evaluate BMD values in a normal population. We present patient selection criteria, CT measurement and evaluation protocols and results of single energy (SEQCT) and dual energy quantitative CT (DEQCT) for trabecular (tBMD) and cortical (cBMD) bone density in 135 males and 139 females. For SEQCT, tBMD loss rates of 1.7 and 1.8 mg/ml per year for males and females, respectively, were determined by linear regression. The respective DEQCT data show smaller decrements with age. Different statistical models for tBMD in females were tested; models based on a multiphase variation of tBMD yielded an improvement of the fit. For cBMD the percent rate of loss with age is much smaller than for tBMD; females showed a significantly higher loss rate than males, however. A comparison of our results with published data is included.
Involvement of the gastrointestinal tract in macroglobulinemia is exceedingly rare. We describe a patient with IgM biclonal immunoglobulin disorder associated with diffuse lymphoplasmacytic infiltration of the small intestine. This chronic illness was characterized by diarrhea, steatorrhea, and intestinal pseudo-obstruction. Full-thickness biopsy specimens of the jejunum showed stunted and fused villi, giardiasis, and a widespread cellular infiltrate in the lamina propria extending through the muscularis mucosae into the submucosa and muscular layers. The infiltrate had a cytologically benign appearance that was shown to be polyclonal by immunochemical stains. Intestinal vacuolated plasma cells were occasionally observed in electron microscopic study. The patient has not developed the features of Waldenstrom's disease on a clinical follow-up of 14 years.
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Theoretical concepts underlying the principle of nuclear magnetic resonance imaging are defined and the technical basis for its use in medical imaging described (sequences, accumulations, contrast media). Results are presented of a spectrometric study of 23 operative specimens from the bladder, prostate and seminal vesicles with analysis in vitro of relaxation time of the various tissues. Findings confirmed the value of NMR imaging for evaluation of macroscopic extension of tumors within the affected organs, as well as the interrelations of the organs, but the impossibility of identifying histologic structure of tumors and organs explored by this technique. Two groups of subjects were studied: a first group of 20 healthy volunteers to define NMR semeiology of male pelvis and a second group of 40 patients with mainly tumoral lesions of vesicles or prostate. Details are provided of the diagnostic value of NMR imaging with respect to the tumor, local and regional invasion and bone metastases. Excellent images of the tumor were obtained, with the possibility of determining its macroscopic stage, but its histologic nature could not be ascertained. Multiplane examination allowed better assessment of local and regional spread than by a CT scan, particularly for prostatic tumors (bladder, prostate bed or seminal vesicle extension). A negative feature of major importance exists, however, in that early glandular involvement is not detected by NMR imaging, which also fails to identify one case in two with bone metastases. Current research should allow progressive correction of present NMR imaging insufficiencies, notably in the field of tissue characterization.
The authors present 32 cases of renal cell carcinoma with inferior vena cava involvement. Three sub-groups of patients can be distinguished on the basis of the level of this involvement: A (24 patients) with infra-hepatic involvement, B (6 patients) with retro-hepatic involvement and C (2 patients) with supra-hepatic involvement. The surgical tactics and results are analysed for each of these 3 sub-groups. The prognosis is relatively good in sub-group A, but is increasingly less favourable in groups B and C.
The first report of dysplasia epiphysialis hemimelica in the spanish literature is presented. The case has peculiar clinical features as the early presentation (two months) and to involve lower and upper extremities. On X-ray examination exostosis and calcium deposits were shown on the most affected epiphysis. Microscopically an osteochondroma, anomalous vascular channels, non hitherto described, were detected, as well as multivacuolated cells into them although ultrastructural and histochemical studies were carried on the precise nature of these cells could not be established. The possible pathogenetic significance of these findings is discussed.
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Clinicoradiologic and pathologic data of a patient with a paraganglioma of the cauda equina are described. The peculiar aspect of this rare case is the gangliocyte differentiation with mature ganglion cells scattered in the tumor. The histologic and ultrastructural features are similar to other described cases of this tumor, with Zellballen pattern and neurosecretory granules. The immunohistochemical studies are quite typical with positive staining with neuroendocrine markers (N.S.E., G.F.A.P.). An interpretation of these findings is made.
The authors present the comparative value of CT scan and MRI in the pre-operative staging of 46 laryngeal carcinomas. The "in depth" evaluation conducts the choice of conservative surgery. CT scan is the reference but MRI reveals itself as effective and even more in certain cases. The spontaneous contrast gradient for soft tissues of the MR imaging explains this effectiveness of the method. The paraglottic space and the subglottic extension are more easily studied by MRI. If the expansion of the MRI Unities allows this indication of the pre-operative staging of laryngeal carcinomas is an excellent one.
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One hundred and twenty-six cases of esophageal atresia from two important centers of Belgium were gathered and subdivided into two groups. Group I ranges from 1969 to 1974 and group II from 1975 to 1980. There was an increase of the postoperative survival rate from 70% to 91%. Nevertheless, a great number of patients die in the late postoperative period (10%), mainly due to the associated cardiac pathology. Thus, the final survival rate is much smaller: 72% in group I, 77% in group II. The basic principles of diagnostic approach, the preoperative as well as the operative strategy are the same in both centers. Secondary interventions, however, are different in these two centers, but the coloplasty as well as the Howard technique have given excellent results. Eleven patients presented the isolated H-shaped tracheo-esophageal fistula. This group was treated separately because of the excellent results of treatment (100% survival).
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