Biomedical subjects
Publications and source records attributed to J Hervé.
A case of transverse testicular ectopia with supernumerary vas deferens and cyst of the ejaculatory duct is reported. The reports relevant to these malformations were reviewed and their embryologic etiology discussed.
DEFINITIONS: Age over 65 years is generally used to define the elderly population. Urinary tract infections are increasingly frequent after this age. Comorbidity and living conditions in the elderly have a particular incidence on the clinical expression and the bacterial flora involved. Besides these elements, altered cognitive capacity and abnormal urinary function prior to the infection and lead to an atypical clinical presentation. ASYMPTOMATIC BACTERIURIA: Systematic screening has produced a large body of literature on asymptomatic bacteriuria. Our review of the literature leads to the conclusion that systematic bacteriology tests are not warranted in the elderly population in general due to the subsequent risk of germ selection and erroneous diagnosis. PRACTICAL ATTITUDE: The diagnosis of urinary infection must be evidence-based, taking into account the patient's history and ruling out other diagnoses. In all cases, antibiotics must be carefully adapted to the patient's situation and titrated to kidney function.
OBJECTIVE: Having demonstrated a poor prognosis of operable lung cancer in patients with previous head and neck malignancies, we intended to evaluate prognosis of lung cancer in patients with a history of extrapulmonary and extracervical malignancies. METHODS: The population of this study included 55 patients; these were 40 males and 15 females, with a mean age 64.4+/-8.6 years. The previous malignancy was considered tobacco-induced in 15 patients (kidney, two; bladder, ten; esophagus, three), hormone-dependant in 18 (breast, six; female genital, eight; prostate, four), and miscellaneous in 22 (leukemia, four; skin, seven; colon, 11). Following complete resection, 25 patients were classified stage I, 13 were stage II, and 17 were stage IIIA. RESULTS: There were two early perioperative deaths (3.6%), and three during the second month owing to cardiovascular complications. At the conclusion of the study (July 1st, 1997), 32 further patients had died (58.2%): 25 had progression of lung cancer, one had progression of previous malignancy, and six were without evidence of disease. Five-year survival (Kaplan-Meier) was estimated 47+/-10.2% in stage I (median 44 months), 30.8+/-15.6% in stage II (median 26 months), and 16. 7+/-9.9% in stage IIIA (median 17 months). When excluding five early perioperative deaths, 5-year survival was 51.1+/-10.6% in stage I (median 93 months), 33.3+/-16.7% in stage II (median 36.5 months), and 19.0+/-11.2% in stage IIIA (median 20.5 months). Comparing the three groups defined according to location of previous malignancy, there was no significant difference neither in stage distribution (chi(2)=1.326; P=0.857), nor in 5-year survival estimates: 38.9+/-12. 9% (median 27 months) after tobacco-induced malignancies, 38.9+/-11. 5% (median 24 months) following hormone-dependant malignancies, and 28.4+/-10.2% (median 28 months) following miscellaneous cancers (chi(2)=0.059; P=0.9707). CONCLUSIONS: In opposition to data collected in patients with previous head and neck cancer, survival estimates according to stage were contained within the universally accepted range no high risk group has been identified. Resection of lung cancer with curative intent is a fair option in patients with previous extrapulmonary malignancy.
Gap junction channels provide a cell-to-cell conduction pathway for direct exchange of ions and small molecules. The intercellular diffusion of a fluorescent dye, quantified in cardiac myocytes from neonatal rats by monitoring the fluorescence recovery after photobleaching, was found to be interrupted after short-term exposure (15 min) to tamoxifen, an anti-oestrogen drug often used in the treatment of human breast cancer. This diffusional uncoupling was dose dependent, occurred in the concentration range 3-25 microM and reversed after tamoxifen withdrawal. Some possible mechanisms of junctional channel closure have been examined. The cytosolic calcium concentration, examined using the fluorescent indicator Indo-1, did not vary during the short-term action of tamoxifen. A second anti-oestrogen agent (clomiphene) was able to impair gap junctional communication, whereas a third (nafoxidine) had no effect. Protein-kinase-C-inhibitor properties of tamoxifen did not seem to be involved in its uncoupling action. The characteristics of tamoxifen's action (i.e. channel inhibition delay, active concentration range, reversibility, etc.) were very similar to the previously observed effects of several other lipophilic compounds (e. g. 17beta-oestradiol, etc.) on junctional channels, and to recently reported effects of tamoxifen on voltage-gated calcium currents.
The authors report the case of a post-traumatic ventricular septal defect diagnosed after the detection of a systolic murmur in a 39 year old man, 18 months after a car accident. Two-dimensional echocardiography and angioscintigraphy showed an abnormal cavity at the apex of the heart. At cardiac catheterisation there was a moderate left-to-right ventricular shunt through this cavity. There were no traumatic or atheromatous lesions of the coronary arteries. The operative appearances were of stunned myocardium which had caused a dissecting haematoma of the cardiac apex which ruptured into both ventricular cavities. The lesions were corrected surgically and the systolic murmur disappeared.
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Cervicobrachial neuralgia and torticolis in a 7 year old child were found to be due to calcification and hernia of an intervertebral disc. Similar cases reported in the published literature are reviewed.