Biomedical subjects
Publications and source records attributed to J Vacant.
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Seven patients presenting with recurrent diffuse, non-infiltrating tumors of the bladder were treated for several years by repeated endo-urethral resection, because radical exeresis was not possible. Each operative specimen was subjected to examination of the ABH blood-group antigens, pneumo-14 precursor, and carcino-embryonic antigens. The authors emphasize the prognostic interest of such studies.
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The authors have studied 125 stage A bladder tumours with a follow-up period of at least 5 years. The ABH cell surface antigens were collected by a double-layer immunofluorescence technique which has already been described. All the cross sections were read by the same pathologist who knew nothing about the clinical developments. The results were divided into 3 groups : (I) all the tumour cells had retained their surface antigens. (II) Only some cells had retained surface antigens. (III) All cells were negative. Study of the development of the 3 groups shows that : in group I, all the patients (11) are alive 5 years later, and only one has presented with a lesion evolving towards infiltration. In group II (32 patients), only 38 p. cent of the patients are still living 5 years later, and 65 p. cent developed towards muscular infiltration. In group III (77 patients), 27 p. cent are alive after 5 years and 80 p. cent have developed towards muscular infiltration. Homogeneous retention of the surface antigens would therefore seem to be a favourable factor in the prognosis, even in the case of a tumour which has already infiltrated the chorion. The significance of the loss of surface antigens is less clear-cut, but is on the whole adverse. The significance would, however, probably be enhanced by study of the mucosa distal from the lesion, and by marking the substances which determine the blood groups.
The presence of A, B and H blood group antigens in paraffin-embedded tissue sections was demonstrated with a routine direct and indirect immunofluorescence technique. Natural and human antisera were used for 102 biopsy specimens of the various blood groups, including normal mucosa and vesical tumors. This technique allows a more precise description than the specific red cell adherence reaction of the differentiation pattern of the tumor itself and of the surrounding and distant mucosa. It may prove useful in suggesting a revised classification system, with more diagnostic and prognostic significance.
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After having experimented with electro-stimulation on monkeys, the authors have put it into practice with the paraplegic. They report observations on pregnancy of a woman with a complete paraplegic below T4 who was injured 15 years ago. Nineteen electro-stimulations and seven artificial inseminations were necessary. The electro-stimulation is easy and can be repeated at will.
27 children, aged 7 months to 15 years, with terminal renal failure and no available vascular access, were treated with chronic peritoneal dialysis for 3 weeks to 9 months (mean 3 months). An indwelling silicon catheter fitted with a subcutaneous dacron felt cuff was used; the average catheter life time was 10 weeks (3 to 25 weeks). Control of uremia was satisfactory with mean serum urea decreasing from 2 to 1 g/l and creatinine from 130 mg/l to 60 mg/l after 48 hours of dialysis. No uremic complications occured. Total serum protein remained stable: mean: 62 g/l prior to treatment and 60 g/l after the treatment period. Hematocrit was higher than in hemodialysed children (17% versus 15%). Three children were directly transplanted without difficulty. However, some complications did occur. There were 27 episodes of catheter obstruction leading to 12 surgical interventions. 18 episodes of peritonitis (5% of total dialyses) occured in 12 patients, and two were lethal. The frequency of complications prohibits a recommendation of chronic peritoneal dialysis over hemodialysis in children; this technique however remains very helpful in those situations where vascular access is difficult.
The treatment and prognosis of dysembryoma of the testis have been transformed by the dissection of retroperitoneal nodes and by combination chemotherapy as early as possible. Routine retroperitoneal node dissection followed by early and prolonged chemotherapy lead to a hope of cure in more than 75% of cases of dysembryoma of the testis. Similar early chemotherapy is effective and indicate for choriocarcinoma of the testis and retroperitoneal node dissection may be of value in tumours in which the chorial element is "minor".
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With reference to 15 cases, the authors carried out a diagnostic and therapeutic study of "suburethral pouches" in the adult female. They emphasize the importance of the micturition phase of intravenous pyelography and retrograde cystography. Retrograde urethrography is rarely necessary. Surgical indications must be limited by the undisputable risks of this form of surgery.
The authors report their experience with 33 tetraplegics undergoing surgery. The operations were varied, endoscopic (resection of the bladder neck, of the prostate or striate sphincter, lithot-itiasis) or surgical (lombotomies, transintentinal cutaneous ureterostomies). The post-operative course may be dramatic or even fatal (acute hypertension with cerebral haemorrhage). Respiratory insufficiency poses no particular problem and can be controlled. Epidural anaesthesia maintained for several days makes it possible to avoid the more serious problems: -- autonomic hyperreflectivity, -- delayed resolution of ileus and digestive complication. The authors hence use epidural anaesthesia routinely and are satisfied with the technique.
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