Biomedical subjects
Publications and source records attributed to K Ben Miled.
Benign myoepithelioma of the lung is a benign tumor caused by proliferating myoepithelial cells with no ductal component. These tumors are exceptional: only three cases have been reported in the literature. We report a fourth case in a 37-year-old woman at 8 months gestation. Pathological proof of diagnosis was obtained.
Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report two cases of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. One case progressed to chronic cor pulmonale. We examine the pathophysiological mechanisms as well as the clinical, therapeutic and evolutive aspects.
Bronchoesophageal fistula is an uncommon clinical problem which can either occur as a congenital or acquired condition. A 40-year-old male had productive cough with production of sputum mixed with food particles and cough when eating and drinking. There was no weight loss nor weakness. Clinical examination led to the diagnosis of a fistula between the lower esophagus and the Nelson bronchus associated with bronchiectasis. The congenital nature of this fistula was suggested by the clinical, operative and pathology findings. Postoperative recover was uneventful. Esophageal respiratory tract fistula presenting in adult life are rare and can cause severe debilitation and suppurating lung disease. Surgical treatment provides complete resolution of the symptoms. Endoscopic obliteration can be considered as an alternative to surgery.
BACKGROUND: Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. CASE REPORTS: Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. DISCUSSION: Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.
The thoracic wall is an uncommon localization for tuberculosis, accounting for an estimated 1 to 5% of all cases of bone and joint tuberculosis which themselves account for 15% of all extrapulmonary localizations. Four patients were hospitalized for tuberculosis of the thoracic wall. The first patient, aged 22 years, had sternal tuberculosis with multiple bone localizations. The second patient was 37 years old and had a cold abscess of the peristernal soft tissues with several other bone localizations devoid of clinical manifestations. A third 37-year-old patient had a cold intercostal abscess revealed by a mass in the upper left quadrant of the left breast. In the last patient, 50 years old, tuberculosis of the ribs was associated with a cold tumor of the knee. Together with cases reported in the literature, these observations demonstrate the difficult diagnostic situation presented by tuberculosis of the thoracic wall. Treatment is based on long-duration multi-drug therapy. Surgical resection is rarely indicated. Cure was achieved in our four cases.
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We report one case of vaginal leiomyoma revealed by dysuria operated with success. Our observation are discussed with the review of the literature data.
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A case of spontaneous subcapsular hematoma of the kidney is reported. CT scan findings and etiologies are examined in the light of previously published data. An etiology-specific therapeutic strategy for subcapsular hematoma of the kidney is proposed.
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A case of idiopathic retroperitoneal fibrosis (IRF) in an 14 year old boy is presented. The diagnosis was mislead by the pelvic localization. One year after the biopsy and without any treatment, the scanner control shows the regression of the fibrotic plaque. The authors review the literature of this condition. They recall the principal clinic features of IRF in the children. A discussion of current diagnostic procedures and treatment is presented.
Twelve patients with idiopathic retroperitoneal fibrosis, between 1973 and 1988 are reviewed. Their mean age at presentation was 41 years. The different and particularly confusing clinical manifestations (ejaculation disorders, pelvic or abdominal or abdominal mass) are discussed. The diagnosis, which was based on pyelography and retrograde pyelography, is now established much more clearly by means of ultrasound examination and CT scan. In case of diagnostic problems, ultrasound or scan guided fine needle biopsy can direct the diagnosis. However, the definitive diagnosis can only be determined by means of surgical exploration and biopsies, which were necessary in four cases. Surgical exploration was followed by surgical ureterolysis in two cases. In four cases, treatment was with corticosteroid therapy only. Five patients were treated by ureterolysis and steroid therapy. Spontaneous remission after biopsy in one case and ureterolysis alone in an another case has been followed by CT scan with a mean follow-up of 24 months. Results were satisfactory in 20 on 22 ureters treated by corticotherapy alone, surgery alone or both operation and steroid treatment with a mean follow-up of 56 months.
The scrotal masses are a frequent motive of consultation. The etiologic diagnosis of scrotal abnormalities is not always resolved by an accurate physical examination. From january 1985 to december 1987, 30 ultrasound examinations were performed. In the same period 245 patients were admitted for a scrotal mass. In a retrospective study the clinical diagnosis and ultrasound examination were compared with surgical and/or pathological findings, concerning 7 scrotal trauma, 8 hydrocele, 6 tumors, 4 epididymo-orchitis, 3 torsion, 1 epididymal cyst and 1 malacoplakia. The ultrasound findings correlated well in 85% of cases. Ultrasound examination appears to be an important complement to physical examination in trauma, large tumors and inflammatory lesions.
The authors report the case of a 31-year old woman who was operated upon for cervical bone tumour. The pathological study showed that it was a primary, highly differentiated osteosarcoma. The clinical picture was limited to a spinal cord compression syndrome without signs of inflammation. Radiological findings were non-specific. Treatment consisted of laminectomy, radiotherapy and chemotherapy. The course of the disease was marked by stabilization, then rapid aggravation 2 years after the operation. A review of the literature highlighted the rarity and relatively slow progression of primary osteosarcomas of the spine.
Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death. This suggests that post-partum and post-abortum are probably instrumental in the onset and deterioration of Wegener's granulomatosis. The two patients previously reported who received immunosuppressants combined with corticosteroids had no flare-up after delivery. It seems permissible to prescribe such a therapeutic combination before and after delivery or abortion, especially since the fear of foetal toxicity from these drugs seems to be exaggerated.
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