Biomedical subjects
Publications and source records attributed to P Caligaris.
We report a case of pulmonary mycobacterial infection due to Mycobacterium simiae followed between 1968 and 1985 and leading to unilateral pulmonary destruction. Formal bacteriological proof was obtained by culturing from the pneumonectomy specimen. None of the usual features of immunosuppression were found. This is the first case suffering from this germ described in this part of the world.
It appears that there are a certain number of complications in the digestive tract that still occur in spite of improvements in techniques of irradiation therapy. They may only appear a few months or even a few years after the treatment, and sometimes they only appear when the initial growth is considered to have been cured. The clinical picture is dominated by the appearance of fistulae, of adhesions and of stenoses which give rise to sub-acute or sometimes acute obstructions. From the anatomical point of view all elements of the digestive tube are affected with a predominance of the fibro-hyaline elements of the muscles and the arteries. The possibilities for surgical treatment are limited. Excision with anastomosis would seem to be more risky than diversion. We have had to operate on ten of our eleven patients, of whom six died and only one of these directly because of recurrence of the initial growth. Only prevention can lessen the mortality of these severe complications.
Endometriosis involving the digestive tract accounts for 1% of all cases of the disease. There is a marked predominance in the recto-sigmoid and terminal ileal loops. Symptomatology is dominated by disturbances in intestinal transit, sub-occlusion or acute obstruction, pain worsening at the time of menstruation and by a haemorrhagic rectal discharge again accompanying menstruation. Apart from classical aetiopathogenic theories such as grafting onto the digestive tract by tubal, lymph vessel or venous propagation, it would appear that prostaglandins and in particular a change in the (formula; see text) ratio may play a large role. Operative resection of localised stenosis combined with oophorectomy, if the latter is possible in view of the patient's age, or prolonged medical treatment with progestational agents or even better Danazol results in cure and avoids recurrences.
The authors give 9 case histories of endometriosis localised to the abdominal wall : 3 of them in the umbilicus, 3 in laparotomy incisions (2 of those were Caesareans), 2 of them in the round ligaments at the external opening of the inguinal canal and 1 of them in the right rectus muscle sheath in the abdomen. The functional symptomatology is rhythmical according to menstruation; it is associated with a burning type of pain, a tumour and blood loss. Over and above the theories of aetiology that are now classical, namely tubal retrograde spill, and lymphatic or venous spread, it would seem that prostaglandins and in particular the ratio of P.G.E. divided by P.D.F2 alpha can play a big role. Although Danazol is an effective treatment for endometriosis, the treatment of choice is, in these lesions that are superficial in localisation and easily accessible, to cut them out surgically. This makes it possible on the one hand to look for other intra-abdominal lesions and also on the other hand to confirm the anatomy and pathology (this was done in 7 out of 9 of our cases).
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