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Biomedical subjects

R Bordes

Publications and source records attributed to R Bordes.

At least 37 records · Page 2Linked to original sources

[Erythroblastopenia during recurrence of a thymoma associated with myasthenia gravis. Apropos of a new case].

A new case of thymoma, myasthenia gravis and pure red cell aplasia is presented. Pure red cell aplasia came out 10 years after the diagnosis of the two other diseases in one of several relapses of metastatic thymoma with clinical signs of myasthenia. Surgery, chemotherapy and radiotherapy besides pyridostigmine treatment were used in the clinical course of the patient. A phenotypical change of medullary T lymphocytes (CD4 to CD8) was observed at the same time of pure red cell aplasia diagnosis. A dual role of medullary CD2+ T cell lymphocytes, stimulant and suppressive, over erythroid progenitor cells (BFU-E and CFU-E) was suggested by in vitro cultures.

Aged↗

Ogilvie's syndrome from disseminated varicella-zoster infection and infarcted celiac ganglia.

We report a patient who had refractory Hodgkin's disease and who received an autologous bone marrow transplantation and 8 months later developed abdominal pain associated with acute colonic dilation. The course of the patient was rapidly fatal due to a lobar pneumonia. Autopsy revealed signs of disseminated herpesvirus infection with marked hemorrhagic infarction of celiac sympathetic ganglia. This finding supports the hypothesis that denervation caused by virus reactivation and secondary hemorrhage is a main mechanism of acute colonic pseudoobstruction.

Adult↗

Viridans streptococcal shock syndrome during bone marrow transplantation.

Of 320 patients receiving a marrow transplant at the Hospital de Sant Pau between 1986 and 1992, 12% developed viridans streptococcal bacteremia during severe neutropenia. Five of these patients (13%) developed a rapidly progressive fatal shock syndrome characterized by bilateral pulmonary infiltrates, acute respiratory failure (ARDS) and septic shock early in the transplantation course (6 or 7 days posttransplantation). All patients were transplanted for acute leukemia in remission, and 2 received an allogeneic and 3 an autologous transplant. Four of these subjects were younger than 15 years of age and all had received cyclophosphamide and total body irradiation as conditioning regimen for marrow transplantation. All 5 patients died, and postmortem examinations revealed diffuse pulmonary lesions characteristic of the ARDS. These observations contribute to defining the clinical and pathologic characteristics of this serious complication of intensive anticancer treatment.

Acute Disease↗

Aggressive natural killer cell leukaemia/lymphoma in two patients with lethal midline granuloma.

We report two patients with leukaemic proliferations of large granular lymphocytes. The immunophenotype study showed that the leukaemic cells were positive for CD2, CD38, CD56 and anti-HLA-DR monoclonal antibodies and negative for other T-cell (CD3, CD4, CD8) and B-cell markers (CD19, CD20 and surface immunoglobulins). The clinical course was acute and a diagnosis of aggressive natural killer cell leukaemia/lymphoma was made. No clonal rearrangements of either C beta T-cell receptor or JH immunoglobulin genes were found. Functional studies done in one patient demonstrated non-restricted cytotoxic activity after activation with IL-2. Lethal midline granuloma had been previously diagnosed in both patients. A possible relationship between this entity and the natural killer cell leukaemia is discussed.

Antigens, CD↗

Active myocardial damage without attending inflammatory response in dilated cardiomyopathy.

OBJECTIVES: This study aimed to compare indium-111 (111In)-monoclonal antimyosin antibody uptake in patients with dilated cardiomyopathy before heart transplantation with the histologic findings in the explanted hearts. BACKGROUND: A high prevalence of 111In-monoclonal antimyosin antibody uptake has been described in patients with dilated cardiomyopathy, suggesting the presence of active, ongoing myocyte damage; however, no correlation between monoclonal antimyosin antibodies and histologic findings is available in these patients. METHODS: A consecutive series of 21 patients with dilated cardiomyopathy awaiting heart transplantation were studied with monoclonal antimyosin antibodies before the operation, and the results were compared with the histologic analysis of the explanted hearts. The interval between monoclonal antimyosin antibody studies and transplantation was 1 to 90 days (mean 58 +/- 31). RESULTS: Using a semiquantitative method (heart/lung ratio), monoclonal antimyosin antibody uptake was present in 15 (71%) of 21 patients, but active myocarditis in the explanted hearts was detected in only 7. In 11 patients, intense monoclonal antimyosin antibody uptake coexisting with absent myocyte damage or cellular infiltration of explanted hearts was noted. One patient who showed preoperative monoclonal antimyosin antibody uptake underwent transplantation 11 h later, and ex vivo diffuse myocardial antimyosin uptake was detected, but active myocarditis was seen only at cardiectomy in only a small area of the heart; the rest of the myocardium showed no signs of myocyte damage. CONCLUSIONS: In dilated cardiomyopathy, monoclonal antimyosin antibody uptake cannot be equated with the presence of an inflammatory response detected in the myocardium of the explanted heart.

Adult↗

Early postoperative reduction of monoclonal antimyosin antibody uptake is associated with absent rejection-related complications after heart transplantation.

BACKGROUND: Detection and treatment for rejection after transplantation are based on the identification of myocyte damage upon endomyocardial biopsy. Noninvasive detection of such damage is possible with 111In-labeled monoclonal antimyosin antibodies (MAA). Although the presence and degree of MAA uptake parallels the rejection activity detected by biopsy, the relation between the degree of uptake and the occurrence of severe rejection-related complications has not been previously assessed. METHODS AND RESULTS: Two hundred forty-seven MAA studies were performed coinciding with biopsies in 52 patients 1-71 months after transplantation. A heart-to-lung ratio (HLR) was used as a measure of relative MAA uptake, with an HLR of 1.55 discriminating normal from abnormal studies. Of the 247 antimyosin studies, 149 coincided with absent, 38 with mild, and 60 with moderate rejection at biopsy. HLR was 1.68 +/- 0.27, 1.79 +/- 0.22, and 1.91 +/- 0.33 in the three biopsy groups, respectively (p less than 0.0001). Two hundred thirty-eight of 247 antimyosin studies coexisted with absent rejection-related complications; in nine of 247 patients, such complications were detected (five congestive heart failure episodes due to rejection and four episodes of vascular occlusion, which resulted in five deaths), and mean HLR was 1.74 +/- 0.3 and 2.1 +/- 0.16 in the two groups, respectively (p less than 0.0001). No complications were noted in 193 studies of patients with HLR of less than 2.00, whereas in nine of 45 with HRL of 2.00 or greater, complications occurred (p less than 0.0001). None of the 23 patients prospectively followed since surgery who had a gradual decrease in MAA uptake during the first 3 months showed rejection-related complications, whereas persistent uptake was associated with complications in five of nine patients (p less than 0.001). CONCLUSIONS: No rejection-related complications are seen coinciding with HLR of less than 2.00, whereas patients who have complications have an HLR of more than 2.00. The early 3-month pattern of decreasing MAA uptake is associated with a clinical course free of rejection-related complications, whereas a persistent pattern is a signal of the possibility of such complications.

Adult↗

[Coronary fistula to the right ventricle in heart transplant patients as a complication of repeated endomyocardial biopsies].

Ninety-six coronary angiographies of 30 orthotopic heart transplant recipients were studied. Eleven coronary artery fistulas to right ventricle were seen in 7 (23.3%) patients; five involved the left anterior descending artery, four the right coronary artery, and two the circumflex artery. All the coronary arterial fistulas appeared within the first year after transplantation, when endomyocardial biopsies were more frequent. In the review of the histologic samples, we found coronary arterioles greater than 0.15 mm of diameter in 3 of 7 patients with coronary arterial fistula; on the contrary, those were not found in any of the 69 histologic samples of 23 heart transplant patients without coronary fistula (p less than 0.001). Neither clinic nor hemodynamic abnormalities were seen in any patient during the follow-up. The coronary fistula had a benign course, with a tendency to decrease in size and to close spontaneously.

Biopsy↗

[Peripheral T-cell lymphoma. Morphologic, immunophenotypic and immunogenotypic studies of 10 cases].

We describe the histopathology, immunophenotype and immunogenotype of 10 cases of peripheral T-cell lymphoma. The majority of patients showed disseminated disease at the time of diagnosis. From a histopathological view point the cases were classified into 5 types: T zone lymphoma (4 cases); Lennert lymphoma (2 cases); pleomorphic lymphoma, small all type (2 cases); pleomorphic lymphoma of medium-sized cell type (1 case); pleomorphic lymphoma of large cell type (1 case). In most of them the neoplastic cells demonstrated a mature T-cell phenotype: CD3+, CD4+, CD8-, CD43+, CD45RO+, CD45RA-, CD20- and surface immunoglobulins. All cases studied displayed gene rearrangements for the T-cell receptor beta chain while the immunoglobulins genes remained in germinal configuration. Antibodies against the human T-cell lymphotropic virus type I were not found in the 9 samples studied.

Adult↗

Immunophenotype of blast cells in acute myelofibrosis.

The immunophenotype of peripheral blood blast cells from six patients with acute myelofibrosis was studied using a panel of monoclonal antibodies directed against granulocytic, erythroid, megakaryocytic and lymphoid antigenic determinants. In all patients most of the blast cells were labeled with anti-HLA-DR and with the early myelomonocytic antibodies My7 (CD13), My9 (CD33) and B1-3C5 (CD34) (3/3). In three cases, platelet antibodies Edu3 (CD41) and GPIIIa (CD61) reacted with about 30% of blast cells. TdT was positive in two out of six samples studied. Lymphoid markers T3 (CD3), Leu9 (CD7), J5 (CD10), B4 (CD19) and B1 (CD20) were negative in all cases. These results suggest that blast cells are mainly of immature myelocytic origin. However, the coexistence of megakaryoblasts cannot be ruled out in the cases with a proportion of cells that are positive with Edu3 and GPIIIa antibodies.

Acute Disease↗

Dopamine treatment of locally procured donor hearts: relevance on postoperative cardiac histology and function.

UNLABELLED: Administration of catecholamines can lead to myocyte damage. Dopamine treatment is often used in potential cardiac donors to attain hemodynamic stability. Donor hearts exposed to dopamine are rejected or selected for transplantation without clearly defined criteria. A prospective study was undertaken to analyze the clinical relevance of dopamine-induced myocardial lesions in 25 hearts (21 male, 4 female; 15-40 years, mean: 26 +/- 7) that were later used for transplantation. Donors were divided into those who had received dopamine and those who had not. Dopamine doses ranged from 2-12.5 micrograms/kg/min (mean: 6.3 +/- 3). Time of administration was 3-26 hours (mean: 16 +/- 8). Use of dopamine was unrelated to donor electrocardiographic findings, intra- or postoperative death, or difficulty coming off by-pass. Postoperatively, filling pressures were similar in both groups of patients at 2 and 10 days postoperatively. Left ventricular ejection fraction was similar in the two groups. Dopamine requirements were significantly higher in the dopamine-treated hearts (P = 0.05). Histologic findings at first biopsy revealed infiltration and cell damage in a similar proportion of patients in both groups. IN CONCLUSION: donor hearts exposed to dopamine can be accepted for transplantation if doses ranging from 2-12.5 micrograms/kg/min have been administered up to 24 hours.

Adolescent↗

[The value of the initial bone biopsy in chronic myeloproliferative syndromes. Review of 80 cases].

In order to review the histological characteristics and to evaluate the presence of valuable findings for diagnostic or prognostic purposes, 80 patients diagnosed of chronic myeloproliferative syndromes (CMPS) who had undergone initial bone marrow biopsy were studied in retrospect. The patients were distributed into 26 cases of chronic myeloid leukaemia (CML), 22 of myelofibrosis (MF), 16 of polycythaemia vera (PV) and 16 of essential thrombocythaemia (ET). The histological findings in the 26 cases of CML consisted of hypercellular bone marrow with fat depletion in all cases; marked thickening of trabeculae was seen in 4 cases and neoformation-like osseous tissue in 7 others. Erythroblastic nests were found in 11 patients, eosinophilia in 23 instances, and abnormal location of immature precursor cells (ALIP) was present in 16 cases. Reticulinic fibrosis was found in 22 patients, collagen fibrosis in 6 and sinusoidal dilatation in 5 cases. Of the 22 MF patients, 8 had normal bone trabeculae, while 14 had trabecular thickening, of moderate degree in 6 cases and marked in 8. Osteoid tissue formation was observed in 21 instances; diminished or absent fat was appreciated in 19 cases. Erythroblastic nests were present in 12 instances, ALIP in 5 and eosinophilia in 14. Reticulin fibres were increased in 22 instances, collagen fibrosis was present in 18 cases, sinusoid dilatation in 12, and lymphoid follicles were seen in 4 patients. Trabecular thickening was found in 15 cases of the PV group (16 patients) and osteoid tissue formation in 2. Fatty tissue was decreased or absent in 11 instances Erythroblastic nests plus eosinophilia were seen in 15 cases, and ALIP in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

[Laryngeal reinnervation in the dog].

In a group of 7 operated dogs, atrophy of the laryngeal musculature begins 3-4 weeks after recurrent nerve division. The atrophy increases progressively as time runs out, so that at the ninth week (last control done) the degree of atrophy of the posterior cricoarytenoid muscle is well marked as compared with that of the initial stage (4-5 weeks). In another set of 8 dogs reinnervation of this muscle was successful in 5 animals. In some of them up to 36 months elapsed after the cutting of the recurrent nerve and 14 weeks after application of a neuromuscular graft (composed of the hypoglossal ansa and a sheet of sternothyroid muscle). Histologic recuperation was good in all cases, but in only 2 of them the motility of the vocal cord at stimulation of the branch of the nerve was effective. The conclusion drawn is that histologic regeneration does now always parallel the functional one. Nevertheless, it seems possible that the elapsing of more time should be necessary in order to restore motility. This point demands new and broader experience before a positive answer can be given.

Animals↗

Von Recklinghausen neurofibromatosis with carcinoid tumor and submucous leiomyomas of the duodenum.

We report on a 63-year-old man with von Recklinghausen neurofibromatosis who developed a carcinoid tumor in the periampullary region and multiple small-sized leiomyomas in the duodenal wall. A high prevalence of gastrointestinal carcinoids has previously been recognized in patients with von Recklinghausen neurofibromatosis, the commonest site of origin being the duodenum or the periampullary region. The association of both conditions seems to be more than casual. Abnormalities in the development of the complex of von Campenhout or high circulating levels of nerve growth factor have been the mechanisms postulated to account for this association.

Carcinoma↗