Biomedical subjects
Publications and source records attributed to R Kerdraon.
A 78-year-old woman underwent a breast implants removal on August 2005. The prosthetic breast augmentation was performed during 1957, in France. The photos of these polyethylene made breast implants are shown.
BACKGROUND: To systematically evaluate the bone status, searching for osteoporosis in patients with cutaneous mastocytosis. PATIENTS AND METHODS: In a prospective study from March 1997 to June 2000, we included all new patients examined for cutaneous signs of mastocytosis. Past history, physical examination, skin biopsy, laboratory tests, bone densitometry, cytology and histopathology of bone marrow and other complementary investigations were performed in all these patients. RESULTS: Ten patients were included. Two patients had osteoporosis. Five others had osteopenia. Four patients had bone marrow involvement due to mastocytosis. One of these four patients had myelodysplasia. DISCUSSION: This study suggests better investigation of bone density and bone marrow in patients who have cutaneous mastocytosis. Systematic histopathology of bone marrow and osteodensitometry help to detect patients with systemic involvement. Bone densitometry is particularly effective for early detection of patients at risk for fracture and is of practical interest since patients with osteoporosis can now be treated with Pamidronate.
BACKGROUND: Recently, preoperative endoscopic ultrasonography (EUS) was shown to be less time consuming, posing less risk of adverse events than other more invasive diagnostic procedures used for locating insulinomas. Furthermore, laparoscopy can be part of a less aggressive approach in the management of such tumors, avoiding open surgery, which is used all out of proportion for benign small-size lesions, as insulinomas frequently are. CASE REPORT: The reported case of pancreatic insulinoma involved a 45-year-old woman suffering from a neuroglycopenic syndrome. Tumor location was possible with endoscopic ultrasonography, which detected a hypoechoic 10 x 10-mm mass in the pancreatic tail. Tumor enucleation was accomplished laparoscopically. CONCLUSIONS: Insulinomas may be managed with videolaparoscopy, but this approach, which is not applicable for multiple or malignant tumors, must be contraindicated also in single insulinomas located on the posterior wall or deeply in the head of the pancreas. The disadvantages of the laparoscopic approach, as compared with conventional surgery, are the absence of palpation and difficulty exploring the whole pancreas, which is partly overcome, but not completely eliminated, by EUS. The advantages are the absence of a parietal incision and good postoperative comfort. The reported low-invasive EUS laparoscopy sequence may be successful in selected cases of pancreatic insulinomas. However, it seems this treatment could be proposed for many patients affected by this benign disease.
Post-vaccination granulomas a well-known reaction due to aluminium adsorbed vaccines. We report three cases of children who developed subcutaneous nodules at the site of a previous injection of Tetracoq*vaccine (tetanus, diphtheria, Bordetella pertussis, poliovirus). Histologically, the lesions were characterized by a necrotizing granulomatous reaction with eosinophilic crystalline material. This material stained positively with the solochrome cyanine stain and was pink-purple. This aluminium stain enabled diagnosis of post-immunization injection-site reaction due to aluminium.
OBJECTIVE: To report a case of bullous eruption at and far from the site of aciclovir injection. CASE REPORT: A 50-year-old man was treated with intravenous aciclovir for Herpes simplex meningoencephalitis. Ten days after treatment onset, blisters appeared on his right forearm, at and far from the site of aciclovir injection. DISCUSSION: This adverse effect has not been frequently reported. To date, bullous eruptions were considered to result from extravasation of the aciclovir solution. In this case, an immunoallergic pattern was discussed with the presence of a histological leukocytoclastic vasculitis.
Alternaria is a fungus that is usually saprophytic but occasionally causes skin infections. Involvement of other structures is exceedingly rare. We report two cases in which a joint was also affected. The possible precipitating role of intraarticular glucocorticoid therapy is discussed. Both patients achieved a full recovery after itraconazole therapy, given for 12 and seven months, respectively.
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BACKGROUND: A correlation between acute intermittent porphyria or porphyria cutanea tarda and hepatocellular carcinoma (HCC) has been noted in several studies, but only one case of association between HCC and porphyria variegata has been reported. We therefore report another case of association between HCC and porphyria variegata. METHODS: A 54-year-old nurse with familial porphyria variegata who developed an HCC was studied. The diagnosis of porphyria variegata was made in the course of a familial survey by means of measuring lymphocyte protoporphyrinogen oxidase activity, at a time when the patient had no symptoms. Eighteen years later the patient presented with a firm enlargement of the liver. RESULTS: Histologic examination showed a well-differentiated HCC. The diagnosis was confirmed by positive immunostaining for alpha-foetoprotein antibodies. DISCUSSION: Sixteen months after surgical resection of the HCC the patient was still alive.
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INTRODUCTION: Pemphigus vegetans (PV) is a rare type of pemphigus vulgaris. We report a patient with pemphigus vulgaris relapsing as an isolated vegetative tumour. CASE REPORT: A 59-year-old man was seen in February 2001 for a tumour on the right groin. He had received systemic corticosteroids and cyclophosphamide for pemphigus vulgaris from 1974 to 1985, and he had been in complete remission since 1985. At the time of evaluation, a 10 x 5 x 5 cm, smooth vegetative tumour was seen on the right groin. Biopsies showed spongiosis, acanthosis and some acantholysis. Direct immunofluorescence showed strong deposition of immunoglobulin G within the intercellular substance of the epidermis. Indirect immunofluorescence revealed anti-intercellular antibodies at a titer of 1/800. Immunoblot analysis showed reactivity with the 130 kD pemphigus vulgaris antigen. PVg was diagnosed. Local corticosteroid treatment was initiated. The patient was disease-free at follow-up three years later. DISCUSSION: Localised forms of pemphigus are very rare. Twenty four other cases have been reported among them just one case of localised PV. Our case report is very unusual because of the variability of the expression of the disease, the high antibody level, the absence of trigger factors, and the efficacy of the local corticosteroid treatment.
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If low LET radiation therapy (photons, electrons), following radical microscopically and complete surgery can improve results in term of local control from 34 to 74% for salivary gland tumors, local control is more difficult to achieve in advanced tumors and only palliative treatment is usually attempted. In this survey, all the patient series treated worldwide were reviewed. They show an overall control rate of 31% with photon vs 64% with neutron therapy. A prospective randomised trial sponsored by the RTOG and the MRC published in 1988 and reviewed in 1993 showed an overall locoregional complete tumor clearance of 67% for neutrons and 17% for photons (P < 0.005), with 68% and 25% survival at two years for neutrons and photons respectively. This study was closed for ethical reasons. In Orleans, since 1987, 59 patients have been treated. At five years the persistent local control probability was 69.5%, the five-year crude survival probability 66% and the five-year tumor free survival probability was 64.5%. This review provides evidence that surgical treatment for salivary gland tumors should be limited to patients presenting a high likelihood of negative surgical margin and a small risk of facial nerve damage. Others patients should receive neutron radiation therapy alone as definitive treatment.
The clinical presentation of the splenic abscess is poorly specific. Its natural evolution is often fatal. The three case reports illustrate the difficulty of the diagnosis and management of this disease. Ultra sound and C.T. scan are the procedures of choice for the diagnosis and follow-up. The choice of the treatment depends on the number of abscesses, their volume, and also the presence of extrasplenic involvement. Antibiotherapy and interventional radiology have modified its therapeutical approach. Although the conservative treatment (antibiotherapy, transparietal drainage) is often successful, splenectomy is still indicated as a first line treatment, or as a salvage procedure.