Biomedical subjects
Publications and source records attributed to T Marsepoil.
The authors report the case of hepatic damage with a favorable outcome, occurring during severe ovarian stimulation which had anatomico-clinical features which distinguished it from the three cases previously reported due to its exclusively cytolytic nature and the histological lesions produced. The physiopathological mechanisms involved are discussed.
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We report 3 patients who developed signs of systemic infection and renal insufficiency after intravesical bacillus Calmette-Guérin (BCG) instillations for a bladder cancer. Renal biopsy showed tubulo-interstitial nephritis with or without epithelioid granulomas in 2 cases, and mesangial glomerulonephritis in the last case. All patients had granulomatous hepatitis in association. It seems that hematogenous dissemination via a traumatic instillation of BCG and/or an immune-complex mechanism may have contributed to the renal damage, which was only partially reversible in 2 patients.
The adult respiratory distress syndrome (ARDS) is rarely due to tuberculosis. Two new cases are reported here. Both were female patients, aged 33 and 41 years. The first, of North African origin, was admitted for epigastralgia, hyperpyrexia and intestinal problems. She underwent an exploratory laparotomy, which only showed oedematous mesenteries. Hepatic and lymph node biopsies revealed an ongoing tuberculosis. On the 4th postoperative day, she developed ARDS. Despite an initial period of improvement after proper treatment (antituberculous drugs, steroids, positive pressure ventilation) had been started, she died 27 days later. In the other patient, smoker and alcoholic, the diagnosis of tuberculosis relied only on bacterial culture of various excretions. She also died after 8 days of treatment. In both patients, the symptoms were atypical. The febrile non cardiogenic pulmonary oedema of sudden onset masked the typical miliary mottling pattern on chest X-rays. The life-threatening character of this condition requires that rapid histological studies are carried out to obtain an early diagnosis. Indeed, the precociousness of appropriate treatment seems to be the essential element of the prognosis.
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A case is reported of an acute onset of previously undiagnosed multiple sclerosis, revealed by an oculomotor paralysis following spinal anaesthesia performed for minor orthopaedic surgery. The need for a complete preoperative physical examination is underlined by this case, looking for latent neuromuscular disorders before undertaking such techniques, and for a thorough neurological work-up should such a complication arise. The harmlessness of regional anaesthesia in multiple sclerosis patients is controversial; without entering into such a debate, the direct relationship between spinal anaesthesia and acute exacerbation of the disease in our patient seemed more than likely.
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The authors report a case of severe Guillain-Barre syndrome that appeared during the eighteenth week of a second gestation which evolved to full term without complication. The particularity of this observation was that the follow-up of the foetus was made possible for the first time by echography which showed normal active foetal movements even during maximum maternal paralysis. From of review of thirty three cases recorded in the literature, it seems clear that the interrelationship between the neurological disorder and pregnancy is nil or minimal beside an increased risk of prematurity childbirth can proceed normally and cesarean section is not indicated. Plasmapheresis proposed as an early treatment is discussed in the case of pregnant women. Today pregnancy is no longer a particular contraindication of such management.
Acute fatty liver of pregnancy, or Sheehan's syndrome, is a rare complication of pregnancy, occurring in about 0.5% cases of jaundice in pregnancy. The anatomo-clinical picture and the biology of the condition is described using as basis a personal case history and the 28 cases to be found in the French literature. The condition shows, vomiting, abdominal pain and tachycardia in an apyrexial patient in the 3rd trimester of the pregnancy in which the disease occurs. The date shows itself a few days after the prodromal symptoms and is characterised by the triad of pruritus, jaundice and encephalopathy. All cases show an increased white blood count and hyperbilirubinaemia. If the condition goes on to become very serious one has to look for signs of haemorrhage and of liver and renal failure. Liver biopsy confirms the diagnosis. Prognosis will be improved if moderate forms are recognized early and if the condition is watched carefully. It may be necessary to stop the pregnancy before the serious conditions of the illness show up. Labour induced at the 37th week after checks had been made for fetal pulmonary maturity seemed to be a good way of treating the condition even if it has not yet become desperate. The final prognosis for the mother and the baby is always favourable if the baby is born alive.
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The authors report a case of "Torsades de pointe" occurring in a patient subjected to intensive surgical care and presenting several causes of magnesium loss: mutilating abdominal surgery, exteriorized gastric fistula, administration of Henle's loop diuretics, electrolytic disorders and exclusive parenteral nutrition without any magnesium Mg supplement. The arrhythmia appeared in the third week and the usual treatment was ineffective. The level of plasma magnesium was below the measurable values on three separate occasions. The administration of magnesium sulphate corrected the dysrhythmia which did not recur. Experimental and clinical data demonstrating the antiarrhythmic effect of magnesium are recalled. The electrophysiological explanation is based on the inhibition of potassium and calcium flow across the cell membrane; magnesium ion has a stabilizing membrane effect and an antagonistic effect on ectopic automaticity. They are particularly important on slowly depolarizing tissue (nodal cells) or partially depolarized cells (ischaemic or digitalis treated cardiac tissue). In intensive care, circumstances for magnesium depletion by digestive or renal losses and by lack of parenteral magnesium supplement are frequently combined. Systematic intravenous administration of magnesium is necessary when such conditions are found and whenever ventricular or auricular dysrhythmias occur.
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