La semaine des hopitaux : organe fonde par l'Association d'enseignement medical des hopitaux de Paris最新文献

The authors report five cases of sarcoma of the bladder and make a distinction between homotypical and heterotypical sarcomas and lymphosarcomas presenting specific therapeutical problems. The prognosis is severe because of very frequent local relapse. They recommend disregard of the invasion of the muscular wall, and the performance of total cystectomy following a positive histological diagnosis. In their view, this is the basis for the treatment of sarcomas.

The authors present two cases of epithelioid sarcoma of the hand and one of the foot with clinical interest. This recently described tumor (Enzinger, 1970), is relatively rare. It occurs in the hand, forearm, pretibial region and foot and affects principally young adults. It should be emphasized, and this is borne out in the literature, that this tumor may appear perfectly benign and often has a course of long duration. The difficulty of clinical and especially of histologic diagnosis as well as the difficulty of determining the boundaries of extension of the tumor make it necessary to carry out radical surgery (amputation or rarely block excision). Every author agrees that local excision is to be condemned, there being an 85% recurrence rate. Spread of the tumor is by way of the fascial planes and tendon sheaths. Lymphatic and pulmonary metastases occur particularly when there is vascular invasion.

Acute post-traumatic pancreatitis in unusual, accounting for no more than 1% of all cases of acute pancreatitis. The authors describe a case of acute pancreatitis in a patient who had a closed abdominal trauma during a football match. The recommended procedures for ensuring early diagnoses are described. Prognosis and management is dependent upon pathology and extension of lesions. Hemorrhagic and necrotic pancreatitis carries a poor prognosis, especially when diagnosis is delayed.

The authors report a case of diffuse hydatid disease of the lung and liver. This association accounts for about 20 per cent of cases. Diffuse lesions are, on the other hand, exceptional. In this case the lung and liver functions were both impaired. Surgical management involved resection of the top of the cyst protruding from the liver and pulmonary cystectomy. The relative simplicity of the postoperative course, restoration of liver function and improvement in lung function prompt the authors to recommend surgical management of these cases, which cannot be treated medically.

Two cases of tetraparesis due to cervico-occipital spinal cord compression in infants with achondroplasia are reported. Neurological disorders in achondroplasia are produced by structural anomalies of the cranium and spinal canal. They can be divided into two categories: hydrocephalus and radicular and spinal cord compression syndromes. Cervico-occipital compression is more frequent in childhood and may occur very early, in the first months of life. Early diagnosis of this complication and anatomic evaluation can now be obtained by computed tomography, which shows the exact dimensions of the foramen magnum, and myelography. Achondroplasia requires very close neurologic monitoring and, when findings are abnormal, radiologic investigations of the cervico-occipital zone. This allows for early surgical management which is the only means of obtaining significant therapeutic results.

Farmer's Lung is an extrinsic allergic alveolitis due to the inhalation of actinomycetes thermophiles. Micropolyspora faeni is the principal allergen implicated in this disease which is very difficult to diagnose. The authors discuss the value of immuno-electro-diffusion on cellulose acetate which is a rapid and sensitive technique for the demonstration of remarkable precipitating systems: polysaccharide and chymotrypsin arcs. This investigation enables subjects who really have the disease to be distinguished from "contact" subjects.

The case of a 52-year-old patient with systemic amylosis diagnosed upon examination of an osteomedullary biopsy specimen is reported. The most prominent clinical manifestation was a major hemorrhagic syndrome which was recognized as being a result of severe factor Stuart deficiency. The new classification of amyloses based on the latest biochemical and immunological findings is recalled. Current physiopathogenic speculations put emphasis on plasmocyte-macrophage cooperation. Lastly, factor Stuart deficiency, which is as classical as it is uncommon, could originate in the particular affinity of amyloid fibers for this factor and in a "mass effect" (quantity of amyloid substance directly exposed to blood flow), explaining why splenectomy is effective in some instances.

In 200 young patients with apparently idiopathic spontaneous pneumothorax, the following radiologic features were analyzed: degree of collapse on the initial chest film, areas of atelectasis, and presence of blebs, apical opacities, fibrous adhesions, pleural effusions, and controlateral shift of mediastinal structures. Confrontation of apical changes with pathologic findings in operative specimens suggests that mesothelial rupture with reactive hyperplasia results in a "pneumatization chamber" visible as a bullous image. Following drainage, homolateral shifts of mediastinum and four cases of pulmonary edema were recorded. Risk factors for pulmonary edema include severe pulmonary collapse with areas of atelectasis, persisting for more than 48 hours and an aspiration which either exceeded 1.5 l. of air or was performed with a depression of more than 30 cm of water.

From a personal case and a review of the literature, it is recalled that bromocriptine may induce pleuropulmonary fibrosis. The various presentations of this condition are described. The index patient is a 56-year-old man, with Parkinson disease and a negative history for respiratory disease, who was taking bromocriptine in a high dose (60 mg/d). Under this treatment, he exhibited weight loss and an inflammatory syndrome and developed interstitial pneumopathy with secondary pleuropulmonary fibrosis, which resolved in part once therapy was discontinued. Bromocriptine, which is an ergot alcaloid with dopaminergic properties, has been used since 1965 in therapy. Its indications, which at the outset were restricted to endocrinology, were extended in 1972 to Parkinson disease, with a significant increase in dosages from 1979. Its responsibility in pleuropulmonary fibroses was suspected in 1981 by Rinne on data from 5 patients. As of now, 8 cases have been reported. All are Parkinson patients who, after a variable time interval (15 days to 3 years), developed a uniform picture of pleuropulmonary disease with rapidly increasing dyspnea upon exertion and deterioration of general health. These features mirror inflammation then fibrosis of the pleura and lung tissue, which results in a variable degree of chronic restrictive respiratory failure. The course is equally uniform, with partial resolution under corticosteroid therapy and more or less significant residual fibrosis at discontinuation of treatment. Immunoallergic rather than toxic or vasomotor mechanisms seem involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Beta-2 microglobulin (beta 2 M) is a low molecular weight protein filtered by the renal glomerulus, then reabsorbed and metabolized at the proximal tubule. Its blood concentration is a good renal index, as it is independent from muscle mass and diet contrary to creatinine. We assayed serum beta 2 M in 190 cases of diabetes mellitus divided into 71 non-insulin-dependent and 119 insulin-dependent forms. We found no significant difference between both groups. Serum beta 2 M was not correlated with Hb A 1 C. Conversely, a highly significant positive correlation between beta 2 M and serum creatinine and a negative correlation between beta 2 M and creatinine clearance were demonstrated. Furthermore, patients with borderline serum creatinine and those with normal renal function show very significant differences in mean serum beta 2 M concentrations, thus making combined assay of both parameters advisable. On the other hand, we were unable to evaluate modifications in beta 2 M according to other complications of diabetes mellitus as vascular and neurologic involvement are very often associated with renal dysfunction.