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

Eleven cases of breast hamartoma are reviewed. This benign lesion can be diagnosed on the basis of its mammographic appearance. It is characterized clinically by a well-circumscribed lump which can be readily shelled out at surgery; radiologically by its typical features of a clear or heterogeneous picture with a radiolucent zone; and histologically by its normal mammary tissue (a mixture of fibrous stroma, fatty tissue, ducts and lobules). Surgical enucleation is not mandatory, and is only performed when the hamartoma is uncomfortable and/or unsightly.

The observation of a 21 year-old man with primary common variable hypogammaglobulinemia and total villous atrophy is reported. Gluten withdrawal induced considerable improvement in malabsorption and mucosal damage. However, protein-losing enteropathy, nodular lymphoid hyperplasia and immunoglobulin deficiency were persistent. To our knowledge, improvement on gluten-free diet has been reported until now in 18 previous cases. This report illustrates the links between immunodeficiency and malabsorption, which are discussed.

Two personal observations of febrile reaction to D-penicillamine in patients with rheumatoid arthritis provide the opportunity for recalling the clinical presentation which is fairly uniform. The physiopathological mechanism is still unknown. In Wilson disease, progressive reintroduction of the drug may be successful.

Cutaneous involvement is uncommon in Hodgkin disease. Among 167 Hodgkin patients, we observed skin lesions in four. Clinical and histopathological features are discussed and compared with those of 40 other well-documented cases previously reported in the literature. The wide spectrum of clinical patterns and variability of outcome are underlined. Skin biopsy is mandatory and provides cardinal evidence for diagnosis; however, the Reed Sternberg cell is not absolutely specific and caution must be taken in affirming a disease which implies major therapy. In most observations, skin involvement obviously has no bearing on prognosis. We believe that the reality of specific Hodgkin skin lesions is subject to major reservations.

This article does not deal with the general problem of splenosis, but with the pathology of splenic nodules implanted in the peritoneum. This condition is uncommon, and chiefly hematological and infectious in the index case. Although this issue is debated, functional activity of these nodules is substantiated, leading to consider therapeutical applications in some exceptional cases.

The etiology of systemic scleroderma is still unknown. This disease is well individualized by its usual forms, i.e. acrosclerosis and diffuse form, whose features and prognosis differ. The description of new entities has generated further interest, particularly through a different diagnostic and therapeutic approach. No specific biologic or immunologic criteria of the disease have as yet been discovered. Prognosis depends mainly upon the severity of visceral involvement. There have been little improvements in therapy which rests upon presumptive physiopathological hypotheses.

Tamoxifen, a non-steroidal antiestrogen, is currently used to treat post-menopausal breast cancer. In estrogen-sensitive breast cancer cell lines, tamoxifen and some of its metabolites display, for the induction of estrogen-regulated proteins, a partial agonist/antagonist activity. They also inhibit totally the proliferation of these cells. Evidence is given, which suggests that the pharmacological properties of these antiestrogens are mediated by the estrogen receptor. These antiestrogens interact with the estrogen receptor but they appear to induce only a partial or altered activation of the receptor. This partial or altered activation and the competition with estrogens for binding to the estrogen receptor could explain the estrogen agonist/antagonist properties of antiestrogens.

After a brief review of menopausal disorders, the author develops three chapters. The first deals with conventional hormonal or replacement therapy, which has beneficial effects on vasomotor disorders, atrophy of the urogenital tract and osteoporosis, but also carries a risk of adenocarcinoma. Next, the author gives the oncologist's point of view, expounding in particular the major contraindications of estrogen therapy. The third chapter develops non-hormonal treatments of menopause, their specific mode of action and advantages, with a reference to veralipride. In his conclusion, the author emphasizes that hormonal and non-hormonal treatments of menopause should not be opposed but are complementary.

A case of leptospirosis with isolated myocardial involvement is reported. Diagnostic problems set by this uncommon clinical picture are considered. The cause of the increase in CPK and MBCPK concentrations, reflecting myolysis, is discussed.

The authors report two new cases of splenic epidermoid cyst. They stress the importance of sonography and the need for thorough examination of the surgical specimen for establishing the diagnosis. They also discuss several etiological hypotheses. Although uncommon, the possibility of an epidermoid cyst must always be considered once the echinococcal nature of the cyst has been ruled out, in all cases of splenic cysts in children or young adults.