[Combined determination of total alkaline phosphatases and 5-nucleotidase in bone pathology].
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Biomedical subjects
Publications and source records attributed to A Flechaire.
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Mitochondrial cytopathies are diseases due to a defect of mitochondrial respiratory chain and are characterized by the presence of morphological abnormalities of mitochondria (ragged red fibers). The clinical manifestations can be polymorphic as various organs may be involved; but in general, these disorders affect either muscle alone (progressive external ophtalmoplegia, myopathy with weakness) or muscle and brain (encephalomyopathies). Some of these diseases may be due to alterations of the mitochondrial genome. Diagnosis can be achieved through the following steps: measurement of lactate, pyruvate and ketone bodies after fasting followed by a carbohydrate rich meal and/or exercise; histological examination and biochemical investigation of a skeletal muscle biopsy; study of possible mitochondrial genome alterations.
The authors present 7 cases of disseminated intravascular coagulation (DIC), 4 of them with hemorragic syndrom, with appeared in the course of different adenocarcinomas (prostatic, pancreatic or undeterminated). Emphasis is set on 2 points : -- in all cases, metastasis of these cancers can be found in the bone marrow and/or the liver ; -- DIC may be the first sign of the disease. The pronostic is very bad, even with heparinic therapy because of the lack of specific treatment but for prostatic cancer.
The authors describe a disseminated multivisceral form of african histoplasmosis due to H. duboisii in a 45 years old black woman. Clinical examination shows characteristic lesions of skin, bones and lymph glands. Lymphography reveals lesions of deep lymph glands and laparascopy lesions of liver and spleen. First untimely stopped, treatment was started again with ketoconazole. 20 months later, the course of the disease is, as for as we can appreciate it, favourable.
The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.