Biomedical subjects
Publications and source records attributed to A Galian.
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The mechanism of chronic cholestasis observed during prolonged parenteral nutrition remains unclear. We studied liver function tests in 18 consecutive gastroenterological adult patients submitted to 18 mo (median; range 6-66 mo) of parenteral nutrition. Seven patients (group B) developed a cholestatic nonobstructive jaundice, culminating after 3 mo, (1-4 mo) whereas 11 patients (group A) did not develop chronic abnormalities on liver function tests during parenteral nutrition. Liver biopsies obtained at 4 mo (3-6 mo) in 6 group B patients demonstrated bile duct proliferation in the portal area, with extensive fibrosis, cholestasis, and focal necrosis of hepatocytes. Initial intakes of calories, fat, and protein were higher (p less than 0.01) in group B than in group A patients and, when reduced, were associated with reversal of jaundice and improvement in liver function tests and histological findings. These data suggest that the development and course of cholestasis are influenced by excess parenteral intake of protein and mixed-energy sources.
The authors report the case of a 38 year old man, presenting with an inverted polypoid hamartoma (IPH) of the rectum, associated with similar colonic localizations and they show the resemblance of these lesions to the colitis cystica profunda (CCP) with involvement of the entire large bowel and eventually the rectum. In fact, moreover, the symptoms, the digital rectal examination and the endoscopic, radiological and pathological data are similar but, in the reported cases, the IPH always included at least one rectal localization whereas the CCP might not show rectal lesion. Advanced lesions of rectal IPH may be confused, by endoscopy and pathology with adenomas or adenocarcinomas. Consequently it is essential to perform large and deep biopsies for histological diagnosis. The IPH and the CCP are benign diseases but "recurrence" may be observed in case of incomplete removal. The removal has to be adequate but not mutilating, either by surgery or by laser endoscopic photoablation. The choice of the procedure will depend upon the size of the lesion.
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Biopsies of 30 consecutive suspected liver cancers were performed with 19-gauge fine needles having circumferentially bevelled tips that produced tiny tissue cores suitable for histologic study. The histologic results were compared with the cytologic results on aspirates obtained at the same time with 22-gauge Chiba needles. While cytologic examination of the aspiration smears produced better results than did histologic study of the tiny tissue cores, an improved overall accuracy of 86% was achieved with the combined cytologic and histologic results. The FNA core biopsy technique did not increase the complication rate.
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Duplications of the small bowel are an uncommon group of congenital malformations whose symptoms rarely occur in adults. We report the case of a 21 year-old man who suffered during four years from symptoms related to the ulceration of ectopic gastric mucosa in an ileal duplication (spontaneously resolving peritonitis, pelvic abscess, recurrent gastrointestinal bleeding and chronic abdominal pain). Radiological and endoscopic explorations and a first laparotomy failed to provide the diagnosis. 99m pertechnetate (99mTcO4) scintigraphy demonstrated ectopic gastric mucosa and guided the radiological detection of an ileal ulceration. Injection of 99mTcO4 during a second laparotomy located the ectopic gastric mucosa at the level of a tumefaction found on the mesenteric side of the terminal ileum. Duplication was only recognized at pathological examination of the ileal resection. This case emphasizes the need to evoke a duplication in clinical circumstances like those described in this patient as well as the usefulness of 99mTcO4 in the diagnosis of such a malformation.
The authors report two cases of multiple cancers (three and four) and precise the criterions of multiplicity of cancers, their frequency and their localizations. The factors incriminated in multiple carcinogenesis, often not well known and complicated, are also studied, such as family ground, age, blood groups, hormones, viruses, immunologic deficiencies and some carcinogenic drugs. Moreover, the actual progress in therapy, leading to the healing of the first tumor, may favour the secondary supervening of one or more cancers, as the survival is longer.
The aim of this study is to precise topography of amyloid deposits in the alimentary tract and to differenciate the primary or secondary nature of amyloid substance according to these topographical data and with the help of the Wright's technic. The material of this study consists in nine necropsies and seventeen digestive biopsies, concerning patients with generalized amyloidosis. Immunoglobulinic amyloidoses (so-called "primary") contain predominating deposits in the muscularis propria which remain after Wright's technic. On the other hand, in the non-immunoglobulinic amyloidoses (so-called "secondary"), deposits are essentially localized in the mucosa and disappear (more than 80%) after Wright's technic. Moreover, some special cases, as Portugese amyloidosis and amyloidosis in the course of Crohn's disease, are studied. In the first case, the immunoglobulinic nature of amyloidosis seems to be very likely. In Crohn's disease, in one case, the classical notion of non-immunoglobulinic amyloidosis is confirmed, while, in another one, the amyloidosis is much likely an immunoglobulinic one, and that is a new fact. The authors insist on the practical aspect of this study: it is usually possible to precise the nature of the amyloid deposit on digestive biopsy and so, to give indications to the clinicians about an etiological group.
Six patients with scleroderma (Barnett's type I and II) associated with hepatopathy are reported. Primary biliary cirrhosis was confirmed in four cases and was probably present in one case, while cirrhosis of unknown origin was present in the sixth patient. The outcome was fatal in two cases. Salivary secretions were reduced in all six cases, and a diagnosis of Gougerot-Sjögren's disease was confirmed in four patients. The frequency with which this triple association has been reported suggests that its incidence has been underestimated.
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