[Posttraumatic hematoma of the adrenal gland. Anatomoclinical study. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to C Bollack.
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The injection of E. Coli into the tail of the epididymis in the rat caused epididymitis. In 20% of the cases, the inflammation is spread through the lymphatic system to the testis. The germinal cells are destroyed in 50% of the cases by the second day, and are not reestablished for several months. Signs of testicular inflammation are not found. The destruction seems to be caused by E. Coli toxins, as shown by injections of killed bacteria.
Suprapubic ultrasonography is now routinely used for prostatic examination as it is simple, non-invasive and accurate. Differential diagnosis between benign hypertrophy and cancer is often possible. Evaluation of the size of the prostate is accurate and is a satisfactory means of monitoring the effect of treatment for prostatic cancer.
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The authors study 39 cases of late genitourinary sequelae following abdominopelvic radiotherapy. Several points appear to be of interest: - the mean latent period was 3.5 years for bladder sequelae and 4 years for ureteric complications. Fistulae could develop on average 14 years after radiotherapy; - the possibility of ureteric complications in the form of stenosis after radiotherapy, exclusive of associated surgery; - all lesions were purely due to radiation, excluding recurrences of neoplasm; - bladder complications had striking symptoms with dysuria and haematuria. Ureteric stenosis was sometimes found by chance, being latent; - associated digestive tract radiation lesions were seen in 1 case in 4; - the frequent need for surgery, since this was required in 30 patients out of 39. The operations performed were often extensive; - the grave nature of surgical operations including a digestive phase in these patients who had received large doses of radiation. Peritonitis due to the breakdown of sutures was a notable source of mortality; - one of the great difficulties in investigating such patients is to be able to confirm the purely radiation aetiology of these complications, bearing in mind that amongst urological complications following the treatment of pelvic carcinomas, the majority are related not only to radiation but also to recurrence of neoplasm.
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The induction of tyrosine aminotransferase by a variety of steroids was studied in cells from a hepatoma tissue culture (HTC). We have defined a class of steroids that induce TAT synthesis to a higher level than optimal inducers described earlier; these are called supra-inducers. When TAT induction is compared with the binding of the steroids to the cytoplasmic receptor or to their binding in the whole cell, a good correlation between binding in vivo of the hormone and its induction capacity can be established, whereas such a correlation was not systematically observed in vitro. A very short exposure of HTC cells to either dexamethasone or corticosterone is sufficient to induce TAT. When the inducer is removed from the culture medium a few minutes after its administration, the intracellular hormone concentration decreases very rapidly but TAT will be synthesized at its maximal rate. Thus the hormones behave as a starting signal for the optimal synthesis of the enzyme, and their presence in the culture medium is not necessary throughout the entire induction period.
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Peripheral blood T lymphocytes were studied in 24 untreated patients with renal adenocarcinoma, 80 per cent of whom had local extension of the tumor. T lymphocytes were evaluated with the total and the active rosette assays, and were further submitted to stimulation by a range of phytohemagglutinin concentrations in vitro. Controls were healthy volunteers tested on the same days as the patients. Total E-rosette forming cells were slightly decreased but the difference compared to controls was not significant. Active rosettes were normal. When present lymphocytopenia affected total E-rosette forming cells. The mean of the log-converted stimulation indexes was reduced significantly in the patient group only when a suboptimal concentration of phytohemagglutinin was used. Total E-rosette forming cells returned to normal 3 weeks postoperatively but lymphocyte reactivity did not improve and active rosette forming cells remained within normal range. Thus, only minor abnormalities of T lymphocytes were disclosed in this study, suggesting functional alterations rather than depletion. Our study confirms that a cancer operation may act as immunotherapy.
In Alsace, urate lithiasis accounts for 32.7% of cases of lithiasis requiring hospitalisation. Fifty nine per cent of patients are hyperuricaemic, and only 10% have typical gout. 14.6% are hyperuricosuric but all have isoaciduria. A male disorder in 3/4 cases, it occurs above all after the age of 50. The relatively late onset, combined with marked obesity (mean weight 81.5 kg) is considered by the authors to be an argument proving the role of dietary excesses in the aetiology of this lithiasis. Excessive protein would seem to be the essential feature.
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In an attempt to clarify the significance of the separable forms of tyrosine aminotransferase, the enzyme from rat liver and from cultured hepatoma cells was studied by carboxymethyl-Sephadex chromatography. Our studies of the form conversion during the purification procedure of the enzyme, where all cellular components were quickly discarded, do not allow us to invoke a specific "converting factor", the existence of which in the particulate fraction has been suggested. Moreover the addition of serine protease inhibitors is not sufficient to prevent the classical conversion. More probably, several factors depending on the environmental conditions might influence different reactions which lead to a preferential conformation of the enzyme in vitro. The difference in the PO4- content of the various enzyme forms and the consecutive differences in negative charge may be the determining factor in the elution pattern of the three forms of the isolated soluble enzyme. This observation raises the possibility that phosphorylation might play a specific role in the regulation of tyrosine aminotransferase synthesis.
The authors report a study of 37 kidneys in 30 patients with staghorn calculi undergoing isotopic investigation of renal function by sequential scintigraphy and isotopic nephrogram by gamma-camera. 7 of the patients had bilateral staghorn calculi. Tracers used: Hippuran labelled with I131 and DPTA labelled with Technetium 99 m. 62% of kidneys poorly tolerated their staghorn calculus as shown by severe impairment of the isotopic nephrogram involving the uptake phase. Amongst the 20 cases of unilateral lithiasis, a nephrectomy was performed whenever the functional value was less than 20% normal (7 kidneys). Twelve stones were removed with conservation of the kidney. It should be noted that with renal function greater than 70% normal, the thickness of the renal parenchyma as assessed by IVU is never less by more than 1/2 cm that of the contralateral kidney. In the group, 11 patients underwent postoperative urography and scintigraphy with a mean follow up of 4 years. All extractions of calculi by pyelotomy with or without a small nephrotomy benefited initially impaired kidneys. By contrast, in 5 kidneys where a large nephrotomy was made, there was a gain in function in only one. 1 remained stationary and the others lost respectively 20, 30 and 100% of their function. Correlation was good with other methods of split renal function studies (IVU and renal arteriography). Of essential importance is the fact that the irradiation associated with these isotopic investigations is 20 to 50 times less than that of IVU. Isotopic investigation is thus a good method for the assessment of changes in renal function after surgery for staghorn calculus.
The authors report a rare case of eosinophilic cystitis presenting with heavy haematuria which led to the discovery of attenuated haemophilia B. Bleeding and clotting times in this patient, with no past history of haemorrhage, were normal. Complete coagulation studies led to the diagnosis in the presence of poor plasma prothrombin consumption and a moderate deficit in clotting factor IX, defining haemophilia B. Despite two partial cystectomies for haemorrhagic lesions of the dome of the bladder (eosinophilic cystitis), carried out with transfusion cover and the administration of P.P.S.B., recurrence of haematuria made it necessary to "rest" the bladder by a cutaneous ureterostomy. Subsequently, the restoration of urinary continuity was possible by uretero-ileo-cystoplasty, without any haemorrhagic complications by virtue of the use of P.P.S.B. The value of the association of epsilon amino-caproic acid with P.P.S.B. is emphasised in the prevention of haemorrhagic complications during surgery in haemokphilia B patients. In attenuated forms of haemophilia B (factor IX level between 5 and 15%) haemorrhages may be only occasional and occur only late in life.