[Amyloid goiter. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to E Justrabo.
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A 58 years-old woman has had a goiter for many years. She was treated by neck irradiation for "lymphadenopathy" 20 years-ago. She is now operated on for bilateral carotid body paragangliomas and a similar tumor of the thyroid gland near the midline. She also presents a papillary carcinoma of the left thyroid lobe with lymph node metastasis and a chief-cell parathyroid adenoma. The diagnosis of thyroid paraganglioma is discussed. Then the authors raise the hypothesis of radiation-induced papillary carcinoma. They try to set a link between thyroid tumors and parathyroid adenoma.
The authors report on two cases of cholesterol embolism, with one masquerading as polyarteritis nodosa. Cholesterol embolism is a frequent but often unrecognized complication of ulcerous athero-sclerosis. Atherosclerotic foci release a large quantity of cholesterol crystals, spontaneously or after endovascular manipulations, inducing the obstruction of small arteries, 150 to 200 microns in diameter, in various organ or tissues of the organism, such as the kidneys, the spleen, the pancreas, the digestive tract, the skin and the retina. Cutaneous, muscular, reno-vascular and visceral forms have been described, based on the distribution of the crystals. This disease, with its multiple systemic localisations and biological abnormalities may sometimes be confused with polyarteritis nodosa and constitutes the pseudo-PAN form of cholesterol embolism. In all these cases, the simplest method of diagnosis consists in the examination of the fundus and in the analysis of skin and muscle biopsies. Finally, the features of the arteriolar lesions and the lack of immunological disturbances suggest that cholesterol embolisms are form of microcrystalline arteriopathy.
The benign clear cell tumor of the lung is an uncommon neoplasm. It is often confused, before histological analysis, with metastases. The data of one personal observation are similar to those of 19 other cases of the literature. This tumor which occurs with an equal frequency in adults of the two sexes is often asymptomatic. It is discovered after a systematic x-ray control of the lungs. It is located in the peripheral parenchyma and looks like a round, homogeneous, well delimited opacity. Its evolution is always favourable after surgical excision. The benign clear cell tumour is never identified before pathological study. This neoplasm 1 to 6 cm in diameter consists of a uniform proliferation of clear cells filled up with free of intra-vesicular glycogen. Its cytological and structural features are not the same as those of the other primitive bronchopulmonary tumours having an important clear cell contingent. The histochemical and ultra-structural studies are at the origin of three hypotheses; is the benign clear cell tumor an apudoma, a smooth muscular neoplasm or an adenoma of the terminal bronchioles?
A long-term experiment was performed to test the ability of chenodeoxycholic acid (CDCA) to induce intestinal tumors in the Syrian golden hamster. Animals were fed a CDCA-enriched diet up to 12 months, and 4 of them were sacrificed every 2 months. CDCA exhibited no carcinogenic activity. However, unexpected amyloid deposits were discovered in both treated and nontreated animals. Their incidence was significantly higher in treated (71%) than in nontreated (27%) hamsters. During CDCA administration, amyloidosis appeared as early as the second month of treatment. It involved the liver, spleen and kidneys in more than half of the animals. On the contrary, in control animals, amyloid deposits appeared later and were most frequently restricted to one organ. The intensity of the lesions also appeared to be greater in the treated group. No monoclonal components were found in either serum or urine of the amyloidotic hamsters. Such an amyloidosis-promoting effect of CDCA has never been reported.
We report the first histologically described case of severe D-penicillamine-induced pneumonitis. It occurred in a 73-year-old woman who suffered from rheumatoid arthritis and had previously demonstrated gold intolerance. Pathologic study disclosed marked interstitial and alveolar damage resembling that described with certain chemotherapeutic agents. We assess the drug's responsibility, discuss possible pathogenetic pathways, and provide suggestions regarding the patient on a D-penicillamine schedule.
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A uraemic patient undergoing chronic haemodialysis developed diffuse metastatic pulmonary calcification and died from acute respiratory insufficiency after renal transplantation. Thirteen similar cases previously published are reviewed, with emphasis on the clinical and anatomical features of such calcinosis. The pathogenesis of this calcification in patients on maintenance haemodialysis and some rules for its prevention are discussed.
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