Biomedical subjects
Publications and source records attributed to F Le Gall.
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OBJECTIVE: To clarify and classify the still debated diagnostic and prognostic elements of borderline tumours of the ovary and analyze the data obtained in our series. AIM: Develop an adapted management scheme, integrating relatively good prognosis and known or suspected factors of poor prognosis. SIEGE: Department of Gynaecology-Obstetrics, Hôtel-Dieu (CHU) Rennes, France. SUBJECTS: Eleven patients with borderline tumour of the ovary diagnosed and managed over the last 5 years. RESULTS: Current morphology and macroscopy examinations of the tumour do not provide data capable of predicting malignancy. The borderline nature of the tumour is not a histological diagnosis. The problems encountered lead to a search for new techniques such as digitalized nuclear morphology. Some progress has been made in classifying prognosis factors. Other than stage, important factors appear to be age, histological type, mitotic index, atypical cells and invasive peritoneal implants. Management decisions depend on prognosis factors but should especially take into account parity. Methods include cystectomy and total hysterectomy with annexectomy. Evaluation of chemotherapy and radiotherapy is still to preliminary. CONCLUSION: The slow clinical course, allowing good mid-term prognosis, is still the best reason for a moderated therapeutic approach relying on conservative or more aggressive surgery alone.
Neighteen Mbororo zebu herds were monitored to evaluate the impact of a trapping campaign against Glossina fuscipes fuscipes restricted to the watering places. This programme is part of the strategy of an integrated campaign against bovine trypanosomoses in the Central African Republic. Trapping reduces the densities of G. f. fuscipes and causes trypanosome prevalence to fall. These effects are shown by the improved hematocrit values and the reduced number of trypanocidal treatments administered. The impact on productivity is more difficult to assess over a short period; nevertheless, it seems clear from the parameters calculated.
The authors report a case of laryngeal ulceration due to cytomegalovirus occurring in a 60-year-old man one month after heart transplant. The recipient was initially CMV seronegative and the donor positive. No preventive treatment was administered. One month after the transplantation, search for CMV in blood and urine became positive and a seroconversion occurred. Laryngeal biopsy showed an inflammatory reaction with cells containing atypical inclusions and positivities with anti-CMV antibody. Usual intranuclear eosinophilic inclusions of classic CMV infection were absent. The authors stress the unusual site of the lesions in this primo-infection and the atypical aspect of the inclusions. Such atypical inclusions which have already been reported in immunosuppressed people make the diagnosis more difficult.
The authors report two cases of non functional parathyroid cyst both found by a systematic clinical examination in two women of 56 and 67 years. In the first case, the cyst was associated to a thyroid dystrophy; the other patient had a history of thyroid dystrophy but also of pituitary prolactin adenoma.
The authors report a case of congenital epulis in the lower gum of a new born female. This rare benign tumor of the newborn is histologically characterized by the granular aspect of its cells. It occurs more frequently in females than in males. Differential diagnosis mainly concerns Abrikossoff tumor whose histogenesis and evolution are different. The distinctive features of epulis are the presence of a fusiform cell component and the negativity of the granular cells for PS100.
In the early 1960s, the most part of the Central African Republic was located inside the distribution area of Glossina morsitans submorsitans Newst. Since the last distribution studies of this tsetse in CAR (in 1963), the number of cattle has increased from 400,000 to approximately two millions, mainly of the Mbororo zebu breed. To set up the present distribution of G. m. submorsitans a study by trapping has been carried out in 27 livestock areas, regarding about 1,200 pastoralists' settlements. Furthermore, north-south transects have been made using both trapping (with bipyramidal traps laid every 2,000 meters) and net-catching (within a car driving slowly). The result have shown the disappearance of G. m. submorsitans from the main livestock areas in the west (Bouar, Bozoum, Bocaranga, Batangafo, Bossangoa, Paoua), centre (Bossembélé, Bouca, Dékoa) and east (Bambari, Grimari, Ippy). The southern border of the distribution area has been moved upwards to the north by up to 400 kilometres in the west of the country. This important retreat is discussed. It leads to a huge increase in the pastures available for the Mbororo pastoralists. Their access is still restricted in the centre-north and in the east by wild game reserves where G. m. submorsitans remains.
Keratomycosis due to Aspergillus fumigatus occurs most often in immuno-competent patients who live and work in a fungus-rich atmosphere. Previous trauma with epithelial lesion are reported by most authors. While the new antifungal drugs may be effective, corneal graft is the most effective solution in uncontrolled cases. When performed early, good visual recovery was observed in most cases as reported in the literature and in our case.
From 1987 to 1993, a survey on the feeding behavior of Glossina fuscipes fuscipes was conducted in the Central African Republic. A total of 556 blood-meal samples was analyzed by ELISA. According to the results, the number of blood meals from cattle was rather low (12% on average). During the rainy season, this number increased significantly and varied according to the sampling area. Along the riverine forests, this amounted to 5%, while blood meals from wild ruminants amounted to 87%. In the neighborhood of watering-places, the number of cattle blood meals reached 9-22%. Reptiles were found to be important hosts (17-35%). In all cases, man presented a non-negligible host (4-14%), similar to suidae (2-19%). The authors discuss the relevance of these results to risk of trypanosomes transmission.
Rhabdomyosarcoma accounts for 5% of childhood malignant tumours; in 10% it occurs in the orbit where it is the most frequent malignant tumour. Rhabdomyosarcoma is a mesenchymatous tumour with striated muscular differentiation. However, this myogenous differentiation is sometimes undiscernable on standard histological examination and requires immunohistochemical and ultrastructural studies to be shown. Treatment depends on the assessment of local extension, principally based on tomodensitometry. When the tumour is limited to the orbit, survival rate may reach 100% with todays therapeutic protocols. When the orbital walls are invaded the tumour is parameningeal and recovery can only be achieved by increasing chemotherapy at the cost of long-term side effects. Hence, this tumour must be diagnosed and treated very early. The authors report two cases of rhabdomyosarcoma dealing with the two main histological forms of the tumour and with their evolutive risks.
We studied the hormonal secretion of a human mixed follicular and medullary carcinoma. Thyroglobulin (Tg) secretion, especially by large cells and sometimes by small ones, was visualized with immunoenzymatic staining. Calcitonin (CT) was produced by small spindle-shaped cells. Moreover, immunofluorescence double staining performed on the resected thyroid tissue showed the secretion of both Tg and CT in a small number of cells. The cells lost their hormonal secretion after 2 months of culture. Hormonal secretion was modulated by different additives in the medium. Tg secretion was induced when TSH was added to the culture medium; the maximal effect was produced with the addition of 1 mU TSH/ml and 1 microM cortisol, which potentiated the effect of TSH on Tg production. A durable Tg secretion was obtained by embedding the cells in Engelbretch-Hohn-Swarn (EHS) tumour matrix. The CT production was reinduced by the addition of 4 mM Ca2+, 1 microM glucagon and 1 microM cortisol to the culture medium. These findings show that different cells are found in a mixed follicular and medullary carcinoma, some of which can secrete both CT and Tg. They can remain differentiated for a long period after being embedded in EHS tumour matrix with Ca2+ and hormonal components.
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The authors studied the diagnostic interest of cell cultures in thyroid tumors. They cultivated 10 tumours (4 papillary carcinomas, 5 medullary carcinomas and 1 sarcoma-looking tumour). In 7 cases, cultures yielded nothing more than pathologic examination. Nonetheless the study allowed to detect a double secretion (calcitonin and thyroglobulin) in 2 medullary carcinomas which turned out to be mixed proliferations. It also detected a production of thyroglobulin by the sarcoma. They think that cell cultures may have a diagnostic interest besides pathologic examination, allowing precise study of secretory features of the tumors.
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The authors report a case of neuroendocrine carcinoma of the lower third of the esophagus. Immunohistochemical study revealed that most tumor cells expressed neuron specific enolase, chromogranin A, carcinoembryonic antigen and glucagon. They insist on the usefulness of this study on biopsies in order to guide therapeutic decision.
We reconstituted functional follicles from isolated cells, after embedding in a collagen matrix. Therefore we could carry out many investigations. We showed that the cells embedded in collagen reorganized into functional follicles secreting thyroglobulin (Tg) visualised in the intra-follicular compartment, and triiodothyronine (T3) after TSH stimulation. We used these reconstituted follicles for testing several drugs, amiodarone, propranolol and some anaesthetic drugs (thiopental, midazolam and ketamine). We observed that all these drugs inhibited partially or totally, according to the dose administered, the follicular production of Tg and T3. We also found that the follicles reconstituted from thyroid Grave's tissues gave an abnormal secretion of Tg and T3. Finally we created in Rennes a human thyroid model that permits the exploration of pathologic tissues and that may be used in pharmacotoxicology.
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