Biomedical subjects
Publications and source records attributed to G Lefort.
The authors report two cases of urinary ascites in neonates secondary to posterior urethral valves. They insist on the fact that the treatment is an emergency and should be as simple as possible. The resection of the urethral valves is done to allow a good bladder drainage. The leak of urine avoids the renal damage due to hydrostatic pressure. This explains the usual good prognosis of this pathology.
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From six cases of brachial arterial injuries following supracondylar fractures in children, a simple management is proposed. Vascular exploration must be done in absence of radial pulse after bony reduction. If non macroscopic lesion exist, it could be a transitory spasm. On the contrary macroscopic lesion of artery point out injury of its layers that requires an arteriotomy with vascular restoration by resection anastomosis.
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The authors have observed an eleven-year-old boy with an unusual example of dysplasia epiphysealis hemimelica. Initially there was an intra-articular cartilaginous loose body in the knee. A discrepancy in limb length was noted, which corrected spontaneously. After an eight year follow-up, knee destruction was severe despite surgical treatment on three occasions. A tibio-tarsal arthrodesis was also performed.
The authors report a case of total bladder duplication by frontal septum. The anterior bladder was functional. The posterior bladder was non-functional, and drained a destroyed kidney. Analysis of the rare cases reported in the literature suggests that this malformation should be differentiated from other bladder duplications, because it may be a giant ureterocele. In conclusion, the authors stress the simplicity of the management, consisting of resection of the septum and nephrectomy of the non-functional kidney.
The discovery of a dislocation of the upper cervical rachis through corporeal hypoplasia of the C3 ans listhesis of the C2 gives rise, at the age of 18 months, to a stabilization by means of surgery due to the threat of compression myelithis. A review of relevant literature brings to emphasis the ill-knowledge of spinal damage and the wide variety of its different types in cases of the Larsen syndrome.
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The staphylococcal cell wall protein A is known to bind specifically and rapidly to most of human immunoglobulin G. We have utilised this immunoadsorbent in a radio-immunoassay for antithyroglobulin antibodies (anti-Tg), to separate autoantibodies-125I thyroglobulin complexes from free 125I thyroglobulin (125I Tg). There was no specific precipitation of 125I Tg in the presence of 95,6% of sera from normal subjects (N = 45). In graves' disease, 56/65 hyperthyroid patients sera were positive, and so were 12/13 sera from patients with primary hypothyroidism. This assay showed a good correlation with the second antibody method, while much more rapid and slightly more sensitive. Compared with the new assay, the red cell agglutination test exhibited a high frequency of false negative results. This rapid, sensitive and inexpensive method provide an easy and reliable tool to screen sera acceptable for thyroglobulin measurement.
In an attempt to identify a possible pathogenetic role for the hCG molecule in the mechanism of the hyperthyroidism which occurs in choriocarcinoma, we have looked for evidence that the hCG molecule has a thyrotropic action on the human thyroid. The thyrotropic activity of various hCG preparations on the human thyroid was assessed by measuring the stimulation of adenylate cyclase activity in human thyroid plasma membranes purified by sucrose density gradient centrifugation. The highly purified hCG CR119 preparation stimulated human thyroid adenylate cyclase activity. Its activity was more than 654 times greater than could be accounted for by human TSH (hTSH) contamination of the preparation, as determined by RIA. The thyrotropic activity intrinsic to 1.0 IU hCG was equivalent to roughly 0.27 microU hTSH. Significant saturable binding of the 125I-labeled highly purified hCG preparation to human thyroid membranes was demonstrated, and the bound component was characterized. Its apparent molecular size, subunit composition, and testis receptor-binding characteristics were those of the hCG molecule. Examination of a crude urinary hCG preparation in adenylate cyclase and TSH radioligand assays using human thyroid membranes showed no evidence of any molecule other than hCG with a thyrotropic action on the human thyroid. Given that hCG binds to and stimulates adenylate cyclase activity in human thyroid tissue, as the above data indicate, then human LH (hLH) would be expected to do the same, since hLH and hCG have such strong structural and functional similarities. As anticipated, a highly purified hLH preparation exhibited TSH binding inhibition and adenylate cyclase stimulation. Its activity was more than 1030 times greater than could be accounted for by hTSH contamination of the preparation. The thyrotropic activity intrinsic to 1.0 IU hLH was equivalent to roughly 44 microU hTSH. Thus, in addition to other shared properties, the hLH molecule and the hCG molecule share the ability to interact with human thyroid tissue. These results strongly indicate that the hCG molecule has a thyrotropic action on the human thyroid and support the hypothesis that hCG is the thyrotropic factor that mediates the hyperthyroidism which occurs in patients with hCG-secreting neoplasms.
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After observing a sternal failure of closure, the authors indicate how rare this anastomic defect is, and explain its embryo-genic formation. Besides the use of early postnatal operations they emphasize the benefit of a delayed operation and the use of a silactic plate. This method is easy, its functional and anesthetic results are stressed.
Concerning a congenital diaphragmatic hernia with abnormal systemic artery, the authors point out the classification of Pryce concerning pulmonary sequestrations and also the new classification proposed by M. Merlier and his collaborators. Their opinion is that in the case of sequestration of type I cutting and stitching of the artery must be carried out as a matter of course in order to prevent accidents which can be serious.
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The incorrect position of the anterior tibial tuberosity responsible for the pushing into jagged shape of the extensor apparatus of the knee has various causes. Among these, "knock-kneed"walking may induce some children to compensate by a hyper rotation of the legs in order to reestablish a normal walking position. Other origins may also be pointed out : --an outward twist of the leg bones --hyper rotation in outward turning sometimes as a result of accident but more often hereditary. The closing of angle Q of the extensor system modifies the pressure vectors on the femur patellar connection leading eventually to disturbances in the growth of its outer side and to a distension of the inner stabilizing elements leading to partial dislocation of the patella. This physiopathological conception should lead to a selective therapeutic orientation based on a clinical examination. In this field much can be said for dynamic interventions (lowering of the vastus medialis transferring of the pes cornivus muscles, etc...) aimed at correcting the imbalance.
Based on a clinical observation of a paranoid filiation delirium, the authors raise the fundamental question of the nature of psychotic structure itself. They suggest an interpretation of the structure of the psychosis as an attempt to rationalize and give shape to an inarticulate discourse. This work as a whole should be looked upon in the perspective of a new approach to the psychiatric occurrence through what might be called a relativist epistemology.
Our surgical therapeutic attitude in neurological complications of fractures of the spine seems to us justified by the results which we have obtained. It never caused any aggravation and permitted better relief of the complications of bed rest during the early stages. It always permitted satisfactory vertebral position. It is of course difficult to say definitely whether it was responsible for the neurological recovery often observed. It is nevertheless probable in a certain number of cases and in any case, this recovery will occur under better conditions more favourable for later rehabilitation. But one should emphasise if one wishes to improve further the results, that this reduction should be performed very rapidly.