[Tuberculosis of the esophagus. Apropos of 7 cases].
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Biomedical subjects
Publications and source records attributed to J Grellet.
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The authors report on the first case of aneurism in a persisting sciatic artery observed in France. The condition was complicated by truncular embolism and fissuration and was successfully treated by endo-aneurismorrhaphy. Restoration of arterial continuity is nevertheless necessary in most cases of aneurysm affecting a complete persistant sciatic artery (providing the vascular supply for the whole lower limb) which represents the commonest anatomical type.
An APUD adenoma of the right adrenal was discovered in an adult after angiography and compted tomography The tumor had provoked a WDHH syndrome. Selective venous sampling before operation demostrated the presence in the tumor of hormonal secretions (VIP and catecholamines). The patient recovered after excision of the tumor, which contained large quantities of intracellular somatostatin and VIP.
Fairly small amounts of air (usually one loop visible) were found in the small intestine of 41,2 plus or minus 3,4 p. cent (at the 95 p. cent confidence level) of a series of 827 adults (553 inpatients and 274 outpatients). Air in the small intestine was noted more frequently in the hospitalized patients (45,2 plus or minus 4,1 p. cent) than in the outpatients (33,2 plus or minus 5,6 p. cent) (p. less than 0,001). This study confirms the hypothesis, contrary to conventional data, that the presence of air in the small intestine occurs sufficiently frequently for it not to be considered pathological. Air is more frequently visible in the proximal jejunum (48,4 p. cent) than in the ileum (27,3 p. cent), and is noted in the umbilical region, the transition zone, in 24,3 p. cent of cases. The mean diameter of th proximal jejunal loops is 25,6 mm (standard deviation 3,7 mm). The thickness of the proximal jejunal folds varies between 1 and 2 mm, the interfold thickness being 3 to 6 mm. The thickness of the small intestine wall (measured in the interfold space) is less than 1,5 mm. These figures relate to direct measurement of radiographic images, without correction due to enlargement.
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Multiple spleens were first discovered accidentally during abdominal arteriography and were then investigated by selective and highly selective injections. The vascularization of the small spleens was by means of a branch of a main coeliomesenteric artery, which appears to be a constant feature in this syndrome, and possibly by an accessory artery arising directly from the aorta.
In this article, concerned with the normal radiological anatomy appearances of the colon after double contrast (mucography) examination, the authors develop the notion of an anteroposterior spatial disposition of the colon. Knowledge of the inclined zones, variable with incidence, in which the barium accumulates, is derived from this notion which appears, therefore, to be of practical value when performing or interpreting double contrast images. The second part of the article concerns a radiological study of the haustrations (blind sacs) and valves of the colon. This precise description of the three rows of haustral sacs could have topographical value in pathological conditions.
After recalling the principles of homothetics which are the basis of radiological pelvimetry by the Thoms method, the authors carry out a study of the pelvimetry accessory presently the most distributed in France. It turns out that the grid introduces an error that, depending upon the conditions under which it is used, can reach levels of 4% underestimation. This error of 4% of something that itself is merely a calculation has little impact since it only affects 8% of the results.
Calculating machines have made the use of Thoms grid unnecessary, and have many advantages: the exact measurements of the different diameters can be obtained, and it is now possible to establish a more precise prognosis by introducing supplementary data such as those obtained by ultrasonography.
In a retrospective study of lymphograms in 55 patients with chronic lymphatic leukemia observed 42-170 months, four lymphographic groups were established according to lymph node size and morphology. In group 1, the lymph nodes were only slightly enlarged and pathologic in appearance. In group 2, the nodes were moderately enlarged and appeared reticular. In groups 3 and 4 the nodes were greatly enlarged and appeared foamy, striated, or "ghostlike" (similar to those seen in lymphoma). The correlation between the lymphographic groups and a new clinical classification (stages O-IV), which has been demonstrated to have prognostic values, was statistically significant: clinical stage O and lymphographic group 1; clinical stages III and IV and lymphographic groups 2, 3, or 4. Clinical stages 1 and II were dispersed throughout the different lymphographic groups. Although the specific prognostic value of the results of lymphography is not apparent in clinical stages O-II, it does seem to be established in stages III and IV. In these stages, the number of deaths was significantly greater in patients in lymphographic groups 3 and 4 when compared with those in lymphographic group 2.
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Two very rare cases of splenic trauma following high translumbar aortography are described. Two types of clinical picture are observed : severe intraperitoneal hemorrhage, subcapsular and then intraperitoneal, from rupture of the spleen, and septic peritonitis following rupture of an intra- and perisplenic abscess. The authors review the frequency, mechanism, and prevention of complications following translumbar aortic puncture.
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On the basis of one case of colonic sub-mucosal cystic pneumatosis explored by double contrast enema, the authors emphasise the pathognomic diagnostic value of the "puzzle" appearance. This appearance is made by precise adaptation of the opaque colonic mucosa depressed in the form of a "cupola" over the intraparietal gas bubble which results in the deformity. Endoscopy failed to reveal the disorder in the case reported here.