Case of the month No. 70: Barrett's esophagus, with structure and ulceration.
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Biomedical subjects
Publications and source records attributed to J M Levy.
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A case of superficial diffuse nephroblastomatosis involving both kidneys in a 14-months old child is reported. Urographic and arteriographic results as well as the still little-known ultrasonographic images made it possible to determine pre-operatively the nature of the tumour and to exclude the initial diagnosis of Wilm's tumour. A relatively non-aggressive chemotherapy resulted in complete involution of the subcapsular tumoral envelope. The close embryogenic and oncogenic relationship between nephroblastoma and nephroblastomatosis is recalled.
At the community medical center, we have introduced and successfully applied digital subtraction angiography (DSA) to disease processes seen in 1,144 patients. Although there is a trade-off between increased contrast resolution and decreased spatial resolution with the DSA approach, nonetheless in many vascular beds it provides rapid, safe, and accurate disease diagnosis.
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Prostaglandin E1 (PGE1) is a rapid, potent vasodilator which, when infused into the arterial system in low doses by bolus injection, has no significant systemic effects and has a relatively long duration of action. Sixty-three hand angiograms were done on 55 patients, comparing PGE1 to tolazoline and to angiograms done with no vasodilation. There was no significant difference between PGE1 and tolazoline in digital artery opacification; however, venous opacification was very significantly better with PGE1. PGE1 should be a drug of choice in hand angiography.
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An osteoid osteoma nidus was removed under computed tomography (CT) scan guidance. This procedure may have advantages over en bloc resection for treatment of osteoid osteoma since it ensures the removal of the nidus without producing a large bony defect such as results from en bloc resection.
Two patients with type I Glanzmann's thrombasthenia and 20 kindred of these patients belonging to 2 families of the Manouches gipsy tribe have been studied. Quantitative measurements of platelet membrane glycoproteins GP IIb and GP IIIa have made it possible to classify the patients into normal, thrombasthenic or carriers of the thrombasthenic abnormality. We have examined several red cell alloantigens and antigens of the major histocompatibility complex. These studies have shown that: 1) type I Glanzmann's thrombasthenia (GP IIb and IIIa abnormality) segregates independently of Ss and Fy systems and the A, B, C, Bf, C2 and C4 loci of the HLA complex; 2) a rare hemolytically inactive C4 variant segregates in these families but is not associated with the GP IIb and IIIa abnormality.
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Transvenous digital subtraction angiography was used before surgery to evaluate seven patients with chemical evidence of hyperparathyroidism. Digital subtraction angiography identified parathyroid adenomas in six of the seven patients. This technique is a sensitive, although not specific, method to identify small vascular tumors.
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Plasma renin (PRA) and aldosterone activities were measured in 29 obese children and in 48 controls of the same age. Blood samples were taken at 8 AM after a night's sleep and after 3 days of a diet with normal sodium intake. The PRA in the obese children was lowered: m = 1.00 ng/ml/h (controls = 1.86 ng/ml/h; p = 0.01). The drop in plasma aldosterone activity was not significant: m = 134.1 pg/ml (controls: m = 167.5 pg/ml). Plasma aldosterone activity was positively correlated with PRA in controls (p less than 0.01): this correlation was not found in obese children. In obese children no dissociation could be found, in the resting state, between plasma aldosterone activity and PRA, contrary to obese adults under stimulation. In fact, 1) the aldosterone/PRA ratio did not differ significantly between obese children and controls, 2) the average value of plasma aldosterone activity that one could predict in the obese children from their average PRA level and the linear regression calculated from the controls exactly corresponded to the measured value. The elevated blood pressure found in the obese children could explain the drop in the PRA which would thus remain adapted to the blood pressure level.
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