Biomedical subjects
Publications and source records attributed to J Palou.
During the study of chronic anemia in a 38-year-old woman, a nonfunctioning left kidney due to multiple asymptomatic ureteral calculi was found on excretory urography. She had self-limited episodes of left flank pain 10 years previously. Antegrade pyelography through the nephrostomy tube and computerized tomography showed a pyonephrotic renogastric fistula on that side.
Histopathologic, immunohistochemical, and ultrastructural studies were carried out on cutaneous lesions of a 43-year-old man with an aggressive peripheral T-cell lymphoma involving the lung, central nervous system, bone marrow, and skin. Some results are distinctive and not previously reported, such as extremely strong epidermotropism, aberrant CD8+ immunophenotype with lack of one pan T antigen (CD5), and giant cytoplasmic granules. We discuss these features comparing them with other hematologic malignancies usually involving the skin, such as cutaneous T-cell lymphoma, adult T-cell leukemia/lymphoma, angiocentric lymphomas, and malignant histiocytosis.
We present a retrospective review of 30 patients who developed upper urinary tract tumors (UUTT) after having been diagnosed and treated for a bladder neoplasm. The mean patient age was 63 years (range 54-72). An average of 4.8 (range 1-10) transurethral resections (TUR) had been performed for bladder cancer prior to the appearance of UUTT. The length of time elapsed between the initial bladder TUR and the subsequent diagnosis of UUTT was variable, with increased incidence in the first 24-72 months (63.3% of the cases). In 21 cases (70%) the bladder tumor was multiple and in 28 (93.3%) the tumor was recurrent. In those patients with unilateral vesicoureteral reflux, an increased incidence of UUTT was found in the refluxing renal unit. In patients with poorly differentiated (grade 3 and grade 2-3) bladder tumors, UUTT was of the similar grade of anaplasia in 75% of cases. These observations, together with those previously published in the literature, allow us to recommend the use of excretory urography (IVP) every 2 years during the first 6 years of follow-up in patients treated for recurrent and/or multiple bladder tumor. Thereafter, follow-up would depend upon the individual clinical situation.
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Presentation of 9 patients with bilateral renal carcinoma, 8 synchronic and 1 asynchronic, diagnosed with intravenous urography, echography and/or CT and all of them treated, in the absence of metastasis, with either radical surgery of one kidney and conservative surgery of the other one, or with conservative surgery of both kidneys. Patients were followed-up until death. Four patients died of cancer, 3 for other reasons and 2 are still alive, mean survival 27.1 months.
For evaluating the therapeutic approaches in the follow-up and complications of patients treated with bone marrow transplantation (BMT), the histopathology is important on many occasions. The authors describe the different morphological changes that have an important role for treatment of these patients, classified according to their target organs of localization: skin, digestive tract, liver, and bone marrow. Graft-versus-host disease (GVHD) mainly affects the skin, gastrointestinal tract, and liver, and is sometimes difficult to differentiate from radiochemotherapy or infectious diseases. In the liver, the most frequent complications are GVHD, veno-occlusive disease, and infections. In the bone marrow, it is most important to evaluate the elimination of hemopathy and the reconstitution of normal hematopoiesis.
Renal haemangiomas, an unusual cause of renal haematuria, are benign vascular dysplasias of uncertain etiology. Usually asymptomatic, their clinical manifestation is a unilateral renal haematuria associated or not to obstructive urological disease through accumulation of clots in the urinary tract and arterial hypertension when associated to a major arteriovenous shunt. Arteriographic diagnosis is based on the size of the vascular malformation but the absence of findings in the arteriography does not eliminate the presence of small-sized haemangiomas or microhaemangiomas responsible for the renal chronic haematuria, also labelled as "essential haematuria", which sometimes can be diagnosed through endoscopic examination of the renal cavities. This report presents one case of renal haemangioma which appeared as a massive, sudden haematuria and prompted haemodynamic instability requiring haemotherapy. Following arteriographic diagnosis, selective transarterial embolization was undertaken with three modified Gianturco's metal helicoids, to which the patient responded favourably. The report includes a review of the clinical, pathological, diagnostic and therapeutical features of renal haemangiomas.
We have studied a family with an autosomal dominant inheritance of primary localized cutaneous amyloidosis (PLCA) and familial medullary thyroid carcinoma (MTC). Ten family members were screened for multiple endocrine neoplasia (MEN) 2; five were found to have MTC and two had C-cell hyperplasia. None had evidence of phaeochromocytoma or parathyroid abnormalities. Five of these seven patients presented characteristic interscapular hyperpigmented lesions, showing dermal amyloid deposits in two of the four patients in which a biopsy was performed. The data are analysed in the light of two recent reports of MEN 2A associated with identical lesions. We conclude that PLCA should be sought in MTC patients, even if no other endocrinopathies are present. This may be informative of the familial character of MTC in index cases and also of the tumour gene status in family members who are being screened.
A randomized trial comparing chemoimmunotherapy (bacillus Calmette-Guérin + chemotherapy) and immunotherapy (bacillus Calmette-Guérin alone) was carried out in high-risk stage I and II malignant melanoma patients. Eight-two evaluable patients were included. The follow-up median duration was 11 years. Recurrent melanoma developed in 28 patients (34%). The overall survival rate was 76% at 5 years and 65% at 10 years. There were no statistical differences in survival probability or disease-free survival (DFS) probability between the two treatment groups. Survival and DFS were also analyzed in relation to various prognostic factors. Statistically significant differences were only seen in a subset of 33 patients with lower limb malignant melanoma, the prognosis being better for the chemoimmunotherapy group in this location. Because of the small number of patients in each group, a week positive effect of either of these two treatments cannot be ruled out. Chemoimmunotherapy only seems to improve the prognosis of stage I or II malignant melanoma of the legs.
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Two cases of metastasic alopecia from breast adenocarcinoma were reported. Clinical and differential aspects from other types of alopecia are also commented.
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We report a case of acne secondary to amineptine (Survector) in a 54-year-old woman. Clinical picture and relationship with excessive drug intake of this drug define this new iatrogenic acne. To our knowledge, this is the first case described in Spain.
We report a case of a 57 year-old male who developed atypical bullous disease and in whom an underlying carcinoma of the bronchus was found. The cutaneous eruption fulfilled the clinical, histological and immunological features of pemphigus herpetiformis. Reports of pemphigus herpetiformis and internal malignancy are extremely rare.