[Heart-lung transplantation in man. Apropos of 12 cases].
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Biomedical subjects
Publications and source records attributed to M Auriol.
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The effect of soft-laser upon human gingival fibroblasts was studied after an initial biopsy followed by irradiation and numerous biopsies performed 5 mn, 15 mn, 1 hour and 24 hours after irradiation. In addition, control biopsies were performed in the same way on a non-irradiated gingival area. One hour after irradiation and up to 24 hours later, the enzymatic activities of the fibroblasts were obvious: oxidative enzymes, leucine aminopeptidase, and considerable Brachet's test highly positive (RNA). By transmission electron microscopy were changes were found in these fibroblasts. They were more numerous and their cytoplasmic organelles were increased (mitochondria, rough endoplasmic reticulum). An abundant granular material as well as collagen fibrils were accumulated along their cytoplasmic membrane. On the whole, from the 1st hour on following irradiation by soft-laser a stimulation of metabolic activity of the fibroblasts (oxidative activities, proteic synthesis) was observed with increased production of collagen.
The effect of soft-laser upon cicatrization of the gum was studied in 14 patients. After the initial biopsy, control biopsies were performed on the same patients in non-irradiated gums. In the absence of inflammation, cicatrization took place in a similar manner in the irradiated and control tissues. After an early vascular growth, connective cylinders occurred, accompanied by an increase of enzymatic activity) (oxidative enzymes, leucine aminopeptidase, alkaline phosphatase). Then, the scar was formed of longitudinal bundles. The laser induced an earlier cicatrization (14th day) than in the controls (21st day). The presence of inflammation in the gum delayed cicatrization and often promoted cheloid scars with abnormal anastomosing connective bundles. In this case also, irradiation by soft-laser was followed by a quicker and better cicatrization.
Among a series of 42 ossifying fibromas and 32 fibrous dysplasias, 5 cases were studied by histoenzymological and electron microscopic methods. The histological study in 2/3 of cases is sufficient for the diagnosis between the two diseases: trabecular bone in a connective tissue with regular collagen fibres in the ossifying fibroma; nodular indented bony areas with irregular collagen frame in fibrous dysplasia. By histoenzymology, the diagnosis between the two affections is not easy: same activity of ATPases and alkaline phosphatases in fibroblasts and osteoblasts. By electron microscopy, the morphology of the two lesions is different: in ossifying fibroma, numerous well-differentiated osteoblasts and large areas of ossification are seen; in fibrous dysplasia, undifferentiated cells are numerous and the collagen frame is irregularly mineralized. This method is also useful for the histogenetic understanding of these two osteopathies.
The 4 cases of malignant xanthogranuloma reported here are peculiar because of their unusual localization in the cervico-facial area and of their good outcome (3 patients are alive without recurrence more than 6 years after chemotherapy and radiotherapy). Besides the histological study, the 4 cases were examined by immunohistochemical methods : vimentin was positive in 20 to 40% of cells and lysozyme in 5 to 15% of cells. In addition, one case was studied by electron microscope which showed the polymorphism of tumoral cells.
Four cellular cultures from explants of human periodontal ligament were studied. In these cultures, cells were fusiform or stellate with a high percentage (5 to 10%) of round mitotic cells. The scanning electron microscope confirmed the simultaneous presence of flat cells in interphase and cells in prophase with microvilli and long filipodes and of round mitotic cells with microvilli and blebs. Histoenzymology disclosed in these cells high activities in oxidative enzymes and leucine aminopeptidase. Furthermore some cells showed an alkaline phosphatase activity. Immunocytochemistry detected in most of these cells intermediate vimentin filaments and the presence of type I and III collagen irregularly distributed among these cells. In transmission electron microscopy the elongated cells presented a clear nucleus, numerous endocytosic vesicles, ribosomes and longitudinal filaments. Variations were noted, especially in the quantity and quality of cell secretions, the fibroblasts secreting either the two type I and III collagen or only type I. The rare cells assuming alkaline phosphatase activity were atypical in possibly being provided with osteogenic potential.
61 cases of histiocytosis X of jaws were reported here. They occurred more often in man (72% of men) than in woman, with an average age of 27 years. The mandible was affected more frequently than the maxilla. Clinically, dental expulsion, gingival swelling, fractures or pain were the usual symptoms. Roentgenographic examination showed either central or peripheral (alveolar bone) osteolytic areas. The histologic diagnosis was easy when eosinophilic polymorphous leukocytes or histiocytes were preponderant. In the other cases, immunohistochemistry (positivity of S-100 protein) and electron microscopy (presence of Birbeck granules about paraffin embedded specimens) were of a great usefulness. The prognosis of the disease was mainly related to the diffusion of lesions to other skeletal portions or extraskeletal localizations (37% of our cases). It has been improved by combination of chemotherapy to surgery (despite of frequent recurrences), 40 upon 45 patients are well after a follow-up of 2 to 10 years after the last localization.
An immunohistochemical study was performed on 9 gingival biopsy specimens from patients suffering of a periodontal disease comparatively to 7 control specimens from patients with inflammatory gingival hyperplasia of various causes and from healthy gums. We used mono or polyclonal antibodies as markers of the different types of inflammatory cells (T-1 lymphocytes and their subsets, B-lymphocytes, macrophages, plasma cells). In patients with periodontal disease, the high percentage of transformed T-lymphocytes with a majority of helpers was obvious. In controls, the inflammatory cells were principally B-lymphocytes, macrophages and plasma cells. The characterization of different types of collagen produced by periodontal fibroblasts was performed by specific antibodies (anti I, III, V collagen sera). The respective ratio and the topographic distribution of those collagen substances were different in patients with periodontal disease and controls. In the first eventuality, one could find quite exclusively type I collagen. In the other group, type I collagen was associated with type III sub epithelial and type IV perivasor ar collagen. By means of these findings, the pathogenesis of the periodontal disease was discussed and its immune mechanism was suggested.
After a short summary of the bone histophysiology, the general characteristics, the nosology and the differential diagnosis of dystrophic and dysplastic lesions of bone are related. Then, their main varieties are classified in two chapters: osteogenic and osteolytic lesions.
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Effects of estradiol (E2) and promegestone (R 5020) were tested on primary cultures of epithelial human breast cells prepared from surgical specimens of reduction mammoplasty. Comparative morphological studies were performed by means of transmission and scanning electron microscopy in cells without any hormonal adjunction and in those previously treated with E2 or E2 + R 5020. The results were as follows: In basal medium used as control the majority of epithelial cells, although well-differentiated, remained flat with few microvilli, well-developed Golgi apparatus and rough endoplasmic reticulum, was obvious. R 5020 added with E2 increased differentiation of epithelial cells covered with scarce long and branched microvilli, but reduced the turn-over of young cells. E2 seemed to generate more active proliferation of cells. R 5020 inhibited this effect and induced a higher differentiation of mammary epithelial cells.
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Numerous vascular dysplasiae belong to the group of genodysplasiae. Most arteriovenous dysplasiae (cirsoid, racemosum aneurysms,...) are the substratum of various regional "angiomatosis". Stenotic or ectatic arterial dysplasiae can be associated with genodysplasiae. In addition, lymphatic dysplasiae (congenital elephantiasis, etc...) also exist. Among benign tumours, angiomas are sometimes hardly distinguishable from dysplasiae. Some tumors with intermediate malignancy have an uncertain prognosis: chemodectoma, hemangiopericytoma. As for malignant vascular tumours, they fall into 3 varieties: angiosarcoma, Kaposi's sarcoma and sarcoma of vascular walls.
During the ten last years, 13 neural tumors of the tongue have been observed in the department of stomatology and maxillo-facial surgery of Salpêtrière Hospital Paris (Prof. J.M. Vaillant): 4 amputation neuromas, 5 benign schwannomas, 1 malignant schwannoma, 2 neurofibromas and 1 multiple endocrine syndrome type III. The authors analyze the clinical and histological data from these case-reports; they point out difficulties encountered in the diagnosis, and the prognostic problems brought up by such infrequent lesions.