Biomedical subjects
Publications and source records attributed to M Conte.
Cutaneous metastasis from prostatic carcinoma are quite unusual (40 reported cases in the literature), usually occurring several months or years after initial diagnosis. In our patient tumoral nodules were exclusively located on the scrotum. Prostatic nature of metastatic cells were proved by Immunocytochemistry.
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Having seen 192 cases of cancer of the endometrium treated at the Institute Paoli-Calmettes between the years 1975 and 1980, the authors have been able to evaluate the place of surgery in the planning of treatment of Stage I and II cases. They hold that: Laparatomy is well tolerated, in 90% of cases of Stage I, 88% of cases of Stage II, 70% of older than 70 years of age and 79% of patients who have some wasting there was no operative mortality. The need to re-explore Stage I and Stage II cases surgically (14%) especially when invasion of the ovaries had not been recognized before histological examination exists. The bad influence of the 5 year survival rate of histological grade 3 or where the myometrium was deeply invaded or where the pelvic lymph nodes were invaded. Studying this personal series and other series found is the literature shows that there is no great value in clearing the pelvis of lymph nodes in order to plan the post-surgical treatment. This is because generally lymph node involvement in the pelvis is associated with other factors that are unfavourable prognostically and these factors can be determined more easily than by removing the lymph nodes. They are, grade 3, invasion of the cervix, positive peritoneal cytology and when the myometrium has been invaded more than 50%. It was only in two cases out of 122 that study of the lymph nodes of the pelvis altered the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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The value of the assay of the sub-units of human chorionic gonadotrophin in the diagnosis and follow-up of trophoblastic disease is generally recognised. The authors stress that this follow-up allows a maximal preservation of the genital tract of the patients and an evaluation of the real effectiveness of treatment.
Atypical and severe hyperplasia of the endometrium is often associated with a carcinoma and, on their own, present a malignant potential which requires a specific treatment, involving an extension of the indications for hysterectomy after the menopause.
Sterility in North African immigrants does not differ greatly from the sterility observed in French women. The authors emphasise one particular difference: the frequency of genital tuberculosis present in 1/3 of cases compared with 6 per cent of the general population.
Gynaecological arteriovenous fistulae are a difficult diagnosis and their aetiology is often difficult to determine. The surgical treatment is not always satisfactory and the prognosis can be transformed by means of embolisation.
The authors study all of the possible forms of foeto-maternal immunisation (ABO system, D antigen and other antigens). They present a general review of the course of allo-immunisations since the establishment of prophylaxis against anti-D allo-immunisations and they define the current situation.
No results from therapeutic trials describing the best therapeutic procedure for cervical carcinoma in stages I and IIa are available. Analysis of a series of 242 cases of cervical carcinoma in stages I and IIa, from 1975 to 1980, treated with radical surgery and radiation therapy, yields a therapeutic approach that envisions the most reliable evaluation of subclinical extension, cure of cervical tumor and prevention of pelvic or extra-pelvic metastases with a minimum of post-radiation problems. The choice of combination surgery and radiation therapy is primarily determined by staging and the volume of the central pelvic tumor. For stages I and IIb (upper third of vagina involved) with central pelvic tumor less than 4 cm in diameter, the usual procedure is recommended i.e. radium application, total hysterectomy with pelvic lymphadenectomy followed by external irradiation of pelvic lymphatics in cases with lymphadenopathy. For stages IIb (obvious parametrial involvement) and for stages I or II with central pelvic tumor between 4 and 6 cm in diameter: total dose external and internal pelvic radiation therapy followed by total hysterectomy without pelvic lymphadenectomy but with exploration of obturator, hypogastric, external iliac, common iliac, and aortic nodes. For the rare supravaginal central pelvic tumors greater than 6 cm in diameter, the risk of clinical evaluative error and incomplete sterility by irradiation alone, warrants first an explorative laparotomy using Wertheim's procedure, then pelvic lymphadenectomy and exploration of pelvic and aortic lymph nodes.
The features of the gypsy population, including the conditions of their lifestyle, are very unusual and medical follow-up is very irregular, resulting in obstetric and neonatal pathology. On the basis of a series of 1571 pregnancies, the authors describe the disadvantages of these features which can only be improved by a reciprocal confidence between gypsies and the medical profession.
The obstetric pathology of North African women, which used to be fairly different from that of French women, is now tending to resemble that of the French population, as the customs of the immigrants tend to coincide with those of the local population, especially in the context of information and antenatal care.
On the basis of a series of 220 operated cases of genital prolapse, the authors describe the complications and classify the various elementary components of the prolapse (120 complete prolapses) and the associated lesions. The operative techniques are classified by category and the results are presented with a follow-up of two and three years. This homogeneous series demonstrates that the vaginal techniques are generally more effective.
Two series of trials of labour are compared: the first series without any particular analgesia and the second under epidural analgesia. The caesarian rate was significantly less in the second series because the trial of labour was able to be pursued for a longer period of time without any danger to the foetus. The authors consider that, provided cases of mechanical dystocia and maternal agitation are eliminated, trial of labour under epidural anaesthesia can result in a real cephalopelvic engagement.
Although urticaria is usually held to be a type 1 hypersensitivity reaction, it may also be the cutaneous manifestation of vasculitis mediated by immune complexes. In this study of 35 patients with chronic urticaria, the authors attempted to specify the prevalence of vasculitis and its possible correlations with particular clinical and/or immunological findings. In 10 cases, lymphocyte subpopulations were also studied, using monoclonal antibodies. Patients included 21 women and 14 men, aged 19 to 80. In each patient: a) systemic signs were looked for by history taking and physical examination; b) a skin biopsy was examined by optic microscopy and direct immunofluorescence; c) the following biological investigations were done: blood count, sedimentation rate, protein electrophoresis and immunoelectrophoresis, IgE, B virus markers, circulating immune complexes, anti-nuclei and anti-ADN antibodies, latex and Waaler-Rose tests, total complement, C3, C4, and C1 esterase inhibitor. Visceral involvement and various immunological disorders are most common in those patients with leukoclastic (n = 7) or mononuclear (n = 9) vasculitis. These patients, as well as those recently studied in the literature, have idiopathic chronic urticaria, the least severe of urticarial vasculitis.