Biomedical subjects
Publications and source records attributed to M David.
Nifedipine, a calcium-channel-blocking agent, is widely used as an antianginal and antihypertensive drug. Cutaneous reactions to nifedipine are extremely rare. A review of the literature revealed only three additional cutaneous eruptions which include vasculitis, erythematous edema of the legs and erythromelalgia. We present the first case of fixed drug eruption due to nifedipine.
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A 63-year-old woman developed simultaneous occurrence of acute febrile neutrophilic dermatosis and subacute thyroiditis, thus suggesting that both diseases had a possible identical viral etiology. As far as we are aware, this is the first report of the association of Sweet's syndrome and subacute thyroiditis.
Nocturnal urinary excretion of melatonin, LH, progesterone and oestradiol was measured by radioimmunoassay in nine normal women during a complete cycle. In addition, these hormonal excretions were studied in two women taking an oral contraceptive. A high within-subject coefficient of variation was observed for melatonin excretion in the two groups. In the nine normal cycling women, melatonin excretion was not decreased at the time of ovulation, but was significantly increased during the luteal phase compared with that of the follicular phase (P less than 0.01). These data are consistent with a positive relationship between melatonin and progesterone during the luteal phase. In the two women under an oral contraceptive, melatonin excretion was found within the same range as for the other nine. The results are discussed in terms of pineal investigation in human.
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Twenty-one patients with pruritic urticarial papules and plaques of pregnancy (PUPPP) were reviewed. Direct immunofluorescence (DIF) examination was negative in all patients. DIF in patients with PUPPP is a useful and reliable laboratory aid in distinguishing this peculiar dermatosis from herpes gestationis.
Nine patients with subacute cutaneous lupus erythematosus (SCLE) are described, all of whom had systemic involvement of the disease although usually milder than in systemic lupus erythematosus. None of the patients had renal disease or died of SCLE.
A 29-year-old woman, referred because of the development of diffuse papules and plaques on the face and progressive hair loss, was found to have generalized hair follicle hamartoma, a very rare condition previously described in only two female patients. All three patients also suffered from myasthenia gravis. The histological appearance of both the involved and uninvolved skin was similar to trichoepithelioma.
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The authors report the case of a tricuspid endocarditis secondary to Streptococcus bovis with important regurgitation and severe hypoxemia secondary to a right-left atrial shunt through a patent foramen ovale, requiring a surgical treatment which included the replacement of the tricuspid valve and closure of the dehiscence in the inter-atrial septum. The presence of a patent foramen ovale in the course of a tricuspid endocarditis has been exceptionally reported. This diagnosis deserves to be evoked in case of an unexplained hypoxic condition or a systemic embolism complicating a tricuspid endocarditis. The report emphasizes the advantage of ultrasonic examinations (contrast sonocardiography, pulsated Doppler) in order to demonstrate this right-left atrial shunt in addition to the data collected about the tricuspid valve.
In pathology, reproducibility of lesional diagnostic and classification is not perfect, particularly when dealing with rare tumors like soft-tissue sarcomas, the classification of which is complex. Reproducibility among many independent observers can be well appreciated by kappa statistics, which take into account the agreement rate expected by chance only. A study of the reproducibility of histological classification and grading of 25 soft-tissue sarcomas by 15 pathologists showed that the agreement was better for the grading. A review of some other applications of kappa statistics in pathology reported in the literature is presented.
Results are reported of a prospective study of 79 CT scan examinations in 50 patients who had undergone sternotomy for cardiovascular surgery. In 69 cases the examination was conducted during the course of a progressive postoperative mediastinitis treated surgically. Mediastinitis was confirmed in 13 cases, including 12 relapses. In 2 cases the CT scan image was normal (2 false negatives) whereas mediastinal drains had been inserted. The CT scan image of mediastinitis shows mainly hypodense fluid collections (0 to 16 UH) in anterior mediastinum or between sternotomy borders (8 of 13 cases). But this type of image, detected 11 times in the absence of recurrence (favorable course), can result from a residual serous collection after ablation of drains. In 8 cases, a CT scan-guided puncture (7 cases) or one under ultrasound control (1 case) eliminated recurrence. The CT scan imaging also allowed diagnosis of 5 cases of osteitis, confirmed surgically. These findings indicate the definite interest of CT scan imaging in postoperative follow-up review of median sternotomies. It appears to be particularly indispensable for surveillance of surgically treated mediastinitis, because of the serious consequences of relapses and the often clinically silent chronic bone lesion. However, the possibility of residual serous collections emphasizes the importance of the clinical context and should lead to guided puncture investigation in doubtful cases.
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In this report we rate a new, third-generation automated hematology system (Technicon Instruments H-1) that can furnish a full range of values, including erythrocyte parameters and a leukocyte differential count. Particular attention is focused on erythrocyte morphometric parameters, including measurement of cell size and hemoglobin content on a cell-by-cell basis. We assess the usefulness of new parameters derived from these measurements, such as mean corpuscular volume and red blood cell distribution width, which characterize cell size, and mean corpuscular hemoglobin concentration, and hemoglobin distribution width, which characterize cell hemoglobinization in evaluating normal and abnormal subjects. The value of these parameters in classifying anemias is assessed in our patient population that includes those with iron deficiency anemias and thalassemias, as well as other forms of anemia.
Reports of individual surgical cases tend to be anecdotal because of the unique circumstances surrounding the patient, the surgeon, the intervention and, where applicable, the prosthetic device. To overcome this limitation the authors have taken a wider collaborative approach and report the analysis of 61 explanted polyester arterial prostheses associated with delayed complications on 53 patients reoperated upon in six different French hospitals. One advantage of such an independent and centralized retrieval programme is that the impact of centre specific factors, such as patient selection and surgical techniques, is minimized. Consequently, by following a standardized protocol for the evaluation of the morphologic, pathologic and mineralogic characteristics of the tissue surrounding the excised grafts, as well as the textile structure of the prostheses themselves, it has been possible to distinguish between iatrogenic and disease related complications and to demonstrate a number of general findings associated with the clinical performance of polyester arterial prostheses. Complications such as thromboses, infections and false aneurysms appear to occur randomly after different lengths of implantation, thicker fibrous tissue capsules are associated with velour grafts with highly textured yarns, the incidence of mineralized tissue and of endothelialized luminal surfaces is rare, weft knitted textile prostheses appear less mechanically stable and more sensitive to iatrogenic trauma than warp knitted, and the incidences of lipid and cholesterol adsorption, bacterial colonization and sterile fluid loss need further investigation. These observations lead to the recommendation that for patients with longer life expectancies surgeons should consider selecting low porosity, woven or warped knitted prostheses which contain yarns that have not been highly textured.
In the few cases of incisional hernia consecutive to transverse laparotomy the classical approximation of the rectus muscles cannot be performed due to the presence of transverse fibrotic scar tissue. An original technique using 4 aponeurotic quadrants cut out of the anterior surface of the rectus sheaths is described.