Biomedical subjects
Publications and source records attributed to M David.
A 63-year-old female who had been suffering from intractable palmoplantar keratoderma for 13 years was found to have myxedema. Shortly after institution of substitution therapy with thyroid hormone there was a striking improvement in her condition. The possibility of a causal relationship between hypothyroidism and hyperkeratosis is suggested.
The study of a series of 21 consecutive cases of adenocarcinomas of the endometrium requiring chemotherapy, has permitted to demonstrate the superior efficacy of an association of doxorubicin and cisplastin as compared to other plans containing only anthracyclin (45% of partial and complete remissions versus 20%); this difference, however, is not statistically significant. Intolerance reactions were similar in both groups. Confirming recent data from the literature, the results conclude in favor of: the determinant contribution of cisplastin to chemotherapy, the need of a strict selection of the patients intended for chemotherapy, the usefulness of induction chemotherapy trials, prior to pelvic radiotherapy in locally advanced forms, to improve their distant prognosis.
A "transient" precocious puberty with ovarian follicular cysts was observed in four girls. Each girl presented with several successive and transient episodes of development of secondary sex characters: breast development, areolar pigmentation, brown abdominal median line were the clinical signs of oestrogen secretion. At the time of referral, plasma and urinary gonadotropins levels were low in the prepubertal range while plasma oestradiol concentrations were elevated, in the pubertal range. At this time, as well as during each episode of "pubertal" development, the gonadotropins response to GnRH stimulation was blunted. In contrast, a prepubertal or pubertal response was observed when the clinical symptoms of estrogenization had resumed. Ultrasonography showed one or several ovarian follicular cysts. In two cases, the treatment with the GnRH agonist, D-TRP 6 GnRH [Decapeptyl (R)], was successful, suggesting a central dysfunction
In 10 years the schemes of medical treatment of breast cancer have progressed in the direction of greater efficacy (balanced multiple associations), improved articulation with other therapeutic tests, increased ease of application (single perfusion) and lower toxicity (especially from the cardiac point of view), which make it possible to extend the indications to less advanced forms.
Aneurysms of the sinus of Valsalva are rarely diagnosed before rupture into the cardiac cavities which usually leads to the appearance of a continuous murmur and cardiac failure. In the two cases described, the presenting symptom of the aneurysm was syncope due to cardiac hyperexcitability: ventricular tachycardia in the first and paroxysmal tachyarrhythmia in the second case. The presenting symptoms of unruptured aneurysms of the sinus of Valsalva were analysed. In general, they are: uncontinuous cardiac murmurs: either diastolic murmurs of aortic regurgitation, systolic murmurs of mitral or tricuspid regurgitation, or, as in our first case, of obstruction to right ventricular ejection; arrhythmias: the commonest are conduction defects, which can be syncopal; hyperexcitability (especially ventricular) seems to be very care. Echocardiography is a valuable tool for the diagnosis of sinus of Valsalva aneurysms. The appearances of unruptured aneurysms in our two patients are described. The presence of syncopal cardiac hyperexcitability, possibly associated with one of the preceding auscultatory abnormalities is an indication for echocardiography which may lead to the diagnosis of this condition.
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The morphologic appearance of osseous metastasis may rarely suggest a specific site of origin. A subperiosteal location has recently been reported to be typical for metastatic lung carcinoma. We report three cases of such metastasis which destroyed the cortex so that it appears saucer shaped. The primary tumor was a bronchogenic carcinoma in every case. We conclude that in the cancer-age group cortical metastasis is a highly characteristic feature of lung carcinoma.
The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.
A series of 51 cases of congenital myxoedemia in children was analyzed to determine incidence of associated hip lesions. Mechanisms of epiphysial and articular cartilage growth are reviewed and events summarized that occur normally in the "growing hip": the upper femoral nucleus, and orientations of femoral neck and their physiologic variations. The role of thyroid hormones in bone growth is also discussed. Reviewed in greater detail are the myxedematous hips in children, or epiphysial dysgenesis, the causes of delay in bone maturation, the effect of substitutive therapy and mineralization disorders. In contrast to the richness of radiographic data, often very disturbing, restriction or even absence of functional signs is almost a constant feature, enabling a diagnosis of Legg-Perthes-Calvet's disease to be rejected, certain radiologic images being considered wrongly as comparable. Radiography provides images varying from delayed ossification of a sometimes very long upper femoral nucleus, termed "joint emptiness", to "pseudo-fragmentations" that are frequently encountered and are actually progressive ossifications. These sometimes progress towards deformity of femoral head in coxa plana but are usually well adapted to the acetabulum, reducing initial fears. Different parameters studied in the 51 patients are analyzed and an optimistic conclusion given, since neonatal screening for congenital myxedema and subsequent therapy should eliminate skeletal complications, particularly in the hip.
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Castelman described as angiofollicular hyperplasia (AFH) a benign lymphovascular hyperplasia forming a single tumour, classically situated in the mediastinum. A multifocal lymph node form of AFH was individualised by Leibetseder and Turner about 10 years ago (MAFH). This is a rare syndrome, the clinical and biological characteristics of which are almost identical to angioimmunoblastic lymphadenopathy (AIL). The only difference is in the histology of the ganglia which shows changes of AFH. We report two cases of MAFH. In one patient with histological confirmation of splenic involvement the evolution was subacute. In the second case, the histological features of the lesions were observed to change during successive biopsies: appearances of AFH changed to typical AIL. This observation suggests that MAFH may be a disorder of the immune system. Usually considered as benign lymphatic hyperplasia with a chronic evolution, the long-term development of lymphoma poses the problem of the evolutionary potential of this condition, which may be likened to AIL in which lymphomatous transformation is also recognised.
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In order to study the posttransplant evolution of serum immunoglobulin levels, we measured serum IgG, IgA and IgM levels in 50 recipients of allogeneic bone marrow before transplantation and at different intervals thereafter (days 39, 120, 365 and 730). IgG and IgM levels were depressed for 1 year and IgA levels for 2 years posttransplant. Immunoglobulin deficiency was more severe and prolonged in patients with graft versus-host-disease. Hypogammaglobulinemia may contribute to the frequent infections observed in these patients, especially those with chronic graft-versus-host disease.
Fatty acid composition of human heart phospholipids was determined in 53 specimens of left ventricular myocardium collected during mitral valve replacement. Ages of the subjects (29 males and 24 females) ranged from 14 to 75 years (mean age = 54). Samples were immediately placed in chloroform-methanol 2/1, v/v to which antioxidant was added. Extracted phospholipids were converted to methyl esters which were analyzed by gas liquid chromatography on glass capillary columns. Morphological examination was also performed on 35 out of 53 samples. Age of the patients as well as the morphological state of the organ had no significant effect on major fatty acids in heart phospholipids. No difference by sex was detected. Trans-octadecenoic isomers were detected in all samples but they remained at a low level (0.4% to 1.2% of the total fatty acids).
The coexistence of psoriasis vulgaris and bullous diseases has been described in the literature, mainly with bullous pemphigoid. In the majority of cases the bullous eruption has been thought to be related to antipsoriatic treatment. We describe nine cases of psoriasis vulgaris that were associated with bullous diseases: five bullous pemphigoid, one cicatricial pemphigoid, and three pemphigus vulgaris. The association between psoriasis vulgaris and these bullous diseases may be explained on an immunologic basis.