[Treatment of refractory ascites].
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Biomedical subjects
Publications and source records attributed to N Bourgeois.
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A study of ellipsoids (EL) in the human spleen was done on 25 surgically resected specimens in order to assess the number of EL, their structure, the nature of the cuff cells and the problem of lymphocyte traffic through their wall. The results show that an average spleen of 200 g contains 1.6 X 10(7) EL. They are localized in a constant segment of the vascular tree, just at the transition of the penicilliary arterioles into capillaries and they consist of a capillary (not an arteriole) surrounded by a cuff of cells. These cells are neither endothelial nor smooth muscle cells, display lysosomal activity and are considered as fixed specialized pericapillary cells capable of cytoplasmic expansion. Since their number is inconstant in different individuals and in different species they are considered to be dynamic histological structures. Because of the constant presence of lymphocytes in their walls we consider the EL to be a transit system for lymphocytes and the splenic equivalent of the high endothelial venules in the lymph nodes.
The clinical efficacy and patient acceptability of a new solution containing mainly sodium sulfate and polyethylene glycol (solution II) compared with a balanced standard electrolyte solution (solution I) for whole gut lavage prior to colonoscopy were evaluated in 240 ambulatory and hospital patients randomly allocated to receive either of the two solutions. On the basis of the quality and rapidity of the bowel preparation and the good results obtained by clinical and biological parameters, we found that the newly designed solution was superior.
The hypertrophic aspect of tissue after endoscopic papillotomy may suggest the diagnosis of a small periampullary tumor. In our experience of 55 periampullary carcinomas, the diagnosis was confirmed histologically in 50% of the cases before endoscopic papillotomy and in 100% of the cases when the biopsies were performed immediately after papillotomy. With this in mind, biopsies were performed in 22 cases of benign biliary tract disease after endoscopic papillotomy. Biopsies within the first 48 hours after endoscopic papillotomy showed cellular atypism.
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Non-lymphoid haematopoiesis in the thymus was studied in 33 cases ranging from 14 weeks gestation up to 15 months postnatally. All thymuses displayed focally granulopoiesis in the connective tissue septa and in the lymphoid tissue, where it was localized in the peripheral cortex and at the cortico-medullary junction. Within the lymphoid tissue the granulocytic series showed many precursor cells with large rounded nuclei. Their origin could only be identified by the naphtol AS D chloroacetate esterase stain. In cases with thymic atrophy these precursor cells were present in relatively large numbers. Within the connective tissue septa many granulocytes with nuclear segmentation were intermingled with precursor cells. The erythroid series were detected with an immunohistochemical method for demonstration of haemoglobin. The positively stained nucleated cells occurred mainly in nests mostly localized in the peripheral cortex. These precursor cells were usually found in different places from the granulopoietic cells. No megakaryocytes were found. With appropriate techniques non-lymphoid haematopoiesis can be demonstrated in the developing thymus and must be considered as an expression of normal growth.
The extension of myeloproliferative malignant tumors to lymph nodes was studied in seven excision biopsies and 27 autopsies in which lymph nodes were obtained from all nodal regions. We observed the proliferation of poorly, partially, and well differentiated neoplastic cells with a predominance of immature cells of the granulocytic series and fewer cells of the erythroid and megakaryocytic cells lines. Disturbances of the lymph node architecture consisted of invasion by abnormal cells of the trabecular stroma, disrupting the reticulin mesh and extending toward the pericapsular area. In the lymph node a loose network of thin and thick fibers replaced the original framework. Generalized lymph node involvement at autopsy showed preservation of the architecture, both in cases with total replacement of the lymphoid population by abnormal cells and in cases with involvement by single cells or small groups of cells. Partial involvement occurred chiefly in the medullary zone, probably the result of hematogenous dissemination from the vascular plexus in medullary cords. Further abnormal cell development was linked to trabecular infiltration. The extensive involvement seen at autopsy took place by lymphatic dissemination. In lymph nodes studied at autopsy an abnormal immunoblastic reaction was observed. At first these abnormal cells were suspected of representing the myeloproliferative malignant disease, but the application of special staining techniques revealed their polyclonal cytoplasmic immunoglobulins. The chloroacetate esterase stain and the immunohistochemical stains for muramidase and hemoglobulin were especially useful in demonstrating that myeloproliferative diseases develop in the environment found in lymph nodes.
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The relationship between mononuclear, multinucleated and multilobated Sternberg-Reed cells was studied by reconstructions done on serial sections 1-2 microns thick. The 21 cells so studied showed the following combinations: 7 were binucleated, but two nuclei were composed of two parts at certain levels; these nuclei we propose to call composite. 8 cells were mononuclear and had composite nuclei and 6 cells were mononuclear and had single nuclei.
Many large cells with a strongly basophilic cytoplasm and large nuclei with a delicate chromatin pattern and large nucleoli were studied in 1 mu sections of core biopsies in 8 patients with iron deficiency anemia and in 5 patients with pernicious anemia. In 2 normal controls these cells were rare. Possible features of granulocytic differentiation were assessed with the Giemsa stain and with the naphtol-ASD-chloroacetate esterase reaction which is indicative of early granule formation: the large cells were constantly negative. In thin sections the morphological appearances of the large basophilic cells are rather similar in such different haematological disorders as pernicious anemia or iron deficiency anemia. A clear difference can be demonstrated by karyometry, which shows that the large basophilic cells in pernicious anemia are significantly larger than those in iron deficiency anemia or in the normal control.
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