Biomedical subjects
Publications and source records attributed to O Bletry.
In two patients suffering from chronic neurobrucellosis with negative Wright's reaction the diagnosis could be made by other serological methods: complement fixation, demonstration of blocking antibodies by indirect immunofluorescence or Coombs'test. The therapeutic problems raised by chronic neurobrucellosis are discussed.
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Ear cartilage has been studied by histochemistry, histoenzymology, immunofluorescence and electron microscopy in three cases of relapsing polychondritis. The most significant lesions have been observed at the cellular level, both by enzymology and electron microscopy: chondrocytes of peripheral zones seem to be first hypertrophic and then necrotic; at the opposite, their is no correlation between histochemical and electron microscopic studies about the chondroid intercellular substance whom lesions are probably secondary to the cellular ones. A few chondrocytes are positive with antiimmunoglobulins sera (IgM and IgA); this fact could be a proof of the dysimmune nature of this disease.
Metabolic and hormonal tests to assess plasma renin, aldosterone, and catecholamine activity were conducted in three patients with idiopathic orthostatic hypotension. Blood pressure readings were then taken in decubitus and orthostatism during treatment with 10 to 15 mg of tyramine and 30 mg of tranylcypromine. Marked functional improvement was observed, with an increase in mean blood pressure in decubitus and a less marked reduction in orthostatism avoiding the onset of severe discomfort. Therapeutic indications are limited, however, because of a possible hypertensive response.
Two patients with Behcet's disease and angiographically demonstrated cerebral venous thrombosis are described. Dural sinuses were involved in one patient and an internal cerebral vein in the other. Cerebral venous thrombosis was the first manifestation of the disease and occurred in the absence of other signs of "Neuro-Behçet". The outcome was favorable. The unusualness of such localisations, their unknown mechanism, and difficulties in their diagnostic and treatment are emphasized.
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The first case of placental choriocarcinoma producing clinical hyperthyroidism reported in France is described. Recovery occurred, with disappearance of the choriocarcinoma metastases and hyperthyroidism signs, after chemotherapy alone (vincristine and methotrexate). A review of the seven cases reported in the published literature showed that the hyperthyroidism could be related to the thyroid-stimulating activity of the tumoral gonadotropin (HCG).
Splenectomy was performed in two patients amongst a group of 120 suffering from bacterial endocarditis. In the first case, rupture of the spleen followed rupture of a partially thrombosed splenic vein and bacteriological specimens were negative despite the presence of multiple infarcted areas, certain of which were suppurative. In the second case surgery was possible before rupture of the spleen. The latter was the site of numerous abcesses, one of which was in the process of fissuration, and bacteriological specimens were positive. The course in both cases was favourable. Twenty two other cases have been found in the literature with 15 deaths. Whilst the prevalence of such complications remains low, their severity is such that routine surveillance of the kidney should be the rule in infectious endocarditis. The methods of such surveillance are discussed, the mechanism of such complications not being fully elucidated: the respective role of splenic infarction, splenic abcess and immunological factors remains to be determined.
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Acute fatty infiltration of the liver in pregnancy is characterised by microvacuolar fatty infiltration, without necrosis, occuring at the end of pregnancy. This syndrome, defined by Sheehan in 1940, remains rare. The authors were able to find 62 authentic cases in the french, english and german literature. The course is fatal in 75% of cases for the mother and 70% for the child. The gravity is related to hepatocellular failure, but also to extra-hepatic complications (renal failure, haemorrhagic syndrome, infectious complications, acute haemorrhagic and/or necrosing pancreatitis). When the course is favourable, the hepatic lesions disappear in a few weeks and there is no recurrence during subsequent pregnancies. The histological lesions of acute fatty infiltration of the liver in pregnancy are identical to those of fatty infiltration of the liver induced by cyclines and of Reye syndrome.
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The authors report 8 cases of scleroderma with oedema in the initial stages which could be divided amongst three groups on the basis of their clinical, biological, histological characteristics and course: normal systemic scleroderma, mixed connective tissue disease, Shulmans syndrome. The relationship between one of these cases and Buschke's scleroderma is discussed. These cases of scleroderma are characterized by diagnostic difficulties in the initial phase and by their relatively favourable vital prognosis (one death only). Corticosteroids may be effective to some extent in the presence of mixed connective tissue disease of Shulman's syndrome.
The authors report the case of a cirrhotic with severe hypokalemia (2 mEq/l) responding incompletely to attempts at correction by classical treatments. The findings of a serum and red cell magnesium deficiency led to administration of this electrolyte which proved efficacous. They then recall the mechanism of hypokalemia and hypomagnesemia in alcoholics, study the possible relationship between these abnormalities, their noxious effects and suggest a treatment.
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The authors compared two series of 27 cases of périateritis over a period of 5 years. The determined the frequency of the nodosa HBs+ (series B) and HBs-- (series A) collected clinical and laboratory signs in both series. There resulted that apart from the hepatic signs constant in series B and absent in series A, the only statistically significant differences were the joint sings and the hypertension more common in series B and the respiratory signs more common in series A. Furthermore, the course of HBs+ cases appears much mote severe than that of HBs-- cases which emphasises the importance of the hepatic involvement but this finding should be interpreted with circumspection for the mode of selection of the patients and the treatment were different in the two series.
The authors report a case of bacterial endocarditis during which the precise nature of the heart lesions were only discovered at operation. There left ventricle and right atrium. The characteristics of the systolic murmur and the findings on phonocardiography together with left ventricular angiography had suggested mitral incompetence. There were no conduction disorders in this patient which might have helped in preoperative diagnosis. In connection with this case, the authors recall the characteristics of aneuryms of the membranous septum and congenital or acquired communications between the left venticle and the right atrium.
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