Biomedical subjects
Publications and source records attributed to P Lecomte.
The author has carried out a general review of the literature on the analogues of GnRH (agonists and antagonists), and their use at present, and of their future use in human reproduction by both sexes and in particular in the fields of contraception, the treatment of hormone-dependent cancers, and also in precocious puberty and possibly endometriosis.
Resuming of menstruation is generally held as a hall mark of recovery in Anorexia Nervosa. Nevertheless, fifteen young women (17 to 28 years old) consulted us about secondary amenorrhea while the acute phase of illness was over. Basal gonadotropins and Estradiol (E2) were measured and a GnRH- TRH stimulation test was performed. Two groups of patients were considered: A - 7 patients with a normal Body Weight Index; B - 8 patients with a Body Weight Index still low. (- 20% - 30%). In group A, 6 out of 7 patients had a early onset of anorexia nervosa (within two years after menarche). In group B, 6 out of 8 patients had a late onset of their disease (more than five years after puberty). As for Body Weight, it seems that the prognosis is better when Anorexia Nervosa occurs within few years after menarche. By comparison with normal women of same age explored in early follicular phase, our population of Anorexia Nervosa showed no significant difference in basal levels of F.S.H., L.H., E2. Cumulative Response F.S. H./L.H. was slightly increased (= 1) compared with normal control (= 0,34). Basal and stimulated Prl were normal. When Body Weight Index was still low, LH and E2 were decreased whereas cumulative response F.S. H./L.H. was dramatically increased. A correlation between E2 and Body Weight Index was shown, low E2 usually fitting well with Low Body Weight Index. Prognosis is poorer for recovery of normal gonadal function in late onset Anorexia Nervosa. Nevertheless, in each group, some patients escaped this rule. Induction of ovulation with Clomifene let us disappointed.(ABSTRACT TRUNCATED AT 250 WORDS)
Luteoma of pregnancy is a benign uncommon ovarian tumor which develops during pregnancy and disappears completely after delivery. It can virilize the mother and female foetus. The coexistence of this ovarian tumor with polycystic ovarian disease is well known but no causal relation has been demonstrated. In polycystic ovarian disease, luteinization is the result of persistent stimulation of the ovary by elevated levels of LH, whereas HCG has been suggested as a factor in the pathogenesis of luteoma. Though not a requisite factor, ovarian polycystic disease promotes the development of luteoma. However, the role of other hormonal and biochemical factors is still unknown.
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Twenty-four cases of duodenal adenomas which did not originate at the ampulla of Vater are discussed. The radiographic and clinical features of these lesions are presented together with a review of 120 cases previously reported in the literature. The role of barium studies and endoscopy in the evaluation of these adenomas is emphasized. A diameter of more than 5 cm represents a criterion favoring malignant degeneration of such non-Vaterian adenomas.
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The general and radiologic features of neurogenic tumors of the stomach are reviewed in connection with 18 cases (16 benign and 2 malignant tumors). Such neurogenic tumors are rare in the stomach, representing less than 0.5% of all tumors. Solitary neurogenic tumors must be differentiated from those encountered during von Recklinghausen's disease. Radiological or endoscopic examination can generally determine the benign or malignant nature of solitary neurogenic tumors, which are essentially represented by schwannomas. Since these tumors are submucosal, a deep biopsy is imperative; furthermore, since such tumors are subject to hemorrhage, prior investigation by CT appears advisable to detect possible hypervascularization after injection of contrast material. For patients with von Recklinghausen's disease, a neurofibroma is usually diagnosed when faced with a digestive hemorrhage. Radiological exploration of the entire digestive tract appears essential to confirm the solitary nature of the gastric lesion and to be sure it is responsible for the clinical symptoms.
On the basis of 27 personal cases of adenocarcinoma of the intestine and a review of the literature, the authors discuss present-day knowledge about this pathology from both radiologic and therapeutic viewpoints. This study, which excludes papillary tumors, reveals that, on a para-clinical level, barium follow-through examinations allow correct diagnosis in 85% of cases. Arteriography does not provide any special data, and more recent techniques such as ultrasound and C.T. do not appear suited for use in initial investigations. From a therapeutic standpoint, surgery is the only effective solution, but long-term survival had not increased for forty years. This rare form of cancer, with an especially insidious clinical course, has thus not benefited from recently introduced diagnostic and therapeutic technics.
The authors studied 65 men who had a varicocele by semen analysis, estimating the levels of FSH, LH, testosterone and prolactin and in some cases the rise in FSH using GnRH. 59 cases were treated by operation and in each of these testicular biopsy was carried out on both sides. Indications are given as to the duration in years of the infertility, the localisation of the varicoceles and the preoperative semen analysis. It would appear that the FSH reading is most important. When it is more than 3.5 ng/ml no pregnancy occurred but when the level was within the mean range of 2.8 ng/ml the chances of pregnancy were higher. It came out at 43% of spouses becoming pregnant within 32 months. The authors make a plea for infertility in both partners to be treated by the same specialist.
In addition to personal observations of 77 patients with one or more metastatic sites in the gastrointestinal tract, the authors reviewed over 1000 similar cases in the literature. The general radiologic aspects of each location (oesophagus, stomach, intestine, colon/rectum) are discussed. The pathophysiology of this type of metastasis explains the radiologic images obtained during barium transit examinations. The lymphatic type of spread observed in the oesophageal region in connection with carcinoma of the breast is the origin of stenosis of the middle third. The haematogenous type of diffusion encountered during melanomas creates intramural or intraluminal radiologic images. Two means of spread can be observed in the stomach. Haematogenous spread can result in frequently multiple and ulcerated nodular submucosal lesions from melanomas and bronchogenic carcinomas; it can also cause a more or less stenotic invasive image, especially in connection with carcinoma of the breast. Dissemination by means of the mesenteric reflections, and in particular around the gastrocolic ligament, explains the spread of a carcinoma of the transverse colon towards the stomach. The most frequent secondary sites in the gastrointestinal tract occur in the small intestine, the majority of these metastases being caused by pelvic tumours. Whether occurring in the small intestine or the colon, the pathophysiology is similar: direct invasion by a non-contiguous primary carcinoma along the fascias and mesenteric attachments (more rarely by lymphatic permeation), dissemination by the peritoneal fluid or haematogenuous spread. In the first two types of dissemination cited, the image encountered is often hard to differentiate from radiation-induced lesions.
The authors relate a case of acute functional obstruction, appearing after treatment of a cancer of rectum with extension to prevertebral plexus. The cause of the colic trouble appears to be neurological and due to a sympathetic and parasympathetic transmission block, while intrincic plexus was normal. Inefficacy of the contractions was established by radiology and endoscopy (electrical and pharmacodynamic stimulation and measure of pressure); it predominated in the left transverse colon. Caecal perforation has been avoided up till now after two years, without modification of clinical course, the patient evacuated his colon with the help of enemas. It seems probable that this case can be classified as Ogilvie's syndrome, the bibliography of which has been looked up and criticized.
On the basis of 144 radiation-induced intestinal and colorectal lesions seen in 109 patients, the authors review the radiologic aspects associated with such affections. Two points are emphasized: (1) the chronic and still active nature of radiation-induced injury which can explain the appearance of lesions more than 10 years after irradiation, and (2) the locoregional nature of the affection which warrants systematic exploration of the urinary tract by intravenous pyelography in addition to radiologic and endoscopic investigation of the digestive tract. The authors also advise an echography and/or CT scan to detect any neoplastic recurrence.
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We have identified three lesions rather than cyclobutane dimers which alter the properties of UV-irradiated poly(dC) as a template for E.coli DNA polymerase I, and have characterised these lesions with respect to their coding properties, rates of formation and decay, and their sensitivity to uracil DNA glycosylase. Our results lead us to conclude that these lesions are (1) cytosine hydrates, which code for cytosine and to a lesser extent thymine, (2) uracil hydrates, which code for adenine and are not sensitive to uracil DNA glycosylase, and (3) uracils, which code for adenine and are removed by uracil DNA glycosylase.
Seven cases of gastric leiomyoblastoma are reported, all of them benign. The subject of gastric leiomyoblastoma is reviewed from both clinical and pathologic aspects based on a review of 307 cases in the literature. Hemorrhage is a frequent sign (51.8%) but in 21.2% of cases leiomyoblastoma is asymptomatic. While such tumors have a malignant potential, a benign course was pursued in most of the cases (79.5%). The radiologic features of these tumors are similar to those of leiomyomas. An intramural location is the most common finding (41.4%) but intraluminal (22.7%), subserosal (25.7%) or dumbbell growth are also seen. In 31.3% of cases, the tumor is ulcerated.
The authors discuss the general and radiologic characteristics of leiomyomas and leiomyosarcomas, based on experience with forty-five cases involving the digestive tract and a review of over one thousand cases reported in the literature. Thirty-six leiomyomas (oesophagus 9, stomach 18, small intestine 9) and nine leiomyosarcomas (oesophagus 2, stomach 2, small intestine 4, colon 1) were observed and compared with reports from the literature. Leiomyomas of the oesophagus lend themselves to radiologic surveillance since there is no tendency for lesion degeneration in this location. Leiomyomas of the stomach are frequently asymptomatic and discovered following radiologic or endoscopic examination. With involvement of the small intestine, the most sensitive radiologic examination remains angiography, even though the information provided does not allow evaluation of the evolution of the tumour. Localization in the colon remains rare.
The authors have studied the toxicity of alkylating agents on the gonads in the light of three cases. The more frequent prescription of these products in chemotherapy when treating cases in Nephrology, Dermatology, Neurology and Ophthalmology as well as general systemic diseases, should make the doctor prescribing them look out for the risks that the reproductive function runs in their use. Although of course there is no valid discussion of the use of these drugs when life is at stake one should all the same, seeing how their efficacy is increasing and survival is becoming more likely, ask oneself about their bad effects on the gonads, and in particular when they are being used for less serious indications. The gonads are often attacked early and insidiously, the the effects on them often starting before the more spectacular secondary effects such as alopecia or neutropenia. A review of the literature brings to light the following : there is a more marked effect on the gonad when it is the testis than when it is the ovary, which seems to be progressively affected; the lesions become worse and increase according to the pubertal state of the male. As far as testicular damage is concerned, it seems debatable whether is is dose-related or related to the length of treatment, and the chances of recovery on stopping chemotherapy with alkylating agents seen to be overall poor. On the practical level the use of sperm banks may resolve some of the worries about later infertility. As far as women are concerned, the greater resistance of the ovary to the effects should make one careful to employ contraceptive measures which are necessary during and after treatment (for fear of teratogenicity).