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Biomedical subjects

R Loire

Publications and source records attributed to R Loire.

At least 127 records · Page 7Linked to original sources
PubMed1992

[Myxoma of the right atrium. Apropos of 10 surgically treated cases].

In a series of 100 patients with intracardiac myxoma, the lesion was in the right atrium in 10 cases. The authors attempt to define the particular features of right atrial myxoma in terms of clinical aspects, outcome and pathology. The diagnostic difficulty raised by complex clinical pictures (including right ventricular failure, pseudopericardial forms and forms with a predominance of systemic problems) has now been resolved by imaging and, above all echocardiography. Consequences for the right side of the heart may involve the pulmonary artery with myxomatous emboli causing multiple fusiform aneurysms and pulmonary hypertension, or, more rarely, the tricuspid (with need for valve replacement), vena cava (Budd-Chiari syndrome) or atrial septum (right/left shunt). Alongside systemic problems due to interleukin 6, erythrocyte abnormalities are a new feature. Frequent etiological inclusion in a Carney complex explains recurrences and multi-cavity forms. The dominant pathological feature is tumor calcifications, no doubt as a result of the long presymptomatic phase of myxoma.

Adult↗
PubMed1991

[Anatomy and etiology of aortic aneurysms].

The term "aortic aneurysm" applies to numerous conditions with extremely varied anatomical and aetiological features, which consist of more or less complete and localized destruction of the aortic wall components resulting in a sacciform or fusiform distension induced by blood pressure, with loss of parallelism between the sides of the aorta. The most frequent aneurysms, leading to numerous cardiovascular operations, are encountered mainly in middle-aged men. These aneurysms complicate the infra-renal terminal atherosclerosis of smokers or the parietal elastic dystrophy of the ascending aorta, where a few subjects in their twenties with Marfan's disease join the older men, and which clinically presents as severe aortic incompetence. The aneurysm of syphilis and its destructive effect on thoracic structures is a thing of the past with a purely historical interest. Dissecting aneurysms--which should be called incomplete internal aortic disease with delamination of the media--remains a fearsome disease in subjects over 50, despite advances in surgery. Rare types of aneurysm (traumatic, infectious, or local accentuation of megadolichoarteries, aortitis or connective tissue dysgenesis) complete the list.

Adult↗
PubMed1991

[Diffuse infiltrative lung diseases and fibrosis].

The clinician confronted to the diagnosis of infiltrative lung disease has to consider a wide spectrum of aetiologies. Among them, diffuse fibrosing interstitial lung disease is characterized by the deposition of collagen within alveolar structures. Either acute alveolar injury or chronic inflammatory alveolitis can induce pulmonary fibrosis. Basic research investigates the cells, the cytokines, and the extracellular matrix involved in the perpetuation of the fibropoliferative process.

Humans↗
PubMed1991

[Acute arterial neoplastic embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case].

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.

Acute Disease↗
PubMed1991

[Acute neoplastic arterial embolism after pneumonectomy for primary bronchial cancer. Clinical and therapeutic consequences apropos of a case].

We report a case illustrating the therapeutic consequences of an intravenous metastasis to the left superior pulmonary vein following resection of a voluminous primary lung carcinoma. Arterial spread of malignant cells occurred because the size of the tumor did not allow immediate clamping of the left superior pulmonary vein. The embolism was situated at the aortic bifurcation and lower limb ischemia persisted despite also emergency embolectomy. Distal (lower popliteal) embolectomy was also unsuccessful, and lower limb amputation was inevitable. This case illustrates the problems encountered in surgical treatment of pulmonary vein invasion by lung carcinoma and the role of adjuvant chemotherapy and radiotherapy.

Acute Disease↗
PubMed1991

[Coronary lesions of a cardiac transplant. (Chronic cardiac rejection). Study of 15 retransplantations].

In order to precise the pathologic aspects of coronary lesions observed in the accelerated coronary disease after heart transplantation, 15 cases of explanted hearts have been studied, and compared to the findings of previous coronarography. Histopathological aspects, modes of diffusion involving the three main coronaries and distal branches, thrombotic complications and their ischemic consequences showed that coronary lesions result in a few months or years to diffuse circumferential atheromatous like lesions. Localized lesions are less frequently encountered than in common atheromatous coronary disease, but multifocal thrombosis is frequent, found in 40% of the cases. This feature leads to ischemic cardiopathy expressed by cardiac failure, indolent because of the denervation of the heart. Correlations with coronarographies showed that this method underestimated the importance of coronary lesions, for which retransplantation represents the only hope. Risk factors include vascular immunological inflammation, viral infection enhanced by immunosuppression, increased platelet aggregation but we still ignore the respective importance of these factors at the present time.

Adult↗
PubMed1991

[Primary tumor of the thoracic wall unusual in aged patients: costal osteosarcoma].

Osteosarcoma is a tumour that is encountered in children and young adults but is exceptional in elderly people. Moreover, it is very rarely located in the chest. A case of costal osteosarcoma revealed by a pleural blood effusion is reported in a 66-year old male patient. Full surgical excision completed by parietal reconstruction was performed. The diagnosis of osteosarcoma was definitely confirmed at pathological examination. A few months later, a local recurrence associated with ipsilateral lung metastasis, was discovered and the patient was put on chemotherapy. The clinical, radiological and therapeutic aspects of this case are discussed.

Age Factors↗
PubMed1991

[Bronchiolitis obliterans organizing pneumonia (BOOP). Characteristics and boundaries of an anatomo-clinical entity].

Bronchiolitis obliterans organizing pneumonia (BOOP) is defined by endoluminal obstruction of distal airspaces by a fibrous granulation tissue consisting of inflammatory cells, fibroblasts, and connective tissue. The morphogenesis of the process is the following: diffuse alveolar injury leading to basement membrane denudation and intra-alveolar exudate of fibrinogen, immunoglobulins, coagulation factors, fibronectin; intra-alveolar migration of interstitial fibroblasts through gaps of the epithelial basement membrane; intra-alveolar secretion of loose connective tissue (codistribution of collagens I, III, V, and fibronectin) by the fibroblasts-myofibroblasts. The main characteristic of this peculiar fibrosis is its possible reversibility. BOOP is not specific for any aetiology, and it is found in various conditions as infectious diseases, drug induced pulmonary diseases, connective tissue diseases. It is also present in other conditions where it is not the most contributive information to diagnosis (hypersensitivity pneumonitis, chronic eosinophilic pneumonia). But in some cases BOOP remains idiopathic and has to be individualized. Three clinical and imaging profiles are distinguished: the most characteristic consists of an inflammatory context with imaging patchy alveolar opacities, migrating and relapsing, and most steroid sensitive; the other two presentations are less remarkable: pseudo-neoplastic localized chronic pneumonia, and diffuse infiltrative lung disease. BOOP is a clinico-pathologic entity that the clinician must know because of the efficacy of corticosteroid treatment in most cases, and it further represents an unique model to understand the pathogenesis of fibrosing pulmonary diseases.

Bronchiolitis Obliterans↗
PubMed1991

[Our experience of the surgical treatment of thirty-nine tracheobronchial carcinoid tumors].

Thirty-nine patients were operated for bronchial carcinoid tumour between 1967 and 1988 out of a total of 97 so-called benign bronchial tumours. Based on a clinical, radiological and endoscopic assessment of this series, the authors discuss the modalities of surgical treatment which depend on the site of the tumour. Treatment consisted of enucleation for the two peripheral carcinoid tumours and tracheobronchectomy in 6 cases (15%) and pulmonary resection in 31 cases (79%) for the central tumours. Lung resection was performed alone in 25 cases (64%): 1 pneumonectomy, 2 bilobectomies, 19 lobectomies and 3 segmental resections. The lung resection was associated with bronchial resection-anastomosis in 6 cases (15%). The immediate postoperative course was uneventful. There were two deaths: one from myocardial infarction after one year and one from hepatic metastases (malignant carcinoid) after 7 years.

Adolescent↗
PubMed1991

[Recurrence of intracardiac myxoma. A propos of 6 patients among 85 surgically treated].

It was sought to determine whether recurrent cardiac myxomas had special etiological, surgical and/or pathological features differentiating them from usual forms. This involved study of 6 recurrences occurring in 85 patients treated surgically between 1959 and 1989, as well as 33 well documented recurrences in the literature. True recurrent myxomas in young adults have a definite familial nature, frequently occurring within the context of Craney's complex and are due to a multicentre onset. Closer postoperative monitoring is therefore required in such cases. Recurrence of sporadic myxomas is generally due to incomplete excision and can be avoided by precautions regarding operative technique.

Adolescent↗
PubMed1991

[Is there a carcinologic malignant potentiality of cardiac myxoma?].

Cardiologists rarely encounter tumoral pathology, the commonest being the myxoma which presents more often as cardiac rather than neoplastic disease. A few cases of "malignant or metastatic cardiac myxoma" have been reported in the literature. We have not observed this behaviour in the follow-up of 100 cases of myxoma between 1959 and 1989. However, during the same period, 14 intracardiac sarcomas (operated or not) were seen, which were all rapidly fatal. A critical review of the cases of metastatic cardiac myxomas reported in the literature enabled us to classify them into three groups: the first, 9 cases of false myxomas. They were cardiac sarcomas and therefore a histopathological diagnostic error had been made. The second group comprised false metastases. They concerned arterial embolism of fragments of myxoma causing ischemic infarction or infiltration of the arterial wall by the myxoma, damaging the artery and resulting in fusiform aneurysm. This cannot be accepted as a true metastasis: a number of examples are given as they are too many to be named individually. The cardiac and cutaneous myxomas observed in Carney's complex may be included in this category. The third group has to be discussed case by case: these "metastatic myxomas" can all be explained logically and malignancy can be excluded; they are few in number (5 cases!) but often published several times by different authors. In our opinion, a carcinologically "malignant" metastatic myxoma remains a questionable pathological entity. This does not mean that a myxoma cannot be lethal: its intracardiac position may cause fatal valvular obstruction, or it may give rise to fatal embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Sudden death of the sportsman. Apropos of 23 cases with autopsy].

The results of a series of 930 coroner's autopsies were analysed retrospectively with the aim of determining the incidence and cause of sudden death during sports activities. Twenty three cases are reported (2.57%) of autopsies of individuals who otherwise had no traumatic lesion and no cerebral or abdominal pathology. Family history revealed no factor likely to favourise sudden death. The sports involved corresponded with various standard activities in France. Patients aged under 35 had a wide range of cardiac diseases. Almost all those aged over 35 died as a result of coronary diseases. This study shows the relative rarity but also the difficulty of preventing such accidents, in particular in the young individual.

Adolescent↗
PubMed1991

[Histopathologic study of cardiac myxoma. Apropos of 80 surgical cases].

The histological features of eighty cardiac myxomas removed by surgery between 1959 and 1988 were evaluated by the usual staining techniques and also by identification of immunohistological markers (vimentin, desmin, factor VIII, actin). Myxoma cells present various forms (polygonal, round, spindle, stellate) when isolated but are characterized by their tubular angioid structures: cellular masses, elementary tubes, organoid formations with several parietal layers and abundant "myxoid" matrix, denser around the angioid structures. Sometimes they are located on the surface forming crypts and vegetations, replaced in old myxomas by hyalinization. Other constituents such as vascular spaces, fibrinous exudate, hemosiderosis pigments, necrobiotic areas, various calcifications, plasma cell infiltrates are also frequently found. The insertion on the endocardium is usually an interesting structure. The presence of mucous epithelial structures and clusters of smooth muscle cells is uncommon but constitutes an additional argument in favour of the present explanation concerning its histogenosis i.e. a tumor derived from vestigial cells, usually confined to the floor of the fossa ovalis. On the basis of these various characteristics, myxomas can be classified as being active or inactive (more or less mummified), poorly differentiated or mature, which may correspond to the duration of the lesion prior to its resection. A precise histological examination of myxoma avoids confusion with more malignant myxomatous cardiac tumors.

Heart Neoplasms↗
PubMed1991

[Myocardial bridging on the left anterior descending coronary artery and sudden death. Apropos of 19 cases with autopsy].

In order to determine the relationship between myocardial bridging and sudden death, the authors analysed retrospectively the macroscopic and histological features of 19 cases of myocardial bridging of the left anterior descending artery (LAD) out of a series of 930 medicolegal autopsy studies. The patients (15 men and 4 women) had an average age of 39.2 years. A potentially lethal cardiac abnormality was found in addition to the myocardial bridge (ischaemic, cardiomyopathy, conduction tissue lesion) in 11 cases; in the other 8 cases, 7 had minor abnormalities and 1 heart was absolutely normal (a 47 year old woman who died while swimming but not of drowning). All hears had fresh, microscopic, ischaemic lesions in the territory of the LAD artery, demonstrated by LIE staining (basic fuschin). The anatomical lesions of the coronary arteries at the site of bridging were varied: 11 dense collagen fibrosis of the adventicia, 16 intimal fibroses of varying degrees of thickness (10 circumferential), 2 atherosclerotic plaques (a 40 and a 54 year old man), 2 recent thromboses (1 at the site of the bridge in a 50 year old man, and the other just distal to the bridge in a 25 year old man). In only 1 case (39 year old woman) there were no microscopic changes of the LAD artery at the site of the myocardial bridge. The hypothesis of the responsibility of the myocardial bridge in the occurrence of sudden death, either during an acceleration of the cardiac rhythm (milking effect) or by thrombotic or spastic phenomena, cannot therefore be excluded.

Adolescent↗
PubMed1990

[Radiation-induced pericarditis. Long-term outcome. 45 cases with thoracotomy and biopsy].

Between 1970 and 1989, 45 cases of pericarditis consecutive to thoracic irradiation for cancer were studied to determine their long-term outcome and the course of their pericardial lesions. All patients were symptomatic and required surgery on account of cardiac dysfunction or, more rarely, for diagnostic purposes, i.e. to distinguish between pure autonomous pericardial complications and recurrent mediastinal neoplasias, the latter being excluded from the study. All patients were explored by thoracotomy which permitted histopathological examination of the pericardium and the pericardial fluid, at the same time as therapeutic surgery (pericardial decortication for constriction in 22 cases, creation of pleuro-pericardial windows to ensure drainage of major effusions in 23 cases). The outcome was often poor owing to associated post-radiotherapy myocardial and pulmonary lesions: there were 20 deaths, 5 of which were directly due to the neoplasia and 13 to the radiotherapeutic complications; 5 patients remained with impaired cardiorespiratory function.

Adolescent↗
PubMed1990

Pulmonary Wegener's granulomatosis. A clinical and imaging study of 77 cases.

We studied 77 patients with biopsy-proven WG and pulmonary manifestations, to characterize the nature and frequency of the clinical, imaging and endoscopic features of this condition. Pulmonary symptoms were cough, mild dyspnea, hemoptysis and chest pain. Five patients had no pulmonary symptoms. Imaging features consisted of nodules, infiltrates and pleural opacities. A CT scan proved useful by disclosing cavities in opacities or opacities which were not seen on an x-ray film. Fiberoptic bronchoscopy was performed in 74 patients, and it was macroscopically abnormal in 55 percent (showing bronchial inflammation or stenosis or both or isolated hemorrhage). Six patients presented with alveolar hemorrhagic syndrome. Four patients had a pleural exudate rich in polymorphonuclear leukocytes. The WG was limited to the lung in seven patients. Sixteen patients died because of active disease or iatrogenic complications (two). An improved knowledge of clinical and imaging features of WG could help the clinician reach an earlier diagnosis.

Adolescent↗
PubMed1990

Human epithelial thymic tumours: heterogeneity in immunostaining of epithelial cell markers and thymic hormones.

Different hormones (thymulin, thymosin alpha 1, vasopressin), antigenic markers of cortical and subcapsular/medullary thymic areas and tumour associated antigens were studied on paraffin or frozen section and cultures of human epithelial thymic tumours ('thymomas'). Thymulin, thymosin alpha 1 and for the first time vasopressin are found in most tumours. The epithelial cells of five 'thymomas' had markers of both cortical (TE3) and subcapsular/medullary thymic regions (A2B5 and/or TE4 and/or anti-p19). Leu-7, a marker of subcapsular epithelial cells was positive only in two tumours. The histological classification into cortical and medullary tumours does not correspond to our immunofluorescence results. The presence of these markers does not support the theory of different embryologic origin of the cortical and subcapsular/medullary epithelial cells. Transferrin receptors were detected on only some epithelial cells of thymic 'carcinomas'. Adenocarcinoma related antigen and carcino embryonic antigen only stained a few epithelial cells of all the tumours. There is no expected correlation between the presence of epidermal growth factor receptors on cell membranes and the number of proliferative cells stained by the anti-Ki67 antibodies. Immunostainings were heterogeneous according to the epithelial thymic tumours, independent of histological classification and not yet useful for prognosis.

Adult↗