Giant cell arteritis of the female genital tract with temporal arteritis.

The clinical and pathological features of a patient with giant cell arteritis of the uterus and ovaries are described. A 61 year old woman had fever and weight loss over a period of eight months. A hysterectomy with bilateral salpingo-oophorectomy was performed for a large cystic ovarian mass. Histological examination showed a benign ovarian cyst and unexpected giant cell arteritis affecting numerous small to medium sized arteries in the ovaries and myometrium. The diagnosis of temporal arteritis was confirmed by a random temporal artery biopsy, despite the absence of symptoms of temporal arteritis. This observation is compared with previously reported cases and the relation between granulomatous arteritis of the genital tract and temporal arteritis is discussed. The main differential diagnosis in this localisation was represented by Wegener's granulomatosis and periarteritis nodosa.

[Distal lesions of the Fallopian tubes. Prognostic values of peroperative tubal biopsy]. / Lésions tubaires distales. Intérêt pronostique de la biopsie tubaire per-opératoire.

78 biopsies were carried out during 63 distal tubal microsurgical operations, followed up for two years at least. The clinical outcome was studied according to the pathological state of the better tube: Viable pregnancies become more frequent with subnormal tubes (40%) and with tubes with moderate chronic salpingitis (65%). The risk of extra-uterine pregnancy is at a maximum with chronic cicatricial salpingitis (29.4%). Progressive chronic salpingitis results in only 6.6% viable pregnancies and will definitely constitute an indication for in vitro fertilization rather than microsurgery.

[Ampulla fibrotuboscopy]. / La fibrotuboscopie ampullaire.

During a microsurgical operation the opportunity was taken to inspect the ampulla of the tube with a soft fibroscope in 68 patients. Several different normal and pathological appearances were found. Ampullary endoscopy gives much more precise information than salpingography and a very valuable prognosis because 14 normal pregnancies occurred where the tubes had been considered to be normal whereas no intra-uterine pregnancy occurred where the tubes were thought to be pathological. Instead, they re-obstructed or were the sites of ectopic pregnancies. This complementary examination carried out during operation seems to be a useful prognostic measure for patients undergoing ampullary surgery.

Acute renal insufficiency due to lymphomatous infiltration of the kidneys: report of six cases.

Described are six patients with acute renal insufficiency due to histologically proven massive lymphomatous infiltration of the kidneys. All patients were admitted to a renal intensive care unit over a period of six years. Oliguria was the presenting symptom in two of the patients. This complication of lymphoma is suggested by enlargement of the kidneys and mild proteinuria in the absence of other causes of uremia and can be demonstrated by renal biopsy. Local radiation therapy performed in two patients produced improvement of renal function.

[Acute kidney failure during periarteritis nodosa]. / Insuffisance rénale aiguë au cours de la périartérite noueuse

In 9 patients aged 16 to 71 years with acute renal failure, histological examination disclosed polyarteritis nodosa. Symptoms of rapidly progressive glomerulonephritis (GN) were present in 7 cases. Hypertension was a constant feature. Fever and muscular articular and cutaneous signs occured at times simulating Henoch-Schönlein purpura. Necrotizing angiitis was a constant finding, with perivascular granuloma in 7 cases. Lesions affecting smaller arteries were associated with diffuse or segmental extracapillary GN, and lesions of larger arteries with ischaemic appearance of the glomeruli. Diagnosis was obtained during life by percutaneous renal biopsy in 5 patients and muscular or cutaneous biopsy in 2 other patients, whereas the evidence was only obtained on post mortem examination in the 2 remaining patients. In the 6 renal biopsies examined by immunofluorescence, fibrinogen was always present in glomeruli and/or arteries. In one patient there was a linear deposit of IgG along glomerular basement membrane (GBM) and there were circulating antibodies directed against GBM. Arteries of different sizes may be damaged in various organs, as showed by arteriography and autopsy. Steroid therapy and immunosuppressive drugs had no effect on renal symptoms. 8 out of 9 patients died rapidly, in 6 the death was due to extrarenal localization of the disease, even though uraemia was controlled by haemodialysis. The last patient died 2 years after onset of the disease, while being on maintenance haemodialysis treatment.