Immunostaining by complement C9: a tool for early diagnosis of myocardial infarction and application in forensic medicine.

Before the first 12 hours, diagnosis of early myocardial infarctions is always difficult for forensic pathologists. We tested complement C9 expression in 121 formalin-fixed and paraffin-embedded heart samples by an immunohistochemical procedure. The heart specimens were separated into four groups: 33 cases in group 1 with typical ischemic damages histologically located, 20 cases in group 2 with death related to myocardial infarction on the basis of ischemic presentation on electrocardiogram but no obvious histological ischemic damage, 35 cases in group 3 with severe coronary disease without cause of death found at the autopsy, and 33 cases in group 4 without sign of myocardial infarction and without coronary disease. In the first group, all 33 heart samples showed a well-defined C9 expression in the necrotic areas. The second group in 17 of 20 cases showed positive areas for C9 expression. In the other three heart specimens, only few stained cells were observed whereas the painful symptoms had begun less than 1 h before death. The third group showed C9 immunopositive areas in six of 35 cases, few stained cells in 8 cases, and no C9 deposition in the 21 other cases. The last group showed no staining area. To avoid nonspecific C9 staining due to tissue autolysis, we studied C9 expression during a controlled putrefactive process in four cases included in group 1; staining was found only in infarcted myocardial areas, and was observed up to ten days. Specificity of C9 expression was evaluated to be 100% [89.4 to 100%] and sensitivity to be 85% [62.11 to 96.79%]. In conclusion, evaluation of immunohistochemical expression of C9 appears to be a highly sensitive and specific marker of early myocardial infarction, useful in forensic medicine if survival is more than 1 h after the beginning of myocyte damage.

[Destruction of tattoo by ruby laser]. / Destruction des tatouages par laser rubis.

The originality of tattoo destruction by ruby laser is to selectively treat the tattooed areas without injuring the surrounding normal cells, in order to obtain better healing. Therefore, we selected a red laser (ruby, emitting at 694.3 nm), with very short flashes (100 ns with self Q switched ruby laser). Ruby laser spots of about 1 cm diameter are delivered to on the area to be treated. As the black particles of the tattoo absorb more laser energy than the surrounding pale-pink skin (140 Mw/cm2, i.e. 14 j/cm2), we can obtain quite localized destruction and better healing. The beam is focussed on one point of the tattoo with a sighting neon-helium laser. In view of the very short impact, the energy absorbed by the pigmented particles diffuses minimally to adjacent tissues. After the crust falls, carrying away some tattoo pigment on its deeper surface, a pale-pink scar forms, then gradually fades in several months. With thick tattoos, it is necessary to proceed in layers and to plan a course of several treatments about one month apart. Compared with the other methods of tattoo removal (dermabrasion, salt, CO2 laser), ruby laser gives the best cosmetic results, even in keloid prone areas.

[The value of ultrasound-guided cyto-biopsy in the study of livers with abnormal ultrasonograms]. / Intérêt de la cyto-ponction échoguidée dans l'exploration des foies d'échostructure anormale.

This retrospective study considers the diagnostic reliability of 97 cyto-biopsies performed with a fine needle and guided by ultrasonography in 92 patients with one or several suspicious liver lesions. The results of the cyto-biopsy were compared with the final diagnosis obtained by histological examination or by the evolution. In 65 confirmed malignant tumors, fine needle biopsy was concordant in 54 cases. The sensitivity of this method in the diagnosis of malignant liver lesions was 83% with a specificity of 93%. In 54 malignant cytologies, the differentiation between primary or secondary lesions was possible in 31 cases (57%). In 32 confirmed benign lesions, fine needle biopsy was concordant in 30 cases. This study confirms the advantage of cyto-biopsy guided by ultrasonography in the positive and etiological diagnosis of malignant liver tumors.

Value of sonographically guided fine needle aspiration biopsy in evaluating the liver with sonographic abnormalities.

This retrospective study was undertaken to evaluate the diagnostic usefulness of 97 sonographically guided fine needle aspiration biopsy cytologies in 92 patients with one or more hepatic lesions suspicious of malignancy. Results of the fine needle aspiration biopsy were then compared with the definitive results obtained by histologic examination, or with the subsequent course of the patient. A final diagnosis of malignancy was established in 65 cases, of which fine needle aspiration biopsy cytology revealed a concordant diagnosis in 54 cases. The diagnostic sensitivity of this technique was 83% for malignant lesions with 93% specificity. Of the 54 cases with malignant cytology, it was possible to distinguish between a primary or secondary lesion in 31 cases (57%). Benign lesions were aspirated in 32 cases, of which 30 cases concorded with the final diagnosis. This study confirms the usefulness of sonographically guided fine needle aspiration biopsy cytology in diagnosing malignant hepatic tumors.

Campylobacter-like organisms and surface epithelium abnormalities in active, chronic gastritis in humans: an ultrastructural study.

A prospective light and electron microscopic study of repeated endoscopic gastric biopsy specimens obtained from 10 patients presenting at the first examination for long-standing erosive gastritis was performed. In nearly all specimens from 7 patients, spiral bacteria were found in close contact to the surface epithelial cells and associated with active inflammatory changes. These organisms appeared similar to those recently described as gastric "campylobacter-Like organisms" (GCLO). It is possible that they are related to unusual anaerobic spirochetes. In the specimens obtained after antibiotic-therapy the bacteria were few in number and damaged. At the ultrastructural level, the presence of cell necrosis and autolytic intracytoplasmic vacuoles combined with damaged bacteria may suggest a relationship between GCLO surface colonization and erosive epithelial abnormality. Such colonization does not occur in normal mucosa.

[A rare form of benign tumor of the liver possibly related to the use of oral contraceptives: focal pediculated nodular hyperplasia]. / Une forme rare de tumeur bénigne du foie en relation possible avec l'utilisation de contraceptifs oraux: "l'hyperplasie nodulaire focale pédiculée".

Following a recent case, the authors review the literature of hepatic nodular hyperplasia. The incidence of this condition increases regularly with the consumption of oestrogens. They attempt to define the methods of detection for patients at highest risk. Without exaggerating the incidence of this complication of oral contraceptives, the authors believe that it will become increasingly more common than the vascular complications which, although frequently discussed, are relatively rare.

PIP: This article describes a case of focal pedunculated nodular hyperplasia, a rare form of benign liver tumor, and reviews the literature on focal nodular hyperplasia (FNH) and hepatocellular adenoma. Focal pedunculated nodular hyperplasia is the rarest form of FNH and accounts for fewer than 20% of cases. Hepatocellular adenoma is usually a single encapsulated tumor ranging in size from 1-30 cm in diameter. FNH is usually also a single tumor which is always polylobed and multinodular. The size is variable and it is well defined although not encapsulated. Microscopically neither FNH nor hepatocellular adenoma has normal portal spaces or centrolobular veins. A peliose (intratumoral pseudomicrocysts) is often observed in oral contraceptive (OC) users in both cases. Atypical, dysplasic, or neoplasic cells are observed in about 10% of cases of hepatocellular adenoma but have never been reported in FNH. Considerable hypervascularization is found in hepatocellular adenoma but not in FNH, although in FNH large vascular pedicel may be observed at the periphery. Both tumors are most frequently seen in fertile aged women. Over 1/3 of cases of hepatocellular adenoma are discovered due to intraperitoneal bleeding. FNH is asymptomatic in 73.5% of cases and hemoperitoneum is very rare. The case reported was that of a 40-year-old woman with no significant medical history who had used a combined OC containing ethinyl estradiol and norgestrel for 6 years until 2 years previously, when she terminated use due to subsequently controlled hypertension. A 6-month history of menorrhagia was uncontrolled despite use of an OC containing levonorgestrel only. The liver tumor was discovered in the course of a total hysterectomy performed because of a large polymyomatous uterus associated with significant menorrhagia. The FNH was surgically removed 2 months later. The tumor was highly vascularized and connected to segment 4 by a voluminous pedicel containing numerous thick vascular elements. The postoperative course was smooth. The relationship between OC use and benign hepatic tumors is now well established. Their overall frequency has been estimated at 4.9/million women aged 15-45. The duration of exposure to OCs seems to be a determining factor. The risk is negligible at durations of OC use under 1 year but is multiplied by 7 for FNH and by 5 for hepatocellular adenoma after 5 years. EE, mestranol, and 19 norsteroids all seem to play etiologic roles. 58% of hepatocellular adenomas in OC users are discovered because of hemoperitoneum following rupture. Bleeding is usually massive and the mortality rate is about 6%. FNH is revealed by bleeding in 15% of cases in OC users and is asymptomatic in 49% of users. Tumor development depends on whether OC use is continued. It is not currently known whether the tumors tend in the long run to degenerate into hepatic carcinoma, and whether OC use plays a role. The occurrence of liver cancer in OC users does not seem to be greater than in the general population, but OC users are younger at diagnosis, their survival time is longer, and alpha fetoprotein levels are not elevated. Surveillance of OC users is difficult because FNH is so often asymptomatic. Periodic sonograms after 5 years of OC use may be indicated.

[Effect of restoring duodenal continuity after total gastrectomy in the rat]. / Influence de la remise en circuit du duodénum après gastrectomie totale chez le rat.

An experimental study in the rat compared efficacy of re-establishment or not of duodenal continuity during digestive reconstruction by Y loop after total gastrectomy. Results were evaluated as a function of growth rate in the two groups. Nutrition following gastrectomy in rats treated by this technique was significantly better than in the other rats. Similar findings have been reported in humans, suggesting that this procedure be used more frequently after total gastrectomy.

[Multiple metastases during the course of a pineal germinoma]. / Métastases multiples au cours de l'évolution d'un germinome pinéal.

The clinical findings and course of a patient with a germinoma of the pineal region is presented. After a surgical procedure and radiation treatment, ten months after, the patient develops successively peritoneal, ventricular, spinal metastasis. Effective treatment was either radiation treatment or chemotherapy. The frequency of metastasis with germinomas of the posterior part of the third ventricle are discussed, following a review of the literature, prevention and treatment are discussed.

[Specific cutaneous localizations in multiple myeloma and Waldenström's macroglobulinemia. Apropos of 4 cases]. / Localisations cutanées spécifiques au cours du myélome multiple et de la macroglobulinémie de Waldenström. A propos de 4 observations.

The specific skin locations of multiple myeloma (M. M.) and Waldenström's macroglobulinemia (M. W.) are rare. The authors report here 4 cases: 2 within M. M., the other 2 within lymphoplasmocytic lymphomas with IgM dysglobulinemia (M. W.) or in situ tumoral secretion of IgM. Observation no. 1. A 56-year-old man is admitted for investigations for spontaneous fractures of the ribs. The skin examination reveals about ten purple, nodular and sometimes ulcerated lesions of the back which appeared over more than one year. The histology of a cutaneous nodule shows a dense infiltrate of plasma cells with numerous atypical cells. The laboratory investigations reveal a IgG, kappa M. M. A polychemotherapy leads to a healing of the nodules in 3 months. Observation no. 2. A 58-year-old man is admitted for investigations of a proteinuria (6.80/24 h) which will be imputed to a lambda chains M. M. One year and a half later appear subcutaneous thoracic nodules. The histology of the skin confirms the diagnosis of metastatic skin plasmocytoma; the patient will die a few months later in spite of the chemotherapy. Observation no. 3. A 84-year-old woman is admitted for investigations of a dysglobulinemia. On the cutaneous part there are tumoral purple plaques symmetrically disposed on the 2 cheeks and the nose. The histology of the skin shows a dermo-hypodermal tumoral infiltrate essentially made of lymphoplasmocytoid cells. In direct immunofluorescence study there is a kappa tumoral secretion of mu type.(ABSTRACT TRUNCATED AT 250 WORDS)

[Necrotizing cellulitis and fasciitis of infectious origin. Review of 10 personal cases and the literature]. / Cellulite et fasciite nécrosantes d'origine infectieuse. Revue de 10 cas personnels et de la littérature.

Ten personal cases of necrotizing cellulitis and fasciitis are reported. The lower limbs were the most common site of infection. Two patients had involvement of the whole of the leg and died of septic shock. Two other patients died of pulmonary embolism. Bacteriological investigations showed multiple infection to be the rule; gangrene due to streptococcal infection alone was only observed in 3 cases, staphylococcus alone in 1 case and serratia alone in 1 case. Surgery was performed within 48 hours of admission under antibiotic cover in all but two cases. The authors emphasize the need for adequate anticoagulation to prevent multiple venous thrombosis in the infected subcutaneous tissues and to avoid the risk of fatal pulmonary embolism.

[Peritonitis following cesarean section. Report of 2 cases. The value of laparostomy]. / Péritonite après césarienne. Rapport de deux cas, intérêt de la laparostomie.

The authors describe two cases of severe septic complications after caesarean section. They compare primary closure of the abdomen with the method of leaving it open. This should only be used very rarely but may help to shorten the stay in hospital and lessen the severity of the complications of severe peritonitis, which still today in these rare cases of surgery carry very heavy mortality.