RESUMEN
The term cryptic miliary tuberculosis designates a particular form of hematogenous tuberculosis in which the usual diagnostic criteria, especially the roentgenographic ones, are lacking. Two cases are reported. Initial clinical manifestations were prolonged fever, poor general condition, low blood pressure, low serum sodium, mild hepatic biological disorders, and myocarditis. No other radiological or biological features, suggestive of tuberculosis were found. In the first patient, the various visceral tuberculous localizations occurred under specific treatment, although the latter was otherwise effective. In the second patient, they were identified by pathological examination. The incidence of these occult forms of tuberculosis, where diagnosis is often established too late, and sometimes only postmortem, is not negligible. This possibility must be borne in mind in severe infectious conditions without obvious etiology, particularly when the following features are present : inadequate secretion of ADH, which often indicates latent encephalitic and meningitic involvement where CSF anomalies may be incomplete or lacking ; leucopenia or pancytopenia ; biological hepatic anomalies ; exceptionally, such as in the two cases described, cardiac involvement. Among diagnostic procedures, liver biopsy is of the utmost importance. Mere diagnostic presumption is sufficient to warrant initiation of antituberculous therapy. This ensures survival and, paradoxically, allows delayed overt clinical manifestations to develop.
Asunto(s)
Tuberculosis Miliar/diagnóstico , Enfermedad Aguda , Adulto , Anciano , Humanos , MasculinoAsunto(s)
Disgerminoma/complicaciones , Síndrome de Meigs/etiología , Neoplasias Ováricas/complicaciones , Adulto , Carcinoma/complicaciones , Cistadenocarcinoma/complicaciones , Femenino , Fibroma/complicaciones , Humanos , Síndrome de Meigs/fisiopatología , Pronóstico , Neoplasia Tecoma/complicacionesRESUMEN
Based on the case of a inflammatory fibroid polyp, the authors review the features of this gastric lesion of tumoral appearance, but of inflammatory kind.
Asunto(s)
Fibroma/patología , Gastritis/patología , Neoplasias Gástricas/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Gástricas/diagnósticoRESUMEN
Vascular exclusion of the liver by clamping the hepatic pedicle and inserting an internal cavoatrial shunt allows bloodless hepatic surgery to be performed. The internal cavoatrial shunt performed on 30 dogs was studied to define its optimal hemodynamic characteristics. The internal diameter should measure half the caliber of the inferior vena cava and the total surface of the holes allowing blood flow to the shunt must be three times the internal caliber of the shunt. The aortic clamping associated with the clamping of the hepatic pedicle and the insertion of the internal cavoatrial shunt considerably diminishes the arterial blood pressure variations resulting from the splanchnic stasis. Administration of methylprednisolone (30 mg/kg) at the beginning of the experiment also plays a role in preventing alterations in the small intestine.
Asunto(s)
Atrios Cardíacos , Hepatectomía , Hígado/irrigación sanguínea , Derivación Portosistémica Quirúrgica , Vena Cava Inferior , Animales , Presión Sanguínea , Perros , Intestino Delgado/irrigación sanguínea , Intestino Delgado/efectos de los fármacos , Metilprednisolona/farmacologíaRESUMEN
On the basis of about one hundred and fifty cases, the authors study the effect of oral contraceptives on the gall-bladder. After having showed their results, they discuss the mechanism of the action of oral contraceptives on the gall-bladder, showing their favouring effect on gallstones and pointing out the delay in gall-bladder emptying induced by them.
Asunto(s)
Anticonceptivos Orales/efectos adversos , Enfermedades de la Vesícula Biliar/inducido químicamente , Animales , Bilis/efectos de los fármacos , Bilis/metabolismo , Colecistografía , Colelitiasis/inducido químicamente , Colelitiasis/diagnóstico , Anticonceptivos Orales/administración & dosificación , Perros , Femenino , Vesícula Biliar/efectos de los fármacos , Vesícula Biliar/patología , Enfermedades de la Vesícula Biliar/diagnóstico , Enfermedades de la Vesícula Biliar/terapia , Cobayas , Humanos , Embarazo , Progestinas/efectos adversos , ConejosRESUMEN
The authors report seven cases of carcinomas of the lower oesophagus with peptic lesions. Based on clinical, endoscopical and histological criteria, they point out these peptic lesions preceded the carcinoma in all the cases certainly or very probably. They emphasize at last two cases where the peptic lesions after a strict supervision during many years, gave place, in spite of it all, to a cancerous transformation.
Asunto(s)
Adenocarcinoma/etiología , Carcinoma de Células Escamosas/etiología , Neoplasias Esofágicas/etiología , Esofagitis Péptica/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Granular cell myoblastoma or Abrikossoff's tumor of the esophagus are exceptional: fiveteen cases have been described in the literature. In this work we present the following case: discovery of a sub mucosal tumor during a systematic fibroscopic examination of an anemix patient. Only histological examination was able to make the diagnosis.
Asunto(s)
Neoplasias Esofágicas , Neoplasias de Tejido Muscular , Adulto , Neoplasias Esofágicas/patología , Esófago/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de Tejido Muscular/patologíaRESUMEN
Studying morbidity according to age and sex in persons decreased at hospital, the authors point out that many illnesses grow in frequency with age. Very often too, illnesses grow in number with age; but this is not constant. At last, this study allows to state the behaviour of old people before illness and the influence of senescence on the terminal evolution.
Asunto(s)
Mortalidad , Adulto , Factores de Edad , Anciano , Enfermedad , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Paris , Factores SexualesRESUMEN
Based on two cases, the authors recall the anatomical lesions of the liver occurring at times in women using oral contraceptives: jaundice, benign tumors, vascular lesions; and they emphasize more particularly the vascular lesions and their relation with oral contraceptives.
PIP: The authors describe 2 observations of anatomical lesions of the liver related to the use of oral contraceptives. They remind of the different forms of lesions of the liver observed in women using oral contraceptives: jaundice (although this form has become relatively rare), benign liver tumors and vascular lesions. Some hepatic alterations provoked by oral contraceptives are very similar to lesions observed during pregnancy. Experiments performed on animals have shown the influence of sex hormones in hepatic tumors: a prolonged administration of high doses of extrogens increases the carcinogenic action of acetylaminofluoren in the female while the occurence of tumors is not increased in males treated in the same fashion. In males as well as females, testosterone has a stimulating effect on the development of hepatic tumors. It is concluded that clinicians should be aware of the hepatic risks carried by oral contraception.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas , Anticonceptivos Orales/efectos adversos , Neoplasias Hepáticas/inducido químicamente , Hígado/efectos de los fármacos , Adulto , Femenino , Humanos , Hígado/irrigación sanguíneaRESUMEN
Since its foundation in the beginning of this century, the Vaugirard hospital of which the origin is briefly recalled, found its way towards digestive surgery and gastroenterology. This induced the creation, 35 years ago, of the Vaugirard Radio-anatomo-clinical Confrontations, only dedicated to digestive pathology.
Asunto(s)
Educación Médica , Gastroenterología/educación , Cirugía General/educación , Hospitales de Enseñanza/historia , Historia del Siglo XX , ParisRESUMEN
The authors report seven cases of carcinomas of the lower third of the esophagus developed on lesions of peptic esophagitis. These lesions precede the carcinoma. They can be real precancerous states and even in situ carcinomas whose evolution over several years could be proved indeed. They argue about the therapeutical indications in peptic esophagitis considering not only that such a cancerous transformation is always possible but also the fact that a surgical ablation is always serious.
Asunto(s)
Adenocarcinoma/etiología , Carcinoma de Células Escamosas/etiología , Neoplasias Esofágicas/etiología , Esofagitis Péptica/complicaciones , Lesiones Precancerosas , Adenocarcinoma/terapia , Anciano , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/terapia , Esofagitis Péptica/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.