[Bronchiolo-alveolar carcinoma complicating systemic scleroderma under long-term treatment with factor XIII]. / Carcinome bronchiolo-alvéolaire compliquant une sclérodermie généralisée traitée au long cours par le facteur XIII.

A 52-year old woman with systemic scleroderma had been treated since 1978 with factor XIII. The skin lesions had improved, and respiratory lesions had become stabilized. In 1984, she developed a bronchiolo-alveolar carcinoma which was treated by surgery. The authors emphasize that factor XIII is well tolerated and has beneficial effects on the skin and probably also on the lungs, without tachyphylaxis; however, the possibility of a bronchioloalveolar carcinoma occurring cannot be ruled out.

[Comparative study of the human basophil degranulation test and total and specific IgE levels in schistosomiasis. 54 cases]. / Etude comparative du test dégranulation des basophiles humains et du dosage des IGE totales et spécifiques dans les schistosomoses. 54 cas.

In 54 patients (45 Africans and 9 West-Indians) we searched schistosomiasis and the presence of immunoglobulins E by different tests (total immunoglobulin E levels, measurement of specific IgE, human basophil degranulation test). In patients with an excretion of living eggs we observed 91.6% of positive responses for the II. B. D. T. and 100% for the specific IgE. In cases only identified by examination of rectal mucosa biopsy specimens showing apparently living eggs, we observed 75% and 87.5% of positive responses for the same tests. But in both categories of patients, the parasitological examination is the most important. Moreover the authors observed "false-positive" and "false negative" tests compared with the parasitological results and between the tests. It suggests that the best use of these is in case of very probable schistosomiasis without positive parasitological results.

Release of LPL activity after intravenous injection of a low molecular weight heparin.

A low molecular weight heparin (MW 4000-6000), PK 10169 (Pharmuka), with much reduced anticoagulant in vitro capacity, retains the properties of the standard heparin in releasing lipoprotein lipase and hepatic lipase activity after being injected intravenously.

[Serodiagnosis of Yersinia infections in cirrhotic patients. Study apropos of 73 patients]. / Le sérodiagnostic des yersinioses chez le cirrhotique. Etude à propos de soixante-treize malades.

It is well-known that cirrhosis is a predisposing factor to Yersinia septicemia. This study includes 73 cirrhotics and shows a high number of positive serologic tests (47/73 : 64.4%). However, there is no correlation with clinical features or bacteriological findings. The most frequent serotypes, i.e. pseudotuberculosis IV and enterocolitica 0:9, differ from those which are usually found in Yersinia septicemias. Iron overload in cirrhosis, increased intestinal load of gram-negative bacilli and possible latent bacteremia may partly explain these results. However, the role probably played by as yet poorly known cross-reactions between Yersinia and other pathogens (Shigella, E. Coli...) must be underscored. The authors conclude that slightly positive, stable, serodiagnostic tests have little meaning in cirrhotics.

[Hepatic granulomatosis and positive serodiagnosis of Yersinia infections]. / Granulomatoses hépatiques et séro-diagnostics de yersiniose positifs.

Four cases of hepatic granulomatosis with positive Yersinia serologic tests are reported. In one case, the Wright serodiagnostic tests were also positive. In the three other cases, no other likely etiology was demonstrated. The authors recall the main causes of hepatic granulomatosis, diagnostic criteria of Yersiniosis infections, and the possible occurrence of simultaneous positive serodiagnostic tests for Yersinia enterocolitica type 9 and Brucella abortus.

[Fiessinger-Leroy-Reiter's syndrome : serological conversion for Yersinia enterocolitica type 9, positive serodiagnosis for Shigella flexneri and Chlamydia]. / Syndrome de Fiessinger-Leroy-Reiter : conversion sérologique pour Yersinia enterocolitica type 9, séro-diagnostics positifs pour Shigella flexneri et Chlamydia.

A case of Reiter disease in a HLA B27 positive man with urethritis followed by polyarthritis is reported. During the disease, serologic conversion for Yersinia enterocolitica type 9 was detected as well as positive serologic tests for Shigella flexneri and Chlamydia. The features of reactive arthritis related to Yersinia and the etiologies of Reiter disease are recalled.

[Therapeutic and economic aspects of dracunculosis in a Parisian hospital]. / Aspects thérapeutique et économique de la dracunculose dans un hôpital parisien.

We studied 18 cases of dracunculosis treated in our department of Internal Medicine in Paris. The mean duration of the hospital stay is 38 days (15 to 90). The cost of this stay, calculated on the basis of the daily charge, accounts for 93.3 % of the total cost. The longest stays are due to serious subcutaneous infections at the site of the worm and to multiple or complex associated diseases. Average charge for laboratory test, roentgenograms or other investigations amounts to 4.4 % of the cost of the hospital stay. A significant part of these investigations is warranted by cellulitis and the diagnosis of associated conditions. Antibodies prescribed for subcutaneous infections account for almost all of the drug expense (2.3 % of the total cost). Thus, investigations and treatment together amount to only 6.7 % of the daily charge. Traditional treatment of dracunculosis is based on manual extraction of the worm. Thiabendazole was added in 12 of the 18 patients. The average duration of hospitalization (34 days) and average charge for investigations and drug treatment (FF 611) were less in these 12 patients than in the 6 others (47 days, FF 1286). However, this result is to be considered with caution as the number of patients in each group is small, treatments were assigned without any statistical rule, subcutaneous infections were more or less serious and associated diseases may have had a bearing on results.

[Hepatopathies associated with chronic carriage of HBs antigen in black African immigrants in France]. / Les hépatopathies associées au portage chronique de l'antigène hbs chez les noirs africains immigrés en France.

The authors report two studies : 1) Retrospective : study of liver biopsies in 44 Africans : 22 were HBs Ag positive and 22 HBs Ag negative ; 10 of the HBs Ag positive subjects were found to have chronic persistent hepatitis (CPH), 4 chronic active hepatitis (CAH) and 3 cirrhosis ; 2 of the HBs Ag negative subjects were found to have CPH and 3 CAH ; as far a biological findings are concerned, only the CAH and cirrhosis groups differed from the control group, with higher prothrombin times, transaminase levels and gammaglobulin levels. 2) Prospective : study of the incidence of HBs Ag carriage in 168 Africans ; 17.8 % of them were found to be carriers ; no correlation was found between HBs Ag carriage and S. haematobium schistosomiasis or hemoglobinopathies.

[Gram-negative septicemia and bacteremia in an internal medicine department]. / Septicémies ou bactériémies à gram négatif dans un service de médecine interne.

Among 31 patients with positive blood cultures for gram-negative bacilli seen in a department of internal medicine, 13 had at least 3 positive blood cultures from samples taken over more than 12 hours and were diagnosed as having septicemia (group I) ; 18 patients had less than three positive blood cultures over the same period or had several positive blood cultures over a shorter period and were diagnosed as having bacteremia (group II). There were no significant differences between these two groups concerning age, sex, fever, other clinical features, or biological findings. E. coli was recovered in 70 % of cases and was almost always related to urinary infection. 8 patients died (3 in group I, 5 in group II), 6 of whom had cirrhosis. The sensitivity of the pathogens to the main antibiotics is described. The most often used antibiotic combination was ampicillin-gentamycin. It is suggested that in departments receiving patients from outside the hospital rather than from intensive care units the ampicillin-gentamycin combination can be advocated as the first treatment. As there were no significant differences between patients with septicemia or bacteremia, in severe infections a single positive blood culture should be taken into account and discrimination between septicemia and bacteremia is useless.

[Bladder bilharzioma and carcinoma in a bilharzial bladder]. / Bilharziomes et carcinomes vésicaux sur vessie bilharzienne.

Over 7 years, 592 patients infected by Schistosoma haematobium were detected. Among these, 102 had a cystoscopy which found carcinoma in 3 patients, polypi in 1 and vesical "bilharzioma" (so-called pseudo-polyps) in 14. From the results of the biopsies and data from the medical literature the relationship between schistosomiasis and carcinoma in the schistosomial bladder is discussed, as well as the meaning of various lesions, such as malpighian metaplasia, papillomatous hyperplasia and glandular cystitis, seen in biopsy specimens from "bilharziomas". The cystoscopic diagnosis of one (or several) tumours resembling "bilharzioma" requires biopsy, resection and close monitoring.

[Angiocholitis and polymicrobial septicemia caused by food obstruction in a patient with a biliodigestive anastomosis]. / Angiocholite et septicémie polymicrobienne par obstacle alimentaire dans une anastomose bilio-digestive.

A case of angiocholitis with polymicrobic septicemia in an 85-year-old man with a history of cholecystectomy and choledocho-duodenal anastomosis is reported. The biliary tract was obstructed by a piece of tomato skin. Antibiotherapy and fibroscopic extraction of the skin ensured recovery. The authors recall the low incidence of polymicrobic septicemias, diagnostic criteria, promoting factors, poor prognosis, and the responsibility of digestive reflux and above all of stasis and high pressure in angiocholitis and septicemia following biliodigestive anastomosis.

[Critical study of serodiagnosis of Yersinia infections]. / Etude critique du sérodiagnostic des yersinioses.

The study concerns 100 patients who are divided in two dissimilar groups. The first group is composed of 39 patients who have signs of possible Yersiniosis infection. In second group composed of 61 cirrhotics patients, the serodiagnosis was systematic. The rate of positive serology, comparing with healthy patients, is significantly high in both groups: 61,5 p. 100 (first group) 64 p. 100 (second group). Six cases in the first group were very likely caused by Yersinia infection and confirm the utility of the serodiagnosis in front of evocative symptomatology. But many positive serodiagnosis remain unexplained and the greatest care must be taken in appreciation of these results. Among cirrhotic patients, the positive serology is not correlated with evocative symptoms and would be the result of asymptomatic bacteriemias.

[Hepatic tuberculosis: anatomical and clinical findings. A review of forty-six cases (author's transl)]. / Tuberculose hépatique. Aspects anatomo-cliniques à propos de quarante-six cas.

Over eight years the authors recorded 46 cases of hepatic tuberculosis. Most cases occurred in patients from black Africa. Forty-five patients had at least one extrahepatic tuberculous localization. Moderate cholestasis, without jaundice, found in 75% of patients, was the main biologic disorder. Upon histologic examination, five different types of granulomas were found. Each one has a specific predictive value concerning the outcome of the tuberculous infection.

[Colic carcinoma and basal cell epithelioma eleven years after Kaposi sarcoma with splenic and cutaneous involvement (author's transl)]. / Carcinome colique gauche et épithélioma cutané onze ans après un sarcome de Kaposi cutané et splénique.

A case of Kaposi sarcoma (KS) with cutaneous and splenic involvement is reported. Carcinoma of the left colon and basal cell epithelioma arose eleven years after KS. Genetic, viral, and immunologic factors which may promote initiation and development of Kaposi sarcoma are reviewed. The responsibility of immunodeficiency, whether resulting from therapy or from other causes, in carcinogenesis is discussed. Prolonged survival may be seen after KS. Another primary malignant disease (lymphoma or solid tumor) may arise. The authors suggest that the risk of immunologic disorders, occurring spontaneously or induced by therapy, should be considered specifically for each patient with KS.

[Primary reticulum-cell sarcoma (Parker-Jackson sarcoma) of the rib. Report of a case with a five-year survival after surgery, radiation therapy and chemotherapy (author's transl)]. / Sarcome de Parker et Jackson de localisation costale. Traitement chirurgical, radiothérapique et chimiothérapique. Recul de cinq ans.

A case of primary reticulum-cell sarcoma of the rib is reported. This rare tumor arose in an unusual site and was revealed by an exceptional clinical picture. Extensive hemothorax was the initial manifestation. Follow-up exceeds five years. Prognosis is not as poor for reticulum-cell sarcoma as for Ewing sarcoma. After radical surgery, radiation therapy and chemotherapy, the five-year total remission rate approximates 50%.