RESUMEN
An accidental transmission of placental choriocarcinoma (CC) from a multiorgan donor to four recipients is reported. The donor was a 26-year-old pregnant woman, died from a cerebral hemorrhage. Histological examination demonstrated the presence of a placental CC. Diagnosis of CC transmission was established on the basis of an increase of human chorionic gonadotrophin hormone (hCG) level. The recipient of combined pancreas-kidney is still in complete remission 2 years after the beginning of chemotherapy without removal of the grafted organs which show optimal function. The recipient of a single kidney was rapidly transplantectomized and treated with actinomycin. At 2 years, she remains in remission. Liver recipient showed intestinal metastasis and died from digestive hemorrhage after an initial response to chemotherapy. Heart recipient had an initial remission under EMA-CO, but at the last report, he showed diffuse metastasis. Published reports on CC transmission are rare. The long-lasting remission of our pancreas-kidney recipient and her good outcome after 2 years make our observation original. Moreover, the high rate of transmission demonstrates the high malignant potential of CC in immunosuppressed patients. Chemotherapy combined or not with transplantectomy in case of nonvital organ, should be discussed.
Asunto(s)
Coriocarcinoma/secundario , Trasplante de Riñón/efectos adversos , Trasplante de Hígado/efectos adversos , Trasplante de Páncreas/efectos adversos , Neoplasias Uterinas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Gonadotropina Coriónica/sangre , Femenino , Humanos , Terapia de Inmunosupresión/efectos adversos , Masculino , Persona de Mediana Edad , Embarazo , Inducción de Remisión , Donantes de TejidosRESUMEN
A rapid method for the determination of chondroitin sulfate in raw materials was developed. The samples were finely powdered, dissolved in water, and injected directly into the liquid chromatograph. The method used a C18 column, a wavelength of 195 nm, and a mobile phase containing octane sulfonic acid. The method gave results that were slightly different from those generated by atitrimetric method using cetylpyridinium chloride.
Asunto(s)
Sulfatos de Condroitina/análisis , Cromatografía Liquida/métodos , Animales , Bovinos , Nefelometría y Turbidimetría , Tiburones , ComprimidosRESUMEN
BACKGROUND: Doppler ultrasound methods were used during haemodialysis sessions for the detection of microemboli and determination of their origin. METHODS: A 2-MHz ultrasound probe (Multidop X(4) DWL((TM))) was used to assess the number of microembolic signals (MES) in the subclavian vein downstream from the arteriovenous fistula before the dialysis session and over two periods of 15 min at the beginning and end of haemodialysis sessions in 25 patients without previous cardiovascular disease. A similar probe was used during in vitro studies to detect MES at different sites in the dialysis machine (before and downstream from the blood pump, and before and downstream from the air trap). RESULTS: No MES were detected during in vivo studies before haemodialysis sessions. MES were registered in all patients (100%) at the beginning and end of the haemodialysis procedure at an average of 12.7+/-9 and 16. 7+/-11.5 signals/min respectively. The average intensity of MES was 19.2+/-5.0 dB and 19.4+/-3.9 dB respectively. No MES were detected on the arterial line during in vitro studies. In contrast, 19+/-6 MES/min were detected after the blood pump, 13+/-4.2 before the air trap, and 16.5+/-5.5 thereafter. CONCLUSIONS: In all patients, MES were recorded during haemodialysis sessions in the drainage vein from arteriovenous fistulae. The results of in vitro studies indicate that MES are formed by the blood pump of the haemodialysis machine. The intensity of the MES suggests that they correspond to synthetic particles or microbubbles, which are not detected by the air trap. The final destination of these microbubbles will be assessed in further studies.
Asunto(s)
Embolia/diagnóstico por imagen , Embolia/etiología , Diálisis Renal/efectos adversos , Vena Subclavia/diagnóstico por imagen , Ultrasonografía Doppler , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Adult's progeria or Werner's syndrome is a rare condition of autosomal-recessive inheritance, characterized by an apparent acceleration of many of the processes associated with aging. We describe the cardiovascular findings in a 44 year-old man with this disorder. Slightly elevation of urinary hyaluronic acid level contributes to the diagnosis.
Asunto(s)
Estenosis de la Válvula Aórtica/complicaciones , Síndrome de Werner/complicaciones , Adulto , Estenosis de la Válvula Aórtica/diagnóstico , Calcinosis , Insuficiencia Cardíaca/complicaciones , Humanos , Ácido Hialurónico/orina , Masculino , Síndrome de Werner/diagnósticoRESUMEN
A retrospective study of 185 cases of left main coronary artery stenosis operated between 1980-01-01 and 1991-06-15 at the Limoges University Hospital Center was performed. The influence of operative procedures: cardiopulmonary bypass and aortic cross clamping times, type and number of coronary grafts, time between coronary surgery and coronary angiography, on early (before the 30th days after surgery) and late postoperative vital prognosis was studied. This study confirms in our study the poor early postoperative prognosis of: 1) cardiopulmonary bypass time over 140 min; 2) coronary bypasses in an emergency context (surgery less than 24 h after coronary angiography); 3) incomplete coronary revascularization. The nature of grafts and the aortic cross clamping time have no influence. The actuarial survival studies confirm the poor long-term postoperative prognosis of incomplete coronary revascularization; the other surgical procedures have no influence.
Asunto(s)
Enfermedad Coronaria/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Puente Cardiopulmonar/métodos , Angiografía Coronaria , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Femenino , Humanos , Anastomosis Interna Mamario-Coronaria/métodos , Masculino , Persona de Mediana Edad , Reperfusión Miocárdica/métodos , Complicaciones Posoperatorias , Pronóstico , Estudios RetrospectivosAsunto(s)
Neoplasias Cardíacas/complicaciones , Lentigo/complicaciones , Melanosis/complicaciones , Mixoma/complicaciones , Neoplasias Primarias Múltiples/complicaciones , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Mixoma/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , UltrasonografíaRESUMEN
Significant left main coronary artery disease is a separate disease entity in coronary artery disease. The prognosis is classically poor and the treatment of choice is surgical. A retrospective study of patients with left main coronary disease, diagnosed and treated at the CHRU Dupuytren, Limoges, between 1/01/80 and 15/06/91 was undertaken to determine the aetiological, clinical and therapeutic factors which influence mortality related to this condition. During this period, 8198 coronary angiographies were performed in the cardiology department. The diagnosis of significant left main coronary disease (> or = 50% stenosis) was made in 250 cases (3% of all investigations). Of these 250 cases, 227 were treated medically or surgically by our group during the study period. Twenty patients were treated in another centre and 3 underwent surgery after the 15/06/91. Seven patients died in the period immediately after coronary angiography. Of the 220 survivors of coronary angiography, 185 (85%) were referred for surgery (direct or sequential venous and/or arterial bypass or coronary endarteriectomy). Four patients died within 30 days of surgery. Thirty five patients were treated medically. The therapeutic decision was based on the absence of surgical contra-indications. The retrospective, non-randomized nature of this study with allocation of patients to surgical or medical treatment without control invalidated statistical analysis. At the date of the last follow-up appointment, arbitrarily chosen as the 1/01/93, 163 operated patients (88.1%) of which 130 (79.7%) were asymptomatic and 13 medically treated patients (37%) were alive. The prognostic factors after surgery in this study were: stage IV dyspnoea at the time of diagnosis, severe abnormalities on catheter study (end diastolic pressure over 18 mmHg after angiography), left ventricular wall abnormalities (functional score > 10) and incomplete revascularization. The risk of coronary angiography in this condition were confirmed in this study.
Asunto(s)
Enfermedad Coronaria , Análisis Actuarial , Anciano , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
The association of Ehlers-Danlos type IV syndrome and acrogeria with renovascular hypertension is reported. Ultrastructural abnormalities observed in our case were different of those associated with acrogeria. We propose that acrogeria associated with Ehlers-Danlos type IV syndrome be a different disease of acrogeria of Gottron. The occurrence of renovascular hypertension in Ehlers-Danlos is unusual.
Asunto(s)
Síndrome de Ehlers-Danlos/diagnóstico , Hipertensión Renovascular/etiología , Envejecimiento de la Piel , Enfermedades de la Piel/complicaciones , Piel/patología , Adulto , Síndrome de Ehlers-Danlos/complicaciones , Femenino , HumanosRESUMEN
Cutaneous drug eruptions have a variety of clinical features. Lichenoid drug eruptions are rare and may be difficult to diagnose. A case of a simvastatin-induced lichenoid eruption with skin and mucosal involvement is reported.
Asunto(s)
Anticolesterolemiantes/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones Liquenoides/inducido químicamente , Lovastatina/análogos & derivados , Femenino , Humanos , Erupciones Liquenoides/patología , Lovastatina/efectos adversos , Persona de Mediana Edad , SimvastatinaRESUMEN
A 64 year-old man was admitted for congestive heart failure induced by an acute renal failure due to obstruction. Retroperitoneal periaortic-aneurysmal fibrosis was the etiology of the obstruction. Type IV Ehlers-Danlos syndrome was diagnosed based upon clinical and histological cutaneous signs.
Asunto(s)
Lesión Renal Aguda/etiología , Aneurisma de la Aorta Abdominal/etiología , Síndrome de Ehlers-Danlos/complicaciones , Fibrosis Retroperitoneal/etiología , Aneurisma de la Aorta Abdominal/diagnóstico , Aortografía , Síndrome de Ehlers-Danlos/patología , Humanos , Masculino , Persona de Mediana Edad , Piel/patologíaRESUMEN
77 pure iliac aneurysms where detected in a group of 48 patients along a period of 21 years, and represented 12.3% of all patients having aortic, iliac, or aorto-iliac aneurysms. The study group comprised 42 men and 6 women, 48-86 years old (mean 67.8 years). The aneurysm was located on the right side in 51.9%, on left side in 48.1%. The affection of the common iliac arteries (70.1%) was more frequent than it was on the internal iliac arteries (18.2%), or in the external iliac arteries (11.7%). The diameter was from 2 to 10 cms. 44 patients out of 48 (91.6%) where symptomatic, and 15 presented a rupture syndrome (31.3%). 10 patients (20.8%) had a pulsating mass. The etiology was unknown in 8 cases (16.7%); 2 patients had a mycotic aneurysm (4.2%). The remaining 38 patients (79.1%) had an aneurysm of atheromatous origin. 5 arteritic patients (10.4%) did not have any cure for their aneurysm, because it was considered threatening for 4 of them. The fifth patient was not treated because the artery was so calcified that it could not be clamped. A lumbar sympathectomy on the same side of the lesion was realised, in addition to the peripheral surgical act for arteritis. One patient had an endoaneurysmorrhaphy, another had an exclusion by ligature section of the aneurysm. For the remaining 41 patients (83.1%) the aneurysms where flattened, and vascular continuity was re-established by a prosthesis. 7 patients (12%) decreased post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aneurisma de la Aorta/diagnóstico , Aneurisma Ilíaco/diagnóstico , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/cirugía , Femenino , Humanos , Aneurisma Ilíaco/etiología , Aneurisma Ilíaco/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Rotura EspontáneaRESUMEN
Four patients aged over 70 received mechanical circulatory assistance for a period of 2 to 48 hours after myocardial revascularisation surgery. Three patients survived. The simplicity and modest cost of the method encourage the authors to use such assistance whenever necessary. This attitude is shared by other authors.
Asunto(s)
Circulación Asistida , Revascularización Miocárdica , Anciano , Anciano de 80 o más Años , Circulación Asistida/instrumentación , Circulación Asistida/métodos , Femenino , Humanos , Masculino , Revascularización Miocárdica/efectos adversos , Periodo PosoperatorioRESUMEN
The unequivocal identification of mineral impurities in talc requires definitive analytical techniques due to the very similar structure of many naturally occurring silicates and the small quantities of associated minerals frequently found. The instrumental methods and techniques extant for this purpose are reviewed. Light microscopy, x-ray diffractometry, and differential thermal analysis have been found to be particularly useful, complementary, and practical for both exploratory and routine determinations of mineral impurities in the talc matrix. When necessary, transmission electron microscopy is recommended for the analysis of mineral components present at sub-trace levels.