Human hepatic stellate cells in primary culture are safe targets for Leishmania donovani.

Leishmania parasites can escape the immune response by invading cell types lacking leishmanicidal mechanisms. Silent persistence of Leishmania parasites in the host organism is responsible for asymptomatic carriage and relapses after cured leishmaniasis. Here, we studied the interaction between Hepatic Stellate Cells (HSC) and Leishmania. An original model of human HSC in primary culture infected with L. donovani was developed. The presence of intracellular parasites was studied and quantified using optical and confocal microscopy. HSC characteristics were studied using microscopy, methylene blue assay, long-term cultures and qPCR. We showed for the first time that human HSC are permissive to L. donovani infection, with no modification of HSC survival, growth rate and proinflammatory and fibrogenic characteristics. Intracellular parasites did not replicate but HSC had no effect on their survival. Indeed, after a 40-day culture, infected HSC cultures transferred on NNN medium yielded new promastigotes that were able to proliferate and efficiently infect new cells. HSC are permissive to L. donovani, with neither parasite killing nor apparent cell damage. Thus, HSC could act as potent sanctuary cells for Leishmania in the liver, which could partially explain parasite reactivation after an asymptomatic carriage or a cured visceral leishmaniasis.

[Idiopathic spontaneous hemoperitoneum]. / Hémopéritoine spontané idiopathique.

Haemoperitoneum is usually associated with trauma, ruptured aortic aneurysm, ectopic pregnancy, bleeding from an ovarian follicle or hepatic tumor. Idiopathic spontaneous haemoperitoneum is a very rare pathology, presenting more often with diffuse abdominal pain, associated with cardiovascular instability. We discuss a case of idiopathic spontaneous haemoperitoneum in a 28-year-old healthy woman, presenting with right lower quadrant syndrome. A review of the literature and practical considerations towards this rare affection are presented.

Quadrilateral space syndrome: case report and review of the literature.

The quadrilateral space syndrome is defined as tenderness over the quadrilateral space and shoulder pain radiating to the arm, secondary to compression of the axillary nerve and posterior circumflex humeral artery in the quadrilateral space. The symptoms are aggravated by forced abduction and extrenal rotation of the arm. The diagnosis is clinical and is documented by arteriography or angio-MR imaging with dynamic maneuvers. A 30-year-old woman presenting with this syndrome is described here, the differential diagnosis discussed, and the literature reviewed.

Abdominal lymphangioma in adults and children.

BACKGROUND: Abdominal lymphangioma is a rare tumour usually classified with mesenteric and retroperitoneal cysts. This experience of abdominal lymphangiomas contrasts the differences between tumours in children and adults. METHODS: Between 1970 and 1996, six patients had surgical resection of an abdominal lymphangioma. RESULTS: There were three children aged 4 years or less and three adults aged 36-76 years. Two children presented with an acute abdomen and one with a rapidly enlarging abdominal girth. Lymphangiomas were located in the mesentery and gastrointestinal tract. In adults, symptoms lasted from months to years and lymphangiomas were found in the pancreas, spleen and retroperitoneum. CONCLUSION: In this series, abdominal lymphangioma presented more acutely in children and usually involved the mesentery, whereas in adults the history was longer and the tumour was found in the retroperitoneum.

[Jejuno-jejunal invagination in polypoid lipoma producing renal failure]. / Invagination jéjuno-jéjunale sur lipome polypoïde entraînant une insuffisance rénale.

This is the case of a 43 years old woman with recurring epigastric pain for 8 years. She was hospitalized emergently for persistent vomiting causing acute renal failure. Numerous radiologic investigations prior to this hospitalisation showed no pathology. The diagnosis was made this time with a small bowel follow through. Intussusception of tumors is a known cause of small bowel obstruction. The clinical picture however, of severe vomiting causing acute renal failure on the basis of a proximal small bowel obstruction is exceptional.

[Segmental ischemic colitis in lymphocytic thrombotic venulitis]. / Colite ischémique segmentaire sur veinulite lymphocytaire thrombosante.

This case illustrates the difficulty of diagnosing a colonic stenosis of ischemic origin. A 70-year-old lady presents with abdominal pain, fever and melaena. Lc are 15.2, ESR 39 mm, CEA 2.7 ng/ml. A barium enema shows a stenosis of the transverse colon that is suspicious of neoplasia. At time of operation, an induration of the transverse colon is found with edema of the corresponding mesocolon but no tumour is palpated. A resection of this area is performed and an end to end anastomosis performed. Pathology shows an ischemic colitis secondary to a lymphocytic thrombotic venulitis. The patient is discharged home one month postoperatively. 4 weeks later she is readmitted with the same symptoms. A gastrograffin enema shows a similar stenosis in the transverse colon including the anastomosis. The diagnosis is made of a recurrent ischemic stenosis. The patient improves over a 10-day period of conservative treatment (anticoagulation, TPN, steroids). A control barium enema shows a near resolution of the stenosis. The majority of ischemic colitis are of arterial origin nevertheless ischemic colitis of venous origin exists. The factor causing venous ischemia are not known. It is though thought to be associated with hypersensitivity vasculitis of drug origin. Its initial diagnosis versus neoplasia is difficult but once made there is a good response to a conservative treatment.

[Pleural mesothelioma. Review of 3 cases and role of thoracoscopy]. / Le mésothéliome pleural. Revue à propos de 3 cas et rôle de la thoracoscopie.

Pleural mesotheliomas are uncommon tumors that can be classified as localized fibrous or diffuse malignant. The frequency in the general population is low and, as it concern the diffuse malignant type, exposure to asbestos, significantly increases the incidence. The most common symptoms are chest pain, short of breath and cough and the roentgenological findings are solitary or multiple pleural nodular lesions. The fibrous type can be excised and recurrence rarely occurs, but the malignant type does not respond either to chemotherapy or to radiotherapy and surgical measures offer only palliation. Thoracoscopy is a possibility of surgical excision in a case of localized mesothelioma and in case of diffuse type it contributes to the diagnostic yield, the open surgical procedures to be considered only in functionally operable patients.

[Prognosis of iatrogenic and accidental vascular trauma]. / Devenir des traumatismes vasculaires accidentels et iatrogènes.

The prognostic of vascular trauma does not only depend on the associated lesions and time before treatment. Without obvious symptoms, serious vascular lesions can be overlooked. A preexisting arteriosclerosis explains the different outcome in geriatric patients. 84 cases of vascular trauma were observed between 1969 and 1977. 33 of these cases were iatrogenic. The patients involved are examined clinically and undergo ultrasonic velocity detection before and after effort (test of Strandness). The outcome showed 5 deaths, 7 amputations and 8 vascular sequela. Only 2 deaths and 3 amputations are directly related to the vascular trauma.

[Value of abdominal ultrasonography for indication of cholecystectomy]. / Valeur de l'ultrasonographie abdominale dans l'indication à une cholécystectomie.

A review of the gall-bladder content of the 193 patients that underwent a cholecystectomy at the University Hospital of Lausanne, Switzerland, in 1977, was done in order to find out the diagnostic accuracy of sonographic examination of the gall-bladder, oral cholecystography and intravenous cholangiography. Sonographic examination of the gall-bladder proofed to be accurate in 92.5% of 109 cases. We found a false negative rate of 4.5% (5 cases) and a false positive rate of 1% (1 case) as well as an indeterminate rate of 2% (2 cases). In 37% (46 cases) of the 124 patients that underwent oral cholecystography and/or intravenous cholangiography the gall-bladder was not visualized. Sonographic examination of gall-bladder is free of side effects and can be done on emergency, on jaundiced or pregnant patients, and it is enough reliable for the surgeon to make a decision to operate the gall-bladder. Low cost of the procedure is another point in favour of sonographic examination of the gall-bladder.

[Acute arterial obstructions of the limbs in the aged]. / Obstructions artérielles aiguës des membres chez les vieillards.

131 cases of acute arterial obstruction were treated during 1973-1977, 70 (52%) of these cases were seen in patients of over 70 years of age and 20 out of them died during the first two months of the surgical treatment, 8 patients were amputed. The long term evaluation of 40 patients who survived for more than two months after the surgical treatment shows a very high mortality (14 of the 40 surviving patients died during the first two years of the surgical treatment). Satisfactory results were obtained in 18 patients. The long term results after arterial obstruction in old patients has high mortality and the number of amputations is directly proportional to the delay before commencement of the surgical treatment.

[Experiences with the ISOP (bubble or integral confinement) in surgery of the motor apparatus in Lausanne]. / Expériences lausannoises avec l'ISOP (bulle ou confinement intégral) en chirurgie de l'appareil moteur

Use of the Celster ISOP integral enclosure method in over 200 bone and joint operations prompts the following conclusions: With ISOP contamination of the surgical field is significantly reduced and the number of discharging wounds after surgery is lower. Delicate operations such as internal fixation of the fractured acetabulum or reinsertion of the cruciate ligament pose few problems under ISOP. The use of ISOP during bone and joint surgery is an advance in the prevention of postsurgical infection.

[Hemobilia. (Apropos of 5 cases)]. / L'hémobilie. (A propos de cinq observations)

Hemobilia or hemorrhage through the biliary tract is increasing in frequency. With spreading knowledge of the syndrome, the diagnosis is now rarely missed. There is also a real increase due to traffic accidents which often cause liver injuries. The typical triade with digestive hemorrhage, biliary colic and jaundice should always arouse suspicion of hemobilia. Hepatic angiography is the best and most accurate diagnostic method. Accidental or operative trauma constitute the major cause of macroscopic hemobilia where as microscopic hemobilia is a very frequent symptom in gallstone-disease. In this report five cases of different ethiology are described. Three were caused by abdominal trauma. The fourth case illustrates the risk of hemobilia from instrumental exploration of the common duct. Even when this is done carefully it might cause a hemorrhage with formation of obstructing clots. In the last patient there was severe hemobilia due to errosion of the cystic artery by a gallstone, penetrating into the duodenum. The treatment given in the five cases are examples of different methods which may be used, according to the nature of the lesion. In the three cases of traumatic hemobilia one healed spontaneously under angiographic control, one was cured by local hemostasis in the central liver rupture and the third had a successful hepatic resection. In the case with post-operative hemobilia, an obstructing clot had to be removed from the common duct. Simple cholecystectomy cured the patient with hemorrhage from the eroded cystic artery.