[Aortic valve myxoma. Conservative valvular surgery]. / Myxome de la valve aortique. Chirurgie de conservation valvulaire.

The authors report a case of aortic valve myxoma discovered in a 35 years-old patient who suffered a transient ischemic attack. At operation a helicoidal gelatinous mass was found attached to the ventricular side of the right coronary cusp of the aortic valve by a pedicle. Through a mini-sternotomy approach the mass was excised and the cusp was repaired. Recovery was uneventful.

Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools.

The overmortality induced by nosocomial infections, especially pneumonia in ventilated patients (VNP), is still a matter of controversy because it is difficult to know precisely the respective effects of VNP per se and both the underlying illness and the severity of the disease that indicates ICU stay. During a 3-yr period, for each patient mechanically ventilated for more than 48 h we recorded underlying illness, reason for mechanical ventilation, clinical and therapeutic data collected during the first 48 h of ventilation, and death in the ICU. Patients with suspicion of VNP (S-VNP) according to clinical, radiologic, and biologic criteria underwent bronchoscopy with protected specimen brush (PSB) and bronchoalveolar lavage culture (BAL-C). VNP was confirmed (C-VNP) if PSB > or = 10(3) cfu/ml and/or BAL-C > or = 10(4) cfu/ml. Prognostic multivariate analysis was performed introducing S-VNP and C-VNP as time-dependent covariates. Of the 387 studied patients, 112 S-VNP and 56 C-VNP were observed with overall mortality of 43% (168 patients). MacCabe, APACHE II score, shock, use of sedatives and absence of enteral nutrition were additively associated with an increased mortality as well as C-VNP (relative risk [RR]: 1.8, p = 0.007). Nevertheless, when S-VNP and C-VNP were simultaneously introduced in the Cox model, only S-VNP remained associated with increased mortality. In patients suspected of VNP, confirmation of VNP using PSB and/or BAL-C adds no prognostic information. Whether this could be explained by the lack of sensitivity of protected distal samples or the severity of underlying conditions of S-VNP patients is still an open issue. A multivariate analysis based on follow-up data during the ICU course of ventilated patients will be initiated in the near future.

[Digitization and image reconstruction: application to iconography of surgical pathology specimens]. / Numérisation et traitement informatique de l'image: application à l'iconographie des pièces opératoires en anatomie pathologique.

A simple method for obtaining imaging documents of surgical specimens is reported. the method uses a scanner and a personal computer with printer. It provides rapid, low-cost high-quality images on paper or transparencies. The document can be used to illustrate a pathology report or discussion between clinicians and pathologists. The computers facilities already present in most Pathology laboratories is sufficient. The scanner with software cost slightly more than a camera.

Reappraisal of distal diagnostic testing in the diagnosis of ICU-acquired pneumonia.

BACKGROUND: The thresholds of the diagnostic procedures performed to diagnose ICU-acquired pneumonia (IAP) are either speculated or incompletely tested. PURPOSE: To evaluate the best threshold of protected specimen brush (PSB), plugged telescoping catheter (PTC), BAL culture (BAL C), and direct examination of cytocentrifugated lavage fluid (BAL D) to diagnose IAP. Each mechanically ventilated patient with suspected IAP underwent bronchoscopy successively with PSB, PTC, and BAL in the lung segment identified radiographically. POPULATION: One hundred twenty-two episodes of suspected IAP (occurring in 26% of all mechanically ventilated patients) were studied. Forty-five patients had definite IAP, and 58 had no IAP. Diagnosis was uncertain in 19 cases. RESULTS: Using the classic thresholds, sensitivity was 67% for PSB, 54% for PTC, 59% for BAL D, and 77% for BAL C. Specificity was 88% for PSB, 77% for PTC, 98% for BAL D, and 77% for BAL C. We used receiver operating characteristics methods to reappraise thresholds. Decreasing the thresholds to 500 cfu/mL for PSB, 10(2) cfu/mL for PTC, 2% cells containing bacteria for BAL D, 4 x 10(3) cfu/mL for BAL C increased the sensitivities (plus 14%, 23%, 25%, 10%, respectively) and moderately decreased the specificities (minus 4%, 9%, 2%, 4%, respectively) of the four examinations. The association of PSB with a 500 cfu/mL threshold and BAL D with a 2% threshold recovered all but one episode of pneumonia (SE 96 +/- 4%) with a 84 +/- 10% specificity. For a similar ICU population, these "best" thresholds increased negative predictive value with a minimal decrease of positive predictive value. They need to be confirmed in multiple ICU settings in prospective fashion.

[Immunohistochemical evaluation of estrogen and progesterone receptors on paraffin sections of breast carcinomas. Practical thoughts based on the study of 368 cases]. / Evaluation immunohistochimique des récepteurs aux estrogènes et à la progestérone sur coupes en paraffine de carcinomes mammaires. Réflexions pratiques suscitées par l'étude de 368 cas.

368 formalin-fixed and paraffin-embedded carcinomas of the breast were studied by immunohistochemistry using antibodies to estrogen and progesterone receptors. The results, which are comparable to the results published in the literature, are discussed with particular emphasis on quality assurance parameters.

[Small intestinal tumors with skeinoid fibers. Report of 3 cases with immunohistochemical and ultrastructural study]. / Tumeurs de l'intestin grêle avec fibres en écheveau. 3 observations avec étude immunohistochimique et ultrastructurale.

Three cases of small intestinal stromal tumors with skeinoid fibers are presented and are confronted to the 15 cases found in the literature. These tumors are characterized by the presence of intercellular eosinophilic globules that stain positively on periodic acid-Schiff stain. Ultrastructurally, these structures are composed of tangles of curved banded (45 nm) fibers simulating an appearance of skeins. By immunohistochemistry, tumor cells express vimentin only. These tumors seem to be derived from the enteric plexus.

Is protected specimen brush a reproducible method to diagnose ICU-acquired pneumonia?

UNLABELLED: Protected specimen brush (PSB) is considered to be one of the standard methods for the diagnosis of ventilator-associated pneumonia, but to our knowledge, intraindividual variability in results has not been reported previously. PURPOSE: To compare the results of two PSB performed in the same subsegment on patients with suspected ICU-acquired pneumonia (IAP). STUDY DESIGN: Between October 1991 and April 1992, each mechanically ventilated patient with suspected IAP underwent bronchoscopy with two successive PSB in the lung segment identified as abnormal on radiographs. Results of the two PSB cultures were compared using 10(3) cfu/ml cutoff for a positive result. Four definite diagnoses were established during the follow up: definite pneumonia, probable pneumonia, excluded pneumonia, and uncertain pneumonia. POPULATION: Forty-two episodes in 26 patients were studied; 60 percent of patients received prior antibiotic therapy. Thirty-two microorganisms were isolated from 24 pairs of PSB. Definite diagnosis was definite pneumonia in 7, probable pneumonia in 8, excluded pneumonia in 17, and uncertain pneumonia in 10 cases. RESULTS: The PSB recovered the same microorganisms and argued for a good qualitative reproducibility. The distinction of positive and negative results on the basis of the 10(3) cfu/ml classic threshold was less reproducible. For 24 percent of the microorganisms recovered and in 16.7 percent of episodes of suspected IAP, the two consecutive samples gave results spread out on each side of the 10(3) cfu/ml cutoff. Discordance was higher when definite diagnosis was certain or probable than when diagnosis was excluded (p = 0.015). There was no statistical effect of the order of samples between the two specimens for bacterial index and microorganism concentrations. CONCLUSION: These findings argue for the poor repeatability of PSB in suspected IAP and question the yield of the 10(3) cfu/ml threshold. In attempting to diagnose IAP, the results of PSB must be interpreted with caution considering the intraindividual variability.

[Colonic elastoma. A pathologic study of 7 cases]. / Elastomes du côlon. Discussion pathogénique à propos de 7 observations.

The occurrence of elastic tissue abnormalities in the digestive tract is not common. There are sometimes observed in genetically transmitted connective tissue diseases in which numerous systemic complications are associated as in Ehlers-Danlos and in Grönblad-Strandberg syndromes. We report 7 cases of an unusual lesion localized in the colon in which abnormally increased amounts of elastic tissue were observed. This elastosis raises many nosological and diagnostic difficulties. We propose the term "colonic elastoma" to describe this lesion. The review of the literature allows to consider several etiopathogenetic possibilities.

Neuroendocrine carcinoma (Merkel cell tumor?) presenting as a subcutaneous tumor. An ultrastructural and immunohistochemical study of three cases.

The clinical and pathological features of three unusual soft tissue tumors are presented. They occurred in the groin of elderly patients in the subcutaneous tissue. In Case 1, the inguino-crural tumor coexisted with a second mass in the pelvis. The tumors had a tendency to recur locally and to invade the regional lymph nodes. Metastatic dissemination of the disease resulted in the death of the patient in Case 3. Histologically, the tumors appeared composed of small round cells with scanty cytoplasms, arranged in diffuse, poorly cohesive or solid sheets. In places, a trabecular pattern was noted. Mitotic figures were numerous. Some cells exhibited argyrophil granules. The ultrastructural study revealed compact whorls of intermediate filaments and neurosecretory granules. All three cases displayed a paranuclear dot-like positive reaction with antibodies to cytokeratins and neurofilaments. A diffuse cytoplasmic immunostaining for neuron-specific enolase was present in Cases 1 and 2. Protein S-100, vimentin and leucocyte common antigen could not be demonstrated. All these characteristics, except for the subcutaneous location, are shared with neuroendocrine (Merkel cell) tumors of the skin.

[Accessory spleen on the left ovary. Discussion on its pathogenesis]. / Rate accessoire sur l'ovaire gauche. Discussion pathogénique.

The authors report a case of an accessory spleen attached to the left ovary, discovered in a hysterectomy and bilateral adnexectomy specimen obtained for leiomyoma. This is an exceptional congenital anomaly as only seven cases have been reported in the medical literature. It may be classified as a type of spleno-gonadal fusion. It is always localized to the left side. This anomaly may be manifest as an inguinal tumefaction or by an intestinal occlusion requiring exploratory laparotomy. It is caused by fusion of the spleen to the left urogenital bud during the 5th to 8th weeks of fetal development.

Persistent perineal sinus following an abdominoperineal amputation: an unusual form of polyvinylpyrrolidone storage disease.

A 58-year-old man had a persistent perineal sinus following an abdominoperineal resection. An excision of the sinus was performed. Histology revealed that the sinus tract was bordered by a granulation tissue exhibiting numerous vacuolated cells containing polyvinylpyrrolidone. The origin of polyvinylpyrrolidone was related to lengthy irrigation of the fistula with Betadine.

Paravertebral malignant rhabdoid tumor in an adult. A case report with immunocytochemical study.

A case of paravertebral malignant rhabdoid tumor in a 59-year-old man is described. The location of the tumor and age of the patient appear to be unique. The clinical evolution was aggressive and resulted in the death of the patient. The tumor exhibited the light microscopic features of a typical rhabdoid tumor. It was composed of poorly differentiated round or polygonal cells with acidophilic glassy inclusions and vesicular nuclei exhibiting prominent nucleoli. Immunohistochemistry revealed the coexpression of cytokeratin and vimentin in neoplastic cells.

Primary leiomyosarcoma of the ovary: a histological and immunocytochemical study.

A case of primary leiomyosarcoma of the ovary in a 35-year-old woman is presented. The tumor was investigated histologically and by histochemistry. Desmin was demonstrated in neoplastic cells. Pertinent literature is reviewed and histogenesis is discussed.

Plexiform tumorlet of the uterus: immunohistological evidence for a smooth muscle origin.

A case of plexiform tumorlet of the uterus is reported and studied histologically and by immunohistochemistry. The presence of desmin in the tumour cells demonstrates their smooth muscle origin. These results are compared with other reports in the literature with special emphasis on histogenesis.

[A case of diffuse pulmonary amyloidosis associated with peripheral neurologic signs]. / A propos d'une observation d'amylose pulmonaire diffuse associée à des signes neurologiques périphériques.

The authors report a case of well-tolerated and prolonged diffuse parenchymal amyloidosis of the lungs associated with signs of peripheral neuropathy. The latest classifications of amyloidosis generally and of bronchopulmonary amyloidosis specifically are reviewed. The problems raised by this particular case, and notably its relation with the neurological signs observed, are discussed.