[Beta-thalassemia intermedia complicated by spinal cord compression. Report of three cases and meta-analysis]. / Bêta-thalassémie intermédiaire compliquée d'une compression médullaire. Etude de trois observations et méta-analyse.

Extramedullary hematopoiesis is common in patients who suffer from beta-thalassemia. Extramedullary hematopoiesis is a compensatory mechanism of chronic anemia. Although the diagnosis is relatively easy, management is still the subject of considerable controversy. The aim of the present paper is to report three cases of spinal cord compression due to beta-thalassemia followed by a meta-analysis. In one of the three cases reported, spinal compression revealed beta-thalassemia. Forty-three cases have been reported in the last 10 years, i.e., four cases per year. The diagnosis was made by CT and myelography and confirmed by histology after surgical treatment. Two patients were followed in the hematology department. Young patients accounted for 95.45% of cases. The time to diagnosis was 3.33 months (3 days to 12 months). The most sensitive exam for diagnosis is magnetic resonance imaging before surgery. The MR image shows a hypointense lesion on T1-weighted sequences in 30.43% of cases or isointense on T2-weighted sequences in 34.78% of cases, and hypointense on T1-weighted sequences enhanced with gadolinium in 42.85% of cases. When MRI is absent, as in our patients, myelography can provide the diagnosis. The vertebrae are enlarged and translucent in 85.71% of cases with a hypodense lesion compressing the spinal cord. Laboratory tests show chronic microcytosis hemolytic anemia in 97.17% of cases. The diagnosis was established by histology performed after surgical removal. The patients recovered 97.5% of their neurologic deficiency after specific treatment. The mean follow-up was 2 years (4 weeks to 15 years).

Decreased number of mast cells infiltrating into needle biopsy specimens leads to a better prognosis of prostate cancer.

Mast cell infiltration is often observed around human tumours. Inflammatory cells such as macrophages, neutrophils and mast cells infiltrating around tumours are known to contribute to tumour growth; however, the clinical significance of mast cell invasion in prostate cancer (PCa) has not been investigated. Mast cell infiltration was evaluated in 104 patients (age range, 45-88 years; median, 72 years), who underwent needle biopsy of the prostate and were confirmed to have PCa. Needle biopsy specimens of prostate were sliced into 5-microm-thick sections and immunostained for mast cells with monoclonal antibody against mast cell-specific tryptase. Mast cells were counted systematically under a microscope (x 400 magnification), and the relations between mast cell numbers and clinicopathologic findings were evaluated. The mast cell count was evaluated for prognostic value by multivariate analysis. Mast cells were immunostained around the cancer foci. The median number of mast cells in each case was 16. The mast cell count was higher around cancer foci in patients with higher Gleason scores than in those with low Gleason scores. The mast cell number correlated well with clinical stage (P<0.001). Prostate-specific antigen-free survival of patients with higher mast cell counts was better than that in patients with lower mast cell counts (P<0.001). Multivariate analysis revealed that mast cell count was a significant prognostic factor (P<0.005). The number of mast cells infiltrating around cancer foci in prostate biopsy specimens can be a significant prognostic factor of PCa.

[Acute non-traumatic extensive subdural spinal hematoma]. / Hématome sous-dural aigu intrarachidien non traumatique étendu.

Acute spinal subdural hematoma is a somewhat rare pathology. Its severity comes from the constitution of an acute spinal cord compression. In many cases MRI is useful for the differential diagnosis with the epidural hematoma. A 79-year-old patient was referred for emergency neurosurgery for acute spinal cord compression. The vascular risk in this patient was significant: hypertension, oral anticoagulants. Clinically, acute non-traumatic subdural spinal hematoma was suspected. The spinal cord MRI was in favor of the diagnosis which was confirmed intraoperatively. The surgical procedure revealed an extensive hematoma which infiltrated the spinal cord. The diagnosis of nontraumatic subdural spinal hematoma may be difficult in some cases and correctly established only during the surgical procedure. In comparison with reports in the literature, we discuss the underlying mechanisms of this hematoma. Spinal subdural haematoma must be considered in patients taking anticoagulant therapy or with a coagulation disorder who present signs of acute spinal cord compression. MRI sagittal T1 and T2-weighted images are adequate and reliable for diagnosis of spinal subdural hematoma. Prompt surgical evacuation of this hematoma is crucial.

[Diagnosis and treatment of extensive vertebral tuberculosis]. / Diagnostic et traitement de la tuberculose vertébrale étendue.

Tuberculous spondylodiscitis called Pott's disease is the most common presentation of vertebral tuberculosis. Atypical presentation is rare and its diagnosis also difficult. We report a retrospective analysis of 7 immunocompetent patients treated for extensive vertebral tuberculosis. Five men and two women, between 5 and 39 Years. The median age was 24 Years. Clinical features were incomplete tetraplegia (4 cases), complete paraplegia (1 case) incomplete paraplegia (1 cases), and lumbocruralgia (1 case). Spinal X-ray revealed spondylodiscitis. Both CT Scan and MRI are very useful to determine the extent of the lesions. Bacteriological and histological diagnosis can be deficient. For this reason, we insist on a the contribution of antituberculous treatment to diagnosis. But the appearance of drug-resistance can limit the role of antituberculous chemotherapy in achieving diagnosis.

[Thoracic spinal stenosis. Clinical and surgical management. Study of 5 cases observed in the Abidjan department of Neurosurgery]. / Les myélopathies dorsarthrosiques. Etude clinique et thérapeutique à propos de 5 cas traités au service de Neurochirurgie d'Abidjan.

BACKGROUND: Spinal cord compression resulting from thoracic spinal stenosis is relatively frequent in Japan but rare in Europe and little know in Africa. OBJECTIVE: We report five cases of thoracic myelopathy caused by thoracic stenosis diagnosed in black African people. METHODS: This was a retrospective observational study of patients treated in the Abidjan department of Neurosurgery from 01.01.1996 to 31.12.1998. The spinal cord compression resulting from thoracic spinal stenosis was confirmed by myelography or myeloscan. The Japanese orthopaedic association (JOA) score was used to evaluate patient outcome. RESULTS: All of these patients were black Africans. The four men and one woman were aged 55, 47, 53, 52, and 60 years. The clinical presentation of thoracic spinal cord compression was confirmed by myelography in five patients and by myeloscan in four. These investigations were useful for guiding surgical treatment. Outcome was favorable in all cases. CONCLUSION: Signs of thoracic spinal cord compression in adults should suggest the diagnosis of thoracic spinal stenosis.

[Spondylodiscitis due to Histoplasma duboisii. Report of two cases and review of the literature]. / Spondylodiscite à histoplasma duboisii. A propos de deux observations et revue de la littérature. A propos de deux observations et revue de la littérature.

We report two cases of African histoplasmosis caused by Histoplasma duboisii located in the spine, on two Malian adults aged 40 and 47 years respectively. Clinical signs consisted of dorsal spinal syndrome in both cases and a paraplegia in one case. Radiography and CT scan revealed a spondylodiscitis without any bone reconstruction in both cases and a prevertebral abscess in one case. Diagnosis was confirmed by mycological and pathological examinations of surgical specimen which revealed Histoplasma duboisii fungus. Medical treatment, after surgical repair, consisted in ketoconazola with positive results after 12 months. This localisation is rare. It raises diagnosis problems with tuberculous spondylodiscitis because of their radio-clinical resemblance.

DnaD protein of Bacillus subtilis interacts with DnaA, the initiator protein of replication.

The yeast two-hybrid assay revealed that Bacillus subtilis DnaD, a possible component of the primosome and required for replication initiation, interacted with DnaA and DnaD itself. The mutant DnaD23 was incapable of interacting with DnaA but retained interaction with the wild-type DnaD. These results suggest that interaction between DnaD and DnaA is important for replication initiation.

[Secondary subdural hematoma in dural metastasis of prostatic adenocarcinoma]. / Hématome sous-dural secondaire à une métastase durale d'un adénocarcinome prostatique.

Non traumatic subdural hematoma secondary to dural metastases is a rare event but is well documented. We report a case of a 73-year-old man who presented a subdural hematoma secondary to dural metastases from prostatic adenocarcinoma. The diagnostic was made during the operation. The bone and the dura-mater were infiltrated by tumor cells. Mechanisms of transdural invasion by metastatic adenocarcinoma and production of hematoma are discussed and the relevant literature is reviewed.

[Medullary compression by Burkitt lymphoma. Analysis of 7 cases]. / Compression médullaire par lymphome de Burkitt. Analyse de 7 observations.

OBJECTIVES: Burkitt's lymphoma is one of the possible cause of spinal cord compression. We defined the surgical approach in this rare localization of Burkitt's lymphoma. PATIENTS AND METHODS: We report 7 cases of spinal cord compression secondary to Burkitt's lymphoma treated at the Yopougon University Hospital from October 1990 to October 1994. RESULTS: Mean age of the patients was 15.4 years, range 8 to 28 years. Five of the 7 patients were children. Surgery was both a diagnostic and therapeutic emergency in this rare but serious localization of Burkitt's disease, which remains highly chemosensitive. CONCLUSION: Surgical management is warranted if Burkitt's lymphoma is revealed by spinal cord compression or if there is a primary spinal epidural localization.

Subcellular localization of Dna-initiation proteins of Bacillus subtilis: evidence that chromosome replication begins at either edge of the nucleoids.

We examined the intracellular distribution of Bacillus subtilis Dna-initiation proteins by immunofluorescence microscopy to visualize the initiation complex of replication in vivo. DnaA was distributed throughout the cytoplasm, but both DnaB and DnaI were always detected as foci during the cell-division cycle. Interaction of DnaI with the DnaC helicase by the yeast two-hybrid assay suggests that DnaI acts as a helicase loader. The number of DnaB and DnaI foci within the cell exceeded that of oriC. Although the foci were not always co-localized with oriC, they seemed to be localized near the outer or inner edges of the nucleoids at initiation of replication. When the replication cycle was synchronized in cells using a temperature-sensitive dnaA mutant, duplication of the oriC region was observed predominantly near an edge of the nucleoid. Before initiation occurred, each one of the DnaB and DnaI foci was frequently observed near there. Furthermore, DnaX-GFP (DnaX is a component of DNA polymerase III) foci were detected near either of the edges of the nucleoids at the onset of replication. These results suggest that the replisome is recruited into oriC near either edge of the nucleoids to initiate chromosome replication in B. subtilis.

[Dural metastasis of prostatic adenocarcinoma presenting as acute intracranial subdural hematoma: a case report]. / Métastase durale d'un adénocarcinome de la prostate simulant un hématome sous-dural aigu intracrânien. A propas d'une observation.

Intracranial malignant metastatic dissemination usually is seen as a unique nodular formation enhanced after intravenous injection of contrast medium. Forms mimicking meningioma or subdural hematoma have been described. We report a case of dural metastasis from an adenocarcinoma of the prostate in a 60-year-old man. The CT image suggested acute subdural hematoma.

[Spontaneous rupture of a renal angiomyolipoma in pregnancy: a case report].

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.

[Epilepsy disclosing cancer of the kidney]. / Epilepsie révélatrice d'un cancer du rein.

Cerebral metastases of renal cell carcinoma are not rare, but metastasis which reveal the primary tumor are uncommon. The authors report a case of a 53-year-old woman who presented with renal cell carcinoma revealed by epileptic fit.

[Clinical experience of ileal neobladder for bladder cancer].

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

[A case of renal cell carcinoma found after skin metastasis].

A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

Draining lymph node cells of contact-sensitized mice induce suppression of contact sensitivity.

The application of hapten to the skin of mice can induce contact sensitivity (CS). It has also been well established that draining lymph node (DLN) cells can induce CS to the hapten used for skin painting when injected into naive mice. This is true for DLN cells recovered about 24 h after skin painting with hapten. It is unclear, however, whether DLN cells recovered shortly after hapten application have the same ability. By using an adoptive transfer assay system, we examined the ability of DLN cells recovered from mice at various times after skin painting with hapten to induce CS. DLN cells harvested 18-24 h after the application of fluorescein isothiocyanate (FITC) or 2,4-dinitrofluorobenzene (DNFB) induced strong CS when injected into naive mice. DLN cells harvested 3-6 h after the application of FITC or DNFB induced either only weak or no CS but induced suppression of the subsequent immunization to the two haptens. The suppression was hapten-specific, MHC restricted, and associated with the appearance of splenic suppressor T lymphocytes. Analyses with antibodies and ultraviolet (UV) B radiation demonstrated that suppression-inducing cells in DLNs were Ia+, Thy-1(-), and functionally UV-sensitive. These data suggest that epicutaneous sensitization with hapten first induces immunologically specific suppressor activity in the draining lymph nodes, whereas immunogenic activity becomes predominant later.

Effects of topical cyclosporin A on guinea-pig toxic contact dermatitis.

It is known that the topical application of cyclosporin A (CsA) has a significant suppressive effect on allergic contact dermatitis. In this study, we investigated the effect of topical CsA on toxic (non-allergic) contact dermatitis. Topical CsA significantly suppressed the toxic contact reaction to croton oil. This suppressive effect was short-lived and reversible. Significant inhibition of the reaction to croton oil persisted for 3 days after stopping the CsA. The toxic reaction was blocked when CsA was applied within 6 h of the croton oil application, but when application of CsA was delayed until 12 h after the oil application there was no significant suppressive effect. Topical administration of CsA could become a valuable tool for treating toxic and allergic contact dermatitis without producing the adverse reactions caused by systemic therapy.