Thymic pseudotumorous enlargement due to follicular hyperplasia in a human immunodeficiency virus sero-positive patient. Immunohistochemical and molecular biological study of viral infected cells.

An enlargement of the thymus suggesting a tumor was discovered in a 28-year-old man who had early-stage acquired immune deficiency syndrome. A biopsy was performed. The adipose involuted thymus, with persistence of many Hassall's corpuscles, was judged to be a large lymphoid follicular hyperplasia. This follicular hyperplasia was similar to that previously described for lymph nodes, spleen, and other lymphoid tissues at earlier stages of human immunodeficiency virus infection, before the development of acquired immune deficiency syndrome. Human immunodeficiency virus RNA and p24 human immunodeficiency virus protein were detected in the hyperplastic germinal centers (lymphocytes and follicular dendritic infected cells), and also in many cells that may have been either lymphocytes and/or epithelial cells in the interfollicular areas. The tissue was negative for Epstein-Barr virus DNA sequences, as determined by the polymerase chain reaction. These observations identify the first state of infection of the thymus in a human immune deficiency virus-infected adult, preceding the severe involution with lymphoid depletion observed in all fatal cases of acquired immunodeficiency syndrome in which the thymus has been analyzed.

[Extracorporeal lithotripsy in experimental vesicular lithiasis in pigs]. / Lithotritie extracorporelle de la lithiase vésiculaire expérimentale chez le porc.

Experimental extracorporeal shock wave lithotripsy of gallstones was performed with the EDAP LT 01 piezoelectric lithotripter. Fragmentation of biliary stones was evaluated after implantation of human stones inside the gallbladder in 10 pigs. Lithotripsy was performed with a firing frequency of 2.5 shots per second during a mean time of 50 min. Zero to 18 days after lithotripsy, complete fragment clearance was seen in 6 cases, fragments less than 2 mm were found in 2 cases and fragments larger than 2 mm with only 1 non fragmented stone in 2 cases. There were no stone fragments in the cystic and common ducts. Damage to gallbladder and adjacent organs was appreciated after lithotripsy to the empty gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. Perforation of the gallbladder was observed in both pigs treated with a firing frequency of 40 shots per second and in 1 pig out of 3 treated with a firing frequency of 20 shots per second. With 10 shots per second and lower firing frequencies, mild histological changes of the gallbladder walls were only observed in 3 cases reoperated on the 2nd day after lithotripsy. The gallbladder wall was normal in the 5 cases reoperated on the 15th day and there were no hepatic, duodenal and pancreatic lesions. These experimental results are consistent with utilization of this machine in the treatment of gallstones in man; low firing frequencies are effective for fragmentation of gallstones without any adverse effects.

[Stauffer's syndrome caused by a benign intracystic renal hematoma]. / Syndrome de Stauffer dû à un hématome intrakystique rénal bénin.

We report a case of Stauffer's syndrome, characterized mainly by cholectasis, that occurred in a patient with benign intracystic renal haematoma and subsided after nephrectomy. Stauffer's syndrome was recognized, in 1961, as a paraneoplastic manifestation, usually associated with hypernephroma. This syndrome has been reported in only 2 cases of benign renal disease, which was a pseudotumoral xanthogranulomatous pyelonephritis.

[Lithotripsy by ultrashort pulsation. Experimental study in renal lithiasis in the dog]. / Lithotripsie à impulsions ultra-courtes. Etude expérimentale sur une lithiase rénale du chien.

A lithotriptor delivering ultrashort shockwaves and designed for use under ultrasonographic guidance has recently been developed. Immersion in water is unnecessary. The device was experimented in renal lithiasis in dogs. Twenty-two animals were treated. In seven, who served as controls, the safety of shots delivered in particular to the lungs, liver, bones and kidneys was demonstrated. Furthermore, no cardiac rhythm disorders were recorded. A human stone was implanted in 15 animals. The stone was successfully broken up in 12. Gross and microscopic examinations done 2 to 30 days after the treatment indicate that the shots initially produce lesions similar to a limited contusion. Healing of the contusion, already underway on the 8th day, is complete by the 4th week. Elimination of the fragments is gradual. The quality of fragmentation can be evaluated during the treatment session using mode A ultrasonography. These experimental data are evidence of the effectiveness of this second generation lithotriptor.

[Focused extracorporeal pyrotherapy. Initial experimental results]. / Pyrothérapie extra-corporelle focalisée. Premiers résultats expérimentaux.

The objective of this study was to develop an apparatus allowing the generation of a high temperature (exceeding 80 degrees C) in a precise focus (20 mm x 2 mm) by means of extracorporeal elastic waves. The treatment time at high temperatures is brief and administered in sequences of 4 to 7 seconds. In vitro studies on blocks of polyurethane demonstrated melting of the plastic at the focal point. Studies on plastic spheres introduced into the bladder of the pig demonstrated melting of the sphere without any alteration in the tissues in the wave path. Studies of cellular viability of bladder carcinoma cultures demonstrated a significant difference after 48 hours between the non-treated control group and the group of cells submitted to high temperatures. This technique, called Pyrotherapy, should be promising if the preliminary results are confirmed.

The plasmin system in human adenocarcinomas and their metastases. A comparative immunofluorescence study.

Components of the plasmin system were comparatively studied in lymph node metastases and corresponding primary tumors by immunofluorescence. Primary tumors, all adenocarcinomas, originated from large bowel (N = 12) or breast (N = 10). We used antisera against plasminogen (Pg), plasminogen activators (PA) such as urokinase (UK) and tissue type PA (t-PA), plasmin inhibitors such as alpha 2 anti-plasmin (alpha 2AP) and alpha 2 macroglobulin (alpha 2M), plasmin-alpha 2 anti-plasmin complex (PAPC). Positivity with anti-PAPC serum was considered as proving that plasmin was formed by Pg activation. The following results were obtained. Breast adenocarcinomas were more strongly stained than colorectal adenocarcinomas using antisera against Pg, PAPC and PA, while their reactivity was much weaker with antisera against both plasmin inhibitors. Lymph node metastases from colorectal adenocarcinomas were more strongly stained than primary tumors using antisera against PAPC and PA. Reactivity with anti-Pg was similar, while that with antisera against plasmin inhibitors was much weaker. Metastasis from breast adenocarcinomas, on the average, showed the same type of staining as primary tumors. However, there was a slight decrease in reactivity with anti-Pg and PAPC in metastases. Tumor cells invading lymphoid areas in metastatic lymph nodes were often strongly labeled using antisera against Pg and UK. Staining was less strong or less frequent using antisera against PAPC and t-PA. These results favor the role of plasmin in the degradation of basement membrane and connective tissue components, thus implicating it in the invasiveness of tumor cells, at least in most primary tumors and metastases.

Right atrial extension of an embryonal carcinoma of the testis.

A case of embryonal carcinoma of the testis extending into the inferior vena cava and the right atrium is presented. Tumor extension was demonstrated preoperatively by computed axial tomography. Successful resection of the intravascular and right atrial extension was achieved using extracorporeal circulation. It is concluded that intravascular and right atrial extension is not a contraindication to radical surgery. This type of metastasis raises the same therapeutic and prognostic problems as those raised by tumor masses in the lungs or lymph nodes found after chemotherapy for malignant nonseminomatous germ cell tumor of the testis.

[Normal ultrastructure of the small bronchi and bronchioli in man]. / Ultrastructure normale des petites bronches et des bronchioles chez l'homme

Ultrastructural topographic and morphological analysis of the small bronchi and bronchioli was carried out on selected biopsy specimens obtained from 6 operative specimens. The small bronchi had a ciliated cylindrical epithelium identical to that in the large bronchi, apart from a smaller number of goblet cells. Their reticulin layer was thin (1 to 3 microns). The glands in the submucosa were rare whereas there was a rich submucosal vascular network. The lobular bronchioli had a ciliated cylindrical epithelium without goblet cells but possessing rare Clara cells. The epithelium of the terminal bromchioli was characterized by: 1 - The presence of numerous Clara cells, generally grouped in groups of 2 or 3. 2 - The appearance on the opposite side of a satellite artery (this side shows alveoli first) of cells which we interpreted as pre-ciliated cells. These cells possess a range of basal corpuscles under the luminal membrane but do not have cilia. 3 - The appearance of small membranous pneumocytes in islets. The epithelium covering the smooth wall of the respiratory bronchioles still have a gutter of ciliated cells and Clara cells which become thinner towards the periphery. After the secondary respiratory bronchioli, there appears in this gutter a new cell type, the cubical cells. These cells which have poorly differentiated cytoplasmic characteristics, seem to us to be immature bronchial cells, precursors of the Clara cells rather than of the ciliated cells. The remainder of the smooth wall of the respiratory bronchioli is covered with membranous pneumocytes and, in the case of the 3rd order of bronchioli, also by granular pneumocytes. The sub-basal reticulin layer is lacking in the terminal and respiratory bronchioli. The total thickness of the wall becomes considerably thinner, the muscular layer becoming proportionally very thick.

Seminal vesicle biopsies in the preoperative staging of prostatic cancer.

Twenty-five patients with localized prostate cancer underwent seminal vesicle biopsies before radical prostatectomy. A transrectal probe of 7 MHz, a 18-gauge needle and a biopsy gun were used. The preoperative biopsy established the absence of seminal vesicle invasion in 89% of cases. When the seminal vesicles are positive at biopsy, capsular penetration is observed in 100% of the cases and lymph node positivity in 50%. When seminal vesicles are negative at biopsy and the prostate-specific antigen level is less than 20 ng/ml (n less than 2.5), capsular penetration of greater than 1 cm is absent in 100% of cases and lymph nodes are positive in only 7% of cases. Biopsy of the seminal vesicle, as an outpatient procedure, improves the preoperative staging of prostate cancer before radical prostatectomy: negative biopsies are good predictors of the absence of lymph node invasion.

Systematic prostatic biopsies in 100 men with no suspicion of cancer on digital rectal examination.

A total of 100 men with a mean age of 63 years underwent, in the following order, prostate specific antigen (PSA) assay (radioimmunometric assay, normal less than 2.5 ng./ml.), rectal examination, transrectal ultrasonography with a 7 MHz. probe, measurement of the prostatic volume, and 6 ultrasound-guided randomized biopsies and biopsies of any hypoechogenic zones. All men with a suspicious prostate on rectal examination (nodule, induration or firm zone) were excluded from the study. There were 14 prostatic cancers detected: 3 (8.5%) in men less than 60 years old, 4 (11%) in men between 60 and 70 years old and 7 (24%) in men more than 70 years old. No cancer was detected in men with a PSA level of less than 10 ng./ml., 5 (26%) were detected in 19 men with a PSA level of 10 to 19 ng./ml., 4 (40%) were detected in 10 men with a PSA of 20 to 29.9 ng./ml. and 5 (100%) were detected in 5 men with a PSA of 30 or more ng./ml. A total of 66 men (66%) had a PSA level of less than 10 ng./ml. There were 18 (18%) hypoechogenic zones detected: 2 (11%) were positive for cancer but, over-all, the hypoechogenic zones revealed cancer in only 2 of 100 cases (2%). In 12 of the 14 cancers detected (86%) with no clinical suspicion the PSA level was higher than the maximal PSA level related to the prostate weight. We conclude that systematic randomized prostatic biopsies are the best method of early diagnosis, detecting 41% of all prostatic cancers in men with a normal rectal examination when the PSA level is 10 ng./ml. or more. The real question is to determine whether this early diagnosis is useful for the patient, since presently, there is no certainty of the therapeutic benefit in terms of quantity and quality of life.

Focussed extracorporeal pyrotherapy: experimental results.

A new device made of piezoelectric ceramic placed in a semispherical dish and focussed at 320 mm was developed in order to generate heat and cavitation responsible for coagulative necrosis of deep tissues. The target to be treated is located with a central ultrasound probe of 3.5 MHz. In vitro studies with polyurethane phantoms showed that the ultrasound melted a surface of 2 x 12 mm within 1 s. The temperature recorded at the focus was 270 degrees C. In tissue samples (prostate cancer and benign prostate hyperplasia), the temperature rose to 85 degrees C in vitro and a hyperechoic zone appeared at the focus during shots. In vivo 8-mm plastic spheres, introduced surgically into the bladder of pigs, were melted by repeat shots without burning of crossed tissues. These studies were performed in the kidney and the liver. Autopsy performed on day 0 showed congestion, autopsy performed between day 6 and day 11 showed necrosis, whereas at 3 months the focussed area was fibrosed. This technique, which we called 'focussed extracorporeal pyrotherapy', combines phenomena of cavitation and high heat at the focus. Prostate tumors, bladder tumors, kidney tumors and liver metastases are potential indications for pyrotherapy.

Comparison of the efficacy of digital rectal examination and transrectal ultrasonography in the diagnosis of prostatic cancer.

167 patients with a mean age of 64 years underwent digital rectal examination (DRE), transrectal ultrasonography with a 7-MHz transverse and/or longitudinal transducer, followed by prostatic biopsy under ultrasound guidance. 231 biopsies were performed. 74 peripheral hypoechogenic zones were demonstrated. The sensitivity of DRE was 82% and the specificity 91%. The sensitivity and the specificity of ultrasound were respectively 69 and 83%. On 123 patients with normal DRE, 19 hypoechoic zones were detected and 2 patients had a positive biopsy (11%). On 104 patients without hypoechoic zone, 5 biopsies were positive (5%). The use of transrectal ultrasound scanning is able to multiply the number of impalpable cancer by 2, but in only 3 lobes, a hypoechogenic zone associated with a normal rectal examination was confirmed to be a cancer on biopsy. These cases represent 5.5 of the 56 positive biopsies, 4% of the hypoechogenic zones and 1.6% of the investigated patients with normal rectal examination. No impalpable cancer of 5 mm or less was detected by high resolution ultrasonography. DRE is still the most reliable examination for the diagnosis of prostatic cancer. Ultrasonography is a useful complement, particularly by allowing collection of tissue interpretable by the histologist in 100% of cases.