[Pharmacodynamic study of myocardial contraction using ultrasonic echography during isoproterenol perfusion in the normal subject]. / Etude pharmacodynamique de la contraction myocardique par échographie ultrasonique lors de la perfusion d'isoprotérénol chez le sujet normal

An echographic study, both before and under isoproterenol infusion, was performed on 50 normal subjects. The movements of the posterior wass of the left ventricle were found to be averagely increased of 62% as regards the amplitude, 114% for the mean speed and 124% for the maximum speed of contraction. The transcerse diameter of the left ventricular cavity decreased by 5.25%. The circumferential fibres shortening speed expressed in circumference by second increased by 128%. An uninvasive method, echography, as cineangiography, makes it possible to assess the myocardial contractility on the basis of measurement of the average speed of circumferential fibres and of the diameter of the left ventricle.

[Fibroblastic constrictive endocarditis. Apropos of a form localized in the left ventricle]. / Endocardite constrictive fibroblastique. A propos d'une forme localisée au ventricule gauche

The authors report a case of a localised form of this strange disorder which was confined to the left ventricle, and in which the diagnosis was tentative for a long time. In this case it was possible to carry out a removal of the fibrous plaque after opening the apex of the left ventricle, the mitral valve being preserved, as described by Dubost; the functional and haemodynamic results of this procedure were very satisfactory.

[Interpretation of minimal medullary plasmacytoses in monoclonal dysglobulinemias. Importance of the study of osteomedullary biopsies of semi-thin sections and immunologic marking]. / Interprétation des plasmocytoses médullaires minimes dans les dysglobulinémies monoclonales. Intérêt de l'étude de biopsies ostéomédullaires sur coupes semi-fines et par marquage immunologique.

A monoclonal gammopathy (M.G.) is usually associated with multiple myeloma or macroglobulinemia. Cases whose follow up have not demonstrated myeloma or lymphoma for several years are called "benign monoclonal gammopathies" (B.M.G.). Numerous criteria were suggested to distinguish multiple myeloma from B.M.G., chiefly an abnormal medullary plasmacytosis. But frequently it is only beyond 15 to 20 % that this plasmacytosis is considered as significative. Some authors have reported the peculiarities of these plasma cells immune labelling with rather conflicting results. We reviewed semi-thin sections of bone marrow biopsies with a low grade plasmacytosis (less than or equal to 10 %) by histological cytological and immunological methods in a group of 39 patients with a M.G. A diagnosis of multiple myeloma or of B.M.G. was made on the initial examination of these biopsies. The 24 cases of multiple myeloma were diagnosed using : --topographical criteria : inhomogenous sharing, nests of plasmocytes exclusively away from the periphery of vessels, --cytological criteria such as frequent cellular immaturity, nuclear immaturity in binucleated cells, bizarre shaped nuclei . . . --immunological criteria obtained by immunofluorescence method : strictly monoclonal labelling of plasma cells or "limit"-monoclonal labelling in 50 % of cases. The latter is less characteristic because of its presence in 25 % of B.M.G. In this prospective study, the initial diagnosis was maintained in 37 out of the 39 cases according to clinical and laboratory data. These results seem to demonstrate the practical value of the proposed criteria.

[Intravascular bronchiolo-alveolar tumor. Study of a form with angiosarcomatous tendency]. / Tumeur bronchiolo-alvéolaire intra-vasculaire I.V.B.A.T. Etude d'une forme à tendance angiosarcomateuse.

Intravascular bronchiolo-alveolar tumor (IVBAT) is a rare pulmonary neoplasm of assumed endothelial nature. We report a new case of peculiar interest because of the association of a diffuse pulmonary involvement with multiple visceral localisations, which has scarcely been proved during life. We found out a striking endothelial differentiation on microscopic examination. The presence of F VIII RAg in many tumor cells as well as the ultramicroscopic findings support the endothelial differentiation. Thus, we regard our case of IVBAT as an aggressive form of the disease behaving as a real angiosarcoma.

[Malignant systemic angioendotheliomatosis. Apropos of a case with an ultrastructural and histo-immunologic study]. / L'angio-endothéliomatose (maligne) systémique. A propos d'une observation avec étude ultrastructurale et histo-immunologique.

Clinico-pathological data in a typical case are compared with those of 54 published reports of systemic angioendotheliomatosis. In this rare disease the lesions, characterized by clusters of abnormal cells in the small vessels, usually have multivisceral localizations, with chiefly cutaneous and encephalic manifestations and a rapidly fatal course. However cases are known with lesions restricted to the skin and a protracted if not regressive course; about half of these cases are associated with an endocarditis. In the case reported, the results of ultrastructural and histo-immunological studies (f. VIII, lysozyme, anti-protease, Ig) are in favour of the endothelial origin of the abnormal cells, a now widely accepted hypothesis.

[Palliative care--objectives and accomplishments of the Association for the Development of Palliative Care]. / Soins palliatifs--Objectifs et réalisations de l'Association pour le développement des Soins Palliatifs.

Associations involved in Palliative Cares want to develop a better use of therapeutic resources and a better support of patients threatened in their Lives. They want to help developing of adjusted structures to a better global tacking charge of patient and his family in hospital and at home. The Association for development of Palliative Cares (ASP) founded 1984 has chosen from the beginning the concept of continuous care and has set since 1986 the first coordinated team of voluntary "Support", selected and trained, in a curative care unit cancer patients with fatal prognostic, after a possible remission. They participated, the ASP also, to the architectural conception and the financing of the first unit of palliative cares in France. The ASP conceived a help to home support for patients in the end of their life, by a team reinforced by a referent nurse, in collaboration with a home hospitalisation unit and a pain consulting. The ASP is now taking action in Paris and its area, with its 180 volunteers and 12 teams in 11 Hospitals and one at home.

[A frequent malignant tumor of the soft tissues, malignant fibrohistiocytoma. Current interest: apropos of 2 cases disclosed by vascular complications]. / Une tumeur maligne fréquente des parties molles, Le fibrohistiocytome malin (M.F.H.). Intérêt actuel: à propos de 2 cas révélés par des complications vasculaires.

Malignant fibrohistiocytoma represents one of the most common malignant tumors of soft tissues. Previously difficult to diagnose with precision, it can now be detected pathologically as a result of recent techniques for investigating cellular development. Treatment is by wide exeresis, prognosis remaining reserved and requiring prolonged postoperative surveillance.

[Tuberculous reactions]. / Réactions tuberculiniques.

Intradermoreaction made with reliable tuberculin is the reference test: it is the only one that allows a therapeutic decision. The other tests can only be used as pre or post vaccinal tests, or as a technical approach for new born. In France, the reading of the IDR is difficult because BCG is almost always applied during small childhood. However it is possible to admit tuberculosis infection for vaccinated person with clear increase of the IDR positivity compared to a measured reference IDR, or when the IDR is superior to 14 mm for persons vaccinated a long time ago. For immunocompetent persons, a tuberculosis infection admitted on an isolated IDR (not associated with tuberculosis disease) does not need chimiprophylaxy for children under five, or in case of clear and recent increase of IDR, or in a context of contamination. For a HIV positive person, a tuberculosis infection admitted on an isolated IDR implies a systematic chimioprophylaxy, but the IDR looses its signification as the immunodepression progresses. An attempt to study the prevalence of tuberculosis infection at twenty in France for vaccinated persons has been realized. In 1984 the admitted rate is over 8%, superior to the calculated rate from Styblo and Sutherland tables. That seems to mean that tuberculosis infection is under evaluated in France.

[Cerebral and pulmonary histiocytosis X. Neurologic manifestations disclosing a pseudotumoral formation on the floor of the 4th ventricle]. / Histiocytose X cérébrale et pulmonaire. Manifestations neurologiques révélatrices d'une formation pseudo-tumorale du plancher du IVe ventricule.

The authors report a case of histiocytosis X which presented with neurological manifestations in a 20 year old man: episodes of headache with vomiting, followed, three months later, by the development of paralysis of the right 6th and 7th cranial nerves associated with nystagmus. The CT scan revealed a tumour-like lesion on the floor of the IVth ventricle with a long axis of 18 mm. The chest x-ray revealed diffuse nodular opacities in the pleural and apical regions with features suggestive of histiocytosis X. The diagnosis was confirmed by surgical biopsy of the typical pulmonary nodules which were rich in histiocytes with X bodies on electron microscopy. The neurological signs disappeared after one month of treatment with Prednisone (1 mg/kg/day) and Vincaleukoblastine (10 mg/week). By the 3rd month, the pulmonary lesions were reduced and the intra-ventricular formation had regressed by 40%. In the authors' series of 29 cases of confirmed histiocytosis X in adults, the present case is the only one with a clinical neurological presentation, apart from 3 cases of diabetes insipidus. A review of the literature confirms the rarity of this type of presentation. The suggestion of the diagnosis by the chest x-ray appearance enabled a dangerous neuro-surgical operation to be avoided.

[Primary pulmonary lymphoma]. / Lymphome pulmonaire primitif.

The authors report 2 cases of primary pulmonary lymphoma. The first case was a 65 year old woman with a diagnosis of lymphocytic lymphoma confirmed by surgical biopsy, after being suspected on the basis of bronchoscopic biopsies and bronchiolo-alveolar aspiration. Twenty one months after the beginning of treatment with chemotherapy and six months after this treatment was completed, the patient was in complete remission. The second patient was a 52 year old man who underwent left inferior lobectomy for a lympho-plasmacytic lymphoma, which was only diagnosed definitively on the operative specimen. The authors discuss the clinical and radiological features and the histological and immunological criteria of primary pulmonary lymphomas (PPL). There are a number of related diseases with varying degrees of malignancy: interstitial lymphocytic pneumonitis (ILP), pseudo-lymphoma, which corresponds to a localised form of ILP, lymphomatoid granulomatosis (LYG) and pulmonary lymphoma, which usually has a lymphocytic or lympho-plasmocytic cell type.

[Data of broncho-alveolar lavage and pulmonary histiocytosis X]. / Données du lavage broncho-alvéolaire et histiocytose X pulmonaire.

The data obtained from broncho-alveolar lavage in 12 cases of pulmonary histiocytosis X explored between 1978 and 1986 are reported. The usefulness of this simple and reliable examination to the diagnosis and follow-up is emphasized. The diagnosis, suggested by radiography of the chest, may be suspected on cytological findings of hypercellularity, macrophage alveolitis and eosinophilia. The occurrence of neutrophilic hypergranulocytosis indicates an unfavourable course towards fibrosis. An increase of cells marked with monoclonal OKT6 antibodies (70% of the cases in this series) contributes to the diagnosis of histiocytosis X and is a good indicator of granuloma activity during the follow-up period. Electron microscopy of the alveolar fluid often confirms the diagnosis by showing the specific organelle: the X granule (60% of the cases in this series), thus avoiding exploratory thoracotomy in many patients.