Granular cell tumour of the male breast.

Granular cell tumour (GCT) is a rare neoplasm that can be found in multiple sites throughout the body. Occasionally GCT is located in the breast. In general, it appears as a singular benign lesion, although it can be multi-focal and rare cases with malignant behaviour have been reported. We report a rare case of granular cell tumour of the nipple in the male breast, treated by wide local excision.

Autoimmune pancreatitis with evolution to cholangitis: a case report.

We report the case of a 47-year-old Caucasian male patient who presented with obstructive jaundice and mild epigastric pain. Autoimmune pancreatitis was diagnosed based on magnetic resonance imaging, biopsy and clinical evolution, and the patient was successfully treated with corticosteroids. However, a few months later ERCP showed an image compatible with sclerosing cholangitis. Again, treatment with corticosteroids was given, after which the bile ducts became normal. A few months later, again there was a relapse and azathioprine was started. After decreasing the dose of immunesuppression, we saw relapses of cholangitis and pancreatitis, with eventually evolution to chronic calcifying pancreatitis. The aim of this report is to describe autoimmune pancreatitis as a cause of obstructive jaundice, and to illustrate that evolution to an immunesuppression-responsive cholangitis, with evolution to chronic calcifying pancreatitis is possible. Also, our patient had a small fluid collection, possibly a pseudocyst, an unusual finding in autoimmune pancreatitis, which disappeared during treatment.

Umbilical discharge: a review of 22 cases.

Umbilical discharge is a symptom of a varied pathology. We analysed the files of 22 patients with umbilical discharge operated on in our hospital over a period of 23 years. In 13 patients the umbilical discharge was accompanied by an acute umbilical inflammation. In 10 patients the symptoms were caused by embryonic anomalies and in 12 patients by an acquired pathology. We propose a surgical technique that can be applied regardless of the pathology, and that does not involve a pre-operative assessment of the causes.

Investigation of the pharmacokinetics and analgesic effects of an intramuscular injection of sustained-release sufentanil for postoperative pain: an open study.

STUDY OBJECTIVES: To investigate the pharmacokinetics after an intramuscular (IM) injection of sufentanil in thin vegetable oil in postsurgical patients and to determine whether sustained-release IM sufentanil can provide safe and sufficient analgesia of long duration in these patients. DESIGN: Open study. SETTING: University hospital. PATIENTS: 10 ASA physical status I and II patients aged 18 to 65 years who were scheduled for elective surgery. INTERVENTIONS: All patients were premedicated with lorazepam and anesthetized with a general anesthetic technique containing nitrous oxide, fentanyl, and isoflurane. As soon as significant pain [visual analog scale score of 5 or greater (range, 0 = no pain to 10 = worst pain imaginable)] occurred during the early postoperative period, the patient received an IM injection of sustained-release sufentanil. MEASUREMENTS AND MAIN RESULTS: During the first 48 hours following surgery, blood samples were taken for determination of plasma sufentanil concentrations. Blood pressure, heart rate, respiratory rate, pain scores, and sedation scores were documented at the same time. The IM administration of sufentanil in thin vegetable oil provided sufficient pain relief, although the onset of analgesia was rather slow (+/- 1 hour). The analgesic effect was still apparent 48 hours later. Plasma concentration of sufentanil at the different time points varied from 0.021 to 0.142 ng/ml, with a mean maximal peak concentration of 0.103 ng/ml. The plasma concentration 48 hours after injection varied from 0.026 to 0.074 ng/ml. CONCLUSIONS: Although an IM injection of sufentanil in thin vegetable oil is effective for postoperative pain relief, it is associated with wide interindividual variability in plasma concentration of sufentanil and long duration of action.

[Phyllodes type of atypical prostatic hyperplasia]. / Phyllodes type van atypische prostaathyperplasie.

The author describes one case of phyllodes type of atypical prostatic hyperplasia. This is a benign prostatic lesion characterised by atypical epithelial hyperplasia and pleomorphism of the stromal elements. There is a resemblance with cystosarcoma phyllodes of the female breast. There have been described only a few cases of such atypical hyperplasia.

Pathogenesis of the lethal multiple pterygium syndrome.

We present autopsy studies in 4 unrelated fetuses with the lethal multiple pterygium syndrome (LMPS) with special emphasis on the neuromuscular system. The data suggest that LMPS combines the manifestations of a jugular lymphatic obstruction sequence with those of an early severe fetal akinesia sequence. The jugular lymphatic obstruction sequence with resultant edema and cystic hygroma colli causes fetal lethality usually in the second trimester of pregnancy. Generalized amyoplasia appears to be an important mechanism in the pathogenesis of fetal akinesia as part of LMPS and is not associated with dysgenesis or degeneration of the central nervous system (CNS) but is apparently the result of an early fetal muscular "dystrophy." We propose a genetically determined insult affecting the early embryonic development of both lymph vessels and muscles as the basic defect in LMPS. Placental structure, studied in all 4 cases, demonstrated that triploidy-like placental lesions are specific to LMPS. The present findings suggest that LMPS may be a less heterogeneous entity than previously proposed.

Bone marrow plasmocytosis in acute leukemia.

A quantitative evaluation of IgA, IgD, IgG and IgM plasmocytes in sequential bone marrow aspirates of patients with acute leukemia using the peroxidase-antiperoxidase method was undertaken. Plasmocytosis resembled that of normal controls or was slightly subnormal on admission. When remission was obtained, bone marrow plasmocytosis was similar to normal controls, irrespective of the type of acute leukemia and the cytostatic treatment. Occurrence of infection strongly augmented the number of plasmocytes, with an initial increase in IgM and later in IgG plasmocytes. This suggests that the immune response is preserved in patients with acute leukemia.

Discordances of cytoplasmic immunoglobulin G staining with the immunoperoxidase technic in plasma cells from bone marrow, tonsils, and appendix.

Plasma cell cytoplasmic immunoglobulin was stained using the peroxidase-antiperoxidase technic in Bouin-fixed, paraffin-embedded human tissues from different origins. Bone marrow (BM), tonsils, and appendices were examined. IgA-, IgD-, and IgM-secreting plasmocytes were easily studied using highly diluted rabbit antihuman antisera in all tissues, including BM. IgG plasmocytes showed good stainability in tonsils and appendices, but variable results were obtained in BM. Bone marrow IgG plasmocytes from persons without infection required a tenfold higher concentration of rabbit antihuman IgG than plasmocytes derived from patients with infection. Stainability of BM plasmocytes from patients with infection was equal to BM plasmocytes from myeloma patients. Because the same rabbit antihuman IgG concentration could be applied for staining plasmocytes derived from tonsils and appendices, it is most probable that the difference in staining ability is due to a difference in activity of the plasmocytes, i.e., a different IgG concentration in the plasmocytes.

A modified immunoperoxidase method for the detection of ABH tissue isoantigens in patients with bladder carcinoma.

Detectable ABH blood group antigens (BGAg) on tumor cells from transitional carcinoma of the urinary bladder, used for diagnosis and prognosis may be evidenced with the existing immunoperoxidase methods. In this study, a modification of the immunoperoxidase method was shown to enable the detection of BGAg in deparaffinized tissue section of normal and malignant human urothelium. To detect antigens A and B a peroxidase-conjugated rabbit anti-human IgM was used and antigen H was visualized by biotinylated lectin.

The thymus as haematopoietic tissue of non-lymphoid cells.

Non-lymphoid haematopoiesis in the thymus was studied in 33 cases ranging from 14 weeks gestation up to 15 months postnatally. All thymuses displayed focally granulopoiesis in the connective tissue septa and in the lymphoid tissue, where it was localized in the peripheral cortex and at the cortico-medullary junction. Within the lymphoid tissue the granulocytic series showed many precursor cells with large rounded nuclei. Their origin could only be identified by the naphtol AS D chloroacetate esterase stain. In cases with thymic atrophy these precursor cells were present in relatively large numbers. Within the connective tissue septa many granulocytes with nuclear segmentation were intermingled with precursor cells. The erythroid series were detected with an immunohistochemical method for demonstration of haemoglobin. The positively stained nucleated cells occurred mainly in nests mostly localized in the peripheral cortex. These precursor cells were usually found in different places from the granulopoietic cells. No megakaryocytes were found. With appropriate techniques non-lymphoid haematopoiesis can be demonstrated in the developing thymus and must be considered as an expression of normal growth.