[Acute acalculous cholecystitis: apropos of 6 cases]. / Cholécystites aiguës alithiasiques: à propos de 6 cas.

Authors relate their experience of six cases of acute acalculous cholecystitis (4 postoperative, 2 posttraumatic and postoperative). Five cases were correctly diagnosed preoperatively and another case was operated on the basis of a high index of suspicion. Acute acalculous cholecystitis is often misdiagnosed and its frequency is probably higher than suspected. Associated diseases, the natural history of the disease as well as delayed diagnosis explain its poor prognosis. The diagnosis of acute acalculous cholecystitis should be routinely ruled out in high risk patients (polyoperated, polytraumatised) in order to improve the mortality rate. Ultrasonography and biliary scintigraphy are useful for the diagnosis in high risk patients. Emergency cholecystectomy is still the best long term treatment.

Increased plasma motilin concentrations in small cell carcinoma of the lung.

Plasma samples from 21 patients with small cell carcinoma of the lung were screened for pancreatic polypeptide, somatostatin, motilin, and vasoactive intestinal polypeptide. One patient had severe impairment of both renal and liver function. In the 20 remaining subjects vasoactive intestinal polypeptide concentrations were normal, and only two patients had increased concentrations of somatostatin. Increases in pancreatic polypeptide were detected more commonly (7/20), but these may have been non-specific age related increases. The major finding was high concentrations of motilin (greater than 496 pg/ml) in 17 of 20 patients. Plasma motilin was subsequently assayed in 16 more patients with lung cancer, including 10 patients with non-small cell carcinoma of the lung. At concentrations over 900 pg/ml plasma motilin appears to be a tumour marker for small cell carcinoma of the lung with acceptable sensitivity (59%) and specificity (78%). The origin of increased plasma motilin in small cell carcinoma of the lung was investigated. Bombesin (gastrin releasing peptide), a peptide known to stimulate the release of motilin in man, was, as in previous studies, detected in tumour but not in plasma, except in one patient out of 21. Immunohistochemical studies failed to detect motilin antigen in biopsy samples. Motilin tumour content was found to be low in tumour tissue from three patients with small cell carcinoma of the lung who had appreciable hypermotilinaemia and from three patients with non-small cell carcinoma of the lung who had either normal or slightly raised plasma motilin concentrations. The stimulus to motilin secretion in patients with small cell carcinoma of the lung remains unclear.

Zinc deficiency and lymphocyte subpopulations. A study by flow cytometry.

Zinc deficiency is well known to alter immunity. We report the case of a 18-yr-old female with relapsing Crohn's disease who experienced acrodermatitis enteropathica due to zinc deficiency during total parenteral nutrition (TPN). Blood lymphocytes have been studied by flow cytometry: before zinc treatment an important decrease of T-helper lymphocytes with high level of OKM-5+ lymphocytes had been observed. Zinc-supplemented diet induced within a few days, a rise of T-helper lymphocytes and a proportional reduction of OKM5+ cells. Increased values of high metabolism surface marker (OKT-9) were also observed, as well as cytoplasmic modifications. The authors suggest that lymphocyte surface markers could be useful to monitor TPN in patients at high risk for zinc deficiency.

[A case of fibromuscular dysplasia in an unusual location]. / A propos d'un cas de dysplasie fibro-musculaire à localisation inhabituelle.

Unusual localization of fibromuscular dysplasia on the common carotid artery. In this paper, the authors are describing an unusual localization of the fibro-muscular dysplasia on the common carotid artery, a lesion that has undergone surgical treatment without any complication.

[A case of primary testicular carcinoid tumor]. / A propos d'un cas de tumeur carcinoïde primitive testiculaire.

Carcinoid tumors are rare and mainly found in the G.I. tractus but also in the tracheobronchial tree and ovaries. The testicular localization, primary or metastatic, is rare. The authors report a primary carcinoid tumor of the testis in a 35 years old male. The tumor characteristics are well enough known from the literature. Primary carcinoid tumors of the testis appear to be of a low grade malignancy. Local therapy suffices for care of the patient as long as, on microscopic examination, it is not an expression of a teratocarcinoma. The diagnosis is made by the discovery of a tumor since the carcinoid syndrome is seldom in the clinical picture (only 2 cases in the literature, one of whom with generalized metastasis).

[Intrathyroid metastasis. Anatomo-clinical problem]. / Métastase intrathyroïdienne. Problème anatomo-clinique.

The authors are describing a case of clear cell renal epithelioma metastasizing in the thyroid gland; the clinical course and the histological appearance were consistent with a primary carcinoma of the thyroid gland of the undifferentiated large cell type.