Raynaud's phenomenon in chain saw users. Hot and cold finger systolic pressures and nailfold capillary findings.

To gain insight into the physiopathology of Raynaud's phenomenon of occupational origin, finger systolic pressures under heat and cold, and results of nailfold capillary microscopy, were examined in 29 lumberjacks with Raynaud's phenomenon vibration syndrome (pathological group) and 24 lumberjacks without it (non-pathological group), and compared with the same values in 26 healthy matched manual workers not using a vibrating tool (controls). Vibration syndrome physiopathology seemed multifactorial, combining 5 features: a rise in brachial diastolic and systolic pressures in the pathological group compared with the two other groups. In lumberjacks with Raynaud's phenomenon, these rises seemed to be acquired, since they were not found when the workers were engaged; a reduction in the number of nailfold capillaries (9.4 +/- 2 per mm in the pathological group vs 11 +/- 2.5 in the controls, P less than 0.025); a rise in the brachial digital systolic gradient (P less than 0.025) in the pathological versus the non-pathological lumberjack group abnormal cold vascular tone, since at 15 degrees C finger systolic pressures in the pathological group were lower than pressures in both the control and non-pathological groups (P less than 0.05 and P less than 0.01, respectively), and at 10 degrees C, they were lower in the pathological than in the control group (P less than 0.01); Within the pathological group, individual paired comparisons between the most and least symptomatic finger revealed a rise in the cold vascular tone, and a reduction in the number of nailfold capillaries in the most symptomatic finger compared to the least symptomatic finger.(ABSTRACT TRUNCATED AT 250 WORDS)

[Raynaud's syndrome in lumberjacks using chain saws. Epidemiology, clinical and capillaroscopic findings]. / Le syndrome de Raynaud des bûcherons utilisant une scie tronçonneuse. Epidémiologie, clinique et capillaroscopie.

The overall incidence of Raynaud's syndrome in lumberjacks using a mechanic chain saw in France is at least 45%; workers exposed to the risk for more than 3 years have an incidence of about 60%. Vibrations are probably directly responsible for the disease, while among the other favorizing factors the different winter climatic conditions do not appear to be relevant, and this is the case with conventional vascular risk factors, apart perhaps for hypertension. A history of injury to hands is significantly more frequent in affected subjects possibly related to a relative digital cutaneous hypo-esthesia. Capillaroscopy shows organic microangiopathies with reduction in number of nail-bed capillaries and functional angiopathies of arteries of hand in the form of abnormal spasm induced by cold. Technical progress by the use of chain saws has markedly reduced incidence of this occupational disease, but in France it would appear that only modifications in working conditions of lumberjacks could reduce the incidence of the disease.

[Endobronchial non-Hodgkin's lymphoma]. / Lymphome non hodgkinien endobronchique.

The authors report a case of endobronchial non-Hodgkin lymphoma, in a 48-year-old woman. This is an exceptional localization. When it reveals the disease, as was the case in the index patient, clinical presentation is usually atelectasis with fever. Diagnosis was established upon bronchoscopy. Histologic examination of biopsy specimens showed an immunoblastic lymphosarcoma. Total pneumonectomy and chemotherapy failed to prevent rapid deterioration with a fatal outcome 7 months after onset. A selective total IgA deficiency and a familial history of malignant tumors were recorded. Immunoblastic sarcoma has a poor prognosis. It often follows a disease whose mechanism is ascribed to an immunological disorder. Lymphoma arising in a patients with prior immune disease should suggest the diagnosis of immunoblastic sarcoma.

[Capillaroscopy in vibration disease]. / La capillaroscopie dans la maladie des vibrations.

The results of nailfold capillary microscopy were compared in 107 lumberers who had been using a chain saw for more than 3 years and 115 manual workers who had never used vibrating tools. The prevalence of Raynaud's phenomenon was 61.7% in lumberers and 5.2% in the control group. The mean time of exposure to risk before the condition developed was 7.86 years. The syndrome was usually mild, but the patients had an abnormally high incidence of accidents at work, including wounds and cut off fingers. The number of capillary loops was significantly reduced. The lumberers affected showed an abnormal spasm of the digital artery in response to cold; the predictive value of this test was 88%. It is suggested that nailfold capillary microscopy should be systematically used in industrial medicine for monitoring workers using a vibrating tool.

[Hepatic syphillis with amyloïdosis and chronic diarrhea. A discussion of etiologic mechanisms (author's transl)]. / Syphilis hépatique, amylose et diarrhée chronique. Discussion étiologique.

A sixty-four year-old woman was admitted for chronic diarrhea with severe weight loss. Investigations showed hepatomegaly, positive serologic tests for syphilis, and nephrotic syndrome with proteinuria. Anasarca occurred and the patient died shortly after admission. Necropsy showed sclero-gummatous hepatic syphilis, generalized amyloïdosis and ulcerative colitis. These last two manifestations and their association with tertiary stage syphilis are discussed.

[Visceral Kaposi sarcoma with angioimmunoblastic lymphadenopathy and latent sicca syndrome (author's transl)]. / Sarcome de Kaposi viscéral associé à und lymphadénopathie angioimmunoblastique avec syndrome sec latent.

A case clinically and morphologically typical angio-immunoblastic lymphadenopathy in a 64-year old man is reported. A sicca syndrome was discovered with histological localization in the labial accessory salivary glands. Death occurred after a course of a few months. The autopsy showed an association of angio-immunoblastic lymphadenopathy lesions of the bone marrow and the lymph node and of typical multivisceral localizations of Kaposi's sarcoma (lymph node, liver, thyroïdd gland) without skin involvement. This association of two diseases characterized by severe dysimmunity with B lymphocytes hyperplasia is discussed, and compared to the others diseases which could be associated with Kaposi's sarcoma.

[Bacterial endocardiitis complicating fibroplastic endocarditis: a case report (author's transl)]. / Une observation d'endocardite bactérienne compliquant une endocardite fibroplastique.

A young Protugese man, who had never travelled outside of Europe, was found to have a bacterial complication of a fibroplastic endocarditis. The onset was by a spontaneous chest pain, associated with a posterolatero-apical subepicardial ischemia and giant T waves in V3, V4, and calcification in the apex of the heart on radiography. Diagnosis was confirmed by intracardiac explorations: ventricular telediastolic pressures were increased; the lower border of the right ventricle was smooth, the left ventricle had a globular appearance with a smooth anterior border, the apex appearing to be completely excluded; coronarography was normal. Histological examination confirmed the presence of fibrosis. Anticoagulant treatment was started. Four months after the onset of the disease, a high fever, an apical systolic murmur, and nine positive blood cultures for a streptococcus mitis, suggested the development of a bacterial endocarditis, though no direct evidence was discovered. Improvement occurred after appropriate antibiotic therapy, and the anticoagulants were continued. Cardiac ultrasonography recordings were normal following this episode. This case-report is of two-fold interest: on the one hand it represents an early form of fibroplastic endocarditis, diagnosed by intracardiac exploration, and on the other hand it emphasizes the rare nature of bacterial complications of this affection. Authors differ in their evaluation of the frequency of chest pain, but their inaugural and isolated nature are rarely described. In most cases the presence of the disease is revealed by a progressive cardiac insufficiency. A very positive factor is the presence of calcifications, and the absence of an eosinophilia does not exclude the diagnosis. Electrical anomalies of the ischemic type are possible, but are rarely isolated findings, and the giant appearance of the T waves in this case is rather atypical. Bacterial complications are rare, and are only reported in 12 of the 218 cases described in the published literature. They are rarely diagnosed during the life of the patient (1 case only). The infection affects the cords, the valves, the thrombus, or the fibrosis itself.

[Bone in hepatic cirrhosis: morphometric and biological study (author's transl)]. / L'os du cirrhotique: étude morphométrique et biologique.

Quantitative bone histomorphometry and evaluation of blood parameters have been performed in 24 patients with hepatic cirrhosis. 13 patients show osteoporosis which, in 8 of them, is associated with osteoclastic hyperactivity but without elevation of blood parathormon. All patients have hypocalcemia and 14 of them hyperosteidosis. These results are compared with data of the literature on bone morphometry and phosphocalcic metabolism during hepatic cirrhosis.

[Acute and chronic tuberculosis of the liver and hematopoietic system (author's transl)]. / Tuberculos hépatique et hématopoïétique: formes aiguës et chroniques.

The authors report three cases of tuberculosis affecting the liver and hematopoietic system. The difficulty in diagnosing the chronic progressive forms of the disease and the severity of the acute forms is stressed. Liver biopsy is considered to be the most effective examination for confirming the nature of the disease. Acute and chronic forms can also be distinguished histologically, as the former produce nectotic lesions rich in tubercle bacillus but with only slight surrounding cellular reaction, while the latter lesions are productive and are rich in epithelioid histocytic cells.

[Vitamin D, parathormone, calcitonin and bone histomorphometry in patients with cirrhosis]. / Vitamine D, parathormone, calcitonine et histomorphométrie osseuse chez les cirrhotiques.

This study deals with 29 patients with cirrhosis, caused by alcohol in 23 cases, at a stage of edematoascitic decompensation. Calcemia was low 88 +/- 7 mg/l) as well as calciuria 87 +/- 92 mg/24 h). Phosphoremia and hydroxyprolinuria were within normal limits. A moderate diminution of 25 OH D3 (29,5 +/- 18 ng/ml) was observed in most patients but one third of them had no or very low levels of parathormone and 10 out of 27 had an elevated level of calcitonin. Bone histomorphometry which was done in 24 cases showed a discrete osteoporosis, a relative hyperosteoidosis and a hyperosteoclasis. There was a very significant relationship between hypocalcemia, and hypoalbuminemia but the other abnormalities could not be correlated significantly with either the duration or the severity of the disease. Hypocalcemia and bone histomorphometric abnormalities of cirrhosis can certainly not be explained only by a lack of liver hydroxylation of vitamin D.