Mucocèles nasosinusiennes post-radiques à propos de trois cas.

Nasosinusal mucoceles, although benign, are aggressive and sometimes destructive lesions. They may occur as a result of trauma, infection, sinus surgery and head and neck radiation. We describe three patients presenting mucocele, with the history of nasopharyngeal and temporal fossa cancers treated by radiotherapy.

Dedifferentiated adamantinoma associated with fibrous dysplasia.

A 21-year-old patient presented with an aggressive lesion of the left tibia associated to lymph nodes and lung metastasis. Histological examination revealed a high grade spindle cell sarcoma involving some areas of cytokeratine positive cells. Ultrastructural examination showed the presence of epithelial features in the sarcomatoid cells. The diagnosis of dedifferentiated spindle-celled adamantinoma was established. A second lesion of the right tibia was diagnosed as fibrous dysplasia. The patient had a leg amputation. He died 2 years later with multiple lung and bone metastases. The diagnosis of dedifferentiated adamantinoma should be considered when a clinician is confronted with a tibial biopsy of a "keratin-positive sarcoma". The association with fibrous dysplasia in this case is discussed.

Morphological and biochemical changes of salmonella hadar exposed to aqueous garlic extract / Cambios morfológicos y bioquímicos de salmonella hadar expuestas a extracto acuoso de ajo

The effect on Salmonella hadar growth was investigated using fresh sterile liquid medium (Pronadisa, Hispanlab) containing aqueous garlic extract (AGE) at different concentration (0, 11, 12, and 13 mg/ml). The garlic extract added at these final concentrations had a bacteriostatic effect on Salmonella hadar. The effect of these bacteriostatic concentration of AGE on the growth of the tested serovar, revealed a pattern of inhibition characterized by: (i) a transitory inhibition phase whose duration was proportional to AGE concentration (ii) a resumed growth phase which showed a lower rate of growth than in uninhibited controls, and (iii) an entry into stationary phase at a lower culture density. The minimal inhibitory concentration and minimum bactericidal concentrations were very close, garlic MIC was 12 mg/ml and the MBC was 14 mg/ml. Among enzymatic activities followed with the API-ZYM system, significant changes during the inhibition phase were detected. These biochemical changes represent an adaptative response towards the garlic stress. Some cellular enzymatic activities disappeared, whereas others were induced or maintained after AGE addition. TEM images of the samples treated with the bacteriostatic concentration of AGE (12 mg/ml) revealed the rupture of cell walls and nonhomogeneous disposition of cytoplasmic materials within treated bacteria.

El efecto sobre el crecimiento de Salmonella hadar fue investigado utilizando un medio líquido estéril fresco (Pronadisa, Hispanlab) conteniendo el extracto acuoso de ajo (EAA) en diferentes concentraciones (0, 11, 12 y 13 mg/ml). El extracto de ajo añadido con estas concentraciones tuvo un efecto bacteriostático sobre Salmonella hadar. La prueba serovar reveló un patrón de inhibición caracterizado por: (i) una fase de inhibición transitoria cuya duración fue proporcional a la concentración de EAA, (ii) una reanudación de la fase de crecimiento, la cual mostró una tasa más baja de crecimiento que controles sin inhibición, y (iii) una ingreso en fase estacionaria con una menor densidad de cultivo. La concentración mínima inhibitoria (CMI) y la concentración mínima bactericida (CMB) fueron muy cercanas, la CMI de ajo fue de 12 mg/ml y la CMB fue de 14 mg/ml. Las actividades enzimáticas seguidas con el sistema API-ZYM, mostraron cambios significativos durante la fase de inhibición. Estos cambios bioquímicos representan una respuesta adaptativa al estrés del ajo. Algunas actividades enzimáticas celulares desaparecieron, mientras que otras fueron inducidas o mantenidas después de la adición de EAA. Las imágenes de MET de las muestras tratadas con la concentración del bacteriostático EAA (12 mg/ml) revelaron la ruptura de las paredes celulares y la disposición no homogénea de materiales citoplasmáticos dentro de las bacterias tratadas.

[Orbital metastasis of liposarcoma]. / Métastase orbitaire d'un liposarcome.

INTRODUCTION: Liposarcoma, the most common soft tissue sarcoma in adults, rarely involves the orbit. Primary orbital liposarcomas are extremely rare, with less than 30 cases previously reported. Metastatic orbital liposarcomas are also extremely rare, with only a few cases documented in the literature. We report a new case of an orbital metastatic liposarcoma and review the literature. OBSERVATION: A 57-year-old man with a history 5 years before of myxoid liposarcoma on the right calf, completely surgically resected, was admitted for recent proptosis of the left eye. A computed tomographic scan revealed a heterogeneously enhancing, left orbital mass measuring 30x23x20 mm. The mass adhered to the internal medial muscle without extension to the optic nerve. A biopsy was taken, which showed typical aspects of myxoid liposarcoma. The patient underwent an orbital left exenteration after first refusing any proposed treatment. CONCLUSION: Liposarcoma metastatic to the orbit is exceptional. It should be suspected in a patient with exophthalmia caused by a space-occupying lesion and a history of liposarcoma.

[Chondrosarcoma of the hand]. / Les chondrosarcomes de la main.

The authors report 5 cases of chondrosarcoma of the hand brought together over a period of 20 years. The series comprises 3 men and 2 woman of average age 42 years. In two cases the tumour arose from degeneration in a preexisting lesion of Ollier's disease. Diagnosis was made on clinical and radiological criteria. Confirmation of the diagnosis by histological examination proved to be difficult in 2 cases. The treatment was surgical, with ray amputation in 3 cases and curettage with bone graft in the other 2. None of the patients had a recurrence at 4.5 years mean follow-up.

[Lanthanides and microanalysis. Effects of oral administration of two lanthanides: ultrastructural and microanalytical study]. / Lanthanides et microanalyse. Effets de l'administration orale de deux lanthanides :etude ultrastructurale et microanalytique.

The subcellular localization of cerium and lanthanum in the intestinal mucosa was studied after oral administration of cerium chloride or lanthanum chloride or lanthanum chloride followed 30 minutes after of cerium chloride to young adults Wistar rats. Two methods of observation and microanalysis were used. The transmission electron microscopy revealed the presence of dense electron granulations in the lysosmes of the duodenum enterocyte, when these elements were administrated simultaneously. The ion mass microanalysis permits to detect the presence of La and Ce as bright points outlining the intestinal villi. These points correspond to the lysosomes containing the granulations previously described. These granulations are formed by the cerium and the lanthanum associated to the phosphor and forming probably insoluble salts of Ce/La phosphate.

[Sequential and ultrastructural study of lactotroph response to stress in rats as a function of age]. / Etude séquentielle et ultrastructurale de la réponse lactotrope a un stress chez le rat en fonction de l'âge.

In adult rats, ether inhalation stress stimulated basal serum prolactin (PRL) significantly, within a maximum delay of one minute. The same pattern was seen with immature animals of 15-20 and 30 days of age. In contrast, in 2 or 6 days old neonates, serum PRL concentrations remained unaffected by stress. This lack of responsiveness suggests the existence of a transient impairment of lactotroph hormones to stressful stimuli during postnatal life. This hypothesis has been controlled by ultrastructural exploration of lactotrophs. The distribution of organites and secretion grains in lactotrophs was similar in unstressed neonates and adult rats, but after ether stress, the distribution of secretion grains became different with age. Adult lactotrophs showed a peripheral secretion grains aspects indicating cells discharge. In the very young rats, the grains were distributed in the totality of the cytoplasm. These results confirm the existence, in the lactotrophs, of a refractory period to stress in the neonate rats.

Subcellular localization of gadolinium injected as soluble salt in rats: a microanalytical study.

The rare earth gadolinium (Gd) is used in modern industry. Solubilized DTPA Gd and DOTA Gd complexes are used as contrast media in nuclear magnetic resonance imaging. In order to determine the subcellular localization of Gd, rats were injected intraperitoneally with Gd nitrate. Two microanalytic methods, ion microanalysis and electron microprobe, enabled the distribution and the intracellular localization of Gd to be determined in the liver, spleen, bone marrow, kidneys and lung. The results showed: a) a punctual distribution of Gd in the tissues (liver, spleen, bone marrow and lung) as observed by ion microscopy; b) a selective concentration of Gd in the lysosomes of macrophages of the liver (hepatocytes), spleen (macrophages), bone marrow (macrophages) and lung (phagocyte cells), as determined by electron probe X-ray microanalysis. In all these sites the Gd is associated to phosphorus. Results are compared to those found for other rare earths and metal elements.

Treatment of alpha chain disease. Results of a prospective study in 21 Tunisian patients by the Tunisian-French intestinal Lymphoma Study Group.

Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease. Twenty of 21 underwent laparotomy. According to Galian et al. six patients were classified Stage A, two Stage B, and 13 Stage C. The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given. The antibiotic treatment was changed in case of therapeutic failure. (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophosphamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used. After 1983 bleomycin 15 mg, Adriamycin 30 mg, vinblastine 10 mg were given on day 15. Serum immunoelectrophoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively. Survival curve analysis was made according to Kaplan and Meier. Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively. The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths. (2) Stage B-C: Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR. (3) All stages mixed, percentage of survival reached 90 +/- 12% at 2 years and 67 +/- 25% at 3 years, all patients alive beyond 3.5 years being disease-free.

Immunoproliferative small intestinal disease without alpha-chain disease: a pathological study.

Biopsy specimens taken during exploratory laparotomy provided the material for a pathological study of 23 cases of nonsecreting immunoproliferative small intestinal disease (Mediterranean lymphomas without alpha-chain disease). The distinctive pathological feature of immunoproliferative small intestinal disease, i.e., a diffuse lymphoid infiltration, was present in the mucosa and submucosa of all or a major part of the small intestine. It was composed of a low- or intermediate-grade malignant lymphoid proliferation associated in 19 of 23 cases with benign-appearing follicular lymphoid structures. These follicular figures were surrounded and partially destroyed by the lymphoma cells. This association strongly resembles the newly described non-Hodgkin's lymphoma entities of perifollicular or parafollicular cell origin. Gross tumors of the small intestine were found in association with the diffuse lymphoid infiltration in 10 cases. They often constituted foci of lymphoma with a higher grade of malignancy. Mesenteric lymph node involvement was frequent and generally in direct ratio to the severity of intestinal involvement. A comprehensive study of the lesions observed in these cases led to the hypothesis that nonsecreting immunoproliferative small intestinal disease could result from the malignant change of perifollicular B cells; during an initial period the tumoral cells retain circulating and homing properties that explain their infiltrative and extensive method of spreading. The possible subsequent emergence of more aggressive subclones of noncirculating malignant cells could then explain the associated inconstant fungating tumor foci. Further studies using more sophisticated immunohistochemical techniques are necessary to establish the meaning of the hyperplastic lymphoid follicles, the possible etiologic role of benign nodular hyperplasia, the exact identification of the tumor cells, and the relationship of nonsecreting immunoproliferative small intestinal disease to closely related alpha-chain disease.

Venous involvement in Takayasu's disease: does it exist?

We describe the case of a 46-year-old man with an isolated superior vena cava syndrome, which was relieved by surgery. Pathologic examination revealed segmental involvement of the superior vena cava with dense collagen sclerosis. Histiomonocytic inflammatory transmural infiltration of all layers was histologically compatible with lesions described in Takayasu's disease. Although not previously described, this pathologic aspect suggests the possibility of venous involvement in this disease.

Diagnostic value of upper intestinal fiber endoscopy in primary small intestinal lymphoma. A prospective study by the Tunisian-French Intestinal Lymphoma Group.

To assess the diagnostic value of upper intestinal fiber endoscopy in primary small intestinal lymphomas observed in an underdeveloped Mediterranean country, the endoscopic records of 40 patients (Group A) offering histologic evidence of lymphoma were compared with those of 80 patients (Group B) displaying clinical findings of small intestinal disease, but who eventually proved to be free of lymphoma after a complete work-up. The endoscopic procedure reached the jejunum in 91% cases and was well tolerated with only one reversible complication. Five primary endoscopic patterns could be defined, occurring either alone or in various combinations. The infiltrated pattern was the most sensitive (0.80) and specific (0.96) finding with predictive positive and negative values reaching 0.88 and 0.93, followed by the nodular pattern (sensitivity 0.60, specificity 0.84). Other primary lesions (ulcerations, mosaic pattern, mucosal fold thickening alone) were either nonsensitive or nonspecific or both. The infiltrated pattern proved to be more valuable than any association of primary lesion. Per endoscopic biopsies were diagnostic of lymphoma in 85% cases. These findings strongly suggest that upper intestinal fiber endoscopy, using long ending view instruments should be the first investigation in patients suspected of small intestinal lymphoma in developing Mediterranean countries.

[Primary, exclusively gastric localization of alpha-chain disease: anatomo-clinical and immunohistochemical study]. / Localisation gastrique primitive et exclusive d'une maladie des chaînes alpha: étude anatomo-clinique et immuno-histochimique.

We report the first case of heavy alpha-chain disease exclusively located in the stomach and in the perigastric nodes in a thirty year old Tunisian patient. Both the small bowel and the mesenteric nodes were evaluated histologically and immunochemically and were found to be free of disease. Complete remission was obtained using chemotherapy. The reasons for which the small intestinal mucosa and the mesenteric nodes, nearly constantly involved, in alpha-chain disease were spared in our case, are discussed.