RESUMEN
Assessment of care supply in terms of medical labor force is difficult because of the disparity of available data. Using the medical specialty of pathology as an example, we present for the first time a demographic analysis based on the confrontation of main data sources. This study underlines some of the structural and dynamic problems which threaten the demographic stability of the specialty. The public service suffers from a lack of practitioners, especially in regional hospitals. Whereas one third of French pathologists work in the larger hospitals around Paris, in some other regions private services constitute the main component of the supply. Projections based on the aging phenomenon and a reduction in entry indicate a future problem in the renewal of generations of pathologists. The consequences of this programmed decrease in the number of French pathologists will be further exacerbated by the movement of the sex ratio in favor of women.
Asunto(s)
Patología , Demografía , Femenino , Francia , Hospitales , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Recursos HumanosRESUMEN
The authors report the case of a 41-year old man who presented simultaneously with phaeochromocytoma, paraganglioma and renal carcinoma. The postoperative finding of metaiodobenzylguanidine uptake foci showed that the phaeochromocytoma was malignant. The patient's son had a phaeochromocytoma and a pancreatic cyst. The phaeochromocytoma had no clinical manifestations and had been discovered by systematic assays of urinary catecholamines and their derivatives. These abnormalities are those of Von Hippel-Lindau disease.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias Renales/complicaciones , Feocromocitoma/complicaciones , Enfermedad de von Hippel-Lindau/complicaciones , Adolescente , Neoplasias de las Glándulas Suprarrenales/genética , Neoplasias de las Glándulas Suprarrenales/patología , Adulto , Quistes/complicaciones , Humanos , Masculino , Enfermedades Pancreáticas/complicaciones , Feocromocitoma/genética , Feocromocitoma/patologíaRESUMEN
A new case of bilateral, diaphyseal hyperostosis of the leg bones is reported. Strictly unilateral symptoms appeared when the patient was 35 years old consisting of unbearable pain in the middle section of the antero-medial side of the left leg. Diagnosis was based on X-rays and a pre-operative bone scintiscan, showing localised hyperfixation opposite the pain site. Preoperative locating using a radioactive marker enabled circumscribed but complete excision of the hyperfixation site. This diagnosis was confirmed by the pathologist examination. The patient, who experienced immediate relief after surgery, has remained pain-free for one year to date. The relationship between this case and Camurati-Engelmann disease (diaphyseal dysplasia) is discussed.
Asunto(s)
Síndrome de Camurati-Engelmann/diagnóstico , Adulto , Síndrome de Camurati-Engelmann/etiología , Síndrome de Camurati-Engelmann/patología , Femenino , Humanos , PiernaRESUMEN
We report 3 cases of undifferentiated carcinomas of nasopharyngeal type (UCNT) found in unusual sites and compare them with histologically identical tumors found in the nasopharynx. Using viral serology and viral marquers found in the tumor cells, we looked for a link with the Epstein Barr Virus (EBV) which exists in the nasopharyngeal site. It appears that UCNT found in unusual sites have a poorer prognostic than the same nasopharyngeal tumors; no link was found with EBV. The number of published cases is too small to form a conclusion, therefore, we propose a systematic search for EBV, presenting our protocol, each time is discovered UCNT in an unusual site.
Asunto(s)
Carcinoma/patología , Neoplasias de Cabeza y Cuello/patología , Anciano , Carcinoma/secundario , Carcinoma/virología , Resultado Fatal , Infecciones por Herpesviridae/diagnóstico , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/virología , Pronóstico , Neoplasias de los Tejidos Blandos/patología , Neoplasias Tonsilares/patología , Infecciones Tumorales por Virus/diagnósticoRESUMEN
We analyzed atelectasic processes occurring in the maxillary sinus. Several publications in the literature have tempted to analyze the pathogenesis. Clinically the processes are often silent and only revealed when the major opthalmological complication, enophthalmia, becomes patent. In other cases there is a long history of chronic sinusitis. There is a spectacular retraction of the maxillary sinus walls leading to collapse of the orbital floor and enophthalmia. We report four cases of maxillary sinusitis with atelectasia of the sinus walls at different stages of progression. These observations and data in the literature emphasize the importance, whatever the state of development, of endoscopic osteal decompression to avoid ophthalmological complications.
Asunto(s)
Enoftalmia/etiología , Sinusitis Maxilar/complicaciones , Adolescente , Adulto , Enfermedad Crónica , Enoftalmia/diagnóstico por imagen , Femenino , Humanos , Masculino , Seno Maxilar/patología , Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/patología , Tomografía Computarizada por Rayos XRESUMEN
We report a case of aspergillous bronchitis in an immunocompetent patient, recalling the clinical signs, laboratory findings and therapeutic management of this uncommon bronchopulmonary disorder related to aspergillus.
Asunto(s)
Aspergilosis/complicaciones , Aspergilosis/inmunología , Aspergillus fumigatus , Bronquitis/microbiología , Inmunocompetencia/inmunología , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergilosis/tratamiento farmacológico , Biopsia , Broncoscopía , Tos/microbiología , Fatiga/microbiología , Fiebre/microbiología , Humanos , Itraconazol/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
Environmental exposure to asbestos, as observed in Anatolia (Turkey), usually results in pleural pathology (plaques and mesothelioma). We report the case of a 50-year old woman who, until the age of 50, had lived in Eregli, central Anatolia, a region where inhalation of environmental asbestos is responsible for a high prevalence of pleural diseases. Radiology showed diffuse interstitial pneumonia without pleural involvement. Bronchoalveolar lavage brought back asbestos bodies (AB) in concentrations of 4,250 per millilitre. All were made of tremolite, a non-commercial variety of asbestos. The patient's family was investigated by chest radiography and search for AB in sputum. The husband, who came from the same town as his wife and had been exposed until the age of 45, had the classical response with bilateral pleural thickening but no parenchymal abnormalities; 2 AB were found in his sputum. The 3 sons, exposed for 10, 13 and 20 years respectively, had normal radiograms and no AB in their sputum, except for the older (3 AB) who had been exposed for 20 years. These cases illustrate the importance of environmental exposure to asbestos which may produce lesions similar to those observed in industrial exposure. Only mineralogical examinations can determine whether the asbestos is environmental or industrial.
Asunto(s)
Asbestos Anfíboles , Amianto/efectos adversos , Fibrosis Pulmonar/etiología , Líquido del Lavado Bronquioalveolar/química , Exposición a Riesgos Ambientales , Femenino , Humanos , Persona de Mediana Edad , Linaje , Fibrosis Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/genética , Ácido Silícico/efectos adversos , Tomografía Computarizada por Rayos X , TurquíaAsunto(s)
Linfoma de Células B/diagnóstico por imagen , Neoplasias Pleurales/diagnóstico por imagen , Tuberculosis Pulmonar/complicaciones , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X , Tuberculosis Pleural/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
AIM: To evaluate clinical, biological and immunological features of patients with increased duodenal intraepithelial lymphocytes (IELs), and its relation to Helicobacter pylori (HP) and coeliac disease (CD). METHODS: We have studied all patients accrued over a 4-year period with increased duodenal IELs. Those patients were recalled for biological and immunological evaluation and a second endoscopy. RESULTS: Twenty-three from a total of 639 patients were identified and 17 of them were included in the study. The median duodenal IEL count was 59 per 100 epithelial cells. Twelve (71%) patients were HP+; eight of them received HP eradication. At the second endoscopy the duodenal IEL count was significantly lower 2 months after HP eradication (73 versus 28), while the IEL count was unchanged in those patients seronegative for HP (n = 5) or those in whom it was not eradicated (n = 4) (55 versus 55). No patient had coeliac antibodies, four expressed HLA-DQ2, lower than in the general population, and the prevalence of CD was 2% (12/639 patients). CONCLUSION: In some cases an increased duodenal IEL count may be due to an inappropriate host response to HP. HP screening and eradication should be considered before recommending a gluten-free diet.
Asunto(s)
Antibacterianos/uso terapéutico , Duodeno/efectos de los fármacos , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Linfocitosis/prevención & control , Biopsia , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/inmunología , Recuento de Células , Duodeno/microbiología , Duodeno/patología , Endoscopía Gastrointestinal , Epitelio/efectos de los fármacos , Epitelio/microbiología , Epitelio/patología , Femenino , Antígenos HLA-DQ/inmunología , Cadenas beta de HLA-DQ , Antígeno HLA-DR4/inmunología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/microbiología , Humanos , Linfocitos/patología , Linfocitosis/etiología , Linfocitosis/patología , Masculino , Estómago/efectos de los fármacos , Estómago/microbiología , Estómago/patologíaRESUMEN
A large cardiac rhabdomyoma was discovered before delivery in a neonate, whose outcome was fatal. The baby and her mother had both cutaneous lesions suggestive of tuberous sclerosis, and the mother's sister had died from Von Hippel Lindau disease. The association of a cardiac rhabdomyoma and a tuberous sclerosis in the same patient is not uncommon, but the existence of Von Hippel Lindau disease in a member of the same family seems to be exceptional.
Asunto(s)
Angiomatosis/complicaciones , Neoplasias Cardíacas/complicaciones , Rabdomioma/complicaciones , Esclerosis Tuberosa/complicaciones , Enfermedad de von Hippel-Lindau/complicaciones , Femenino , Neoplasias Cardíacas/genética , Humanos , Recién Nacido , Rabdomioma/genéticaRESUMEN
The authors report a new case of pneumoblastoma concerning a 63 years old man who dies with hepatitic insufficiency and massive metastasis. The study in optic and electronic microscopy shows the three cellular contingents which form the pneumoblastoma: clusters of indifferenciated cells, spindle cells and cubic or cylinder epithelial cells, with few secretory granules and microvilli which form tubes or lobules. All the features show clearly a blastematous character very similar to a foetal lung which allows to differenciate the pneumoblastoma from carcinosarcoma.
Asunto(s)
Carcinosarcoma/patología , Neoplasias Pulmonares/patología , Carcinosarcoma/diagnóstico , Carcinosarcoma/ultraestructura , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/ultraestructura , Masculino , Persona de Mediana EdadRESUMEN
The association of a diaphragmatic hernia and a pulmonary sequestration is known, though very rare. The authors present one singular observation because it were involved in aplasia of the homolateral pillar and a digestive duplication. They insist about the gravity of the reflux inherent to the malformation; they suggest its differed cure in spite of nutritional difficulties. Pathogenic considerations are advanced on that malformative complexe which is combined with the broncho-pulmonaries malformations of the foregut. It seems a direct proof of the theory of "the accessory lung". Finally, is underlined the gravity of the aplasia of the diaphragmatic leaf extensive to the pillar.
Asunto(s)
Anomalías Múltiples/cirugía , Secuestro Broncopulmonar/complicaciones , Diafragma/anomalías , Anomalías del Sistema Digestivo , Hernias Diafragmáticas Congénitas , Anomalías Múltiples/patología , Secuestro Broncopulmonar/patología , Secuestro Broncopulmonar/cirugía , Diafragma/cirugía , Reflujo Gastroesofágico/cirugía , Hernia Diafragmática/cirugía , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
Cholesterol crystal embolization is a well-known disorder resulting from release of cholesterol crystals from ulcerous atherosclerotic plaques. Gastrointestinal involvement occurs in about a third of cases, but it is usually asymptomatic. We report a case of an old woman with small bowel obstruction secondary to atheromatous embolism. She was treated by acenocoumarol for atrial fibrillation and pulmonary embolism. Two weeks before admission for small bowel obstruction, she had a watery diarrhea. After 3 weeks of parenteral nutrition, she underwent resection of the involved ileum. Pathological examination showed a small bowel stricture secondary to atheromatous embolism. Cholesterol emboli should be considered as a potential cause of small bowel obstruction in old patient who has taken anticoagulant therapy or after vascular invasive procedure.