Femoral bifurcation infected pseudoaneurysm: a simple and quick arterial reconstruction with reversed bifurcated saphenous vein graft.

Septic endarteritis complicating arterial cannulation is an exceptional condition. The authors report a quick and feasible surgical procedure to reconstruct a femoral bifurcation with reversed bifurcated saphenous vein graft.

[Functional assessment and rehabilitation of eosinophilic fasciitis]. / Intérêt du bilan fonctionnel et de la rééducation dans la fasciite à éosinophile.

PURPOSE: To evaluate functional assessment and rehabilitation in eosinophilic fasciitis. METHOD: Description of a clinical case of eosinophilic fasciitis, including the evolution of functional assessment after treatment with corticotherapy and rehabilitation. CASE REPORT: Our case was a 33-year-old patient with major walking disability and pain in the left calf. Biological examination and imaging, including nuclear magnetic resonance and bone scintigraphy, showed inflammation of the adipose and muscular tissues of the posterior area of the leg. Cutaneomuscular biopsy confirmed the diagnosis of eosinophilic fasciitis. Corticotherapy was then instituted in parallel with rehabilitation to limit deficiencies and disability function. DISCUSSION-CONCLUSION: Functional assessment used as indicating objective could, in partnership with follow-up of the biological inflammatory syndrome, lead to decreased use of corticoids in iosinophilic fasciitis. Moreover, supplemental rehabilitation could limit deficiencies and the functional disability resulting from the fasciitis.

Gastric ulcers and Helicobacter heilmannii.

OBJECTIVE: To compare 14 patients with gastric ulcer and Helicobacter heilmannii with other patients with gastric ulcer: age and sex matched patients, patients colonized by Helicobacter pylori and patients on nonsteroidal anti-inflammatory drugs (NSAIDs). SETTING: The endoscopy unit of a university-affiliated hospital. PATIENTS AND METHODS: All patients underwent endoscopy with two antral biopsies and smears from biopsies (touch cytology) in addition to biopsies of ulcers. Most patients had fundic biopsies (n = 10), antral biopsies for culture (n = 7) and/or a urease test (n = 9). Serologic determination of antibodies against H. pylori was obtained in nine patients. RESULTS: Patients with H. heilmannii diagnosed on smears from biopsies (touch cytology) had multiple and antral ulcers in 11 samples, and nodular or irregular lesions in five samples. No patient had a history of peptic ulcer disease. Biopsy revealed mild chronic gastritis in all patients, with features of reactive gastritis in nine. No patient had coexistent infection with H. pylori. Only two of ten patients with follow-up endoscopies had persistent H. heilmannii infection on smear or biopsy. No patient had symptomatic recurrence. Patients with H. pylori infection were older and often had recurrent ulceration. The majority of ulcers associated with NSAIDs occurred in elderly women. CONCLUSIONS: Newly diagnosed gastric ulcers are associated with H. heilmannii infection. Healing is associated with the disappearance of H. heilmannii and the regression of reactive gastritis. Ulcers differ from those associated with H. pylori infection or with the use of NSAIDs, suggesting that H. heilmannii is a possible cause of gastric ulcers.

Touch cytology. A quick, simple, sensitive screening test in the diagnosis of infections of the gastrointestinal mucosa.

To assess the role of touch cytology (imprint from endoscopic biopsy specimens) in the diagnosis of mucosal infections of the gastrointestinal tract, we reviewed all records and specimens of patients seen during a 30-month period. Touch cytology was performed by rolling biopsy specimens on glass slides. After air fixation, a rapid staining method similar to May-Grünwald-Giemsa was used. The following infections and pathogens were diagnosed (in decreasing order of frequency): Helicobacter pylori gastritis (n = 53), Candida albicans esophagitis (n = 40), Giardia lamblia (n = 13), Gastrospirillum hominis (n = 11), and Blastocystis hominis (n = 8). The smear was positive in 45 patients with H pylori, in 35 patients with C albicans, in nine patients with G lamblia, in 11 patients with G hominis, and in eight patients with B hominis. Cytology was the only positive test in eight, nine, four, seven, and eight patients, respectively, and increased thus the diagnostic yield obtained by histologic examination.

Cytologic patterns of reparative processes, true dysplasia and carcinoma of the gastric mucosa.

The cytologic features of dysplasia and carcinoma of the stomach are still poorly defined. In a series of 90 cases, a precise correlation could be made between smears and histologic data. Cytology was sensitive enough to allow characterization of: (1) active repair/regeneration, associated, in a number of cases, with intestinal metaplasia (slight dysplasia); the cellular atypia is minimal; (2) true dysplasia (formerly moderate and severe); this preneoplastic state is characterized by cellular atypia within clusters; and (3) true carcinomas (intestinal or diffuse type); classic criteria for malignancy are present, with a prominent lack of cell cohesiveness, though distinction from dysplasia may be very difficult. The advantages of cytology are the survey of large mucosal areas, investigation of the cardial region, not always accessible to endoscopic biopsy, and exploration of large ulcers. With the adjunct of cytology, the specificity and sensitivity of endoscopy plus histology clearly increase.

[Stomach ulcers and Helicobacter pylori. Clinical, endoscopic and histological characteristics]. / Ulcères gastriques et Helicobacter pylori. Caractéristiques cliniques, endoscopiques et histologiques.

OBJECTIVES: The aim of the study was to determine in a large group of patients with a gastric ulcer the differences between patients, ulcers and gastric mucosa as related to the presence or absence of Helicobacter pylori (H. pylori). METHODS: This prospective study evaluated 150 patients with a benign gastric ulcer. A patient was considered as H. pylori positive on the basis of a positive culture or the presence of gastritis and another positive diagnostic test for H. pylori (urease test, cytology, histology, serology). RESULTS: One hundred and five patients were positive for H. pylori (70%) whereas 45 patients were not infected (30%). There were significant differences regarding the clinical characteristics of patients, the ulcer and the mucosa. H. pylori positive patients differed in terms of past history of ulcer (63 vs 12%), age (57 vs 50 years), sex (48% males vs 24%) and consumption of non steroidal antiinflammatory drugs (39 vs 75%). H. pylori positive ulcers were more often single (79 vs 53%) and located on the small curvature (76 vs 33%). Chronic gastritis was always present in positive patients, with associated intestinal metaplasia (35 vs 2%) and atrophy (45 vs 9%). Negative patients often had a normal gastric mucosa (53%) or reactive gastritis (27%). CONCLUSION: Seventy percent of gastric ulcer are associated with H. pylori infection, corresponding to the classical ulcer. The majority of H. pylori negative ulcers appears to be associated to non steroidal antiinflammatory drugs.

Motor blockade and absence of local nerve toxicity induced by liposomal bupivacaine injected into the brachial plexus of rabbits.

Bupivacaine has been encapsulated into multilameller liposomes in order to reduce its systemic toxicity and to lengthen its action. Low, constant and sustained plasma levels have been observed after epidural injection and brachial plexus administration to rabbits. The present experiment was performed in order to study the motor block effect and the possible neurotoxicity of bupivacaine encapsulated in multilamellar liposomes applied in vivo to intact peripheral nerve bundles. Five milliliters of sterile solutions containing 0.75% bupivacaine encapsulated in 42.5 and 85 mg of lipids (phosphatidylcholine and cholesterol in a molar ratio 4:3) were administered to 4 rabbits at the level of the brachial plexus. A motor blockade of the forelimb lasting for 10 hours was measured immediately after injection of the liposomal drug. Light microscopic analyses of the nerves after 2 and 7 days revealed weak inflammatory perineural infiltration. Electron microscopy showed no changes of the myelin sheaths and no alteration of unmyelinated fibers. It may be concluded that the pharmacologically active liposomal formulation of bupivacaine did not induce alterations of the nerve tissues.

[Repeated perforations of the small intestine in muscular agenesis in a newborn infant. Apropos of a case. Review of literature]. / Perforations itératives du grêle sur agénésie musculaire, chez un nouveau-né. A propos d'un cas. Revue de la littérature.

A rare case of intestinal muscular layers agenesis is described. Ten other cases were founded in the literature and are briefly reported. Association of ischemia and congenital abnormality of the muscular layers is probably the cause of the perforation. Prognosis is very bad: all the children with clinical symptoms (occlusion or perforation) died.

[Hepatic peliose, nodular focal hyperplasia of the liver: a propos two cases (author's transl)]. / Péliose hépatique, hyperplasie nodulaire focale du foie. A propos de 2 observations.

This is a report on the pathology of the liver in two patients under continuous and prolonged oral contraceptives (11 and 8 years): the first had peliose, the other had focal nodular hyperplasia. Present etiopathogenetic theories are reminded: anabolic steroids in peliose and contraceptives in focal nodular hyperplasia. These lesions should be searched systematically in such patients at any laparotomy.

Measurements of cell-mediated cytotoxicity on target cells labelled with the indium-111-oxine complex.

The preparation is given of an 111indium-oxine complex that is non toxic and can label reproductively various types of cells. They retain the label for long periods (24 hours and more). This method gives parallel results for cell-mediated cytotoxicity measurements to Chromium-51 labelling and is found to have wider uses. It can label cells that release 51Cr too fast, makes possible long term measurements of cytotoxicity and accurate counts on small numbers of target cells.

[Cementiform cyst of the sinus. Apropos of a case]. / Kyste cémentiforme du sinus. A propos d'un cas.

An unusual case of cementifying fibroma is presented; a few examples with an extension to the maxillary sinus have been only recorded.

Helicobacter pylori: 200 patients with a follow-up of 5 years. An observation endoscopic study.

OBJECTIVES: As data on the long-term effects of Helicobacter pylori infection are limited, our aim was to review patients seen repeatedly at endoscopy with biopsies for a minimal period of 5 years. METHODS: The records of 200 patients who had at least two endoscopic examinations with antral biopsies and touch cytology (imprints from biopsies) with an interval of at least 60 months between the first and the last endoscopy. Helicobacter pylori diagnosis was based on the smear. RESULTS: At the first endoscopy, 57% had Helicobacter pylori on the smear, 70% had chronic gastritis on biopsy. During a mean follow-up of 70 months, a colonization rate of 3% per year and an eradication rate of 1% per year were observed. Helicobacter pylori status remained unchanged in 89%. During follow-up, duodenal ulcer was diagnosed at endoscopy in 21 patients, with a significantly (p < 0.05) higher frequency in Helicobacter pylori positive patients, in the presence of gastritis and in men. In two patients, the sequence of colonization and later duodenal ulcer was observed. CONCLUSION: Our retrospective observation study based on endoscopy confirms the chronicity of Helicobacter pylori infection and the low incidence of colonization and eradication. Duodenal ulcer occurred more frequently in Helicobacter pylori positive patients.

Gastrospirillum hominis ("Helicobacter heilmanii"): a cause of gastritis, sometimes transient, better diagnosed by touch cytology?

OBJECTIVE: Besides Helicobacter pylori, another spirillar microorganism, provisionally called Gastrospirillum hominis, has been described in the human stomach in association with gastritis. The aim of this study was to assess the role of cytology in the diagnosis, to assess the gastritis associated with this infection, and to approach its natural history. METHODS: Charts and endoscopic biopsies and smears (touch cytology) from 28 patients with G. hominis seen between 1986 and 1992 were reviewed and compared with biopsies and smears from 28 patients with H. pylori gastritis. RESULTS: G. hominis was seen on smears from all 28 patients but diagnosed in only 15 of the corresponding sets of biopsies. No patient had evidence of H. pylori colonization. All patients had chronic antral gastritis with lymphoplasmocytes, and neutrophils were present in 13 patients. In addition, reactive changes were frequent: foveolar hyperplasia (n = 25), vasodilation (n = 23), lamina propria edema (n = 23), and increased intracytoplasmic mucin (n = 19). In contrast, intestinal metaplasia (n = 3) and glandular atrophy (n = 2) were infrequent, and lymphoid nodules were not seen. In patients with H. pylori, reactive changes were mild, and the lymphoplasmocytic infiltration was more intense (p < 0.005). Eleven patients had at least two endoscopic examinations with biopsies, with persistent colonization in only four. Seven patients cleared the infection with a concomitant regression of gastritis. CONCLUSIONS: G. hominis is more often detected in smears than biopsies. It is seen in association with a peculiar form of gastritis-associating chronic and reactive changes. Colonization may be a transient phenomenon and is never associated with H. pylori.

Detection of secondary tumours in patients with renal carcinoma: comparative study of ex vivo ultrasonography and histological examination.

Seventeen kidneys removed from patients with renal carcinoma were submitted to ex vivo ultrasonography and then to serial pathological examination in an attempt to detect secondary tumours in apparently normal tissue. Ex vivo ultrasonography failed to reveal further tumours, but 2 lesions measuring 5 and 8 mm were found on pathological examination. These preliminary data suggest that intra-operative ultrasonography may be of little value in detecting secondary tumours in conservative surgery for renal carcinoma.

[Neuroendocrine tumors of the prostate]. / Les tumeurs neuroendocrines de la prostate.

Neuroendocrine carcinomas of the prostate is rare and usually concern patients with an initial diagnosis of adenocarcinoma of the prostate which become refractory to hormonal treatment. Here is reported the case of a patient who presented with a primary neuroendocrine tumor of the prostate. A review of the literature shows the differences with usual adenocarcinoma and the diagnostic and therapeutic implications.

Helicobacter pylori and gastric cancer. An endoscopic series.

In a series of 92 patients with gastric cancer who had biopsies of the antrum and fundus, we compared the 65 patients with Helicobacter pylori (71%) with the 27 negative patients. No difference was observed for age, gender or histology (intestinal or diffuse). Significant differences concerned location (11% of H. pylori positive patients had a cancer at the cardia or fundus vs 44%), the presence of a normal mucosa (3% vs 30%) and atrophy in the antrum (53% vs 17%). Seven of the ten patients with a normal mucosa had a cancer located at the cardia (p < 0.05) and in nine of the eleven patients younger than fifty, the cancer was of the diffuse type (p < 0.005). Thus, patients with H. pylori and gastric cancer differ from those uninfected. Of future concern is the large increase in cancers of the cardia, a cancer unassociated with H. pylori.