The myorelaxant effect of theophylline on smooth muscle cells of the afferent arterioles and glomerular tuft.

Theophylline, infused i.v. into rats increased the diameter of the glomerular afferent arterioles by 35.78%; when added to a suspension of isolated glomeruli, it increased the diameter of the capillary tuft within the glomerulus by 25-30%. These variations in diameter can be explained by the myorelaxant effect of theophylline on the smooth contractile fibers present in the arteriolar cells and in certain glomerular cells, such as the mesangial cells. These observations explain, in part, the marked changes in glomerular hemodynamics caused by the injection of theophylline.

Direct-to-vial use of the AutoCyte PREP liquid-based preparation for cervical-vaginal specimens in three European laboratories.

OBJECTIVE: To compare the AutoCyte PREP direct-to-vial procedure to the conventional Pap smear in two large and similar patient groups compiled from the testing experience of three cytology laboratories in Switzerland and France. STUDY DESIGN: Randomly selected, large patient groups were evaluated using either the conventional Pap smear or the AutoCyte PREP direct-to-vial liquid-based preparation. Results were then compared statistically as to disease detection and sample adequacy. RESULTS: Specimen adequacy was greatly improved in the group tested with the AutoCyte PREP. PREP also demonstrated a significant reduction in ASCUS and ASCUS:LSIL+ ratios. The three laboratories participating in this review found significantly improved detection of both low and high grade SIL. Routine use of AutoCyte PREP for cervical cytology screening offers substantial improvements in adequacy and disease detection.

[Prognostic factors for survival of ovarian epithelial cancers: apropos of 287 cases]. / Facteurs pronostiques de survie des cancers épithéliaux de l'ovaire: à propos de 287 cas.

OBJECTIVES: To evaluate survival and assess prognostic factors in patients with epithelial ovarian cancer. METHODS: Retrospective analysis of 287 patients treated between 1975 and 1995. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, logrank test and multivariate analysis. RESULTS: The five-year survival rates 76%, 42%, 21% and 6% for patients with stage I, II, III and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality was reduced by 57% for patients whose tumor distribution permitted optimal surgery (RR = 0.43, 95% CI [0.29-0.64]; P < 0.001). The risk of mortality according to FIGO stage was 2.8 (95% CI [1.2-6.3]; P = 0.01) for FIGO II, 5.6 (95% CI [2.9-10.8]; P < 0.001) for FIGO III and 10.5 (95% CI [4.9-22.1]; P < 0.001) for FIGO IV in comparison with FIGO I. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy taxanes or carboplatin plus paclitaxel regimen compared with patients who did not receive treatment was reduced by 47% (95% CI [8%-69%]; P = 0.025), 55% (95% CI [22%-74%]; P = 0.005) and 70% (95% CI [35%-86%]; P = 0.002), respectively. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types (RR = 1.7, 95% CI [1.1-2.8]; P = 0.02). CONCLUSION: Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy, which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.

[Liquid phase cytology in the primary screening for cervical cancer: a multicenter study]. / Cytologie en phase liquide dans le cadre du dépistage primaire du cancer du col utérin: une étude multicentrique.

The aim of this six-centre, split-sample study was to compare ThinPrep fluid-based cytology to the conventional Papanicolaou smear. Six Cytopathology laboratories and 35 Gynaecologists participated. 5428 patients met the inclusion criteria. Each cervical sample was used first to prepare a conventional Pap smear, then the sampling device was rinsed into a PreservCyt vial, and a ThinPrep slide was made. Screening of slide pairs was blinded. On initial screening, 29% more ASCUS and 39% more low-grade squamous intraepithelial lesions (LSIL) and more severe lesions (LSIL+) were detected on the ThinPrep slides than on the conventional smears (p = 0.001). Independent and consensus review confirmed 145 LSIL + diagnoses; of these, 18% more had been detected initially on the ThinPrep slides than on the conventional smears (p = 0.041). The ThinPrep Pap Test is more accurate than the conventional Pap Test and has the potential to optimize the effectiveness of primary cervical cancer screening.

[Endometrial resection for metrorrhagia: 45 cases]. / Endométrectomie pour métrorragies : 45 cas.

Treatment of metrorrhagia has recently been modified because of the use of the hysteroscope which allows two methods to be used: diathermy and endometrial ablation or laser destruction of the endometrium. This retrospective study of ablation of the endometrium was carried out on 45 cases: the patients had excessive bleeding or menorrhagia that had been developing and in an average about 18 months. The mean age of the patients was 48 years with a deviation of 7 years. More than half the women were overweight, a quarter weighing more than 80 kgs with a height of 1 metre 60. A third of the cases had pathology associated with the condition. In 24 cases endometrial resection was carried out by itself but in 21 cases endometrial resection was accompanied with removal of polyps or of submucous myomata. The results were: There was no anaesthetic complication or accident; The operation was complicated only once by perforation of a cornu; Bleeding stopped completely in 94% of cases with an average duration of follow-up of 7 1/2 months; Control hysterosalpingography showed synechiae in 70% of the cases; The histology showed a preponderance of mucosal hyperplasia and of small fibroids. The authors point out: that it is important to learn carefully the operative technique to lessen the risks of complications, but the clinical results compare with the best in the literature but with the price to pay of a high incidence of synechiae. The following questions will have to be answered in the future: What is the risk of cancer after endometrial ablation? Is it possible to avoid synechiae so that the whole cavity of the uterus can be assessed later? What is the role of medical as opposed to surgical treatment in heavy bleeding at the time of the menopause?

[Breast cytology. Its place in the diagnosis of tumors]. / La cytologie mammaire. Sa place dans le diagnostic des lésions tumorales

Our work consists in the review of the experience in our hospital over 9 months and 110 cases in which tumours of the breast were seen. In most of them a clinical study, a radiological study, a thermographic study and a cytological and histological study was carried out. This shows that an examination of the ctyology is a very useful addition to the work-up to be carried out before therapy is started. The difficulty in cytology of the breast lies in the obviously serious problems in interpretation of the appearances, and explains why there are 2.7% of false negatives and 0.9% of false positives. All the same we think that we can find out how to lessen the number of these failures in diagnosis by a better knowledge of the traps to be found in breast cytology. Far from being a substitute for pathological anatomy, cytology is an indispensable complement to the study of the pathology of the breast.

[Behavior of an intra-uterine device in the abdomen of animals (author's transl)]. / Comportement du stérilet intra-abdominal chez l'animal.

The authors have carried out an experimental study on the reaction of an animal's organism to the presence of an open copper intra-uterine device when placed in the abdomen. The study was carried out on two groups each of 10 rabbits and two bitches. The intra-uterine device was placed in the pouch of Douglas by laparotomy, directly in one group and after contamination with genital secretions in the other. The state of the animals was checked six weeks after the initial laparotomy. Trauma caused by the operation was minimal because there were no adhesions found on the parietal peritoneum. On the other hand in experimental conditions that are very similar to those found when an intra-uterine device goes through the uterus in a human subject and involves contamination with genital secretions, in 50 per cent of cases the intra-uterine device migrated within the abdominal cavity. It was picked up by the omentum and this underwent such a strong fibrous reaction that it brought about multiple intestinal adhesions. Though the authors admit that experimental results in animals cannot be extrapolated to women, they believe that these results should be taken into consideration and that it would be imprudent to leave an intra-uterine device in the abdomen in a woman when there is proof that it has migrated, because there would then be a major risk of intestinal obstruction due to an adhesion that as formed a band.

[Gonadoblastoma. Review of the literature. Apropos of a case]. / Le gonadoblastome. Revue de la littérature. A propos d'une observation.

Gonadoblastoma, which was described for the first time by Scully in 1953, is a rare tumour of the gonads. Only about 150 cases have been reported. Anatomo-pathologically it shows itself by a combination of large primitive germinal cells, small cells which resemble the immature cells found in the granulosa and in the Sertoli and sometimes Leydig-theco interstitial cells. Calcification is suggestive. Gonadoblastomas usually develop in a dysgenetic gonad. Pure gonadic dysgenesis is more commonly found. The subjects usually are of feminine phenotype and can demonstrate somatic or sexual abnormalities. The caryotypes most frequently found are 46 XY or 45 XO/46 XY. It is rare for the Y chromosome to be absent. All patients with gonadoblastomas should be HY antigen positive. The tumour is benign but the germinal epithelium can change towards a seminoma type. Because of this it is wise to carry out laparotomy with removal of both adnexae if there is a gonadoblastoma present. The case we have studied illustrates the typical profile of a gonadoblastoma. It occurred in a young woman who had pure gonadic dysgenesis with a caryotype 46 XY (Swyer's syndrome). It was bilateral associated on the left side with a seminoma, and for this reason we carried out bilateral extirpation of the adnexae followed up by therapy with cobalt.

[Swyer syndrome. Apropos of a new case of pure gonadal dysgenesis with Karyotype 46 XY]. / Syndrome de Swyers. A propos d'un nouveau cas de dysgénésie gonadique pure à caryotype 46 XY.

The authors describe a case they have personally seen of pure gonadal dysgenesis with caryotype 46 XY (Swyers' syndrome) in which they found absence of HY antigen. They analysed the descriptions in the literature about this syndrome and show how this antigen is responsible for testicular differentiation. They show the place this syndrome has in the group of syndromes of bands and once again draw attention that there is a great risk of gonadoblastoma development when the Y chromosome is present and especially when the HY antigen is present. This means that these dysgenetic gonads should be removed surgically.

[Langerhans-cell histiocytosis of the vulva. General review and a case history]. / Histiocytose à cellules de Langerhans de la vulve. Revue générale à propos d'une observation.

Localisation of Langerhans' cell histiocytosis (HCL) is rare. In solitary form the prognosis for this pathology is good, if the tumour occurs in a woman of 36 years of age. (In this case the woman's age was 91) The appearances may be misleading clinically. The diagnosis is made by histological examination of P-S 100 positive cells and by finding Birbeck's granules on electron microscopy. Treatment may be surgical or as in our case medical.

[Leydig cell tumor of the ovary (biologic (in vivo and in vitro) and ultrastructural study) (author's transl)]. / Tumeur ovarienne à cellule de Leydig. Etude biologique (in vivo et in vitro) et ultrastructurale.

The authors present the case of a young hirsute woman of 28 years old. Urinary 17 KS were very increased without DHA, but with androsterone, etiocholanolone and 11 oxy 17 Ketosteroids. Androstenedione and testosterone plasmatic levels were very high and per operative selective ovarian vein catheterization showed a direct production of these potent androgens. In vitro study of the tumor allowed to obtain same results. Light and electron microscopic study showed a Leydig cell tumor of left ovary.

[Parapharyngeal tumors: apropos of 14 cases]. / Les tumeurs para-pharyngées, à propos de 14 cas.

The author reports on fourteen parapharyngeal tumours, of which 7 are of parotidean salivary origin. The other etiologies, in particular 1 chemodectoma and 1 aneurysm of the internal carotid artery, justify a systematic arteriography with a CT scan. In surgery, 9 operations were performed via the purely cervical approach, and 5 via a combined cervical and transvelar approach. The endobuccal vault is limited and dangerous.

[Leiomyosarcoma of the larynx: presentation of a case]. / Léiomyosarcome du larynx: présentation d'un cas.

The authors report a new case of laryngeal leiomyosarcoma. The patient was a 43-year-old-man. The tumor extended to the left vocal cord, the paraglottic space and the deep layers of the left false vocal cord. Histologically, the lesion showed the typical pattern of a grade-3 leiomyosarcoma. Immunochemical studies revealed a strong positive staining with the actin smooth muscle antisera. A partial laryngectomy was performed. There was no evidence of recurrent or metastatic disease 10 months after surgery.

[Chondroma and chondrosarcoma of the larynx: apropos of 4 cases]. / Les chondromes et chondrosarcome du larynx: à propos de 4 observations.

Chondroma and laryngeal chondrosarcomas, tumours of variable malignancy, are rare but a source of concern given their location and the surgery involved. Their anatomical limits and classification are still difficult, to the extent that the diagnosis of chondroma is often questioned. Of the four cases reported, two presented a high degree of malignancy, including one with metastasis. Two required a total laryngectomy, and two a partial laryngectomy with a costal cartilage graft in one case.