Transbronchial needle aspiration in the diagnosis of sarcoidosis.

A total of 258 patients with suspected sarcoidosis underwent transbronchial needle aspiration lymph node biopsies and forceps bronchial biopsies during rigid bronchoscopy. Transbronchial needle aspiration biopsies revealed noncaseating granulomas in 66.3 percent of patients. When transbronchial needle aspiration biopsies were combined with forceps bronchial biopsies, the positive rate increased to 77.7 percent. No major complication occurred when using transbronchial needle aspiration. Rigid bronchoscopy with transbronchial needle aspiration biopsies appears to offer a sensitive and specific alternative to more invasive techniques used in the diagnosis of sarcoidosis.

Bronchial-pulmonary artery fistula after unilateral lung transplantation: a case report.

We report on a right bronchial-pulmonary artery fistula resulting in fatal hemoptysis in a 54-year-old man, 3 months after right unilateral transplantation for end-stage emphysema. The posttransplantation period was complicated by ulcerative tracheobronchial aspergillosis. Early treatment with itraconazole was performed. All samples of bronchial washing, bronchoalveolar lavage, and bronchial and transbronchial biopsy specimens were free of aspergillus after 3 weeks of treatment. Necropsy showed a fistula between the right pulmonary artery and the main right bronchus, situated just beneath the suture line.

Cutaneous leishmaniasis in Niger.

This is the first report of cutaneous leishmaniasis in Niger subsequent to the initial finding in 1911 and the report of a second case in 1943. The clinical, histopathological, and epidemiological features of 64 parasitologically confirmed cases are described. Lesions were mostly multiple, situated on exposed areas of skin, but rarely on the face. Two clinical forms were predominant: ulcero-crusted and humid-ulcerous. Nodular lymphangitis was not uncommon. Patients were mostly from rural areas, but urban transmission did occur. The majority of lesions appeared during the June-October rainy season. All features appeared to be similar to those of this disease in other countries in the sahelian endemic zone.

Mycetoma in the Republic of Niger: clinical features and epidemiology.

Mycetoma is a common disease in the Republic of Niger. In two hospitals 133 cases were observed. The major site of lesions was the foot. Actinomycetomata were seen more often than eumycetomata. Streptomyces somaliensis is prevalent in the north desert zone while Actinomadura pelletieri is common in the southern part of the country. Madurella mycetomatis, the usual etiologic agent of eumycetoma, is seen in both regions. The species incidence and distribution in Niger differs from those of the west and east African endemic areas.

Hepatitis B, C, and D virus infections in patients with chronic hepatitis, cirrhosis, and hepatocellular carcinoma: a comparative study in Niger.

Eighty-nine Sahelian African patients with chronic active hepatitis (CAH) (14), cirrhosis (49), hepatocellular carcinoma (HCC) (26), and 47 controls were tested for hepatitis B virus (HBV, hepatitis B surface antigen [HBsAg]) and hepatitis D virus (HDV, anti-HDV antibody). Seventy-three percent of the patients were positive for HBsAg versus 29.8% of the controls (P < 0.0001). With anti-HDV test, 55.0% of the patients were positive versus 17.0% of the controls (P < 0.0001). To assess the prevalence of antibody to hepatitis C virus (HCV), we used an enzyme-linked immunosorbent assay for screening (anti-HCV2): 19.1% of the patients were positive versus 6.4% of the controls (P < 0.05). An association between HBsAg and anti-HDV-positive test results was found in 46.1% of the patients versus 6.4% of the controls (P < 0.0001). A combination of HBsAg and anti-HCV2-positive test results was found in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Anti-HDV and anti-HCV2 test results were positive in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Triple-positive test results (HBsAg, anti-HDV, and anti-HCV2) were found in 11.2% of the patients but in none of the controls (P < 0.025). Triple-negative test results were found in 14.6% of the patients versus 57.4% of the controls (P < 0.0001). The predominant association of the chronic HBV infection with CAH, cirrhosis, and HCC is confirmed in Sahelian Africa. The HDV superinfection (chronic HBV plus HDV infections) may be a major etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoid of the small intestines with right cardiac involvement. Clinical, phonomechanographical hemodynamic and anatomical study]. / Carcinoïde de l'intestin grêle avec atteinte cardiaque droite. Etude clinique, phonomécanographique, hémodynamique et anatomique

The authors report a case of carcinoid of the small intestine with liver metastases in whom the entire right side of the heart was affected, with severe tricuspid incompetence and pulmonary stenosis. The extent of the fibrosis, which affected all three layers of the heart on the right side has lead the authors to reconsider the various factors which cause the heart failure in carcinoid syndrome. This must now be included in the wider category of APUD. The severity of the tricuspid lesions compared with the derangement of the valvular and subvalvular structures makes an argument in favour of surgical correction.

[Apropos of 1 case of ophthalmologic manifestation of bilharziasis]. / A propos d'un cas de manifestation ophtalmologique de bilharziose.

We present an ocular manifestation of schistosomiasis. We observed the case of a 10 year old young girl living near a flooding canal of the Niger river. She presented a tumor of the left lid associated with an important ptosis. This tumor resulted from numerous polyps of the conjunctiva. The histological analysis of a biopsy of the conjunctiva made the diagnostic. It was confirmed by the analysis of urine and by the important amelioration of inflammation resulting from a specific therapy.

[Gingival lesions in ameloblastoma: value of preoperative biopsy]. / Les lésions gingivales dans l'améloblastome. Intérêt de la biopsie pré-opératoire.

Ameloblastomas are common in Niger. Their main risk is recurrence, which nearly always follows inadequate surgery: these tumors require radical excision followed with mandibular graft. A preoperative diagnosis is therefore indispensable. X-ras are non-specific. In Niger, the danger of osteomyelitis makes surgical biopsies dangerous. The attention is brought to the existence of gum lesions in 8 cases of ameloblastoma in Nigerian patients. Their biopsy may provide the diagnosis in quick and safe conditions.

[Spontaneous dactylolysis or ainhum. Histopathologic study]. / La dactylolyse spontanée ou aïnhum. Etude histopathologique.

Ainhum or dactylolysis spontanea is characterized by the occurrence of a circular constriction located at the root of the 5th toe, rarely of a finger. It deepens, the toe becomes disabled and finally amputation occurs, spontaneously or by surgery. It is a tropical disease of the adult, the origin of which remains obscure. It seems frequent in Niger. 7 cases have been histologically studied. Classical features have been found, including hyperkeratosis, chronic dermatitis, osteoporosis with cortical bone resorption. This study has also revealed in all cases complete ligamental destruction. Moreover, vegetal foreign body granulomas have been found in 4 cases, lying deep in the dermis and in one case in a synovial membrane. Ainhum is compared with pseudo-ainhum seen in genodermatosis, in yaws and in congenital strictures. Among the usually considered etiopathogenetic hypotheses, our findings are in favor of a mechanical and inflammatory origin.

[A new technic for examining breast amputation specimens. Results of 11 cases of Paget's disease of breast]. / Une nouvelle technique d'examen des pièces d'amputation mammaire. Résultats concernant onze cas de maladie de Paget mammaire.

Mammectomy specimens fixed to maintain their anatomical shape may be cut in slices parallel to the thoracic wall. The resulting histologic slides (serially cut or single) always show all the ducts. With a comparatively small number of slides, the galactophoric system may be explored as a whole from the nipple to the surgical section. This technic is especially efficient to establish the extent of the intraductal lesions of the Paget's disease, their relation with the nipple and with a possibly associated invasive cancer. It leads to propose three groups of related lesions, the disease of the nipple being constant: 1 - an infiltrating cancer unrelated to the intraductal cancer. 2 - an infiltrating cancer associated to part of the ducts involved by intraductal cancer, several ducts in a distant part of the breast being involved too by intraductal carcinoma. 3 - intraductal cancer without invasive cancer. These facts and the topography of the intraductal carcinoma are inconsistent with the conception of cells from an invasive cancer reaching the epidermis of the nipple by spreading through the ducts.

[Histopathology of microsurgical arterial repair. Use of fibrin cryoprecipitates]. / Histopathologie de la réparation artérielle microchirurgicale. Apport des cryoprécipités fibrineux.

The increasing practice of small arteries anastomosis especially in neurosurgery entails improvements in suture techniques. Classical suture is slow and needs a prolonged clamping. The stitches are responsible for severe necrotic lesions in the arterial wall. A biological glue made of cryoprecipitated human fibrinogen, factor XIII and fibronectin, locally activated by thrombin, is tested here on rabbit's common carotid. The application of the glue on intact or sectioned arteries appears innocuous, notably with regard to its thrombogenic potential. Comparison of classical sutures and sutures with glue and a greatly reduced number of stitches shows histological results of equivalent quality. At the early stages, the fibrin glue doesn't exceed in volume the usual perianastomotic hematoma. It is completely resorbed within two weeks. Later the scar is thinner than after classical suture, although no ruptures or aneurysms were observed. This method shortens the surgical procedure, with presumed benefit for the drained territories. It diminishes the lesions caused by the stitches. Moreover it allows an easy application of an arterial patch on the sectioned vessel: a comparative series with sutured patches shows on the contrary poor results. Although aggresive for the tissues, a minimal number of stitches remains necessary: it is actually the only available means of correctly positioning the anastomosis area.

[Development of 62 typical carcinoid tumor of the bronchi surgically treated. Prognostic value of histopathological features]. / Evolution de soixante-deux tumeurs carcinoïdes typiques des bronches opérées. Valeur pronostique des caractères histopathologiques.

The pathological and clinical features of 62 carcinoid tumours of the bronchus operated between 1975 and 1987 were reviewed in order to determine the prognostic value of certain parameters: limit of proliferation, vascular invasion, lymph node involvement. This series corresponded to 36 central tumours and 25 peripheral tumours, all treated surgically. One patient was lost to follow-up, 3 developed recurrences, 56 are still alive without recurrence and 3 died from intercurrent causes. The histological appearance of the tumours was homogeneous and typical. Twenty-eight lesions were strictly intrabronchial, 34 invaded the lung with incomplete limits in twenty cases. The tumour showed signs of vascular invasion in ten cases and the adjacent lymph nodes were invaded in eight cases. The local recurrence was undoubtedly related to an excessively conservative primary resection, as the primary tumour did not demonstrate any unusual features. The two tumours which metastasized showed vascular invasion: one metastasized to a hilar node, but these features were observed in other cases which retained a benign course. The standard histological diagnosis of typical carcinoid tumour does not appear to raise any particular difficulties; it is reliable. The course of the disease is sometimes malignant but no histological parameter is able to accurately predict this outcome.

[Non-aplastic N2 operated bronchial cancers. Multifactorial analysis of the prognosis]. / Cancers bronchiques non anaplasiques, N2, opérés. Evaluation multifactorielle du pronostic.

The marked disparity of the published 5-year survival rates (0 to 3%) for non-anaplastic, operated N2 lung cancers would suggest the marked heterogeneity of the patients studied. We prospectively studies 97 N2 tumours for which "curative" resection was performed between 1983 and 1986. The overall survival rate was 28% at 3 years, 19% at 4 years and 12% at 5 years. Survival was studied on the basis of several parameters concerning the tumour: histological type and degree of differentiation, T (TNM), modality of invasion (circumscribed, infiltrating), the quality of the stroma (absent, fibrotic, cellular), the mitotic index, the necrosis rate, presence or absence of microscopic invasion of blood vessels; and concerning the nodes: site, number (solitary, multiple), size of the metastasis (massive, microscopic), macroscopic or microscopic invasion of the capsule. We know the outcome for all of our patients: 81 have died and 16 are still alive. Sixty-one have developed metastases, 5 have developed local and regional recurrences and 3 have both a recurrence and metastases. Univariate analysis demonstrated that a small number of parameters significantly influence survival: microscopic invasion of blood vessel (chi 2 = 5.24, p less than 0.02), macroscopic and microscopic invasion of the lymph node capsule. In order to more clearly define the prognostic factors, we used Cox's multidimensional model. This model was applied to the three significant parameters to which we added two other variables which non-significantly tended to be related to survival: tumour necrosis and number of lymph nodes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pleural and mediastinal metastases from a malignant mesothelioma of testicular vaginalis membrane]. / Métastases pleurales et médiastinales d'un mésothéliome malin de la membrane vaginale testiculaire.

The authors describe an original observation of secondary intrathoracic metastases due to a malignant adenomatoid tumour or mesothelioma of the testicular tunica vaginalis. The hypothesis of a primary pleural mesothelioma could be excluded here as could secondary pleural deposits from another neoplasm. The exceptionally malign potentialities of this common tumour of the testicular adnexae were reviewed as well as the extremely poor prognosis.

[Sweat gland tumors in Niger. Anatomopathology]. / Tumeurs sudorales au Niger. Etude anatomo-pathologique.

The authors report 15 cases of sweat gland tumour observed over 2 years in Niger where their pathology was never studied. These tumours accounted for 0.38 p. 100 of all examinations performed during the same period at the pathological laboratory of the University of Niamey. They ranked sixth among the diagnoses of skin pathology. Only routine histological techniques were used. The diagnoses obtained could be divided into 5 groups. Eight women presented with partly solid cystic tumours located on the legs in 5 cases; their structure was typical of nodular hidradenoma. Two male patients had cyst-pitted tumours the superficial portion of which showed a structure of papillary eccrine adenoma, while the deep portion contained a multitude of cysts with atrophic walls; the authors consider this type of tumour as a variant of papillary eccrine adenoma. One patient had a syringocystadenoma which also included a large cyst. Finally, one patient presented with a chondroid syringoma in the axillary region, and 3 patients had histologically aggressive carcinomas located on the sole, forehead and axillary region respectively. Clinical and paraclinical investigations failed to detect any deep malignancy in these three patients, and their tumours were regarded as compatible with sweat gland carcinomas. In this series, two lesions were unusually numerous: carcinomas and nodular hydradenomas. The first named probably are a consequence of the socio-economic conditions prevailing in the population of Niger: poverty prevents patients from consulting for diseases which produce no symptoms, which artificially increases the apparent incidence of aggressive lesions. As for nodular hydradenomas, they are large owing to the presence of cysts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Occlusion of the pancreatic ducts with "Ethibloc" injections. Experimental study in the dog]. / Occlusion des canaux pancréatiques par injection d' "Ethibloc". Résultats d'une étude expérimentale chez le chien.

"Ethibloc" is a zeine-alcohol suspension which polymerizes in an aqueous medium after approximately 15 minutes. The product was injected in the pancreatic duct of 20 dogs. The procedure was free from complications, apart from the development of edematous pancreatitis without clinical manifestations. Healthy pancreases were transformed into fibrous organs within ten days or so, as is found in advanced stages of chronic pancreatitis. No effect occurred on the islets of Langerhans and a diabetes of the experimental type did'nt develop. "Ethibloc" would therefore appear to be of value in humans for the treatment of chronic pancreatitis, in order to reduce the period for transformation of the lesions without increasing the incidence of complications, and also for pancreatic fistulae of various origins, as a result of the rapid sclerosis of exocrine tissue that it provokes.

[Thymoma. Analysis of a series of 42 cases]. / Les thymomes. Analyse d'une série de 42 cas.

The authors have treated 42 patients with thymoma and report on their experience. The mode of discovery, and notably the thymoma-myasthenia association in 8 cases (20%), the diagnostic approach and the management of the disease--surgery alone : 18 cases, surgery combined with radiotherapy : 24 cases and/or with chemotherapy : 5 cases--were analyzed. The thymomas were classified according to the G.E.T.T. system after re-examination of the histological sections. The course of the disease was studied. The overall survival rate, which depends on tumoral stage, was 71% at 4 years and 69% at 10 years; 5 patients died of the disease and 9 of other causes, including 5 who presented with a blood disease. This series is compared with other published series. The frequency of myasthenia and the respective prognostic values of anatomico-surgical, histological and histo-immunological classifications are discussed.

[Uninodular bronchiolo-alveolar cancer. Apropos of 5 cases with a prolonged course]. / Les cancers bronchiolo-alvéolaires uninodulaires. A propos de 5 cas d'évolution prolongée.

Five cases of uninodular bronchioloalveolar cell (BAC) carcinoma are reported. These 5 cases were characterized by the protracted course of the disease: 14.5 and 11.5 years respectively in the 2 patients who died; 7.5, 12 and 12.5 years respectively in the 3 patients who are still alive. Prior to being diagnosed at excision, the tumours had been followed up for an unusual 2 to 10 years period, with phases of radiological stability and phases of very slow growth. This very slow course is exceptional in lung cancer. It differs not only from the course of diffuse BAC carcinoma, but also from the habitual course of uninodular BAC carcinoma and from that of peripheral adenocarcinoma. Similar cases could be found in the literature, and a comparative study has been conducted between these slow-course carcinomas and normal-course carcinomas. Whatever their outcome, slow-course carcinomas are asymptomatic tumours which present at radiography of the chest as a peripheral round or oval opacity devoid of pathognomonic features. The post-operative prognosis of slow-course tumours seems to be more favourable than that of the other lung cancers. At histology, carcinomas with a protracted course usually show a pattern similar to that of lesions called by some authors "benign adenomatosis"; however, some of these tumours exhibit fairly distinct signs of malignancy, and electron microscopic images also are far from being uniform.

[Cylindrical cancer of the lung. Analysis of a series of 191 cases]. / Les cancers cylindriques du poumon. Analyse d'une série de 191 cas.

The authors analyse 191 cases of cylindrical carcinoma of the lung. Study of the clinical and radiological characteristics, as well as the course, revealed the following: the reduced male predominance of this type of lesion, the often distal site and the primary pulmonary nature. The prognosis is identical to that for squamous forms: 31% survivors at 5 years.