Takotsubo Cardiomyopathy Following Traumatic Hand Amputation: A Case Report.

INTRODUCTION: Takotsubo or stress cardiomyopathy is a syndrome of transient left ventricular systolic dysfunction seen in the absence of obstructive coronary artery disease. CASE REPORT: We describe a case of stress cardiomyopathy diagnosed in the emergency department (ED) using point-of-care ultrasound associated with traumatic hand amputation. The patient suffered a near-complete amputation of the right hand while using a circular saw, subsequently complicated by brief cardiac arrest with rapid return of spontaneous circulation. Point-of-care ultrasonography in the ED revealed the classic findings of takotsubo cardiomyopathy, including apical ballooning of the left ventricle and hyperkinesis of the basal walls with a severely reduced ejection fraction. After formalization of the amputation and cardiovascular evaluation, the patient was discharged from the hospital in stable condition 10 days later. CONCLUSION: Emergency physicians should be aware of the possibility of stress cardiomyopathy as a cause for acute decompensation, even in isolated extremity trauma.

Ciliated bodies in gynecologic cytopathology: parasite or cellular debris?

Ciliated bodies, similar to the ones described originally by Gaudefroy and Coliche, were discovered in fluid from an ovarian cyst and fluid in the Douglas pouch. These were reproduced experimentally by mucosal scraping of Fallopian tubes. In fact, they were of cellular origin from desquamation of the ciliated apical portion of columnar cells.

[Ovarian cancer in France. Epidemiological, clinical and histological status]. / Le cancer de l'ovaire en France. Bilan épidémiologique, clinique et histologique.

With 2 436 deaths in 1979, ovarian cancer is relatively infrequent in France comprising but 5 per cent of female mortality from malignant disease. However, the rate of increase in mortality is considerable, 70 per cent between 1955 and 1979 or 2,9 per cent per year, greater than that for female bladder and breast cancer. The estimated morbidity and mortality rates (age-adjusted to the world standard population) were 7,5 and 5,4 per 100,000 per annum respectively for 1979, figures in the mid range of international data. This is situated below the rates observed in Scandinavia and North America which occupied the first ranks. The high proportion of metastatic dissemination (55%) at the time of diagnosis and the variety of morphological types (80% being epithelial cancers) emerges from clinical data relating to a series of 2,937 ovarian cancers diagnosed by the "Enquête Permanente Cancer". The 5-year survival rate was 13 per cent with only 50 per cent being alive at the end of the first year. To improve these poor results it is necessary to identify new risk factors in a future French epidemiological study using case control and prospective approaches.

[Cancer of the breast in Cote-d'Or (1982-1987). The Burgundian register of gynecologic diseases]. / Le cancer du sein dans le départment de la Côte-d'Or (1982-1987). Registre bourguignon de pathologie gynécologique.

Burgundian registry of gynaecological pathology, formed in 1982 is involved in the study of epidemiologic and clinical features of breast cancer in the district of Côte-d'Or. One thousand two hundred and twenty nine new cases were recorded from 1982 to 1987. Crude incidence was 82.8/100,000 women. Age standardised incidence, based on world standard population was 63.4/100,000 women. Incidence of breast cancer was higher in urban areas (66.0/100,000 women) than in rural (55.0/100,000 women) areas. In comparison with data of other cancer registries, women from Côte-d'Or are in the high risk group. Histological diagnosis was reported in 97% of cases. The most frequent histologic types were infiltrating duct carcinoma (81.6%) and infiltrating lobular carcinoma (4.4%). Non-invasive carcinoma was present in 4.2% of cases; 4.8% of patients presented metastases at the time of primary diagnosis. Sixty four percent of tumors measured less than 30 mm (on gross specimen). Frequency of axillary nodal involvement was lower than 20% for tumors which measured less than 10 mm but increased up to 40% for larger tumors. From a therapeutic point of view, 91% of patients underwent mammary surgery, 67% underwent radiotherapy and 44% underwent chemotherapy and/or hormonotherapy. Five-year observed actuarial survival rate was 68%, corrected 75% and specific 77%. These results point out the necessity of extensive use of mammography for screening of small breast tumors which have a low risk of nodal involvement.

[Malignant lymphomas in Burgundy, France (1976--1977): a new approach using computerized pathological diagnoses (author's transl)]. / Les lymphomes malins en Bourgogne (1976--1977). Etude de leur fréquence par la méthode informatique anatomopathologique.

Pathology laboratories in the Burgundy region have recently been equipped with mini-computers using the same software and working method. This report brings together their histological records, stored on magnetic discs, and describes the first results of this regional data base. Malignant lymphomas were chosen as a pilot study and evaluated between January 1976 and December 1977. After a brief presentation of the method, 246 cases of malignant lymphoma are analysed: 95 of Hodgkins disease, 103 of non-Hodgkins malignant lymphoma of the nodes and 48 cases of extranodal non-Hodgkins malignant lymphoma. The distribution of patients in terms of sex and ten year age groups is analysed, together with the various incidence rates for a year in Burgundy and in its four administrative units (Cote-d'Or, Nievre, Saone-et-Loire and Yonne).

[Cancer of the prostate. Epidemiologic evaluation, incidence, and trends, especially in France]. / Cancer de la prostate. Bilan épidémiologique, fréquence, tendance, en particulier en France.

With 7,172 deaths in 1982, prostatic cancer is a frequent cancer in France observed among old men, coming just after the lungs cancers and representing 9.6% of male mortality from malignant disease. Its incidence in the French regional population based on departmental registries is about 25/100.000 (age adjusted to the world standard population). The geographical distribution throughout the world shows a high incidence rate among the black american, the Scandinavian countries and low rates in the south-east of Asia. As well as incidence as for mortality low trends of increase all over the world are observed. In the clinical data from the "Enquete Permanente Cancer" (E.P.C.) the high proportion of metastatic dissemination (48%) at initial time of diagnosis, and also the high proportion of epithelial cancer (92%) emerge from a series of 1,223 prostatic cancer registered between 1975 and 1982. The 9 year-survival relative rate (32%) for the whole group lets appear a level of cure observed after the 8 years of follow-up. Few risk factors have been yet recognized so that it is not easy to identify risk population and propose them any preventions.

A complete form of testicular feminisation syndrome; a light and electron microscopy study.

A case is described of testicular feminisation syndrome in a 19-yr-old patient with a normal female appearance. A laparotomy with removal of the gonads was performed. The latter looked like testes with intraparenchymal nodules. Light and electron microscopy study of these nodules revealed the presence of immature seminiferous-like tubules and of Leydig cell clusters. The tubules were filled with clear Sertoli cells, few degenerative dark cells and scanty spermatogonia. Thin collagen bundles surrounded the tubules and the foci of Leydig cells without any crystals of Reinke. The immaturity of all these cellular components could be connected with a mutation at a repressive locus which could be responsible for the abnormalities observed in the different steps of androgen action at target cell level.

Telepathology: a new tool of pathology? Presentation of a French national network.

The field of pathology is constantly growing and the responsibility of the pathologists has progressively increased in the decision of application of some efficient but aggressive therapies. They justify the increasing necessity of discussion between pathologists about the diagnoses of difficult or rare or severe lesions. It is now possible to discuss at distance on good definition digitized images transmitted through I.S.D.N. A French experimental network between 12 workstations has been introduced since 2 years. Difficult or severe diagnoses have been immediately solved in 85% of the discussed cases. It remain legal problems and the necessity of an evaluation protocol which could be discussed at a European level. The increase of technical progress and, above all, the decrease of the costs might favour the development of telepathology. The workstation of the pathologist in the year 2000 could be the combination of a microscope, a HD-TV-camera and a personal computer with many softwares allowing treatment and transmission of numerous pictures.

Distal phalangeal metastasis of a chondrosarcoma presenting initially as bilateral onycholysis.

Onycholysis is the detachment of a nail plate from its distolateral attachments. There are numerous aetiologies: congenital, traumatic, microbial, toxic, dermatological, systemic and benign or malignant tumours. We report a case with onycholysis of the ring-fingers of both hands whose symmetrical and bilateral characteristics temporarily confused the diagnosis.

[Fibroadenoma and phyllode tumors. Cytopathological aspect]. / Fibro-adénomes et tumeurs phyllodes. Approche cytopathologique.

Fibro-adenomas and phyllode tumors of the breast are a classical cause of errors in cyto-diagnosis. On the basis of six personal cases, the authors show that the cytological diagnosis of fibro-adenoma is possible and that there are certain minimal factors which favourise the presence of a phyllode tumour. They emphasize the differential characteristics between fibro-adenomas and carcinomas on the one hand, and between fibro-adenomas and mastitis on the other hand.

[Multiple paragangliomas of the neck localized in the thyroid region. Papillary thyroid cancer associated with parathyroid adenoma]. / Paragangliomes multiples du cou avec localisation thyroïdienne. Cancer papillaire thyroïdien et adénome parathyroïdien associés.

A 58 years-old woman has had a goiter for many years. She was treated by neck irradiation for "lymphadenopathy" 20 years-ago. She is now operated on for bilateral carotid body paragangliomas and a similar tumor of the thyroid gland near the midline. She also presents a papillary carcinoma of the left thyroid lobe with lymph node metastasis and a chief-cell parathyroid adenoma. The diagnosis of thyroid paraganglioma is discussed. Then the authors raise the hypothesis of radiation-induced papillary carcinoma. They try to set a link between thyroid tumors and parathyroid adenoma.

A clinico-pathological and prognostic analysis of non-Hodgkin lymphoma. A study of 203 patients.

In a retrospective analysis of 203 patients with non-Hodgkin lymphoma (NHL) treated between 1975 and 1985, the relationship between pathology, clinical presentation and course, was studied, using the Kiel classification. This classification was a much better predictor of prognosis than clinical stage and within the different pathology groups there was no significant difference between the stages concerning the survival rate. In the group with low grade malignancy this latter was positively associated with nodular architecture, bone marrow involvement and complete or partial response to therapy. In the high grade group, the survival was positively correlated to complete remission, but no plateau was seen in the survival curve. All extranodal sites had poor survival. For both grades, age (greater than 60 years), systemic symptoms and biologic signs (Ann Arbor 'B' and 'b') were unfavorable prognostic factors.

[Neonatal hepatitis with alpha-1-antitrypsin deficit. Apropos of a personal case]. / Hépatite néonatale avec déficit en alpha-1-antitrypsine. A propos d'une observation personnelle

The authors report a case of neonatal hepatitis with alpha-1-antitrypsin occuring in a child of ZZ phenotype. The anatomopathological study carried out on two liver biopsies showed changes of common cholestatic hepatitis developing into cirrhosis, as well as intrahepatocytary globulins. Moreover, these globulins, P.A.S. positive after treatment by alphaamylase, fix an antialpha-1-antitrypsine antiserum. Ultrastructural analysis shows them to be masses of amorphous material, feebly osmiophilic, outlined by a unitary membrane the moniliform aspect of which recalls the ergastoplasmic membrane. These findings are identical to those already made in cases of cirrhogenous neonatal hepatitis by alpha-1-antitrypsine deficit reported in the literature. They point out the irreversibility of the affection which, after a stage of cholestatic hepatitis with or without inflammatory portal fibrosis, develops into cirrhosis. At this stage cholestasis has regressed or disappeared whereas portal sclerosis, often infiltrated with free elements, surrounds hepatic lobules and biliary neocanaliculi. But the globulins are still present and appear to be the specific feature of this deficit. By their ultrastructural and immuno-histochemical features, these globulins would represent a form of accumulation of alpha-1-antitrypsin in the hepatocytes which normally carry out the synthesis of this antienzyme. Accumulation in the hepatocytes proves excretory disturbance of hypothetical mechanism: structural anomaly, changes in the permeability of the membrane. Its role in the occurrence of hepatitis or cirrhosis lesions is still to be demonstrated but one may think that it consists in absence of inhibition of the enzymatic factors discharged during agressions.

[Bilateral breast localization of Kahler's disease: cytological and histological aspects]. / Localisation mammaire bilatérale d'une maladie de Kahler: aspects cytologiques et histologiques.

Breast localisation of multiple myeloma is quite unfrequent. In one case of a 69 years old man, the diagnosis was suspected by a cytological aspiration biopsy of the lesion, and later confirmed by histological and biological investigations. The analysis of the literature has enabled the authors to gather 7 other cases and to describe the characters of this peculiar tumoral localisation. The breast involvement is mostly observed in women. The average is 38 years old. Only 2 cases deal with men, both treated with estrogens. The lesion is usually bilateral and nearly always associated with other visceral and bone localisations. It is not modified by chemiotherapy and appears shortly before death.

[Mucinous adenocarcinomas of the scalp. Anatomo-clinical, histochemical and ultrastructural study of a case and a review of the literature]. / L'adénocarcinome mucineux du cuir chevelu. Etude anatomo-clinique, histochimique et ultra-structurale d'un cas et revue de la littérature.

The third recurrence of a primary mucinous adenocarcinoma of the right parietal scalp was studied by histochemistry and electron microscopy. Histochemically the mucin produced by this neoplasm was of the sialomucine type. Electron microscopy revealed a high differentiated tumour whose cells looked like eccrine mucinous ones. The natural history of this carcinoma is similar to that of 33 ones already published. The tumours, round and elevated, grow in 75 p. 100 of the cases in patients over 50 years of age. They are located on the face or the scalp and more rarely on the trunk. Such tumours are frequently misdiagnosed as carcinomas. But the knowledge of thier morphological and histochemical features should lead to the right diagnosis all the more since the various biological and radiological investigations do not discover other primary neoplasm. Besides if these neoplasms are not metastases they are quite different from the other sweat gland carcinomas. They have a better prognosis than these tumours. However they give local recurrences, lymph node or subcutaneous metastases and a fatal issue in 6 p. 100 of the cases.