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Erdheim-Chester disease is an endogenous, non-genetically-determined lipidosis characterized by infiltrates of foamy, lipid-laden histiocytes and by bilateral symmetric foci of sclerosis in appendicular long bones. The clinical spectrum ranges from focal bone lesions to systemic disease with life-threatening visceral involvement. In one third of patients, roentgenograms show focal osteolysis within areas of sclerosis. Authors report a new case of Erdheim-Chester disease documented by two bone biopsies in different sites. Features in their patient included: 1) osteolysis and sclerosis of the long bones of the limbs and maxillas, with CT scan evidence of cortical rupture; 2) on magnetic resonance imaging studies, heterogeneous foci of decreased signal intensity on T1 images and heterogeneous areas of moderately increased signal intensity on T2-weighted images; 3) increased serum osteocalcin levels; 4) laboratory evidence of chronic inflammation with no extraosseous manifestations. The clinical, radiological, and pathological features of Erdheim-Chester disease are different from those of Langerhans cell histiocytosis. However, three cases of patients with both conditions have been reported in the literature, suggesting that there may be links between the two diseases.

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Mexiletine was recently shown to antagonize the effects of sotalol on repolarization of canine Purkinje fibers. The significance of this interaction for the antiarrhythmic properties of these drugs remains unknown. The antiarrhythmic effects of sotalol and mexiletine alone and in combination on induced ventricular tachycardias (VTs) were assessed in 20 conscious dogs with chronic infarction. Electrophysiological measurements and programmed stimulation were performed before and after the infusion of sotalol (4 mg/kg) or mexiletine (4 mg/kg), and after infusion of the combination. The electrophysiological parameters didn't change after mexiletine. Sotalol alone and the combination both similarly prolonged the QT interval and VERP. Induction of VT by programmed stimulation was not prevented by mexiletine, but the cycle length of monomorphic VT was increased in 7 of 10 dogs. The induction of VT was prevented by sotalol (11/16 dogs), but VTs were not slowed significantly. Sotalol plus mexiletine prevented VT as did sotalol alone (11/16 dogs). The combination also increased the cycle length of VT in all eight dogs with monomorphic VT. Thus, the antagonism shown in vitro appears to have no consequences in this model. On the contrary, the sotalol-mexiletine combination showed some additive antiarrhythmic effects on induced VT in dogs.

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The authors describe a case of cutaneous and lymph node granulomas first reported as sarcoidosis. As skin sarcoidlike reactions disappeared, the development of typical histologic and immunopathologic features of cutaneous mycosis fungoides suggested granulomatous mycosis fungoides. This case illustrates the difficulties in differentiating true systemic sarcoidosis associated with mycosis fungoides from sarcoidlike reactions when extensive granulomas obscure the underlying cutaneous lymphoma. This report emphasizes the utility of immunohistochemical analysis to identify the early cutaneous T-lymphomatous infiltrate, initially admixed with epithelioid and giant cell granulomas. This technique also made it possible to characterize a Ki-1-positive anaplastic large-cell lymphoma when the transformation of mycosis fungoides into highly malignant lymphoma occurred in the lymph node.

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Bone lesions of sarcoidosis occur in 10 to 15% of the cases, most often involving the extremities. These frequently corticosteroid-dependent lesions worsen the prognosis of the disease. We report a case of sarcoidosis of 14 years duration in a 58-year old woman who presented with a bone lesion strictly localized to the calcaneum. To our knowledge, such lesion has not previously been reported.

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A 69-year-old woman with a 25-year history of recurrent sciatica presented with an expanding lytic lesion of the right side of the first sacral vertebra. Histological examination proved the lesion to be a DF. DF is usually diagnosed in young patients and is very rarely located in the spine and sacrum. The growth rate of the tumor was presumed to be very low because it had not progressed from radiological studies performed 9 years previously. The clinical, radiological, and pathological features of DF are described, and the differential diagnoses are discussed. The most difficult problem is to distinguish DF from a low-grade fibrosarcoma or chordoma.

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In order to compare conventional microvascular suture anastomoses with CO2 laser-assisted anastomoses, 240 anastomoses were performed in Wistar albino rats. Average time required for anastomosis was 8.30 minutes in the laser group and 14.30 minutes using the conventional technique. Patency rate was the same in both groups for arterial anastomosis but in femoral veinous anastomoses, the patency rate was of 89% using laser and 75% when done by hand. Secondary vein thromboses amounted respectively to 2% with laser and 18% with conventional sutures. Scanning electron microscope examination revealed a better endothelialization in the laser group. T.E.M. examination showed an important inflammatory reaction around the threads in the conventional suture group, even at the end of the first month. In the laser group, a partial and transient necrosis of the media appeared between the second and fourth day. Laser assisted microvascular anastomosis seems to be a promising technique with potential clinical applications.

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108 cases of Ewing's Sarcoma are collected at the "Curie Institute" and studied by the authors using the modern Technics of electron microscopy, cytochemistry, immunohistochemistry and cytogenetics. They raise the histogenesis and etiological factors not entirely resolved yet at the light of literature review.

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This experiment investigates CO2-laser-induced histological effects on fallopian tubes obtained during hysterectomies in women. Tubal transversal sections were performed at isthmic and ampullar sites. Forty strips were available for histological study of the cut section area. The role of different parameters such as radiation power and beam fractionation (continuous versus pulsed) on tissue lesions was assessed. In tubal microsurgery, the CO2 laser can be used as a scalpel with the predominant advantage of minimal tissular alterations. As a result of this study, our recommended parameters are the following: radiation power, 7-10 W; beam focalization zone, 0.2 mm; energy density, 20,000-35,000 W/cm2; continuous operation; moving speed, 1 cm/s.

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The authors describe their experience in the use of CO2 laser in microsurgical treatment of tubal sterility. An experimental study was carried out on Fallopian tubes in order to define the parameters for the use of CO2 laser in tubal surgery. Certain microsurgical techniques were altered when CO2 laser was used. The procedures were improved by the ease of surgery and the speed with which it could be carried out. Our clinical experience was on 153 patients who were operated on. In 66 laparotomies the combined use of microscope and CO2 laser seemed to improve the handling of tubal sterility.

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It is about an unique case of an intra-articular osteoid osteoma, located in the back of the acetabulum in a 14 years old girl. Synovitis made clinical and radiological appearances very suggestive of an arthritis. Diagnosis was recalled in the view of biological negativity, the notion of nocturnal pains, reduced by aspirin, and especially radiological features with densification of the back of the acetabulum. Scintigraphy revealed hyperfixation located in the back of the acetabulum and scanner showed a picture, in the same place, buldging towards the joint, suggestive of the osteoid osteoma. The operation, made by anterior approach with anterior dislocation of the hip, allowed the "in bloc" resection of an osseus piece whose immediate radiographic examination confirmed that the whole osteoma was removed. A synovial biopsy was also performed. The pathologist confirmed the diagnosis and showed a reactional synovitis within the soft tissues. Pain disappeared as soon as the waking up. This case report is interesting because: this localization is very exceptional, the reactional synovitis was evocating of an arthritis, the iconography is absolutely complete, a review of publications is done for this subject.

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A case of extraskeletal mesenchymal chondrosarcoma in a 62-year-old woman is reported. This unusual sarcoma was localized in the right thigh (quadriceps) and treated with a combination of surgery, chemotherapy and radiotherapy. Sixty-three cases were found in the literature, with neurologic localization in 29 cases and muscular localization in 34 cases. Among clinical features, a significant difference in age at the time of diagnosis was found between the two localizations, which strongly suggests the possibility of two different types of extraskeletal mesenchymal chondrosarcoma.

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A 76 year old man, presenting with symptoms of general malaise alone, had a marrow biopsy which showed and undifferentiated carcinoma. A subsequent autopsy revealed a multi-nodular pleural mesothelioma, which was not seen radiologically, presumably because of the small size of the nodule. There were bilateral adrenal metastases and diffuse bony metastases involving the marrow. An occupational contact with asbestos was retrospectively confirmed. It is rare that a pleural mesothelioma does not exhibit thoracic signs and very uncommon that bony metastases should give the diagnosis in such a tumour.

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Glycoregulation and insulin secretion abnormalities and micro-angiopathy were systematically investigated in 46 patients (6 men and 40 women; mean age 34.8) seeking medical attention for obesity. In all patients, a three-hour oral glucose tolerance test (OGTT) with 50 g glucose, with concomitant plasma insulin determinations, Hb A1c assay and skin biopsy (SB) at the medial aspect of the arm (optic microscopy study, PAS stain) were performed. We obtained 46 Hb A1c assays, 45 OGTT, 43 insulin determinations and 42 SB. In 40 patients, all four studies were available. We consider as abnormal blood glucose greater than 7.8 mmol at 120 mn with intermediate measurement greater than 10.1, insulin greater than 64 mcU with a maximum delayed after the 60th mn, Hb A1c greater than 6.3% and SB score greater than 10 (evaluating basement membrane thickness, endothelium swelling, aspect of pericytes, perivascular infiltration and percentage of capillaries involved). We observed 6 abnormal OGTT, 12 dysinsulinisms (DI), 5 Hb A1c greater than 6.3% and 17 SB greater than or equal to 10 with typical diabetic microangiopathy. Out of 40 fully investigated patients, 14 were normal for all criteria, 12 had only one abnormality (12 SB, 5 DI, 1 OGTT), 6 had 2 abnormalities (2 SB + DI, OGTT + DI, SB + OGTT, SB + Hb A1c, DI + Hb A1c) and 2 had 3 abnormalities (SB + DI + Hb A1c, OGTT + DI + Hb A1c).(ABSTRACT TRUNCATED AT 250 WORDS)

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The concept of atherosclerosis is essentially applicable to the arteries of the elastic type. Lesions in the arteries of the muscular type have a different character. They show an association of fibrosis of the media with a diffuse intimal thickening and the presence of stratified fibro-hyaline plaques, representing organized parietal thrombi. Deposition of lipids is weak or moderate and apparently a secondary event. Intimal thickening of peripheral arteries exceeds largely the limits of the thrombotic zone. It is covered by normal endothelium and populated by myocytes with a few fibroblasts. The intercellular substance shows all stages of formation of elastic structures, a process which is probably related to the activity of myocytes. It leads to the formation of one or several fairly distinct elastic membranes. Concomitantly the lamina elastica interna undergoes considerable degradation. We are, thus, confronted with a lesion of considerable age which, nevertheless, remains active and shows continuing structural changes. The origin of cells in intimal thickening and its significance in terms of general pathology are discussed with respect to the experimental results.

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