[Pleural mesothelioma: morphology, histochemistry, difficulties in diagnosis and nosologic problems (author's transl)]

Using the material of the French Register, these authors define the epithelial aspects and the histological forms of diffuse pleural mesothelioma. Histochemistry studies, on pleural cytology and on tissues, are of the utmost importance in distinguishing mestothelioma from carcinoma. Hyaluronic acid is almost always showed in the epithelial mesothelioma, being otherwise only noticed in some very flourishing forms of mesothelial cell hyperplasia nad in rare mucus-secreting carcinoma. Cytoenzymology studies are very useful on pleural fluid material, making it possible to show the difference between macrophages and mesothelial cells. Difficulties encountered by pathologists are analysed with reference to the materials examined: cytology, needle biopsy, guided biopsies, surgical material and documents from autopsies. After a critical study of the structures seen in other pleural tumors mesothelioma is defined as a localized or diffuse tumor of the pleura, positively originating from mesothelial cells which manifest either epithelial structures of a double epithelial and mesenchymal composition.

[Digestive symptoms of scleroderma (author's transl)]

The authors successively study the oral, peri-oral, esophageal, intestinal and anal manifestations of systemic scleroderma. They point out that dental, salivary, and esophageal involvement is of great interest for diagnosis and prognosis. They particularly describe the malabsorption syndrome including anatomical and ultrastructural lesions of the smooth muscle fibers. They present an original study of arrector pili in clinically and histologically non-involved skin of patients undergoing scleroderma. Finally they state that any suspected or diagnosed scleroderma needs a digestive check-up as follows: radiologic examination of the teeth, biopsy of the minor salivary glands of the lower lip, radiologic study of esophageal motility and radioactive C 14 glycocholate test.

[Desquamative interstitial pneumonia. Clinical, optic, ultrastructural, histo-immunoligical and enzymatic study of a case]

The desquamative intersitial pneumonia is a rare, sometimes curable from of diffuse interstitial fibrosis. A clinical, optical and ultrastructural, immunochemical and histo-enzymologic study of one case proved the macrophage nature of the intra-alveolar cells and suggested in the histo-genesis an immunological mechanism depending on lymphocytes.

[Mortality due to tuberculosis. Statistical concepts]

The mortality statistics due to tuberculosis drawn up by INSERM for the years 1968-1973 show the rate to be 0.86% in the Paris region. A study based on autopsy results of 7,400 adults gave a rate of 3.3%. The causes of this discrepancy are analysed.

[Diaphyseal bone tuberculosis]

The authors report a case of diaphyseal bony tuberculosis, in which the diagnosis was not made for a long time as bony tuberculosis is considered exceptional and owing to the presence of a staphylococcus which oriented the diagnosis towards osteomyelitis. Bony tuberculosis certainly affects more easily immigrant patients, in whom one may see multifocal forms, but also affects those who, by their environment, might imagine they are protected, and it is not exceptional to see unifocal forms.

[Fulminating refractory hypoxemia. Apropos of 3 cases including 1 case of tuberculosis]

The authors report 3 cases of refractory fulminant hypoxemia. The etiology was various, neoplastic lymphangitis, influenza and tuberculosis. The authors emphasize the role of tuberculosis in the onset of certain diffuse interstitial fibroses.

[The necropsy, contribution to the knowledge of the undesirable effects of medications and toxic agents]

All the examples quoted demonstrate that in the field of toxicology, pathologic anatomy still offers the means of establishing the first links between macroscopic and microscopic lestions and physiology. The current trend in this disciplin is to look beyond the clinical symptom or morphologic disturbance and seek the causal biochemical interactions. Through the methods of systematic autopsy and electron microscopy of biopsy specimens, pathologic anatomy continues to provide the alarm signal for the pharmacologic warning system our modern environment demands.

[Results of concentrated irridiation in glioblastomas, astrocytomas and brain tumours of the adult (author's transl)]

Concentrated irradiation (two series of 1,800 rads in 2 sessions and 3 days) separated by a rest period of 3 to 4 weeks has been used to treat 214 adult patients with brain tumors between 1965 and 1972. These included 108 glioblastomas, 18 astrocytomas and 88 brain metastases from different origins. Early side effects are moderate or inexistent provided synthetic ACTH or corticoid steroids have been given several days before irradiation. Survival is related, at least, in the first 2 groups of primary tumor to local failure. For brain metastases, death could be related to others reasons. In spite of the fact that comparison is made with a previous series of 121 cases it seems that this type of irradiation gives the same survival rates. Moreover it has specific advantages as reducing duration of hospitalization and the number of treatment sessions.

External radiotherapy and radioiodine in the treatment of 359 thyroid cancers

Between 1943 and 1965, 359 patients with carcinoma of the thyroid were treated by external radiotherapy or radioiodine out of a total number of 560 patients treated during the same period. In 65 of these patients surgery had been satisfactory from a macroscopic point of view. Prophylactic post-operative irradiation was given to 55 and the survival rate was 91 per cent at five years and 85 per cent at ten years. Ten received radioiodine, eight were alive at five years and six at ten years. In 95 patients excision of the tumour had been macroscopically incomplete. Fifty-four were treated by external radiotherapy and the survival rates were 50 per cent at five years and 48 per cent at ten years. For the differentiated carcinoma of this group 68 per cent were surviving at five years and 58 per cent at ten years. Of 41 patients treated with radioiodine, 75 per cent were surviving at five years and 31 per cent at ten years. Eighty-five patients were inoperable. Sixty were treated by external radiotherapy, the survival rates were 17 per cent at five years and 8.5 per cent at ten years. For the differentiated carcinomas of this group the survival rates were 24 per cent and 18 per cent. Twenty-five were treated with radioiodine, 26 per cent were surviving at five years and 4.5 per cent at ten years. The patients treated by external radiotherapy can be divided into two subgroups according to the technique of treatment and dose used. Between 1943 and 1955, patients were treated with conventional X rays (mean applied dose 2,800 rads), between 1956 and 1965 the patients were treated with 60Co (mean applied dose 5,000 rads). For the 45 patients of the first group, the survival rates were 35 per cent at five years and 32 per cent at ten years. For the 124 of the second group the respective survival rates were significantly higher: 60.6 per cent and 53 per cent. The results of external radiotherapy were similar to those of radioiodine at five years and better at ten years. In conclusion, a dose of 5,000 to 6,000 rads delivered by megavoltage external radiotherapy in five to six weeks, is well tolerated and effective mostly in differentiated carcinomas and medullary carcinomas. The survival rates of 64 patients whose metastases were unable to pick up iodine is practically zero at five years. For 68 patients with uptake in their metastases the survival rates were 53 per cent at five years and 23 per cent at ten years. The survival rate in patients with pulmonary metastases was higher than in patients with bony metastases (75 per cent versus 44 per cent at five years and 42 per cent versus 8 per cent at ten years.

[Ultrastructural study of the arrector muscle in the patient with scleroderma. Preliminary analysis apropos of 3 cases]

An electron microscope study of the arrector pili muscle, using biopsies obtained from clinically and histologically healthy skin in 3 cases of scleroderma, showed the primary origin of the muscle disorders. They showed a certain number of changes, both of the differentiated cytoplasm and of the common cytoplasm.

[Arrector muscle in patients with scleroderma. Histological and histo-enzymological study]

In a previous paper, we have found, at post-mortem examination of three cases of scleroderma, the oesophageal smooth muscle alterations already predicted by physiologists and reported by Treacy. These lesions mostly consist of a loss of the staining properties of the differenciated cytoplasm of the muscle cell, preceding any appearance of interstitial fibrosis. We have already reported these muscle lesions at all other levels of the digestive tract (stomach, small and large bowels), and also in the bladder muscle. In the present study, we have attempted to precise these notions in biopsies and have studied the arrector pili muscles in normal skin of 13 sclerodermic patients by means of histochemical (Regaud, Mallory, etc. ...) and enzyme stains. In all cases, we have been able to identify morphological alterations of the muscle fiber, mostly consisting in an irregular pattern of enzyme properties, especially when diaphorases, dehydrogenases and ATP ases were concerned. This work seems to confirm that the primary site of the sclerodermal lesions is situated in the smooth muscle fiber.