Bacillus Calmette Guérin (BCG) is an attenuated strain of Mycobacterium bovis that is currently used as a live vaccine for human tuberculosis. Disseminated BCG infection may rarely occur following vaccination of children. In half of the cases, regarded as idiopathic, no well‐defined immunodeficiency condition can account for the infection. However, the high rates of parental consanguinity and familial forms and the associated opportunistic infections with Salmonella suggest that these idiopathic BCG infections result from one or several new type(s) of inherited immune disorder(s). As an approach to the description and understanding of this newly described condition, the associated lesions were examined. Samples from 14 patients collected from a French national retrospective study were analysed. Pathological data from 22 cases reported in the world literature were also reviewed. Two types of granuloma were found. The first type (type I, tuberculoid) consisted of well‐circumscribed and well‐differentiated granulomas, with epithelioid and multinucleated giant cells containing very few acid‐fast rods, surrounded by lymphocytes and fibrosis and occasionally with central caseous necrosis. The second type (type II, lepromatous‐like) consisted of ill‐defined and poorly differentiated granulomas, with few if any giant cells and lymphocytes but widespread macrophages loaded with acid‐fast bacilli. Most children displayed a single type of granuloma. One half displayed type I lesions and the other half displayed type II lesions. There was a strong correlation between the type of granuloma and the clinical outcome. Tuberculoid lesions were associated with survival, whilst lepromatous‐like lesions correlated with death. Correlation of granuloma structure with clinical outcome defines two types of idiopathic disseminated BCG infection. The phenotypic heterogeneity of the course of BCG infection reflects distinct pathogenic mechanisms and probably results from a genotypic heterogeneity of the underlying inherited immune disorder. © 1997 by John Wiley & Sons, Ltd.

The aim of this study was to provide a comprehensive description of both penile innervation and vascularisation. Eighty-five male cadavers were examined through gross and microscopic anatomical analysis. The pelvic nerve plexus had both parasympathetic and sympathetic roots. It was distributed to the external urethral sphincter giving rise to cavernous nerves which anastomosed in 70 % of the cases with the pudendal nerve in the penile root. Accessory pudendal arteries were present in the pelvis in 70 % of the cases, anastomosing in 70 % of the cases with the cavernous arteries that originated from the pudendal arteries. Transalbugineal anastomoses were always seen between the cavernous artery and the spongiosal arterial network. There were 2 venous pathways, 1 in the pelvis and 1 in the perineum with a common origin from the deep dorsal penile vein. It is concluded that there are 2 neurovascular pathways destined for the penis that are topographically distinct. One is located in the pelvis and the other in the perineum. We were unable to determine the functional balance between these 2 anastomosing pathways but experimental data have shown that they are both involved in penile erection. These 2 neurovascular pathways, above and below the levator ani, together with their anastomoses, form a neurovascular loop around the levator ani.Key words : Penis ; vasculature ; pudendal artery ; pelvic plexus. The location of the penis at the junction of 2 anatomically distinct regions, i.e. the pelvis and the perineum, separated by the levator ani muscles, suggests that both supra and infralevator neurovascular pedicles are destined for the penis. According to classical anatomical data, the pathway for the neural proerectile fibres is represented by the cavernous nerves, the antierectile fibres arising from the lumbosacral sympathetic chain and travelling in the pudendal nerve (Giuliano et al. 1995) with somatic fibres. Arteries to the penis originate from the internal pudendal arteries and the venous drainage travels via the deep dorsal vein to the periprostatic venous plexus. Recent anatomical studies have suggested a more complex organisation of these structures, describing nervous connections in the penile ' hilum ' and accessory pudendal arteries Narayan et al. 1995).Correspondence to Professor G. Benoit, Service d'Urologie Centre, Hospitalo-Universitaire de Bice# tre, Avenue du Ge! ne! ral Leclerc 94275, le Kremlin Bice# tre Cedex, France.We reviewed the results of 4 anatomical studies performed from 1987 to 1997 in our institution to provide a comprehensive overview of the neurovascular structures destined for the penis. We sought to provide evidence for 2 different neurovascular pathways, their origin in the internal iliac vessels, the sacral anterior roots, and the lumbosacral sympathetic chain, their termination in the penis and the existence of a loop surrounding the levator ani muscles.    SpecimensEighty-five fresh unfixed human male cadavers aged 48-90 y were studied. Caus...

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Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.