[Hartmann's intervention in emergencies. Reflections apropos of 50 cases].
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Biomedical subjects
Publications and source records attributed to D Fournier.
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alpha-Ethylphenethylamine proved to be a weaker inhibitor of rat brain synaptosomal [3H]norepinephrine ([3H]NE) uptake than amphetamine, while 2-amino-tetralin and 2-amino-1,2-dihydronaphtalene, compounds in which the alpha-side chain ethyl group is tied to the aromatic ring have a similar inhibiting potency as amphetamine. Hallucinogenic polymethoxy substituted phenethylamine analogs have very low inhibitory potencies indicating that inhibition of NE-reuptake in brain noradrenergic neurons is not associated with the drug-induced hallucinogenic syndrome.
The progesterone receptor (PR) in the oviducts of aged, nonlaying hens was compared to that in laying hens. The PRs in the mature oviducts of chicks that were diethylstilbestrol (DES) primed and of chicks with DES withdrawn were similarly analyzed for comparative purposes. The oviducts from the DES-withdrawn chicks and from aged nonlaying hens showed marked atrophy. The PR concentrations in the oviducts of DES-withdrawn chicks and of aged nonlaying hens were reduced to one half and one fourth those of controls, respectively. The oviduct atrophy and reduced PR concentrations in the nonlaying hen were not caused by decreased plasma estrogen since estrogen concentrations were similar in aged nonlaying hen and in the laying hens. The stabilities of the PR from laying and nonlaying hen oviducts were identical. However, analysis in vivo and in vitro revealed that the PR from the oviducts of DES-withdrawn chicks and of aged, nonlaying hens had lost the capacity for nuclear translocation and binding. This was accompanied in the DES-withdrawn chick by the inability of progesterone to alter RNA synthesis in the oviduct in vivo. This loss in nuclear binding capacity of PR in both animal models was accompanied by a loss of one of the molecular species of the PR (the B species). The loss of the B species differs from the loss of the A species that occurs during the winter in the domestic fowl. Thus, two types of regulation of the receptor may exist. The results suggest that biologically inactive receptors may explain the cessation of reproductive function in these aged animals.
Diverticulectomy and esophagomyotomy provided a successful result in a patient with idiopathic muscular hypertrophy of the esophagus complicated by a pulsion diverticulum. The anatomical, clinical, and etiopathogenic features of this affection are described and problems concerning differential diagnosis discussed.
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Myeloma is a malignant hematopathy with multiple lesions, mainly in bones. The authors report a case in which the myeloma was present in the mandibuloparotid region only. The atypical nature and rarely observed location (mainly parotid) of the lesion raised diagnostic, prognostic, and therapeutic problems that were resolved by close cooperation with a team of hematologists. Therapy was by surgery only, in this particular case, because of the early stage of the lesion, but regular close surveillance is essential.
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A young Protugese man, who had never travelled outside of Europe, was found to have a bacterial complication of a fibroplastic endocarditis. The onset was by a spontaneous chest pain, associated with a posterolatero-apical subepicardial ischemia and giant T waves in V3, V4, and calcification in the apex of the heart on radiography. Diagnosis was confirmed by intracardiac explorations: ventricular telediastolic pressures were increased; the lower border of the right ventricle was smooth, the left ventricle had a globular appearance with a smooth anterior border, the apex appearing to be completely excluded; coronarography was normal. Histological examination confirmed the presence of fibrosis. Anticoagulant treatment was started. Four months after the onset of the disease, a high fever, an apical systolic murmur, and nine positive blood cultures for a streptococcus mitis, suggested the development of a bacterial endocarditis, though no direct evidence was discovered. Improvement occurred after appropriate antibiotic therapy, and the anticoagulants were continued. Cardiac ultrasonography recordings were normal following this episode. This case-report is of two-fold interest: on the one hand it represents an early form of fibroplastic endocarditis, diagnosed by intracardiac exploration, and on the other hand it emphasizes the rare nature of bacterial complications of this affection. Authors differ in their evaluation of the frequency of chest pain, but their inaugural and isolated nature are rarely described. In most cases the presence of the disease is revealed by a progressive cardiac insufficiency. A very positive factor is the presence of calcifications, and the absence of an eosinophilia does not exclude the diagnosis. Electrical anomalies of the ischemic type are possible, but are rarely isolated findings, and the giant appearance of the T waves in this case is rather atypical. Bacterial complications are rare, and are only reported in 12 of the 218 cases described in the published literature. They are rarely diagnosed during the life of the patient (1 case only). The infection affects the cords, the valves, the thrombus, or the fibrosis itself.
The authors report five cases of streptococcal gangrene and stress the fundamental role of surgical excision. Parenteral anti-streptococcal antibiotics should not lead to this essential step being forgotten, its early application being the most important element in prognosis. It is thus essential to clearly understand the local and general criteria of rapid diagnosis in this condition, which is far from rare.
Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.
From 1958 to 1970, in 435 cases (60%) out of 725 carcinomas of the uterus sole radiation therapy by cobalt-60 beads was performed; in 288 cases (39.7%) surgery was done (combined with tele-cobalt-irradiation in almost all cases, 5000 to 6000 rd TD). Two cases (0.3%) received no treatment. The unfavorable selection of the irradiated women (average age 64,6 years) as against the surgically treated ones (average age 50.9 years) did allow a complete intracavitary irradiation only in 60.6% of the cases; in 39.4%, the dose had to be reduced considerably. The five-year survival amounted to: 64.4% after sole irradiation, 93.2% after operation/postirradiation in stage I; 46.9% after sole irradiation, 75.0% after operation/postirradiation in stage II; 30.8% after sole irradiation in stage III. No survivors existed in stage IV. Mortality from treatment with sole irradiation amounted to 1.8% (8/435). Radiation fistulas were observed after sole irradiation in 0.4% (1/435), after operation/postirradiation in 0.7% (2/288). As long as there is no satisfactory afterloading technique for intracavitary irradiation of the carcinoma of the uterus, an application of cobalt-60 beads seems to offer the following advantages as compared to an implant of radium filters: Shorter duration of the application, better adaptability to the cavitary lumen, diminished risk of perforation. No perforation was observed.
From 1960 to 1972, 276 out of 330 cases of ovarian cancer were treated by different techniques of postoperative radiation therapy; 54 advanced cases underwent prospective chemotherapy. Radiogold intraabdominally administered (190 to 300 mCi), telecobalt (5000 rd) or the combination of radiogold and telecobalt was chosen for postoperative radiation therapy. Cyclophosphamide (Endoxan), prednisolone, and gestagenes (Prothil) were given as a long-term chemotherapy. The most successful technique of radiation therapy is confronted with long-term chemotherapy after three years (five years) of survival: Stage I a, b, c: Radiogold = 91.7% (66.7%), chemotherapy (only I c) = 100%. Stage II a, b: Radiogold + telecobalt = 47% (35%), chemotherapy = 85%. Stage III: Radiogold + telecobalt = 25% (0%), chemotherapy = 52%. Stage IV: Radiotherapy = 0%, chemotherapy = 25%. The absolute five-year survival without chemotherapy amounted to 23%. The mortality curve under chemotherapy shows a four-year survival rate of 88%, if tumor cells had been detected microscopically (ascites, omentum), but of only 30% after macroscopical verification of the tumor. Therefore, the maximally possible partial resection of the tumor is recommended in inoperable stages before the beginning of chemotherapy. "Prophylactic" long-term chemotherapy following macroscopically complete surgical treatment is recommended, whenever microscopical spread of tumor cells appears to be possible. In inoperable stages, chemotherapy ought to be applied prior to radiation therapy. In stages I a, b, c, and II a, postoperative irradiation with radiogold (100 mCi) and in stage II b additionally radiation teletherapy of the pelvis (6000 rd) is recommended.
Ninety-nine strains of Gram-negative black-pigmented anaerobic rods, grown on Todd-Hewitt blood agar plates, were identified and characterized according to a typing scheme including UV fluorescence, catalase, trypsin-like and haemagglutinating activities, biochemical tests with the ATB 32A kit, and gas-liquid chromatography. To determine the taxonomic position of the Porphyromonas gingivalis biotypes, 68 strains (31 of human origin and 37 of animal origin) were compared to 31 strains of closely related species or of uncertain generic status. Most animal strains were isolated in our laboratory by subculturing samples from the oral cavity of five mammalian species (bear, cat, coyote, dog and wolf). Those strains differed from human P. gingivalis strains in that they were positive for catalase, beta-galactosidase and glutamyl-glutamic acid arylamidase; from Bacteroides macacae by more rapid pigmentation, positive haemagglutination, failure to produce propionic acid, and negative alpha-galactosidase; and from Bacteroides salivosus by more rapid pigmentation, positive haemagglutination and failure to produce propionic acid. These data demonstrate that phenotypic heterogeneity within the taxon P. gingivalis can be resolved into two biotypes, each corresponding to a human source or an animal source.
The enzymatic activity of acetylcholinesterase (AChE) has been shown to be altered by environmental contaminants such as metals. However, the available literature illustrates a background of contradictory results regarding these effects. Therefore, the main purpose of this study was to investigate the potential of five metal ions (nickel, copper, zinc, cadmium and mercury) to inhibit AChE activity in vitro. First, to accomplish this objective, the possible interference of metals as test toxicants in the Ellman's assay, which is widely used to assess AChE activity, was studied. The potential influence of two different reaction buffers (phosphate and Tris) was also determined. The results suggest that the selected metals react with the products of this photometric technique. It is impossible to ascertain the artefactual contribution of the interaction of the metals with the technique when measuring AChE inhibition. This constitutes a major obstacle in obtaining accurate data. The presence of phosphate ions also makes enzymatic inhibition difficult to analyse. Attending to this evidence, an assay using the substrate o-nitrophenyl acetate and Tris buffer was used to investigate the effects of metals on AChE activity. O-nitrophenyl acetate is also a substrate for esterases other than cholinesterases. It is therefore only possible to use it for the measurement of cholinesterase activity with purified enzymes or after a previous verification of the absence of other esterases in the sample tissue. Under these conditions, the results indicate that with the exception of nickel, all tested metals significantly inhibit AChE activity.
Elicitins, proteinaceous elicitors secreted by Phytophthora spp., act as inducers of a hypersensitive-like response in tobacco during incompatible interactions. We have isolated and cloned sequences encoding cryptogein and related isoforms from P. cryptogea that belong to the elicitin family. The isolation of a genomic clone led to the characterization of four clustered genes. Two of these genes encode distinct elicitins, and two genes would encode, if expressed, a class of highly acidic elicitins which had not been observed so far. Northern blots indicate that elicitin genes are expressed in the fungus grown in vitro, though at different levels. Southern hybridization revealed that elicitins are encoded by a multigene family in several other species of Phytophthora. Moreover, isolates of Phytophthora parasitica var. nicotianae, pathogenic to tobacco, which do not produce elicitins, possess several elicitin-encoding genes. Involvement of elicitins in plant-pathogen interactions is discussed.