A rapid access to biaryl ether containing macrocycles by pairwise use of Ugi 4CR and intramolecular S(N)Ar-based cycloetherification.

[reaction: see text] From readily accessible starting materials, macrocycles with an endo aryl-aryl ether bond are synthesized in only two operations by combination of the Ugi four-component reaction and an intramolecular S(N)Ar reaction. The nitro group serves as an activator for the macrocyclization and provides a handle for the introduction of functional group diversity. A Ugi reaction promoted by ammonium chloride in aprotic solvent is documented for the first time.

[The complementary reasonable explorations to consider about young hypertensive patient. (With regard to 389 selection bed-rests in view of national service) (author's transl)]. / Les explorations complémentaires raisonnables à envisager chez le jeune hypertendu. A propos de 389 dossiers de sélection pour le service national.

About a retrospective study turning on 600 bed-rests during 3 years, the writers study 433 confirmed high blood pressures including 389 without therapeutic among which 67 p. 100 labil or limit H.B.P. and 33 p. 100 permanent H.B.P. By light of current ideas and withdrawn informations from complementary explorations done, they try to define a reasonable attitude concerning twenty years old young hypertensive male patients in view of selection. This attitude can be extended to the general field of young H.B.P. people. They establish that a good number of systemically researched elements are without great interest; functional signs, which are more the neurotonia witness than the H.B.P. consequence, heart or renal repercussion, negligible in this age, the too shematic distinction between permanent, labil or limit H.B.P. On the other hand, some parameters deserve to be searched : family antecedents (greater than 60 p. 100), obesity (approximately 20 p. 100), ocular repercussion (approximately 15 p. 100), perturbation of lipidemia, above all hypertriglyceridemia, hyperuricemia and urinary sediment abnomalies. As for I.V.U., in spite of an exact study of vascular times, and second reading by the same observer, it never allowed to display any renovascular H.B.P. Other pathologic uronephrologic established images are all almost associated to urinary sediment anomalies or to proteinuria. More, a few frequent incidents among young people and the price of the exam bring to purpose. I.V.U. only when H.B.P. context is hard or going with urinary signs. Other more specific exams (V.M.A., catecholamines) will be asked according to the context.

[African schistosomiasis at the invasion stage. Criteria for diagnosis. Control after 5 years (author's transl)]. / Les bilharzioses africaines de première invasion. Eléments de diagnostic. Evolution à 5 ans.

The authors expose their conclusions after controlling 181 young soldiers affected by schistosomiasis in an epidemic having occured in Tchad en 1973-74, none of them having been later on submitted to parasitic infection: --relative value of classical diagnosis criteria (50 p. 100); --reliability of immunologic symptoms; -- frequency, importance and precocity of specific granulomatous hepatic changes, detected by laparoscopie and biopsy (87,2 p. 100 of the cases). The value of niridazole is confirmed but continuance of granulomatosis after clinical recovery is not an exceptionnal possibility five years after the treatment, then raising diagnostic and immunologic problems.

[The cost of alcoholism in a hospital medical department (author's transl)]. / Le coût de l'alcoolisme dans un service de pathologie interne.

The authors evaluated the costs involved when alcoholic patients were admitted to a hospital medical department. Costs which were identical for all patients, such as basic services and hospitalization fees, were discounted, and only those for individual investigations and treatment were calculated. These costs were then compared with the average daily costs for non-alcoholic patients in the same department over the same period. The results are discussed in relation to other similar studies.

[Polymorphic histological changes in a case of angio-immunoblastic adenopathy (author's transl)]. / Evolution histologique polymorphe d'une adénopathie angio-immunoblastique.

A patient aged 65 years was observed to have successive adenomegalic syndromes over a period of 4 years, with variable histological appearances. A right cervical adenopathy had the histological appearance of a simple antigenic-stimulation lesion. Three years later, a right inguinal adenomegaly presented all the histological criteria of angioimmunoblastic adenopathies, without, however, any humoral immunity disturbance. Two months later, a biopsy of a palatine tumour confirmed the diagnosis of an immunoblastic sarcoma. The condition then became generalized as a lymphoblastic type of diffuse lymphosarcoma, and autopsy one year later showed the presence of a pleomorphic lymphosarcoma in several lymphoid formations. This case serves as a basis for discussing the concept of angio-immunoblastic adenopathy; the result of various antigenic aggressions or the early stage of a haematosarcoma. It also clearly demonstrates the sometimes contingent characteristics and difficulties in classification of haematosarcomas.

[Abnormalities of fibrin formation in benign viral hepatitis (author's transl)]. / Les anomalies de la fibrinoformation au cours des hépatites virales bénignes.

Abnormalities of fibrin formation were studied in 42 young adult patients with benign viral hepatitis. It was observed that there was a constant increase in thrombin time and reptilase time, evoking an abnormality of the second stage of fibrin formation, or the aggregation of fibrin monomers. This abnormality is not associated with the presence of inhibitors in the patients' serums, and is maximum at an alkaline pH. The hypothesis of an abnormality of the fibrinogen molecule, a dysfibrinogenemia, is the most likely cause, and this has to be confirmed by biochemical and immunochemical studies.

[Post-meningococcal rheumatism (apropos of 3 cases)]. / Le rhumatisme post-méningococcique. A propos de trois observations.

A report is given on 3 cases of arthritis after cerebrospinal meningitis caused by B meningococci, with a relapsing course in 1 case. The observations are compared with the literature and the characteristics of articular manifestations of meningococcal infections are outlined. Three types are distinguished. Type I is characterized by banal arthralgias masked by the symptoms of meningitis. Type II encompasses septic arthritides preceding or concurring with the meningitis and like the latter sensitive to antibiotics. Type III includes postmeningococcal arthritides with sterile articular fluid refractory to antibiotics and showing a spectacular reaction to non-steroid anti-inflammatory drugs. These arthritides constitute a true infective rheumatism, post-meningococcal rheumatism, and should be related to other post-meningococcal manifestations such as pericarditis, myocarditis, cutaneous and ocular changes. All these manifestations are attributed to the production of immune complexes. Postmeningococcal arthritides, whose characteristics are described, may occur after septic meningococcal arthritis or appear as such. The distinction of postmeningococcal rheumatism where only anti-inflammatory treatment is effective might lead to the question whether certain postgonococcal arthritides refractory to antibiotics and responding to anti-inflammatory drugs are not provoked by an immuno-allergic mechanism leading to postgonococcal rheumatism -a nosological entity that has been abandoned possibly too fully and definitively.

[Post-meningococcal rheumatism]. / Le rhumatisme post-méningococcique.

Two cases of post-meningococcal inflammatory arthritis with a relapsing course in one case are reported. The authors then recall the characteristics of the joint manifestations during meningococcal infections in the light of other cases in the literature. These arthropathies are generally aseptic and their resistance to antibiotics is remarkable, whilst non- steroid anti-inflammatory drugs, even used alone as in one of the cases reported here, are remarkably effective. The pathogenesis of these cases of arthritis is not clear: it seems however according to Greenwood and Whittle that they are manifestations of immuno-allergic type. This "post-meningococcal rheumatism" may be compared to the gonococcal rheumatism of certain cases of Reiter's syndrome.