[Evolutionary comparison of laboratory cardiac and infectious parameters during septic shock: about an original case]. / Evolution comparée des indicateurs biologiques cardiaques et infectieux lors du choc septique: à propos d'une observation originale.

A massive release of troponin Ic and CKMB was described in a patient during septic shock. According to experimental animal models previously described, this release of biological markers by myocardial tissue could be due to an inflammatory process of myocardial tissue during septic shock without myocardial infarction in non cardiac critically ill patients.

[About two cases of massive hypercholesterolemia]. / A propos de deux cas d'hypercholestérolémie massive.

Two patients presented massive hypercholesterolemia related to acquired disease, intrahepatic cholangitis with cholestasis in one and nephrotic syndrome in the second. Comparison of the lipoprotein patterns demonstrated distinctive pathophysiological processes different from those operating in primary causes of hypercholesterolemia.

[Unexpected occurence of hemoglobin Athens-Georgia]. / Révélation inattendue de l'hémoglobine Athens-Georgia.

The following report concerned a 47 year old Caucasian diabetic patient. Routine HPLC of HbA1c (Variant II Biorad Laboratories - hemoglobin A1c program) resulted only in the evidence of HbF (1%) and increase in HbA1c (10%). Considering the presence of HbF a standard agarose gel electrophoresis of patient's hemoglobin was performed and revealed the presence of Hb Athens-Georgia. Consequently the occurrence of HbF during determination of HbA1c by HPLC should lead to perform a standard hemoglobin electrophoresis in order to explore an hidden, unsuspected and clinically silent occurrence of rare Hb variant or additional unsuspected increase in HbA2.

In vitro glycoxidation of insoluble fibrous type I collagen: solubilization and advanced glycation end products.

The deleterious effects of glycoxidation are dependent on the half-life of proteins. Collagen, the main component of extracellular matrices, is a long live protein and thus may be sensitive to the glycoxidation process. We incubated calf skin fibrous type I collagen in PBS at 37 degrees C with glucose. The fibrous type I collagen was solubilized and an increase in the amount of advanced glycation end products of the solubilized fraction was observed. As there was no bacterial contamination and no proteolytic activities in the incubation medium, the solubilization of fibrous type I collagen is probably due to the speculative production of the free radicals in our experimental conditions. To test this hypothesis, fibrous type I collagen was incubated in PBS with AAPH (2,2'azo-bis 2-aminodinopropane) a free radicals generator. AAPH induced a dramatic and dose dependent solubilization of fibrous type I collagen.

Nutritional markers, acute phase reactants and tissue inhibitor of matrix metalloproteinase 1 in elderly patients with pressure sores.

BACKGROUND: Loss of collagen and elastin is observed in the elderly. In geriatric inpatients, chronic protein malnutrition could induce susceptibility to additional morbidity such as pressure sores. OBJECTIVE: The purpose of this study was to explore the relationship between nutritional and inflammatory status and the production of tissue inhibitor of matrix metalloproteinase 1 (TIMP-1). METHODS: Chronically ill elderly inpatients, without or with pressure sores, were enrolled. Nutritional protein markers, acute phase reactants, and TIMP-1 were determined, and changes in these biological parameters were compared. RESULTS: Chronic inflammatory process and protein malnutrition were observed in all enrolled patients. The severity of these two pathophysiological processes was independent of the occurrence of pressure sores. The serum prealbumin and albumin levels were lower in patients with pressure sores than in those without. In addition, the general increase in the TIMP-1 level was independent of the occurrence of pressure sores. The TIMP-1 level was mainly related to the prognostic inflammatory and nutritional index. CONCLUSIONS: The general increase in acute-phase reactants observed in the elderly could be related to the intercurrent diseases. The generally low serum albumin level, lowest in patients with pressure sores, may be considered evidence of protein malnutrition and hypercatabolism. Regarding the morbidity, the increase in TIMP-1 levels could be explained as an adaptive process to prevent intrinsic protein expenditure of extracellular matrices.

Residual inflammatory process after aortoiliac reconstructive surgery.

BACKGROUND: The aim of the present study was to investigate the inflammatory reaction and its evolution in patients who underwent a prosthetic vascular procedure. Moreover the participation of this chronic process, during the follow-up, as a promoting or a consequence of vascular injury must be discussed. METHODS: Thirty-four patients were enrolled in the study. All patients had an aortic disease and underwent a prosthetic vascular procedure. Preoperative exclusion criteria were an emergency situation, diabetes, infection, chronic inflammatory disease, cancer and hemopathy. Postoperative exclusion criteria were the same together with abdominal complications and additional surgery during the follow-up. The inflammatory process was investigated with the measurement of blood acute phase proteins, haptoglobin, alpha1-glycoprotein acid, C-reactive protein and interleukin-6, before, immediately after surgery and several months after surgery. RESULTS: An increase in acute phase proteins was not observed to the same extent for all the studied patients. Before the surgical procedure, chronic inflammatory process was revealed by an increase in haptoglobin (52.9 p 100) and alpha1 glycoprotein acid (52.9 p 100) whereas increase in C-reactive protein (26.4 p 100) and interleukin-6 (92 p 100) are related to an acute process. Later after surgery, the chronic inflammatory process remained but differed from the observed process before surgery only by haptoglobin (61.7 p 100) and interleukin-6 (47 p 100). CONCLUSIONS: The presented results, observed during the follow-up of vascular surgery focused on persistent inflammatory process and the surgical procedure did not modify the time course of this process. The evolutionary disease could be considered as chronic and independent of the local effect.

[Study of the spermatic bacterial flora in infertile males (author's transl)]. / Etude de la flore microbienne spermatique chez des patients consultant pour stérilité.

Two groups of infertile males (65 and 132 patients) have been investigated in two different laboratories, with two different methods to obtain semen. The bacteriological results are quite similar in the two groups. The microorganisms which have been isolated are : beta-hemolytic Streptococcus, Proteus, Epidermidis staphylococcus, Micrococcus, Corynebacter, Viridans streptococcus, Klebsiella, Pseudomonas, Enterobacter, Bacillus, Neisseria, Escherichia coli, anaerobic Staphylococcus, anaerobic Streptococcus, anaerobic Corynebacter type IV. Fungus, Achromobacter, 20 p. cent of the patients are chronically infected without any clinical signs. This infection is probably of prostatic origin with an important number of bacteria in the semen (more than 3 000/ml). No relation has been shown between the bacteriological data and the physical and cytological characteristics of the sperm, except the pH : semens with a low pH are generally azoospermic and highly contaminated.

[Study of the spermatic bacterial flora in infertile males (author's transl)]. / Etude de la flore microbienne spermatique chez des patients consultant pour stérilité.

Two groups of infertile males (65 and 132 patients) have been investigated in two different laboratories, with two different methods to obtain semen. The bacteriological results are quite similar in the two groups. The microorganisms which have been isolated are : beta-hemolytic Streptococcus, Proteus, Epidermidis staphylococcus, Micrococcus, Corynebacter, Viridans streptococcus, Klebsiella, Pseudomonas, Enterobacter, Bacillus, Neisseria, Escherichia coli, anaerobic Staphylococcus, anaerobic Streptococcus, anaerobic Corynebacter type IV, Fungus, Achromobacter. 20 p. cent of the patients are chronically infected without any clinical signs. This infection is probably of prostatic origin with an important number of bacteria in the semen (more than 3,000/ml). No relation has been shown between the bacteriological data and the physical and cytological characteristics of the sperm, except the pH : semens with a low pH are generally azoospermic and highly contaminated.

[Acute, recent and sometimes persistent Mycoplasma pneumoniae infections associated with neurologic manifestations. Discussion of causal relations]. / Infections aiguës, récentes, et parfois persistantes à Mycoplasma pneumoniae, associées à des manifestations neurologiques. Discussion des liens de causalité.

Neurological disorders associated with recent and sometimes persistent Mycoplasma pneumoniae infections were present in 9 patients, examined within the course of a year, during the 1980 epidemic in Saint-Etienne, France. Cases included 5 with acute polyneuritis, 2 with lymphocytic meningitis, 1 with a bilateral optic neuritis, and 1 with mild encephalitis presenting as an amnesic disorder. Causal relationships are examined with respect to semiological, biological, therapeutic and epidemiological data. Clinically an initial infection compatible with the mycoplasmic etiology and its time relationship with the nervous system lesion appear to be more significant than the inflammatory neurological symptoms and signs. It is often impossible to ascertain the efficiency of the antibiotic therapy, which thus cannot help to the aetiological diagnosis. From the biological point of view, though seroconversion by complement fixation test remains the basis of the diagnosis, it has been completed by the isolation of Mycoplasma pneumoniae in the blood of 3 of the patients, and by a longitudinal study of specific blood IgM levels in the 6 others. Presence in the CSF of these locally synthesised specific IgM during the early stages of the neurological disorders in 2 patients, constitutes a new significant fact for the physiopathological discussions and a basic fact to clarify the aetiological diagnosis. The concept of persistent infection is discussed with respect to the isolation of Mycoplasma pneumoniae in the blood at a late stage, and the abnormally long presence of high levels of specific serum IgM levels. This biological persistence does not always correspond to a chronic course of the clinical disease which was observed in only 3 of the patients. The mixed viral infection, present in 3 cases, is linked with immunity disorders due to Mycoplasma pneumoniae, which are mainly a cell immunity depression: this markedly complicates the analysis of causal relationships. Finally, the chronological order of the clinical and biological events remains of prime importance when studying each case individually, whereas epidemiological data are essential for establishing a posteriori that the neurological manifestations were true complications of the microorganism.

Human glomerulonephritis and persistent non-polio enterovirus infection.

In a prospective work, we have studied the non-polio enterovirus (NPEV) excretion in spot urine and stools by four appropriate cell cultures, in four different groups: 20 exposed controls (GI), 88 patients with renal biopsy 'proven GN' (GII), 38 cases with 'proven nonGN' (GIII), and 9 with 'probable nonGN' (GIV). The positive excretion in stools and/or urine is respectively 0 and 5% in Group I, 14 and 33% in Group II, 6 and 19% in Group III, and 13 and 22% in Group IV. Viruria, the consequence of a viraemia, is therefore associated with 'proven GN' (p less than 0.05). In the majority of patients with positive NPEV excretion, we have made an additional but similar study, 3-12 months later. Persistent excretion was confirmed in 22/30 cases in Group II (73%) versus 0/8 in Group III-IV (p less than 0.001). These data concerned patients with membranoproliferative GN [5], membranous GN [6], mesangial IgA GN [6], endocapillary GN [2] or minimal lesions [3]. Thus we have demonstrated a significant relation between persistent NPEV urine/stools excretion and the occurrence of active GN in humans. Such persistent viral infections may represent the cause of some GN, probably mediated by an immune complex mechanism with viral antigens.

[Persistent non polio enterovirus infections associated with glomerulonephritis. 9 cases (author's transl)]. / Infections persistantes à entérovirus non poliomyélitiques associées à des glomérulonéphrites. 9 observations.

All patients are excreting the virus in urines and in 4 cases in stools. The virus has also been isolated from the blood. These cases focused on the possible role of enteroviruses as causal agents for the glomerulonephritis.