[Cholesterol embolism: an often unknown disease; a report of two cases]. / La maladie à embols de cholestérol: une pathologie souvent méconnue; à propos de deux cas.

We report on a case of post-invasive acute renal insufficiency and a case of acute necrotizing pancreatitis, both histologically proven to have been caused by cholesterol embolisms. A survey of the literature with discussion of diagnostic and therapeutic options is given.

Flow cytometric determination of endocytosis of viable labelled Legionella pneumophila by Acanthamoeba palestinensis.

Endocytosis of fluorescently labelled cells of Legionella pneumophila (L. pneumophila) by free-living Acanthamoeba palestinensis (A. palestinensis) has been studied using flow cytometry. L. pneumophila cells were labelled with CM-DiI, a lipophilic fluorescent probe under conditions that did not modify viability. Coculturing the bacteria with amoebae was accompanied by rapid endocytosis; after 5 min, 90% of the amoebae had internalized bacteria. This percentage remained unchanged during further coculture, but the number of bacteria ingested per amoeba increased. Moreover, the number of ingested bacteria was found to be dependent on the size of the amoeba. The validity of the internalization analyzed by flow cytometry was confirmed by observation using epifluorescence and phase contrast microscopy. CM-DiI labelling associated with flow cytometry provides a very valuable technique for the determination of bacteria endocytosis by free-living amoeba.

Symbiotic interactions between free-living amoeba and harboured mercury-resistant bacteria.

A co-culture of environmental Acanthamoeba sp. associated to Hg-sensitive, narrow or broad-spectrum Hg-resistant Aeromonas sp. strains was exposed to HgCl(2) and phenylmercuric acetate. Amoebic growth depended on the Hg-resistance determinants of harboured bacteria. This laboratory model helped in understanding the mechanisms of Hg-resistance observed in amoeba isolated in river waters after a mercuric pollution. Amoeba acquired Hg-resistance by using symbiotic resistant bacteria.

Synthetic oligonucleotide probes for detection of mercury-resistance genes in environmental freshwater microbial communities in response to pollutants.

Mercury-resistance genes were detected byin situ hybridization using new synthetic oligonucleotide probes specific formerA andmerB genes according to the published sequences of the corresponding enzymes. These DNA probes were used for the detection of specific mercury-resistant microorganisms isolated from the Rhine River which had been polluted 3 years previously in 1986. Mercuric reductase and organomercurial lyase genes persist in the bacterial genome even after the disappearance of the pollutant but are absent in axenic amoebae. A total of 49 bacterial isolates showed DNA homologies with the(32)P-labelled DNA probes and 15 free-living amoebae were selected due to their harboured symbiotic mercury-resistant bacteria.

[Treatment of massive arterial thrombosis caused by thrombocytopenia induced by heparin with local thrombolysis]. / Traitement par thrombolyse locale d'une thrombose artérielle massive par thrombopénie induite par l'héparine.

The authors report the case of a patient treated by subcutaneous injection of calcium heparin after deep vein thrombosis with floating thrombus and pulmonary embolism. She was readmitted to hospital after 16 days' treatment because of a massive aorto-iliac thrombosis due to heparin-induced thrombocytopenia (platelet count = 29.000). This thrombosis was treated by local injection of Urokinase (total dose = 7.425.000 U) over 93 hours without any major complications. The aorto-iliac circulation was completely restored to normal after treatment. Thrombotic complications secondary to immuno-allergic heparin-induced thrombocytopenia are relatively common because of the widespread use of heparin. From the therapeutic point of view, it is imperative to stop the heparin, which makes surgery very difficult, and the platelet-fibrin composition of these thrombi suggests that local thrombolysis with Urokinase is the treatment of choice in this syndrome.

Phenylmercuric acetate biodegradation by environmental strains of Pseudomonas species.

Organomercurial pollution occurring in the Rhine river in 1986 led us to study the possibility of depollution by mercury-resistant environmental aquatic strains. Four species of Pseudomonas were investigated for their ability to biotransform phenylmercuric acetate (PMA). Such biological depollution was demonstrated to be due to an enzymatic activity in whole cells and in cell-free extracts from Pseudomonas fluorescens and other Pseudomonas species. PMA biotransformation was followed by high-performance liquid chromatography. Some of those bacteria growing between 4 and 41 degrees C probably represent a natural means of organomercurial depollution, which acts slowly in interaction with other organisms and non-organic porous surfaces.

[Use of a rinsing solution for contact lenses in the prevention of amebic keratitis]. / Utilisation d'une solution de rinçage pour lentilles cornéennes dans la prévention des kératites amibiennes.

Recent reports incriminating Acanthamoeba, a small free-living amoeba, wide-spread in environmental soils and waters, in acanthamoebic keratitis cases wearing soft contact lenses, drew attention to cleaning solutions for contact lenses. The purpose of this report is to discuss the amoebicidal action of a rinsing solution containing 0.001% thimerosal. A. castellanii cysts and trophozoites were incubated with the rinsing solution. Amoeba saline was used as control solution. After 1 h to 96 h of contact time, the survival was studied by growing of trophozoites and excystment of cysts on cultures. The results indicate that trophozoites were destroyed by the rinsing solution after 6 hours, whereas for cysts a negative culture was obtained after 72 h to 96 h. The amoebicidal and cysticidal action of this solution containing mercury corroborates our preceding experience on the effects of mercury derivates on amoebae. The use of amoebicidal solutions in contactology could inhibit and even destroy amoebae on contaminated lenses preventing severe keratitis.

Emergency treatment of severe cardiogenic pulmonary edema with intravenous isosorbide-5-mononitrate.

Intravenous isosorbide-5-mononitrate (IS-5-MN) was administered to 24 patients, mean age 73, with severe respiratory distress after pulmonary edema and acute left heart failure. The condition was due to ischemic cardiopathy in 18 patients (4 with acute myocardial infarctions), congestive cardiomyopathy in 3, hypertensive cardiopathy in 2, and mitral valvular disease in 1. Therapy consisted of an intravenous (i.v.) bolus dose of IS-5-MN, followed by a continuous infusion (mean 8 mg/hour over 24 hours) of i.v. furosemide and additional oxygen. Clinical data were recorded as well as blood gas values and repeated chest radiographs. All patients survived and improved markedly; only 6 needed mechanical ventilation. Most patients had fast respiratory relief, with no untoward reaction, except a brief decrease of blood pressure in a ventilated patient taking morphine. These data indicate that i.v. IS-5-MN is effective and safe for the management of severe acute cardiogenic pulmonary edema.

[Acute treatment of severe cardiogenic pulmonary edema. Effect and tolerability of ISDN as bolus and continuous infusion]. / Die Akutbehandlung des schweren kardialen Lungenödems. Wirksamkeit und Verträglichkeit von ISDN als Bolus und als Dauerinfusion.

Isosorbide dinitrate (ISDN) was administered intravenously to 21 patients with severe cardiogenic pulmonary edema. In 15 cases the condition was due to coronary heart disease (3 of them had arterial hypertension additionally), and 3 patients due to cardiomyopathy. In the remaining 3 valvular disorders were prevailing. The ISDN solution was administered as an i.v. bolus followed by continuous i.v. injection from an automatic perfusion device. Oxygen, furosemide, and in some cases digitalis were given in addition. Monitoring consisted of clinical surveillance, blood gas analyses, and repeated X-ray control. The results obtained confirm the efficacy and safety of this mode of ISDN administration. This applies particularly for patients in whose therapy is aimed at fast control of life-threatening hypoxia. Despite extreme asphyxia, only three patients needed artificial respiration, one died in cardiogenic shock, while all others were rapidly improved. It could thus be demonstrated that this type of therapy may be safely and efficiently handled by careful clinical supervision, without invasive hemodynamic monitoring.

[Epidemiology of free-living amoebae in the waters of Strasbourg (France) (author's transl)]. / Epidémiologie des amibes libres dans les eaux de Strasbourg.

164 strains of free-living amoebae were isolated from public drinking water supplies, swimming pools and official swimming ponds in Strasbourg; 11 genera and 16 species were identified. Some strains of Acanthamoeba are pathogenic for mice by intracerebral inoculation. Among the two strains of Naegleria found none is pathogenic. The results concerning free-living amoebae are compared with the level of chlorine and bromine and with the presence of bacteria in swimming pools.

[Study of free living amoebae in the waters of Strasbourg. Preliminary report (author's transl)]. / Etude des amibes libres dans les eaux de Strasbourg. Résultats préliminaires

75 strains of free living amoebae were isolated from public drinking water supplies, swimming pools and official swimming ponds in Strasbourg. 42 strains were identified till now. No pathogenic strain of Naegleria fowleri was found.