Angiography contrast agents interact with serine proteinases. The molecular structure of the model system elastase/iohexol.

Pancreatic elastase was co-crystallised with iohexol, a tri-iodo benzenic contrast agent used in angiography analyses. The X-ray analysis of the complex reveals the presence of three molecules of iohexol associated with the proteinase with low occupancy factors. Two iohexol molecules are located in and near the active site of the enzyme and provide a model for explaining the inhibition of the hemostatic system, one of the major and inconvenient side effect associated with these chemicals.

[Bypass for limb salvage. A matter of the veins? Preliminary report apropos of 100 femoro-distal revascularizations]. / Les pontages pour sauvetage de membre. Une question de veine? Rapport préliminaire à propos de 100 revascularisations fémoro-distales.

The authors have performed a prospective study on 100 cases of limb salvage. The reference procedure was the in situ femoro-subinguinal bypass (67 observations). If no vein could be used, replacement material was thin-wall PTFE (33 observations). Both groups are clinically and radiologically homogeneous. The longest delay is 30 months. The cumulated patency rate is 86% for venous bypass grafts against 62% for prostheses. The difference is less marked for limb salvage: 96% with venous bypass and 84% with a PTFE bypass. Without trying to oppose both techniques, the authors emphasize the need for revascularization, even when distally seems to be compromised.

[Quantitative measurement of lectin activities using an autoanalyser]. / Mesure quantitative des activités lectiniques par un autoanalyseur.

Today, an increasing number of lectins are available for a diagnostical purpose. Using an autoanalyser, it is possible to study and to measure the agglutination of red blood cells, one of their main properties.

[Rare lesions caused by seat belts]. / Quelques lésions rares provoquées par la ceinture de sécurité.

The authors report a number of rare traumatic lesions which can be described under the heading of "safety belt syndrome". The superficial haematoma which is invariably present ("seat belt sign") would seem to be a reliable indication of improper wearing of the seat belt which has been attached too loosely. The lesions seen were a vertebral arteriovenous fistula after cervical contusion, a closed rupture of a rectus abdominis muscle, associated with rupture of the homolateral renal artery and finally pelvi-ureteric disinsertion with laceration of the renal pelvis. It is important to be aware of such lesions which must be suspected in case of accident with a seat belt since the diagnosis is often difficult. The superficial haematoma is a valuable sign which should suggest the possibility of underlying deep lesions.

Ultraviolet difference spectroscopy study of peanut lectin binding to Mono- and disaccharides.

Ultraviolet difference spectroscopy was used to study the interaction of peanut (Arachis hypogaea) lectin with complementary carbohydrates. A correlation was observed between variations of ultraviolet spectra during the binding of sugars to the lectin and the specificity and the strength of the binding. The association constant, free energy, enthalpy and entropy for peanut lectin-lactose interactions were calculated over the temperature range 10-30 degrees C. The binding constants for 10 mono- and disaccharides containing a D-galactopyranosyl or a D-talopyranosyl residue were calculated. Comparing their effectiveness to interact with peanut lectin, methyl alpha-D-galactopyranoside appeared to have a more marked affinity than lactose; D-galacturonic acid and methyl 7-deoxy-D-glycero-beta-D-galacto-heptopyranoside had no measurable affinity; the other sugars showed a lower affinity than lactose. The correlations between these differences and the conformations of the sugars obtained by X-ray analysis are discussed.

[Laser nephelometry for the quantitative determination of the interaction between peanut lectins and asialoglycoproteins]. / Utilisation de la néphélométrie laser pour la détermination quantitative des interactions enter lectine d'arachide et asialoglycoprotéines.

The reaction of precipitation between peanut lectin and human serum desialylated glycoproteins was measured by means of laser nephelometry. Such a study can be used for the interactions with a purified asialoglycoprotein or with a whole serum. So, nephelometry allows investigations of abnormal or modified circulated molecules in a number of pathological situations.

[Intramural hematomas of the small bowel (duodenum excluded) during long-term anticoagulant treatment. Report on 6 cases of which 2 required operation (author's transl)]. / Les hématomes intra-muraux de l'intestin grêle (duodénum exclu) lors de traitements anti-coagulants au long cours. A propos de 6 cas dont 2 opérés.

Hematomas developed in the small bowel of 6 patients receiving long-term anticoagulant therapy with antivitamins K. As the report by Chapuis and Mercier during the 81st French Congress of Surgery has fully covered this subject, the authors present their cases to illustrate their clinical features, while emphasizing certain particular characteristics: 1 - Associated hemorrhagic lesions were frequently observed. 2 - Early diagnostic follow-through barium meal examinations of the small intestine could be conducted without any particular problem. 3 - Laparotomy was necessary in two patients because of shock or local signs on examination. 4 - Small bowel lesions can vary in severity, sometimes in the same patient (case no 1). Some hematomas heal spontaneously after discontinuation of anticoagulant treatment, while others can, theoretically, develop necrotic reactions. Small bowel resection was necessary in two patients. 5 - A frequent occurrence was the association of lesions in the right colic and ileal regions. 6 - Finally, anticoagulant treatment can often be reduced, discontinued, or replaced by other therapy.

[Pulmonary wounds (author's transl)]. / Les plaies pulmonaires.

A study of 22 patients with pulmonary wounds has confirmed the advantages of the traditional therapeutic attitude adopted in the majority of cases, and the rare indications requiring urgent or early operation for pulmonary lesions. Hunting gun pulmonary wounds, in which there is predominant "contusion" require individual treatment, and in 2 of the 4 cases treated in this serie, secondary excision was necessary.

[Shy-Drager syndrome and megaesophagus (author's transl)]. / Maladie de Shy et Drager et megaoesophage.

Authors report the case of a Shy-Drager syndrome (idiopathic postural hypotension due to a central degenerative lesion) syndrome which evolution uncovered a megaesophagus. The knowledge of degenerative lesions of the vagus nerve in megaesophagus, the effectiveness of motory lesions of the esophagus in Parkinson's disease where lesions of the vagoglosso pharyngeal dorsal nucleus frequently occurs, allow to discuss the central nervous origin of the megaesophagus appeared in the reported case.

[Segmental colonic lipomatosis. A case of isolated caecocolonic lipomatosis (author's transl)]. / La lipomatose colique segmentaire. A propos d'une observation de lipomatose caeco-colique isolée.

The authors report a case of isolated segmental caecocolonic lipomatosis complicated by infarts. The diagnosis was made from the urgent symptoms and treatment was by simple right colectomy and immediate reconstitution of continuity.

[Gangrenous cholecystitis without lithiasis. A report on a case diagnosed by simple radiography of the abdomen (author's transl)]. / Cholécystite gangréneuse non lithiasique. A propos d'un cas diagnostiqué sur les radiographies d'abdomen sans préparation.

The authors report a case of gangrenous cholecystitis without lithiasis but with secondary infection of the gallbladder by anaerobic germs. Pre-operative diagnosis was possible from simple x-rays of the abdomen which demonstrated an obvious fluid level in the gallbladder, and by parietography. An immediate cholecystectomy was performed. Bacteriological examination of the bile confirmed the presence of Clostridium perfringens. The main bile duct appeared normal and the bile in the common bile duct was sterile. Convalescence was uneventful with antibiotic cover, in spite of the age and condition of the patient. Gangrenous cholecystitis occurs more frequently without gallbladder stones in humans. Clinical signs are not specific but simple x-rays of the abdomen are pathognomonic and enable pre-operative diagnosis to be made. Urgent cholecystectomy appears to be the ideal treatment. This affection has a high mortality and early operation is therefore justified.

[Mesodiencephalic level of severe head injuries (author's transl)]. / Le stade méso-diencéphalique des traumatismes craniens graves.

From the study of 65 severe traumatic comas, the authors describe the syndrome of mesodiencephalic dysfunction, because of its frequency and its particular clinical signs. This peculiar level of loss of consciousness is characterized by a coma without mimic and without awakening after painful stimulation, by a stereotyped motor pattern in extension, by a perseverance of the photomotor reflex, while fronto-orbicular and vertical oculo-vestibular reflexes are lacking. This level of deterioration appears to be a critical point in the natural history of comatose patients. If this level is not surpassed, the probability of early death due to evolutive neurological lesion is low (18%). One half of these patients have a good prognosis, more than 75% have an excellent recovery. This high probability of recovery is decreased by a half when the level of mesencephalic dysfunction is reached.

[Diagnostic and prognostic value of the brain stem reflexes in severe post-traumatic coma]. / Valeur diagnostique et pronostique des réflexes du tronc cérébral dans les comas post-traumatiques graves.

Authors study the neurological evolution of 50 cases of traumatic coma and recognize 5 misfunction levels corresponding to five steps of rostrocaudal deterioration. The level 1 (cortico-sub-cortical) is defined by the persistence of the mimic and flexion response to painful stimulation. The level 2 (diencephalic) is characterized by stereotypic responses to pain and lack of mimic. At these two levels, the fronto-orbicular and vertical oculo-vestibular reflexes are persistent. These reflexes disappear when the status impair caudodal to the level 3 (meso-diencephalix junction). The photomotor reflex disappear at the level 4 (mesencephalic), where the motor response to pain may be very poor, or may be a bilateral extension. The horizontal oculo-vestibular reflex is always persistent, except for the level 5 corresponding to a pontine lesion. The meso-diencephalic level 3 appears to be a critical impairment point: as long as the level is not overpassed, the half of the patients do improve and 10% only die. More than 75% of those who improve from this level have an excellent recovery. The restructuration probability is diminished by the half when the level of mesencephalic misfunction is reached.