Regulation of ProMMP-1 and ProMMP-3 activation by tissue factor pathway inhibitor-2/matrix-associated serine protease inhibitor.

Tissue factor pathway inhibitor-2 (TFPI-2)/matrix-associated serine protease inhibitor (MSPI), a 32- to 33-kDa Kunitz-type serine protease inhibitor, inhibits plasmin and trypsin. Because plasmin and trypsin are involved in the activation of promatrix metalloproteases proMMP-1 and proMMP-3, we investigated the role of TFPI-2/MSPI in the activation of these proenzymes. Both plasmin and trypsin activated proMMP-1 by converting the 53-kDa proenzyme to the partially active 43-kDa polypeptide; this activity was inhibited by TFPI-2/MSPI. Similarly, TFPI-2/MSPI inhibited the conversion of 66-kDa proMMP-3 to the activated 45- and 30-kDa polypeptides by plasmin and trypsin. Because plasmin is involved in the physiological activation of proMMP-3, we tested whether TFPI-2/MSPI inhibits the activation of proMMP-3 by HT-1080 fibrosarcoma cells and urokinase-charged HeLa cells. We found that the inhibitor inhibited proMMP-3 activation by HT-1080 cells and urokinase-charged HeLa cells. Collectively, our results suggest that TFPI-2/MSPI indirectly regulates MMP-1- and MMP-3-catalyzed matrix proteolysis by regulating the activation of proMMP-1 and proMMP-3.

Small bowel obstruction due to disease of epiploic appendage.

Primary disease of an epiploic appendage is rare. Small bowel obstruction is an unusual complication of such disease due to bands or adhesions caused by torsion or inflammation. A 49-year old man presented with small bowel obstruction and was found to have a band from a necrotic epiploic appendage adherent to mesentery, obstructing the ileum. The band was released and the epiploic appendage removed.

Endoscopic diagnosis of aortoduodenal fistula. Complication of abdominal aortic by-pass grafts.

If not treated promptly, gastrointestinal bleeding due to aortoduodenal fistulas is a fatal complication. Preoperative endoscopic diagnosis is a valuable addition. We present two cases with endoscopic findings and a brief review of aortoduodenal fistula.

Possible association between peliosis hepatis and diethylstilbestrol: Report of two cases.

In the two cases presented here, peliosis hepatis occurred after prolonged administration of diethylstilbestrol for treatment of prostatic carcinoma. Hepatic dysfunction has not been reported in previous trials of this drug, and further study is needed to confirm an association between diethylstilbestrol and peliosis.

Case report: primary actinomycosis of external oblique muscle.

A 67-year-old man had actinomycosis with primary involvement of the abdominal wall, which is rare. His chief complaint was an enlarging, hard, nontender mass in the right lower quadrant of the abdomen. The mass had been present for two weeks and measured 11 X 8 cm. An x-ray film of the chest, barium studies of the gastrointestinal tract, and an intravenous pyelogram showed no abnormalities. Excisional biopsy was performed, and the findings were consistent with Actinomyces israelii infection. There was no evidence of underlying bowel disease or break in continuity of the mucous membrane. The patient responded well to a three-month course of penicillin therapy.

Fulminant hepatic failure associated with methyldopa.

A patient with fatal submassive hepatic necrosis after methyldopa is described. Patient had positive L.E. cell preparation. The literature and the two previous cases of submassive hepatic necrosis were briefly reviewed. Methyldopa occasionally produces severe hepatitis, chronic active and rarely submassive necrosis.