Determination of human liver cytochrome P-450 by electron paramagnetic resonance of liver biopsies.

Human liver cytochrome P-450 level has beenen determined by direct electron paramagnetic resonance spectroscopy at 77 degrees K of liver specimens obtained by surgical biopsy. A preliminary experiment with rat livers was performed in order to calibrate the intensity of the cytochrome P-450 EPR signal as a function of the cytochrome concentration obtained by the classical spectrophotometric method. 44 subjects have be examined. We found a cytochrome P-450 value of 21.5 plus or minus 11.2 nmoles per gram of liver in normal subjects. Variations of this level in some pathological liver states are discussed.

[Viral hepatitis in patients over 60 years of age. Clinical, etiologic and developmental aspects]. / Les hépatites virales après 60 ans. Aspects cliniques, étiologiques et évolutifs (78 cas).

The authors report a retrospective study of 78 cases of acute viral hepatitis observed from 1971 to 1985 in patients over 60. Viral hepatitis involved males as often as females. A, B, delta and non-A, non-B viruses were responsible for 11.5, 23.1, 5.1 and 60.3 p. cent of cases, respectively. From 1975 on, the frequency of non-A non-B viral hepatitis has reached 85 p. cent while blood transfusions appeared as the most important route of transmission. Outcome was severe in 10.3 p. cent of cases. Early in the course of disease, the risk of progression to cirrhosis was obvious and concerned 12 patients (1 out of 18 with B hepatitis, 3 out of 4 with D hepatitis, 8 out of 47 non-A non-B hepatitis). The long term prognosis (from three to five years) was not as poor as stated in previous studies.

[Effect of enprostil on the healing and the recurrence of duodenal ulcer. Comparison with ranitidine]. / Effect de l'enprostil sur la cicatrisation et la récidive des ulcéres duodénaux. Comparaison à la ranitidine.

Enprostil, a synthetic prostaglandin E2, has been shown to exert both antisecretory and mucoprotective activity. It is effective in duodenal ulcer healing. OBJECTIVE--This study was performed to compare the frequency and the delay of spontaneous duodenal ulcer relapse during a two-year follow up period after initial healing by enprostil (35 micrograms, twice a day) or ranitidine (300 mg per day). METHODS--This multicentric, double-blind, randomized study included 642 patients (324 in the enprostil group and 318 in the ranitidine group). Patients included in the follow up period were evaluated by an endoscopy at 6 months, one and two years after healing. RESULTS--After a 6 weeks treatment period, healing rate was 85% for ranitidine and 70% for enprostil, respectively (P < 0.001). Adverse effects, especially digestive ones, occurred more often with enprostil than with ranitidine (P < 0.001). After initial healing, there was no significant difference between the 2 groups concerning the cumulative rate of relapse, despite a non significant trend for a milder rate of relapse in the enprostil group (P = 0.08). Twenty-seven % of the patients randomized to treatment (intend-to-treat analysis) in the enprostil group and 29% in the ranitidine group had no ulcer recurrence 6 months after ulcer healing, and respectively 12% and 13% at 2 years (difference not statistically significant). CONCLUSIONS--It is concluded that a) ranitidine is more effective and has less adverse effects than enprostil for duodenal ulcer healing, b) after duodenal ulcer healing by enprostil, there is a non significant trend for a lower rate of relapse than after healing with ranitidine, c) there is the same proportion of patients without ulcer in the 2 groups after 6 months and 2 years.

[Variations of plasma gastrin (basal and postprandial) in ththtreatmentof duodenal ulcer with either enprostil or ranitidine. Correlations with rates of relapse]. / Variations de la gastrine plasmatique (basale et post-prandiale) au cours de traitements de l'ulcère duodénal par l'enprostil ou la ranitidine. Corrélations avec les taux de rechute.

Enprostil, a synthetic E2-prostaglandin efficacious for duodenal ulcer healing, presents both antisecretory and antigastrinic effects. This is at variance with the elevation of plasma gastrin observed with ranitidine. OBJECTIVE--This leads us to compare enprostil and ranitidine on the following points: a) variations of plasma gastrin (basal and postprandial) parameters over a 6-week conventional treatment; b) correlation studies between ulcer relapses (frequency and temporal evolution) after treatment discontinuation and various gastrinic criteria. METHODS--Among a group of 642 patients followed for ulcer relapse, 165 were considered for gastrin (78 of the "Enprostil" group and 87 of the "Ranitidine" group). RESULTS--Initially, both populations were comparable for clinical and plasma gastrin parameters. After 6 weeks of treatment, the increases in the various gastrin parameters (basal, postprandial, peak, integraded) were significantly greater and the absolute values higher (Wilcoxon, P < 0.001) with ranitidine than with enprostil. No correlation was found between relapse occurrence after drug discontinuation and these gastrin parameters. CONCLUSIONS--Ranitidine hypergastrinemia seems directly related to gastric hyposecretion whereas its absence with enprostil is likely more dependent upon a specific antigastrinic activity than on a reduced antisecretory activity. Those differences in mechanism of action have no consequence on the stability of ulcer obtained by either drug.

[Hepatic amebiasis: study of 152 cases]. / L'amibiase hépatique: étude de 152 observations.

The purpose of this study was to describe and analyse retrospectively the clinical, serological, anatomical and evolutive features of 152 cases of hepatic amebiasis in young adults, treated and followed up in France from 1969 to 1983. The disease was revealed 3 times out of 4 by tender hepatomegaly with fever, but only in 6 cases by complications. Serological tests (immunofluorescence or hemagglutination) were always positive for amebiasis, whereas Entamoeba histolytica was absent from stools in 96.7 p. 100 of the cases. Hepatic amebiasis always caused a hepatic abscess: in these cases, the superiority of ultrasonography over all other diagnostic methods was confirmed, especially concerning the detection of multiple abscesses (47 p. 100). Complete recovery was obtained by medical treatment in 117 cases, either alone (98 cases), or combined with needle aspiration (19 cases). Nitro-imidazoles are the simplest treatment, but nevertheless in 5 cases they were not effective. These patients were then treated with dehydroemetine, associated in 2 cases with surgery. Four patients relapsed at mid or long-term after apparent recovery, in the absence of any obvious reinfection. A significant correlation between the course of the treated disease and the size and number of abscesses was demonstrated: it was possible to define a group characterized by a slow and/or complicated course (with single abscess of the right lobe whose diameter is equal to or greater than 10 cm, or multiple abscesses). The pathogenesis of hepatic amebiasis is not yet fully understood.

[Changes in HBs antigen and anti-HBs antibody in 77 patients with acute B-virus hepatitis]. / Evolution de l'antigène HBs et de l'anticorps anti-HBs chez 77 patients ayant une hépatite aiguë due au virus B.

Serum HBs antigen (HBs Ag) and anti-HBs antibody (anti-HBs), as determined by radioimmuno-assay or ELISA methods, were studied in a group of 77 patients with acute icterogenic viral hepatitis over a period of at least three months and correlated to the evolution of the disease either to return to good health or to a chronic state. The cumulative rate of patients in whom HBs Ag had disappeared (n = 53) was a linear function of time during the first sixteen weeks. Correlation seemed even stronger in the subgroup of patients restored to good health before the third month. Time of HBs Ag disappearance ranged from 5 days to 5 months in common forms of hepatitis. There was no evident correlation between the time of disappearance and the normalization of ALAT levels. Among the four cases of chronic persistent hepatitis, three had no detectable antigenemia six months later. Development of anti-HBs preceded the loss of HBs Ag in one case, was simultaneous or posterior to it in all other cases; the absence of any serologic HBV marker could last up to 4 months. No chronological link was found between seroconversion and normalization of ALAT levels. The correlation between time and HBs Ag disappearance from the blood could be specific for a given group of patients placed under specific conditions; its determination might help in understanding the factors that influence the course of the disease.

[Neuropathy in long term treatment with metronidazole (author's transl)]. / Polynévrites au cours des traitements prolongés par le métronidazole.

Two patients developed a sensory neuropathy while under treatment with Metronidazole for Crohn's disease. Recovery took place within a few months after drug withdrawal but was still incomplete in one patient one year after cessation of Metronidazole intake. The incidence of neuropathy appears to be high in long term use of this drug. The morphological study of a sural nerve biopsy showed a severe loss of myelinated fibers (1 800 par mm2). Quantitative teased fibers preparation showed that 56 per cent of the fibers were undergoing wallerian degenerations ; segmental demyelination with subsequent remyelination was found in 4 per cent of the fibers and seem to be secondary to axonal involvement.

[Yellow nail syndrome with chylous effusions]. / Syndrome des ongles jaunes avec épanchements chyleux.

Yellow nail syndrome is characterized by a yellow discolouration of the nails associated with idiopathic lymphoedema and pleuropulmonary manifestations. Pleural effusions are usually of the exudate type with a normal lipid content. The case reported here of a 74-year old man who had yellow nails together with chylothorax and chylous ascites provides an opportunity to discuss the origin of these rare effusions which, like the syndrome itself, were most probably due to primary abnormalities of the lymphatic system.

[Ultrasonographic appearances of hepatic amebic abscesses. Findings in 22 cases]. / Aspects échographiques des abcès amibiens du foie. A propos de 22 cas.

Ultrasonographic findings in 22 patients with hepatic amebic abscesses are described. All patient were febrile, complained of pain in the liver region, and had a raised ESR with polymorphonucleosis, and enhanced immunofluorescence or hemagglutination. Initial ultrasonography demonstrated a preferential site for the lesion in the right side of the liver, with three non-specific types of image. Indirect signs and the severity of the disease could be determined. Patients were followed up during specific treatment with metronidazole by means of clinical, biological, and ultrasonographic examinations, confirmation of healing depending entirely upon clinical evidence of absence of hepatic signs. Three types of healing, as shown by ultrasonography, are described: the homogeneous hypoechogenic form, known as the slow healing form, can raise ultrasonographic diagnostic difficulties. Apart from routine straight radiography of the chest and abdomen, ultrasonography was, in the majority of cases, the only radiological examination conducted, even in cases of recurrence or relapse; it enables the puncture to be controlled directly. Scintigraphy and scanning were rarely employed, except when ultrasonography was ineffective, and arteriography was reserved for certain very particular differential diagnosis problems. An algorithm, employed for facilitating diagnosis of hepatic amebic abscesses, emphasizes the primary role played by ultrasonography.

[Disseminated Histoplasma duboisii histoplasmosis in a female inhabitant of the Ivory Coast]. / Histoplasmose disséminée à Histoplasma duboisii chez une Ivoirienne.

The authors describe a disseminated multivisceral form of african histoplasmosis due to H. duboisii in a 45 years old black woman. Clinical examination shows characteristic lesions of skin, bones and lymph glands. Lymphography reveals lesions of deep lymph glands and laparascopy lesions of liver and spleen. First untimely stopped, treatment was started again with ketoconazole. 20 months later, the course of the disease is, as for as we can appreciate it, favourable.

[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.

[Hepatic amebiasis in France. Apropos of 152 case reports]. / L'amibiase hépatique en France. A propos de 152 observations.

The authors report upon 152 cases of hepatic amebiasis (H.A.) observed in France between 1969 and 1983, among young european men (average age 29,2) who were hospitalised in the initial phase of their illness. H.A. was clinically revealed through a painful and febrile hepatomegaly in 3/4 cases and in 6 cases through complications. No chronic form was observed. The amebic serology (I.F.I. and/or H.A.P.) was always positive. The research of an intestinal portage of the parasite was generally negative. The hepatic functions were impaired in the third of the cases. Whichever technique was employed, the anatomic diagnosis has always been made in a phase of intra hepatic collection. The superiority of echotomography over other methods is confirmed (especially for diagnosis of multiple abscess: 47% of success). All patients recovered, most frequently through medical treatment (117 cases). The nitro-imidazoles (1,5 to 2 g per day during 7 to 14 days) remain the prefered treatment, but they are responsible for 5 failures which were overcome by emetine. On the other hand, 4 patients had, after being cured, showed middle and long term relapses without patient recontamination. The evolution of the treated H.A. is significantly correlated to the importance and/or the multiplicity of the liver collection: the voluminous abscess of the right lobe being the most potentially dangerous. The pathogenesis of the H.A. remains imperfectly known. The different clinical aspects which have been found, depend upon the preexistant immunity of the patient and could also be equally associated with a pathology of complex immunity systems.

[Aspects of viral hepatitis in patients over 60 years of age]. / Aspects des hépatites virales chez les malades de plus de 60 ans.

78 acute viral hepatitis (VH) cases were seen from 1971 to 1985 in patients over 60. Virus A, B, B-Delta and non-A, non-B are, respectively, responsible for 11.5, 23.1, 5.1 and 60.3% of the cases. Severe outcome occurs in 10.3%. Early in the course of VH, the risk of progression to cirrhosis concerns 1/18 VHB, 3/4 VHD, 8/47 VH NA NB. But the long-term prognosis is not so poor as stated in previous studies.

[Acute form of primary bilharziasis]. / Formes aiguës de primo-invasion bilharzienne.

Acute schistosomiasis is observed in subjects with primary infestation, Schistosoma mansoni and S. japonicum being the responsible parasites in the vast majority of cases. The disease occurs between 2 weeks and 6 months from the first infesting bath and presents as fever with cutaneous, pulmonary and gastrointestinal manifestations. Eosinophilia is frequent. The diagnosis is made by serological tests. Myelopathies are rare and may leave severe sequelae. Treatment rests on praziquantel combined with a short course of corticosteroid therapy.