Interaction of steptolysin O with sterols.

A quantitative study of the specific inhibitory power of cholesterol and other sterols on the hemolytic properties of streptolysin O is reported. This streptococcal exocellular protein is a cytolytic toxin which disrupts cytoplasmic membranes of eukaryote cells. The structural characteristics, particularly the stereochemical ones required for a steroid molecule to inhibit the cytolytic activity of streptolysin O, have been investigated in detail. By immunodiffusion techniques, in agar gel plates or tubes containing sterols, the formation of hydrophobic complexes between streptolysin O and inhibitory steroids, but not non-inhibitory steroids except lanosterol, is shown. Upon interaction with inhibitory steroids streptolysin O loses its immunoreactive properties towards neutralizing and precipitating homologous antibodies. An interpretation of the mechanism of biomembrane disorganization by streptolysin O is discussed in the light of its steroid binding properties.

[Role of vitamin deficiency in pancytopenia in Djibouti. Findings in a series of 81 consectutive patients]. / Place des étiologies carentielles dans les pancytopénies à Djibouti a propos de 81 patients consécutifs.

The purpose of this study of patients with pancytopenia in Republic of Djibouti was to identify etiologic factors and attempt to define diagnostic and therapeutic strategies adapted to local conditions. Clinical, biological and radiological assessment was performed in 81 patients hospitalized for pancytopenia. There were 56 men and 25 women. Mean hemoglobin, leukocyte and platelet rates were 56,5 +/- 22,7 g/l, 2,1 +/- 0,7.g/l and 56,2 +/- 24,7 g/l respectively. Vitamin deficiency was the most common cause of pancytopenia (49%), followed by hypersplenism (9%), HIV infection (6%) and leishmaniasis (6%). Vitamin-deficient patients had significantly more severe anemia and thrombopenia and significantly higher mean corpuscular volume than patients with pancytopenia related to other causes. Hemoglobin rate lower than 40 g/L and platelet rate lower than 35 G/L showed a positive predictive values of 90% and 100% respectively for a vitamin deficient pancytopenia. Vitamin deficiency is the most frequent etiology of pancytopenia and causes the most severe cytopenia in Djibouti. Rapid vitamin supplementation after minimal etiologic assessment including a myelogram is an effective treatment strategy for this public health problem.

Matrix metalloproteases are involved in granuloma-induced cartilage degradation.

The aim of this study was to test the role of matrix metalloproteases (MMP) in the in-vivo degradation of an implanted cartilage, using the modified mouse air-pouch model. Rat femoral-head cartilages were wrapped in cotton and implanted in 6-day-old mouse air-pouches. The mice were killed and the pouches opened 4, 7, 14 and 21 days after implantation. At each time the cartilages were removed and their contents of sulfated proteoglycan and collagen were determined. The collagenolytic activity of the pouch granulation tissue was measured, using a synthetic substrate. The implanted cartilage was found to be degraded, as previously described by Bottomley et al. (1988). The disappearance of proteoglycan and collagen began at days 4 and 7 respectively and increased progressively until day 21. An EDTA-inhibited collagenolytic activity was detected in the granulation tissue, and this increased from day 4 to day 21. These results demonstrate a progressive increase in the collagenolytic activity of the mouse air-pouch granulation tissue with a parallel loss of the matrix-macromolecules content of the implanted cartilage. The characterization of the metalloproteases involved is in progress.

Gelatinase is the main matrix metalloproteinase involved in granuloma-induced cartilage degradation.

This study was performed to characterize the matrix metalloproteinases (MMPs) produced during the degradation of cotton-wrapped cartilage, implanted into the murine air pouch. One, two or three weeks following cartilage implantation, proteins were extracted from the granulation tissue and MMP activities were measured. Although collagenase-, gelatinase- and stromelysin-like activities were detected at each time point, gelatinase activity was by far the most prominent. These enzymes were inhibited by EDTA, but not by NEM or PMSF, indicating that these proteinases were metalloproteinases. Gelatin zymography revealed several lysis zones amongst which a major 92-kDa band shifted to 83- and 68-kDa species during the course of implantation. The emergence of these species coincided with enhanced gelatinolytic activity and collagen loss from the implanted cartilage.

[Hodgkin's disease in French Polynesia. 7 cases observed at the Territorial Hospital Center from 1985 to 1990]. / La maladie de Hodgkin en Polynésie Française. A propos de 7 cas observés au Centre Hospitalier Territorial de 1985 a 1990.

Seven Polynesians suffered from Hodgkin's disease were admitted in the territorial Hospital Center in 6 years. They came from different Polynesian archipelagos. Three of them are 30 years old and 3 are 40 years old. Diagnosis is based on an histological test, but has to be confirmed by a center specialized in lymphomae investigations since a scanner has been installed at the Territorial Hospital Center of Papeete (March 1987) results are satisfactory: echography and abdominal scanner lymphography and thoracic scanner osteoma medullare biopsy and liver biopsy puncture. Six patients presented a diffuse lesion (III B or IV) and one an intermediary phase (II B2). Treatment started by chemotherapy MOPP and ABVD alternatively. Four patients out of seven did not continue their treatment up to the end; one patient aged 34, after six treatments by MOPP and a recovering treatment by MIME got an autograft of bone marrow in Paris in October 1989, and he is actually in a good shape. Most of the patients are out of control. Application of complex therapeutic protocols during several months and inducing side effects, demands a large agreement of both patients and relatives. That is very rarely got nowadays.

[Study of hyperuricemia in Tahiti. 31 cases hospitalized at the Territorial Hospital Center in Papeete (Tahiti)]. / Etude de l'hyperuricémie à Tahiti. A propos de 31 cas hospitalisés au centre hospitalier territorial de Papeete (Tahiti).

Frequency of gout in French Polynesia has induced us to define a type of "hyperuricemia Polynesian" from a population of patients admitted in a general Medicine Ward. Each admitted patient gets immediately a blood check-up. A figure higher than 70 mg/l in male and 60 mg/l in female is considered as pathological. In such a case, uricemia and uraturia are tested every 24 h for three days and we consider the mean value of these three tests. On the other side, some admitted patients non-hyperuricemic, are examined according to the same protocol. So, we have two groups: 31 hyperuricemics and 20 non-hyperuricemics, secondarily grouped according to age, sex, ethnic. We did not consider some secondary causes of hyperuricemia (chronic renal insufficiency diuretic treatment, psoriasis etc.). 1. Within the hyperuricemic population, mean uricemia is 85.35 mg/l versus 52.65 mg/l in the second sample. In the hyperuricemic group (21 males and 10 females) 48% are gouty and 13% of them are females. Articular manifestations are acute arthritis, affecting mainly inferior limbs, ankles, knees). We did not notice any significant divergence between uricemia and uraturia of gouty and non gouty people. Within the group of gouty people, percentage of individual hyper excretion is 53% (uraturia greater than 600 mg/24 h) with no significant divergence with the non-gouty group: Nephrolithiasis is rare (3%). There is no significant divergence between urinary pH of gouty and non-gouty people. Associated metabolic troubles are: diabetes (26%) high triglyceridemia (43%) three syndromes associated together (hyperuricemia + diabetes + hypertriglyceridemia) in 19.5%, total cholesterol is normal (2.07 g/l) but a low cholesterol (0.30 g/l).(ABSTRACT TRUNCATED AT 250 WORDS)

[Parietal fibroplastic endocarditis]. / L'endocardite pariétale fibroplastique.

Parietal fibroplastic endocarditis is commonly observed in two main diseases: Löffler' endocarditis and Davies' endomyocardial fibrosis. Endocarditis' damage is explained by the cytolytic effects of basic proteins present in eosinophil granules (major basic protein and cationic protein); long standing and amount of eosinophilic cells condition anatomic lesions. The clinical features are explained by the ventricular seat of endocarditis lesions (right, left, or both). They include in all cases: tricuspid and/or mitral insufficiency, adiastolic syndrome. Two-dimensional echocardiography has improved the diagnosis; ventricular angiocardiography remains the reference examination. Prognosis has been largely improved these recent past years by surgical endocardiectomy and valvular conservative surgery among children.

[Psychological follow-up of 52 patients in an internal medicine service at the Territorial Hospital Center of Papeete (Tahiti)]. / Suivi psychologique de 52 patients dans un service de médecine interne du centre Hospitalier Territorial de Papeete (Tahiti).

This prospective study of a duration of 7 months was made on 52 patients admitted in a International Medicine Service and watched over psychological aspect. The sample was composed mainly of Polynesians, two third of them being females. On the somatic aspect, the complaint more frequently recorded is a painful condition. Diagnosis of depressive status is made about almost half of the patients. The most obvious point is that Polynesian depressive patients are young and they expressed their profound discomfort not only by a suicidal attitude but also by a symptomatology in which body, body surface are the privileged significants.

[Epidemiologic aspects of 42 cases of human brucellosis in the Republic of Djibouti]. / Aspects épidémiologiques de 42 cas de brucellose humaine en République de Djibouti.

Brucellosis is an ubiquitous anthropozoonoses in the Republic of Djibouti, but it has only been studied in the City of Djibouti. This retrospective study of 42 cases of human brucellosis diagnosed between April 1993 and April 1995 was carried out at the Peltier Hospital in Djibouti to obtain epidemiological data concerning brucellosis in the Republic of Djibouti. Diagnosis was based on clinical symptoms and positive immunologic tests (Rose Bengal test > 100 UI and Wright serology > 1/80). The following information was obtained for each patient: nationality, ethnic origin, place of residence, age, sex, and risk factors for exposure to infected animals or products. There were 30 men and 12 women including 38 Djiboutis, 3 Somalis, and 1 Ethiopian. Ethnic origin was Afar in 32 cases, Somali in 6 cases, and undetermined in 4 cases. Mean age was 31.6 years. Of the 38 Djiboutis, 15 lived in the district of Djibouti, 17 in the district of Tadjourah, 3 in the district of Obock, and none in districts located in the Southern part of the country. In 18 cases brucellosis involved cattle raisers from the Northern part of the country. In five cases no risk factor could be identified. The incidence of brucellosis in the Republic of Djibouti appears to be comparable to that observed in other highly endemic countries. Further study is needed to determine the exact incidence in man and animals and ascertain the need and feasibility of preventive measures.

[Management of an isolated thyroid nodule or a heterogeneous nodular goiter, when thyroid scintigraphy is not available (Tahiti)]. / Conduite à tenir devant un nodule thyroïdien isolé ou au sein d'un goître multi-hétéro-nodulaire. Quand on ne dispose pas de scintigraphie thyroïdienne (Tahiti).

Thyroidal nodes (non-cystic) always put forward some difficult decision. As a matter of fact, it would not be reasonable to undergo each time a surgical operation, but it would be catastrophic to abstain wrongly. When scintigraphy and mainly cyto-puncture are feasible, so a coherent decision can be taken. When they are not possible and when only ultrasonography is available, we propose that a decision be taken according to a comprehensive approach although each argument being individually disputable.

[The non-insulin-dependent diabetic (type II) in Tahiti]. / Le diabète non insulinodépendant (type II) à Tahiti.

The authors report on the monitoring in the Diabetology Service of the Territorial Hospital Center of Papeete (French Polynesia) of 51 Polynesians, diabetics non insulin-dependent over periods of 12 to 30 months (average 26.5 months) from July 1988 to December 1991. 31 males and 20 females (sex-ratio 1.5). Mean age: 55.9 (extremes: 22 and 76 old years). Non insulin-dependent diabetes risk factors: heredity (43%), obesity (67%), new-born babies with a weight more than 4 kg (10%). Revealing factors of diabetes: systematic check-up (37%), clinical complications (36%), cardinal signs (20%). Recorded complications are: 1. microangiopathy: nephropathy (25%) including 7 renal insufficiency and 2 patients under dialysis; retinopathy (29%); 2. macroangiopathy: cardiovascular accident 1 case; angor 4 cases; obliterative arteritis of inferior limbs 5 cases; 3. neuropathy 9 cases (17%); 4. high arterial tension 55%; 5. metabolic complications (20%): 4 acidocetosis; 2 hyperosmolar coma; 4 severe hypoglycemia; 6. 16 diabetic feet (32%) among them 8 amputations; 7. 45 infectious complications in 27 patients are reviewed. Review of the complications according to diseases ancientness; before 10 years of evolution, each patient suffered of at least one complication, after 10 years, each patient got an average of 2 complications. Review of diabetic balance: 80% of the patients present a mean glycemia greater than 1.50; 54% present a postprandial glycemia greater than 2 gr. and 34% a A1 C Hb greater than 9%. The possible treatments are reviewed. During this monitoring, mortality was one case; 35 patients were admitted totaling 881 days of hospitalization.

[Epidemiological surveillance of infection by the human immunodeficiency virus (HIV) and of the acquired immunodeficiency syndrome (AIDS) in French Polynesia in 1991]. / Surveillance épidémiologique de l'infection par le virus de l'immunodéficience humaine (VIH) et du syndrome d'immunodéficience acquise (SIDA) en Polynésie Française en 1991.

The authors make out a statement about HIV infection in French Polynesia at the date of 1991 December 31. 96 cases all together of seropositive and AIDS infected people were recorded. These patients are young generally (78 p.c. between 21 and 40 years old) sexually contaminated (72 out of 96) and live in Tahiti island (94 p.c.). Sex-ratio is 2.8 male/1 female. Among them, we noted 55 p.c. of Europeans, 38 p.c. of Polynesians and 7 p.c. of Asiatic people. Epidemiological monitoring of the infection was made easy because of a set of laws and possibilities of detection highly favourable. Progress of the infection is constant, with 20 new cases detected each year with a prevalence of 150 cases of AIDS per 1 million of inhabitants, French Polynesia could be classified as the 5th or 6th region of France as far as the importance of the disease. Clinical, biological and epidemiological taking of charge of patients is detailed as well as the prevention campaign.

PIP: Serological surveillance of HIV infection in accordance with World Health Organization guidelines has taken place in French Polynesia since 1985. 20,000 tests are conducted annually in a population not exceeding 200,000. 30% of tests are among blood donors. An average of 20 new cases of HIV infection are diagnosed each year. A total of 96 cases of HIV infection or AIDS were reported to the public health authorities between 1985 and December 31, 1990. 78% of the 96 persons were aged 21-40 years. The sex ratio was 2.8 men per woman. 55% were in Europeans (53 cases among 24,000 European residents), and 7% were in Asians (7 cases among 10,000 Asians). 94% of the patients were inhabitants of Tahiti. 44 of the 96 patients were male homosexuals or bisexuals, 18 were heterosexuals with multiple partners, 13 received transfusions before 1985, 10 were sex partners of seropositive persons, 9 were former addicts, 1 was the infant of an infected mother, and 1 had no known risk factor. ELISA tests were conducted in 6 different laboratories in the island of Tahiti, with confirmation by Western blot at the laboratory of the Louis Mallarde Territorial Medical Research Institute. Contacts are traced and tested, and seropositive individuals are followed regularly, with consultations at 6 month intervals for seropositive persons. Of the 46 patients present in the territory as of December 1990, 36 were at stage 1, 2 at stage 2, 5 at stage 3, and 3 at stage 4 according to the World Health Organization guidelines. 20 of the other 50 had died and 30 left the territory.

[Cerebral vascular accidents in French Polynesia]. / Les accidents vasculaires cérébraux en Polynésie Française.

The authors report on the results of a survey on cardiovascular accidents hospitalized between 01 April 1990 and 31 January 1991 carried out in the Services of Medicine and Cardiology in the Territorial Hospital Center of Papeete. This survey was: 56 cardiovascular accidents: 1/4 (hemorrhagic and 3/4 (42) ischemic. Mean age 59 (extremes 23-86). 36 males (64%); 20 females (36%). 50 Polynesians; 6 Chinese people. Among the risk factors recorded, 38 (68%) were hypertensed patients; 17 (30%) were due to tabagism and 15 (25%) to diabetes; 3 (5%) are known to be carriers of a hypercholesterolemia. 59% of the patients had no case history; 25% the cardiovascular accidents have been observed in patients with cardiopathy; 12.5% are recurrent cardiovascular accidents. Clinically, 5 transient ischemic accidents (12%) out of 42 cardiovascular ischemic accidents. High arterial tension was recognized in 12/14 (86%) of hemorrhagic cardiovascular accidents and in 26/42 (62%) of ischemic cardiovascular accidents. In 42 ischemic cardiovascular accidents, 31 patients suffered from cardiopathy (74%) of which 15 (36%) presented an embolic cardiopathy. Interest of echography and electrocardiogram are discussed. Ultrasonic exam of carotid vessels was found abnormal in almost half of the cases when utilized (12/26). Finally, etiological diagnosis was certain in 17 cases, of presumption in 16 cases, and in 9 cases, it was not possible to precise any cardiovascular etiology. Tomodensitometric tests are discussed. 86% of the ischemic cardiovascular accident were treated with anticoagulants/thrombocyte antiagglutination. 24% of the patients died, 50% recovered incompletely and 26% completely.

[Goiter in Tahiti]. / Le goître à Tahiti.

The authors report on a prospective study about goitre in French Polynesia carried out in 1989, dealing with epidemiology and disease characterization in 39 patients. 1. Epidemiology of goitre in Tahiti; In schools: 517 children (236 boys and 281 girls) aged from 10 to 15. Prevalence rate is 1.55 p.c. (8/517); Adults: 226 adults (112 males and 114 females) aged from 50 to 65. Prevalence rate is 4.42 p.c. (10/226). 2. Case study on 39 Polynesian patients (38 females and 1 male) living in Tahiti (mean age: 35.6 years old) showing euthyroidic goitre, detected from 1989 April 1st and October 31; Goitre did not present in Tahiti any particularity. It is a pathology mainly feminine, at low evolution and late local consequences; In 3/4 of the cases, goitre is visible and more it is voluminous more modules are present; There is no iodine deficiency, and the mean value of iodine excretion (536 mcg/24 h) is very high in comparison with what is described in the literature; Presence of a high thiocyanatemia (greater than 100 mmol/l) is found in 1/4 of the patients; There is no correlation between consumption of foods well-known as cyanogenical ones and the level of thiocyanatemia; There is a correlation between the rate of thiocyanatemia and tabagism.

[Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia]. / Evaluation de l'efficacité du mannitol dans le traitement de la ciguatéra en Polynésie Française.

Up till now, in the French Polynesia and in New Caledonia, people showing ciguatera intoxication receive a standard treatment: calcium + vitamins B6 and C by intravenous way and in addition, some drugs arriving to cure some symptomatic manifestations. In 1988, an investigation carried out in Majuro, Marshall Islands concluded that intravenous mannitol is efficient in the treatment of serious intoxications with suspecting cerebral oedema. Since, such a treatment has been utilized with success in several endemic areas. Our therapeutic evaluation was arrived to determine whether mannitol's efficiency is higher than the standard treatment in the ciguatera intoxications of mean seriousness. This investigation was carried out on two randomized groups: The first one receiving mannitol (250 cc intravenous at 20% injected in 1 h) the second one receiving the standard treatment (intravenous perfusion glucose serum 250 cc with 1 g of vitamins C, 250 mg of vitamin B6 and 1 g of calcium gluconate injected in 1 h). Seriousness of clinical status was evaluated according to a scale of score from 0 to 50, based on the importance of the clinical manifestations paresthesia, aches, asthenia, cardiovascular and digestive signs. Only patients getting a score at least 20 were included in this investigation. Clinical status of each patient was evaluated before any treatment (initial score) at the end of perfusion and at the 24th hour. Efficiency of each treatment respectively was evaluated according to the differences between these three different scores. CHI 2 and U Mann's and Whitney's tests were utilized for the statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of reflex algoneurodystrophies by sympathetic blockade with guanethidine]. / Traitement des algoneurodystrophies réflexes par blocs sympathiques à la guanéthidine.

Reflex sympathetic dystrophy (RSD) can be treated by regional sympathetic blockade with guanethidine. This method was used systematically in 25 patients with post-traumatic RSD of the upper (n = 8) or lower limb (n = 17). Sixty three blocks were performed, each patient receiving 1 to 4 blocks. The results were appreciated by the effects after one month on pain, mobility and trophic changes. They were excellent in 7 cases, good in 4 cases and poor in 7 cases. The results were better in moderate RSD without psychiatric overlay. Thirteen patients were cured after 3 months. Pain decreased significantly 2 days after injection in 28 of the 63 blocks. The effects on mobility and trophic changes always occurred after the analgesic effect. No side effects were observed with the exception of one patient who had a convulsion 2 hours after the injection. These results show that regional sympathetic blockage with guanethidine is useful for the treatment of RSD, especially in its moderate stages. In view of the negligible risks and its efficacy, the authors consider it to be the first line treatment of moderate RSD.

Proteoglycan degrading activity in granulomatous inflammation: comparison between the C57b1/6 and C57bg/bg mouse.

OBJECTIVE AND DESIGN: Proteoglycan (GAG) and collagen are lost from cartilage juxtaposed to murine granulomatous tissue in both control and C57bg/bg (elastase deficient mice). The objective was to extract and characterise proteoglycan degrading activity within granulomas of both strains. MATERIALS: 15 animals (female C57b1/6 and C57bg/bg mice) per group were used. TREATMENT: Cotton-wrapped rat femoral head cartilages were implanted subcutaneously into the dorsum of the mice and the granulomas excised fourteen days later. METHODS: Granuloma and granuloma cell-granule preparations were fractionated within a detergent-based buffer and tested for their abilities to degrade cartilage in vitro in the presence and absence of enzyme inhibitors. Elastase and cathepsin G activities were also assessed using specific substrates. Statistical significance was calculated using Student's t-test. RESULTS: Extracts from both strains induced the loss of cartilage GAG. This was correlated with cathepsin G activity (r = 0.96) and was inhibited by a specific cathepsin-G inhibitor (95%, p < 0.001), but not specific elastase or metalloproteinase inhibitors. Elastase activity but not that of cathepsin G was absent in the beige mice, whilst both enzymes were active in the controls. CONCLUSIONS: It appears that neutrophil cathepsin G may play an important role in the degradation of cartilage proteoglycan in the murine cotton-pellet granuloma in both C57b1/6 and C57bg/bg.

[Articular manifestations of Behçet's disease. Apropos of 65 cases]. / Manifestations articulaires de la maladie de Behçet. A propos de 65 observations.

The authors, in a series of 65 cases of Behçet's disease, notice 53% of rheumatological manifestations which are third in line after aphthosis and ocular disease. In order of decreasing frequency, it concerns arthritis (mono, oligo or poly-arthritis), arthralgias with an almost identical frequency, sacroiliitis, extraarticular involvement. These rheumatological manifestations are readily associated with necrotic pseudo-folliculitis and cutaneous aphthosis.

[Fulminant pneumococcal septicemia in a splenectomized child despite vaccination and chemoprophylaxis: necessity for education of the entourage]. / Septicémie fulminante à pneumocoque chez un enfant splénectomisé, malgré vaccination et chimioprophylaxie: nécessité de l'éducation de l'entourage.

A splenectomized three-year-old developed fulminant pneumococcal septicemia despite immunization and chemoprophylaxis. The course was rapidly fatal. Fulminant pneumococcal septicemia mainly affects splenectomized individuals and is associated with very substantial mortality. Immunization prior to splenectomy and daily prophylactic oral penicillin have partial preventive efficacy. Other useful measures include carrying a health status card and inpatient antimicrobial therapy in the event of fever. The need for these precautions should be repeatedly discussed with the child's parents and physician.