Extracellular fibrinogenolytic enzyme of Aspergillus fumigatus: substrate-dependent variations in the proteinase synthesis and characterization of the enzyme.

To get a better understanding of the role of the previously reported fibrinogenolytic enzyme of Aspergillus fumigatus, we investigated the in vitro conditions of enzyme synthesis and attempted to characterize it. Modification of the nitrogen source did not influence the extracellular serine-proteinase profile, but resulted in important quantitative differences in the yields in batch cultures. The enzyme synthesis appeared to be an inducible phenomenon in A. fumigatus since it was initiated exclusively in the presence of proteins or protein hydrolysate. Free amino acids or inorganic nitrogen compounds could not promote significant enzyme production. Moreover, peptone at a concentration of 0.1% appeared to be the best inducer of enzyme synthesis. Conversely, modification of the carbon source did not affect fungal growth or enzyme synthesis. However, the production of chymotrypsin was highly sensitive to the carbohydrate level in the culture medium and, with peptone as nitrogen source, highest yields were obtained in the presence of 0.3 or 0.5% glucose. Culture filtrates of A. fumigatus CBS 113.26 grown with peptone or nitrate as nitrogen source were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Comparison of the protein patterns suggested for the proteinase a molecular mass of 33 kDa which was confirmed by chromatographic purification of the enzyme through (N alpha-CBZ)-D-phenylalanine agarose.

Prevention of recurrent variceal bleeding in alcoholic cirrhotic patients: prospective controlled trial of propranolol and sclerotherapy.

We conducted a prospective randomized controlled study to evaluate the effectiveness of propranolol and sclerotherapy, compared to a control group, in the prevention of variceal rebleeding in alcoholic cirrhotic patients. Among the 79 patients included, the distribution of patients according to Child-Pugh classification was: A, 22%; B, 40%; and C, 38%. Propranolol was given twice daily with a mean final dose of 54 +/- 16 mg/day, this resulted in a mean reduction in resting heart rate of 26 +/- 7%. Sclerotherapy was performed weekly using 1% polidocanol. End points were rebleeding or death. During the mean follow up of 19 +/- 16 months, 43 patients bled and 22 patients died. The cumulative percentages of patients free of rebleeding at 1 year were: propranolol, 81% (95% confidence interval (CI): 63-92); sclerotherapy, 64% (95% CI: 45-82); control, 54% (95% CI: 36-71); these differences did not reach statistical significance. The cumulative percentages of patients alive at 1 year were: propranolol, 92% (95% CI: 76-98); sclerotherapy, 79% (95% CI: 58-91); control, 81% (95% CI: 60-93); these differences were not statistically significant. Alcohol withdrawal, which occurred in 66% of patients, was an independent predictive factor associated with a decreased risk of rebleeding or death. In conclusion, a life table analysis of patients free of rebleeding, as well as of patients surviving, revealed a tendency in favour of propranolol. The lack of a statistical support for these two favorable effects could be due to poor statistical power.(ABSTRACT TRUNCATED AT 250 WORDS)

[Abnormalities of the intrapetrous internal carotid artery]. / Anomalies de la carotide interne intra-pétreuse.

The abnormalities of the internal carotid artery along its intrapetrosal course are infrequent, but they are interesting because of the etiological hypotheses that must be put forward and because they sometimes have extremely serious consequences if middle ear surgery is performed without a preliminary study of the anatomy and vasculature of this region. No statistics likely to produce accurate guidelines are available at present, as the literature has reported too few cases. After attempting to explain these aberrant variations on the basis of anatomical and embryological considerations, we describe one case encountered in the ENT department of Brest University Hospital, then discuss it according to the data provided by the literature.

[Clinico-immunological profile of hepatic and extrahepatic diseases accompanied by anti-mitochondrial antibodies]. / Profil clinico-immunologique des affections hépatiques et extra-hépatiques s'accompagnant d'anticorps anti-mitochondries.

In a 13 year retrospective study mitochondrial antibodies were found in 1.71 p. 100 of patients about 60 years old with a strong female predominance. The presence of these antibodies was associated with a significantly increased level of the three classes of immunoglobulin and a marked cholestatic syndrome. In 76.9 p. 100 of cases the antibodies were associated with hepatic disease, mainly of immunological origin (67.7 p. 100). Primary biliary cirrhosis was the most frequent with significantly increased levels of mitochondrial antibodies, immunoglobin M, alkaline phosphatase and cholesterol. However, there was no correlation between the antibody levels and the clinical, biological and histological stages, thus ruling out any prognostic significance. The use of human cultured cells in the antibody detection assay increased the positivity of antinuclear antibodies compared with assays using classical rat liver substrates. Six sera were positive for anticentromere antibodies: 5/6 showed signs of the CRST syndrome with a primary biliary cirrhosis in 3/5 cases. The frequency of the association of primary biliary cirrhosis and other autoimmune diseases supports the results of previous reports as well as the finding of an association between mitochondrial antibodies and other auto-antibodies. In 3 cases primary biliary cirrhosis was associated with a chronic pancreatitis, suggesting a pluriglandular sicca syndrome, and in 3 other cases with a monoclonal IgA gammopathy. Mitochondrial antibodies are associated with other auto-immune non-hepatic diseases in 15.4 p. 100 of cases. The presence of increased levels of mitochondrial antibodies without any other auto-antibody associated with a chronic non-surgical cholestasis and an increased level of immunoglobulin M is still strongly suggestive of primary biliary cirrhosis.

[Leukemoid eosinophilic reaction in angioimmunoblastic adenopathy]. / Réaction éosinophile leucémoïde au cours d'une adénopathie angio-immunoblastique.

A case of eosinophilic leukemoid reaction is described. This picture is seldom encountered during the course of angio-immunoblastic adenopathy. After reviewing various diagnoses and pointing out similar cases of the literature, the authors discuss the possible pathophysiologic mechanisms of eosinophilia in this disorder.

[Spontaneous intramural hematoma of the esophagus. Apropos of a case]. / Hématome intramural spontané de l'oesophage. A propos d'un cas.

Spontaneous intramural haematoma of the oesophagus is a rare condition which usually produces a clinical picture marked by chest pain, dysphagia and haematemesis of moderate severity. The authors report a new case in a woman aged 70 years, under anticoagulant treatment for viral meningitis and presenting with repeated vomiting. Endoscopy of the upper alimentary tract and oesophageal radiography showed a pseudotumoral appearance of the middle and lower portions of the thoracic oesophagus. Progress was favourable under medical management, with uncomplicated recovery. A review of the 38 cases previously published emphasizes in particular the favourable outcome and the conservative medical treatment of this condition.

[Primary intestinal lymphangiectasis or Waldmann's disease (author's transl)]. / Lymphangiectasie intestinale primitive ou maladie de Waldmann.

The authors report the observation of a primary intestinal lymphangiectasy diagnosed on a young girl sent for isolated edema of her inferior members, recently appeared. Clinical examination was normal. Biology found a low protein rate at 33 g/l and a low lymph rate : 183 L/mm3. Hepatic and renal records were normal. Test to marked albumin asserted the exsudative enteropathy with a fecal radio-activity of 3.6% (N 1%). Biopsy of the small intestines set out lymphangiectasies of the intestinal mucosa. Referring to this observation and to literature date, the authors realise a clinical and physiopathological analysis of Waldmann's disease or primary intestinal lymphangiectasy.

[Amyloid tumors of the lung. Apropos of a new case]. / Tumeurs amyloïdes du poumon. A propos d'un nouveau cas.

The authors report a new case of pseudo-tumoral nodular amyloidosis of the lungs. The amyloid nodules being discovered during a surgical procedure for an adenocarcinoma of the lower oesophagus. The histopathological study of the nodules confirmed their amyloid origin and allowed to precise their histochemical features.

[Unusual digestive manifestations during rheumatoid purpura. Apropos of 2 cases]. / Manifestations digestives inhabituelles au cours du purpura rhumatoïde. A propos de deux observations.

We have observed two unusual forms of rheumatoid purpura with digestive symptoms in two young girls aged 16 years. In the first case, the signs of complete duodenal stenosis led to a surgical operation which led to the discovery of an infiltrated mesenteric band of adhesions containing numerous lymph nodes, with on the oedematous loops of small intestine, numerous ecchymoses. In the second case, the duodenal-jejunal radiological abnormalities suggested protein-losing enteropathy. especially as this patient like the first, had major hypoproteinemia without albuminuria. The Cr51 radioisotope test confirmed this quite exceptional diagnosis in this disease.

[Extrinsic compression of the celiac trunk by the arcuate ligament of the diaphragm. Apropos of 5 cases]. / Compression extrinsèque du tronc coeliaque ligament arqué du diaphragme. A propos de 5 cas

The authors report 5 cases (3 women and 2 men) of extrinsic stenosis of the coeliac axis by the arcuate ligament of the diaphragm. In one of the latter, the stenosis of the coeliac axis was associated with chronic calcific pancreatitis. These 5 patients were operated on. Division of the arcuate ligament gave on the whole very favourable results. (3 excellent results, one good and one average result). The authors then recall the clinical, angiographic and pathogenic data in this disease which remains exceptional. The diagnosis should be made and operation decided only after a fairly long period of observation during which one has elimiatned the diagnoses of gastro-intestinal, gall bladder, pancreatic and above all psychiatric disease by endoscopy, radiography and symptomatic medical treatment.