Connective tissue changes in rheumatic heart disease.

The connective matrix of 17 surgically excised mitral complexes from patients with clinical diagnosis of rheumatic carditis was evaluated by semi-quantitative histopathological, immunohistochemical and ultrastructural parameters. Different and concomitant patterns of loose and dense fibrosis were observed with variable constitution and organization of collagen I, III, IV, procollagen III, laminin, fibronectin and elastin. Loose fibrosis exhibited codistribution of all matrix components, Initial phase of fibrosis was characterized by deposition of all matrix components organized in a network pattern. In dense fibrosis a parallel disposition of type I collagen bundles predominated. In the denser (hyalin) fibrosis, the collagen exhibited abnormalities in fiber diameters and in fiber conformation (hyperfibers) and there was reduction or disappearance of other matrix components. The presence of these different kinds of connective matrix and the ultrastructural alterations in collagen fibers are associated to different stages of fibrosis organization and probably reflect changes in collagen susceptibility to degradation. These morphologic patterns may be related to the evolution (stability or reversibility) of rheumatic sequelae.

[Role of Chlamydia trachomatis in tubal pathology (acute salpingitis and tubal sterility). Microbiological study of 175 samples of peritoneal fluid]. / Rôle de Chlamydia trachomatis dans les pathologies tubaires (salpingites aiguës et stérilité tubaire). Etude microbiologique sur 175 liquides péritonéaux.

The study was carried out on 175 patients who underwent laparoscopy together with search for chlamydia in the peritoneal fluid when they were having investigations for sterility or for pelvic pain. These patients are classified into three groups according to the clinical and laparoscopic features: 50 cases of acute salpingitis. 104 cases of tubal sterility and 21 control cases who were normal on laparoscopy. The mean age was 25.7 years for acute salpingitis and 30.4 years for tubal sterility. The purpose of this study was to work out the role played by chlamydia trachomatis in tubal phatology and two techniques were used at the same time: The identification of chlamydia trachomatis in 175 samples of peritoneal fluid taken during a laparoscopy; Research for anti-chlamydia antibodies in serum using an indirect micro-immunofluorescent technique. Cell cultures were performed after the peritoneal fluid had been centrifuged. It had been in transport medium 2 SP and frozen. Our technical methods for isolating chlamydia (microplaque culture on Hela lines, incubation in the presence of cycloheximide and research for chlamydial inclusion bodies using direct immunofluorescence with monoclonal antibodies and 2 successive passages of the cells) have allowed us to confirm that chlamydia was present in 44% of cases of acute salpingitis and in 37% of cases of tubal sterility. The search for anti-chlamydial antibodies in the serum in indirect immunofluorescence with a single antigen (of L2 serotype) gave positive results which were comparable to those in other studies, i.e. 50% of positive serological results in acute salpingitis and 63% in tubal sterility.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of a fast test for direct research on streptococcal group A from pharyngeal samples]. / Evaluation d'un test rapide pour la recherche directe du streptocoque du groupe A dans les prélèvements pharyngés.

Importance of streptococcal pharyngitis rapid diagnosis is increasing. 645 patients with pharyngoamygdalitis were tested. The correlation between bacteriologic culture and rapid test is 86%, the sensibility of the test is 68%, its specificity is 92%, while the predictive positive and negative values are 75% and 90%. These results show the interest of the rapid test for the diagnosis of streptococcal pharyngitis.

Streptococcal group A polysaccharide antibodies assayed by an ELISA determination of antibodies in rabbit hyperimmune sera; normal levels in man and comparison with levels in patients with rheumatic fever and with poststreptococcal glomerulonephritis.

An enzyme-linked immunosorbent assay (ELISA) was adapted to measure antibodies to streptococcal group A polysaccharide. The components of the reaction were studied, including the concentration of the polysaccharide antigen, the suppression of non-specific reactions, optimal conjugate binding conditions and the most suitable plates. The specificity of this test was documented by studies using immune sera and polysaccharide antigens of various groups of beta-hemolytic streptococci. In addition dynamics of the antibody response in animals as well as in man were investigated. The upper limit of normal level of this antibody in normal healthy persons was determined by this technique. We found that 80% of patients with rheumatic fever and acute glomerulonephritis showed an elevation of the group A polysaccharide antibody titer. Determination of this antibody response by the ELISA technique is clinically useful in evaluation patients with the nonsuppurative sequelae of group A streptococcal infections.

[Current aspects of chemotaxis of phagocytic cells]. / Aspects actuels de la chimiotaxie des cellules phagocytaires.

Phagocytic cells, the first host defence against microbial attack, are remarkably mobile; they can move very rapidly to the infectious or inflammatory site. They migrate toward a chemotactic factor: C5a, lymphokines, bacterial products, leukotriene B4, etc. The binding of the chemotactic factor to its specific receptor on the cell leads to an activation of the phagocytic cell: the electric potential of the membrane changes, ionic fluxes and free calcium rate increase, arachidonic acid metabolites are produced, cyclic nucleotides are activated. This produces a change in shape, a polarization of the cell and, after cytoskeleton reorganization, migration of the cell towards the chemotactic factor. A constitutional or acquired abnormality of one of these steps induces a defect of chemotaxis for the phagocytic cells and severe infections.

[Our experience with the determination of serum anti-alphastaphylolysins and antigammastaphylolysins during infectious osteoarthritis. A personal series of 53 staphylococcal osteoarthritis cases, 14 cases of osteoarthritis from various germs, 47 extra-articular staphylococcal infections and 500 control subjects]. / Notre expérience du dosage des anti-alphastaphylolysines et des antigammastaphylolysines sériques au cours des ostéo-arthrites infectieuses.

The difficulty of directly isolating the casual agent (by obtaining specimens in situ or if necessary by hemoculture), during infectious osteo-arthritis and mainly during those deeply located such as spondylodiscitis and sacro-iliac infections, has led authors to investigate the field of serologic examinations. In staphylococcosis, which is quite frequent, they report results of serum anti-alphastaphylolysin dosage (AASTL) in 500 controls, 100 patients in whom a staphylococcus was recovered and 14 patients with other germs. In the first group, 10 subjects out of 500 ad a level greater than 2 IU whereas in the second group an elevation of the level of AASTL was observed in 66% of cases of staphylococcal osteo-arthritis (35 out of 53) and in 54% of cases of staphylococcosis without esteoarticular localization (25 out of 47), a total of 60% of staphylococcosis with various localizations (60 cases out of 100). Despite the elevation AASTL serum in 4 of the 14 cases of the third group, this study confirms the great diagnositc value of this dosage mainly when the levels are higher than 4 IU or are still rising. The recent study of the serum antigammastaphylolysins represent an additional factor of interest because of its reliability and its frequent positive result during staphylococcosis (in 19 cases of osteo-arthritis out of 27, and in 10 cases of staphylococcosis without osteo-articular localization out of 16: a total of 29 cases in a series of 43 staphylococcosis). The dosage of both AASTL and AGSTL, however, seems more valuable since out of 40 cases of staphylococcosis, we have observed a simultaneous elevation of AASTL and AGSTL in 22 cases (55%), a sole elevation of AASTL in 8 cases and AGSTL in 5 cases (12.5%). Therefore, in this series, at least one of the enzymes was elevated in 15 cases out of 40 (87.5%) which represents an increase of 12.5% when compared with the study of the sole AASTL and an increase of 20% when compared to the study of AGSTL.

[Bactericidal power of polymorphonuclear neutrophils. Trials for standardization of a micromethod using autoradiography (author's transl)]. / Pouvoir bactéricide des polynucléaires neutrophiles. Essai de standardisation d'une microméthode utilisant l'autoradiographie

A 50 mul sample of blood is placed successively in the presence of staphylococci, then of tritiated thymidine. Stripping film autoradiography permits identification of living intracellular bacteria which metabolize the marked precursor. In our experimental conditions, the percentage of marked intracellular bacteria is: -- 15,4 +/- 3,7% (x +/- 1s) among adults -- 14,6 +/- 3,2% among children.