Biological study of intravenous anisoylated plasminogen streptokinase activator complex in acute myocardial infarction.

An anisoylated plasminogen streptokinase activator complex (APSAC) has been administered as a bolus intravenous injection of 30U to 14 patients with acute myocardial infarction. Systemic effects on coagulation and fibrinolysis were studied. In 1 patient, the treatment produced no biological modification, which could be explained by an increased streptokinase resistance in this patient, apparent from the sample collected before treatment. In the other patients, as expected, fibrinogen, plasminogen, alpha 2-antiplasmin and factors V and VIIIc fell dramatically, while there was an increase in serum fibrinogen degradation product concentrations. In addition, plasma fibrin derivatives increased during APSAC therapy, both in patients who had occluded or patent coronary arteries. Discrepancies were found between methods used to measure fibrinogen: with the Ellis and Stransky method, concentrations were higher than with the Clauss method; and for plasminogen, automated methods using different analysers may give higher results in some patients.

[Tissue plasminogen activator (t-PA) in myocardial infarction. Biological aspects]. / Activateur tissulaire du plasminogène (t-PA) dans l'infarctus du myocarde. Aspects biologiques.

A group of 37 patients with myocardial infarction less than 6 hours old was given 5,000 IU of heparin and 0.75 mg/kg of tissue plasminogen activator (rt-PA) (Group A, N = 18) or placebo (Group B, N = 19) intravenously over 90 minutes in a double blind study. Blood sampling was performed before, during and after treatment. The plasma rt-PA concentrations (micrograms/ml) of Group A were as follows: (Table: see text) The concentrations of plasminogen and antiplasmin have decreased significantly as did the fibrinogen level: a concentration of 1 g/l was observed in 7 cases during rt-PA therapy, lasting for 4 to 8 hours after the end of the infusion of rt-PA in 3 cases. The increase of FDP during rt-PA (m = 551 and 222 micrograms/ml at the 60th and 90th minutes) was relatively moderate considering the average level of defibrination (61%). No significant biological changes were observed in Group B. These results support those of our in vitro trials: at comparable thrombolytic activities, the reduction of plasma fibrinogen is less with rt-PA than with streptokinase (SK) or urokinase (UK). However, at concentrations 1 microgram/ml, rt-PA causes almost complete defibrination.

Comparing HEp-2 cell line with rat liver in routine screening test for antinuclear and antinucleolar autoantibodies in autoimmune diseases.

The comparative study of the human tumor cell line HEp-2 and rat liver for the detection of antinuclear and antinucleolar autoantibodies by the indirect immunofluorescence technic in routine screening test demonstrate that, taking titer and staining pattern into account, both substrates are able to separate autoimmune disease (systemic lupus erythematosus, rheumatoid arthritis, scleroderma and primary biliary cirrhosis) patients from healthy subjects. The minimal screening test must include sera diluted 1:20 and 1:80. The capability of the HEp-2 substrate to reveal and to discriminate different speckled nuclear and nucleolar patterns explain its greater performance, notably in detecting anticentromere antibodies highly specific for the CREST syndrome and a speckled nuclear antibody frequently associated with primary biliary cirrhosis, allowing an earlier diagnosis of autoimmune diseases presenting these patterns.

[Immunological disorders of coagulation in habitual abortion. Prospective study]. / Désordres immunologiques de la coagulation dans la maladie abortive. Etude prospective.

The physiopathological role of antithromboplastin-type circulating anticoagulants in habitual abortion may be envisaged since the presence of antithromboplastin has been reported in most studies on women at high risk of abortion. To avoid a possible statistical bias, we conducted a prospective study in a sufficiently large group of women with habitual abortion (n = 99) compared with a control group of women with normal fecundity (n = 50). In addition, all women were investigated for lupus symptoms. The circulating antibody was detected by the diluted thromboplastin time and activated cephalin time methods. The results were considered positive when the patient/control diluted thromboplastin time ratio was 1.2 and/or when the increase in activated cephalin time was not corrected by a control plasma. In the patients' group, 10 women (10%) had an anti-thromboplastin type circulating anticoagulant, whereas no circulating anticoagulant could be detected in the control group. Three women with circulating anticoagulant had signs of systemic lupus erythematosus. None of the patients presented with Soulier-Boffa syndrome. These data have established a significant correlation between habitual abortion and circulating anticoagulant whilst avoiding statistical bias. Our results suggest that women with idiopathic habitual abortion should be subjected to systematic immunological exploration and that a small number of them should be followed attentively.

[Anti-centromere antibody, biological marker of the CREST syndrome as distinct from scleroderma]. / L'anticorps anticentromère, marqueur biologique de la variété CREST de la sclérodermie.

Using HEp2 cells to study antinuclear antibodies has resulted in the discovery of the anti-centromere antibody which is thought to separate the CREST syndrome from progressive systemic sclerosis (scleroderma). This antibody seems to be exceptional in healthy subjects and are in patients with connective tissue diseases, except for scleroderma. It has also been found in CREST syndrome associated with other diseases, such as primary cirrhosis and neoplasias. In our study, the sensitivity of the anti-centromere antibody was 89.1% and its specificity 92.3% which shows that it is worth looking for.

[Can glucose-6-phosphate dehydrogenase deficiency alone explain neonatal jaundice]. / Un déficit en glucose 6 phosphate déshydrogénase peut-il à lui seul expliquer un ictère néo-natal?

Several authors have insisted on the role of a glucose 6-phosphate deshydrogenase (G6PD) deficiency in the occurrence of neonatal jaundice which can be severe, leading to exchange transfusion. Considering the fact that haemolysis, occuring in deficient patients, is most of the time induced, our aim was to search if a neonatal hyperbilirubinemia could be explained by the sole G6PD deficiency or by extra "oxidant stress". Red blood cell G6PD activity of 289 newborn babies of African or Antillian origin was tested by a Tetrazolium linked method. 21 newborns were deficient. 8 female babies were heterozygous for G6PD deficiency. No neonatal jaundice was observed. With Bienzle and all., we can suppose that the "environment" takes an important part in the incidence of neonatal jaundice among G6PD deficient newborn of African or Antillian origin. However as triggering factors could be ignored, we think compulsary to search a G6PD deficiency in every neonatal jaundice necessitating an exchange-transfusion.

[Human basophil degranulation test (HBDT) for diagnosis of respiratory allergic disorders. A study of eighty-four HDBT performed in forty-seven patients (author's transl)]. / Le test de dégranulation des basophiles humains (TDBH). Son application dans le diagnostic des allergies respiratoires. Etude à propos de quatre-vingt-sept TDBH effectués sur quarante-sept patients.

The HBDT uses basophils of patients with respiratory allergic disorders. In this simple method the basophils are stained by toluidine blue and the erythrocytes are destroyed. The basophils are then exposed to solutions containing different concentrations of the antigen. The basophil degranulation rate in response to a given antigen can be determined. The test is positive if the degranulation rate is over 50% and negative if the rate is under 30%. Our clinical study induces 47 patients. The correlate rate between HBDT and skin tests is 81,5%. This test's technical simplicity allows it's routine use by a non specialized laboratory.

Autoimmunity in 28 patients after allogeneic bone marrow transplantation: comparison with Sjögren syndrome and scleroderma.

The occurrence of autoantibodies in 28 long-term survivors of allogeneic bone marrow transplantation (BMT) (21 with chronic graft-versus-host disease) was compared with 48 cases of idiopathic Sjögren syndrome and 82 cases of scleroderma. Antinuclear, anti-smooth muscle, and anti-mitochondria antibodies occurred respectively in 80%, 82% and 14% of the post BMT cases. Anti-native DNA, anti-soluble nuclear antigen and anticentromere antibodies were not found. Antiepidermal antibodies were present in 14% of the cases but their pathological role is unclear. Although the clinical manifestations of chronic graft-versus-host disease are similar to Sjögren syndrome and scleroderma the autoantibody profile is significantly different.