Study of the formation of fibrin clot in cirrhotic patients. An approach to study of acquired dysfibrinogenemia

Alterations in the coagulation system are common in patients with liver disease. We have examined the importance of the species and chains of fibrinogen in 3 groups of cirrhotic patients. The study of the gelation of fibrinogen in cirrhotic patients shows that the lag time increases in 80.3% of them and that the maximum gelation rate is altered in 51% of these plasmas. Also it is observed that 80% of the plasmas from cirrhotic patients have a percentage (23.3 +/- 7.7%) of unpolymerized alpha chain, after highly cross-linked fibrin formation. These alterations, in lag time and in the maximum gelation rate, have no significant correlation with the situation of the fibrinolytic system in these patients. The study of isolated fibrinogen from cirrhotic patients and normal subjects plasma, shows that there are no objective alterations in the percentage of fibrinogen species, the amount of sialic acid or the ratio of polypeptide chains.

Jejunal malignant lymphoma in a patient with adult-onset hypo-gamma-globulinemia and nodular lymphoid hyperplasia of the small bowel

A malignant lymphoma of the small bowel developed in a 55-yr-old woman who had intestinal malabsorption for 20 yr, late-onset hypo-gamma-globulinemia, and nodular lymphoid hyperplasia. The tumor arose in the first jejunal loop and appeared to be of B-immunoblastic type (diffuse large noncleaved cells). This case indicates that nodular lymphoid hyperplasia in the context of immunodeficiency may be a condition leading to lymphoid malignancy.

Failure of a cytoprotective dose of arbaprostil to heal acute duodenal ulcers. Results of a multiclinic trial

Previous therapeutic trials with prostaglandins have shown them to be effective in healing duodenal ulcers when used at doses that are highly effective suppressors of gastric acid secretion. We undertook this trial to determine if a cytoprotective dose of arbaprostil (10 micrograms q.i.d. for 4 wk) would also be efficacious in this disease state. Eighty-two patients between the ages of 19 and 72 yr with endoscopically documented duodenal ulcers were entered into this randomized double-blind placebo-controlled trial. The patients were monitored with biweekly endoscopies and laboratory examinations, weekly interviews during the period when drug was administered, and a follow-up interview plus laboratory examinations 1 wk after drug administration was completed. No statistically significant differences between the arbaprostil and placebo treatment groups were found for ulcer healing rates, pain relief, antacid consumption, side effects, or laboratory examinations. It is presumed that this prostaglandin may not have sufficient duodenal cytoprotective capacity to effectively heal duodenal ulcers, or that some suppression of gastric acid secretion may be required to achieve significant clinical efficacy.

Variability in the posttranslational processing of penicillin-binding protein 1b among different strains of Escherichia coli

Screening of a number of unrelated strains of Escherichia coli confirms the existence of at least two patterns of molecular forms for penicillin-binding protein 1b in E. coli cell envelopes. Our data support that the beta-form of this protein is produced by posttranslational modification of the alpha-form and suggest that the absence of the beta-form in some strains is due to a strain-dependent variability in the alpha-form processing mechanism.

Return of esophageal peristalsis after Heller's myotomy for idiopathic achalasia

A 23-year-old male was diagnosed as having idiopathic achalasia on the basis of clinical, radiologic, endoscopic, and manometric evaluation. He underwent a Heller's myotomy with 180 degrees posterior fundoplication as an antireflux procedure, and he did well subsequently. On reexamination one month later, return of peristaltic activity throughout the body of the esophagus was shown on manometric studies. Two years after the operation, peptic esophagitis was diagnosed by esophagoscopy, and the acid reflux test confirmed the existence of gastroesophageal reflux. To our knowledge, this represents the first reported case of return of esophageal peristalsis in idiopathic achalasia after surgical myotomy.

The effect of 180 degree anterior fundoplication on gastroesophageal reflux

Sixty-seven patients with symptoms of gastroesophageal reflux not responsive to medical therapy were treated by 180 degree anterior fundoplication. The operative mortality was 1.5% (one patient). The follow-up period ranged from 6 to 132 months and averaged 3 1/2 yr. The overall clinical results were satisfactory in 94% of the cases; one patient had mild retroesternal heartburn after operation, and three patients had recurrence of symptoms with persistent reflux in two of them. Among the improved patients, one experienced a transient gas-bloat syndrome. In 41 patients manometric evaluation of the gastroesophageal high pressure zone showed a significant increase in both the pressure and the length below the respiratory inversion point (p less than 0.001) but not in the total length. The standard acid reflux test carried out on 47 patients after surgery was found to be negative in all of them. We conclude that in patients with severe gastroesophageal reflux, 180 degree anterior fundoplication achieved good clinical results confirmed by objective methods.

Effects of atropine and pirenzepine on sphincter of Oddi motility. A manometric study

We studied the Oddi sphincter motility by endoscopic manometry in 10 consecutive patients randomized in a double-blind fashion, after i.v. administration of two anticholinergic compounds (0.5 mg atropine sulfate and 10 mg pirenzepine). Pirenzepine significantly decreased the basal sphincteric pressure, as well as the amplitude and frequency of the phasic contractions. The only significant effect of atropine was the modification of the frequency of the phasic contractions, but only for a short period of time. Our results suggest that muscarinic innervation must be present for a normal sphincter of Oddi motility.

Increase in serum total cholesterol and low-density lipoprotein cholesterol by high-dose chenodeoxycholic acid in patients with radiolucent gallstones significantly reversed during preventive low dose after gallstone dissolution

This study examines the effects of high-dose chenodeoxycholic acid (CDCA) on serum lipids and lipoproteins in 25 patients who underwent a 12-month therapy with CDCA for the dissolution of cholesterol gallstones. All patients received a daily dose of CDCA of 15 mg/kg body weight. Complete dissolution of gallstones was achieved in 16 cases. After 6 months of therapy the mean total cholesterol levels and low-density lipoprotein cholesterol (C-LDL) significantly increased (p less than 0.001). The decrease of mean triglyceride levels was significant too (p less than 0.01), although it was greater among patients with effective gallstone dissolution than in patients with persistent gallstones. The effects of high-dose CDCA after 12 months of therapy were similar to those observed at 6 months. 12 patients of the gallstone dissolution group were treated with a continuous low dose of CDCA (250 mg/day) for preventing gallstone recurrence. 6 months after dissolution, the mean total cholesterol levels and C-LDL significantly decreased (p less than 0.01 and less than 0.05, respectively). High-dose administration of CDCA produced an increase in total cholesterol and C-LDL, but did not alter high-density lipoprotein cholesterol levels. These effects were significantly reversed when a preventive low dose of CDCA was given after gallstone dissolution.

Multiple hepatic adenomas after long-term therapy with testosterone enanthate. Review of the literature

We report a case of multiple hepatic adenomas developed in a 32-year-old man with renal allograft after long-term therapy with testosterone enanthate. Histological assessment showed a benign hepatocellular adenoma, which has not regressed over a 6-month follow-up since androgen withdrawal. A review of primary hepatic tumors associated with androgenic-anabolic steroid therapy published in the English literature has been carried out, concentrating on the more relevant recent publications. No previous case of hepatic adenoma with possible relationship to the use of non-17-alpha alkylated compounds has been reported.

Meningitis caused by Mycobacterium fortuitum

A previously healthy 16-yr-old Caucasian male developed a relapsing purulent meningitis shortly after a motor accident in Venezuela, in which he received a small wound with a retained foreign body in the sacral region. Repeated initial physical examinations, radiographs of lumbar and sacral regions, and contrast myelography failed to demonstrate a cerebrospinal fluid leak or bone involvement, and Mycobacterium fortuitum was repeatedly isolated from the cerebrospinal fluid. Finally, from the originally "cured" lumbar wound a purulent material was obtained from which M. fortuitum was also isolated. A retained foreign body was removed, and an abscess and fistulous tract were incised and drained. The patient responded dramatically to the combination of isoniazid plus co-trimoxazole and surgery.

Binding of 125I-labeled beta-lactam antibiotics to the penicillin binding proteins of Escherichia coli

125I-Labeled derivatives of the beta-lactam antibiotics cephalexin, cephradine, cefaclor and 6-alpha-aminopenicillanic acid have been obtained by reacting these compounds with (125I)-Bolton-Hunter reagent. The following target proteins were found in Escherichia coli: (1) The derivatives of cephalexin, cefaclor and cephradine preferentially interact with the high molecular weight penicillin binding proteins ( PBP1a and PBP1b ); (2) The 125I- derivative of 6-alpha-aminopenicillanic acid is preferentially bound by the low molecular weight penicillin binding proteins 4 and 5/6. The iodinated derivatives showed a very high affinity of binding to their target proteins with apparent half-saturating concentrations in the nano -molar range.