Alanine and lactate as gluconeogenic substrates during late gestation

Rates of alanine incorporation into glucose by isolated liver cells of fed rats are 5-fold higher than those observed when lactate was used as substrate. The rates of gluconeogenesis from alanine and lactate in isolated liver cells of fed pregnant rats increase 50 and 200-400%, respectively, over virgins during the last 3 days of gestation. The results support the existence of an increase in the alanine-glucose cycle in the late pregnancy as an important homeostatic pathway in the supply of glucose to the growing fetus.

Effect of 28 consecutive days lymphoblastoid interferon (alpha-IFN) administration on hepatitis B virus related chronic liver disease

Eight HBsAg, HBeAg, DNA-p, HBV-DNA-positive patients with biopsy-proven chronic hepatitis were treated with human lymphoblastoid interferon (Wellferon) given for 28 consecutive days at a dosage ranging from 2.5 to 7.5 MU/m2 i.m.; 10 patients were used as controls. Our results suggest that certain chronic carriers may respond to the treatment with this agent. In fact, the treated patients showed a permanent inhibition of HBV replication sooner and in higher percentage with respect to untreated patients (37.5% vs 20%). IFN administration does not induce any important changes in the immunoregulatory wetwork, but is able to increase significantly the cytolytic activity of NK cells in the patients who respond to the therapy with a permanent inhibition of HBV replication.

[Misleading pains in the lower limbs of rheumatologic origin]

Pain in the lower limbs related to rheumatic disease may be the source of diagnostic difficulties when it presents in the guise of pseudo-vascular manifestations. A narrow spinal canal and atypical neuralgia may present a very misleading clinical picture. Similarly, traumatic muscular pathology and bone trauma and tumours may also be misleading. A popliteal cyst and reflex sympathetic dystrophy may simulate venous disorders. Iatrogenic disease, particularly complications of anticoagulant treatment also need to be recognized.

Antigen specific suppressor T cells from chronic hepatitis B virus (HBV) carriers inhibit the responsiveness to HBsAg of allogeneic high-responder lymphocytes

Immunoregulatory mechanisms in chronic HBsAg carriers have been investigated through the study of in vitro proliferative responses to HBsAg by allogeneic coculture experiments between T lymphocytes from HBsAg + chronic active hepatitis (CAH) patients (HBsAg no responder) and PBMC from subjects boosted with anti-hepatitis B vaccine (high responder). When high-responder PBMC have been challenged with the hepatitis B surface antigen (HBsAg) in the presence of HBsAg no-responder T lymphocytes, HBsAg no-responder T lymphocytes caused an antigen specific, dose-dependent, suppression of the responsiveness of high-responder PBMC. On the other hand, T cells from patients with autoimmune CAH did not exert any suppressor effect in our system. The suppressor T lymphocytes were mitomycin C resistant and were positive for OKT8, but were negative for OKT4. When T8 + cells were depleted from HBsAg no-responder PBMC, the in vitro immunoproliferative response to HBsAg in chronically HBV infected patients was markedly improved. Out data clearly demonstrate the existence of T8 + suppressor T lymphocytes that can control low responsiveness to HBsAg in chronic HBV patients.

[Esophageal motility in Raynaud's disease, systemic scleroderma and presclerodermal Raynaud's syndrome]

Fifty-five consecutive subjects with Raynaud's phenomenon were submitted to esophageal manometry. According to the results of clinical examination and periungual capillaroscopy, they were divided into three groups: sixteen patients presented presclerodermal Raynaud's phenomenon, and nineteen, systemic sclerosis; twenty others had Raynaud's disease. Twenty volunteers formed the control group. Esophageal motor disorders were observed in the group with presclerodermal Raynaud's phenomenon, affecting the esophageal lower sphincter and the peristalsis of the body of the esophagus. In the group with systemic sclerosis, these motor disorders were associated with alterations in the amplitude and the duration of contractions. Esophageal motility was normal in subjects with Raynaud's disease. We can conclude that: 1) esophageal motor disorders can be seen in presclerodermal Raynaud's phenomenon. The kind of abnormalities observed at this stage of the disease are in favor of an early alteration of the neurogenic component of esophageal motility; 2) there is no relationship between esophageal motor disorders and Raynaud's phenomenon in scleroderma.

[Capillaroscopy and Raynaud's phenomenon]

Nailfold capillary microscopy is a simple and noninvasive screening test for the etiological diagnosis of Raynaud's phenomenon: --dilating capillary dystrophia, with its large capillary loops (megacapillaries), it is a very specific sign of connective tissue disorders, especially systemic sclerosis; --meshed or branched-tree shaped capillaries are neocapillaries, the meaning of which is very often a dermal vasculitis (S. L. E., rheumatoid arthritis, paraneoplastic Raynaud's phenomenon, or even chilblains); --when numerous abnormal capillary loops and hemorrhages are seen without any special pattern, the diagnosis of idiopathic Raynaud's disease is very unlikely and an extensive biological investigation is needed; --nailfold capillaries look like normal in idiopathic Raynaud's disease and, in this case, only a sharp physical examination and a few biological tests are required. Conjunctival angioscopy is a useful complementary test in some cases when nailfold capillaroscopy is unreliable. Capillary video microscopy is an interesting method for further investigations about the physiopathology of Raynaud's phenomenon.

[Acute thrombosis of the aortic bifurcation caused by heparin allergy. Apropos of 5 cases]

Five patients with humoral intolerance to heparin developed acute thromboses, with a fatal outcome in two cases from failure to establish the diagnosis, marked sequelae in one case, and recovery without complications in the other two. Accidents of this type may occur in 0.6 p. cent of patients on heparin therapy and are almost always fatal if administration is not discontinued. They result from a severe immunoallergic. Thrombocytopenia which may lead to the formation of arterial clots. Arterial thrombosis during heparin therapy is suggestive of the diagnosis and tests for diminished platelet counts are necessary. Apart from surgery, treatment involves the immediate cessation of heparin therapy.

Primary non traumatic intracranial hemorrhage: 139 consecutive cases treated at an emergency regional hospital

We review 139 consecutive cases of primary non-traumatic intracranial hemorrhage observed at the Neurosurgical Division of Pellegrini Hospitals, Naples. We excluded 20 similar cases which were not thoroughly studied. In the region Campania, which has almost five and a half million inhabitants, there are four emergency centres for neurosurgical patients one of which is at the Pellegrini Hospitals in Naples. In our series of 139 patients, 68 (48.92%) had an intracerebral hematoma (CH); while 71 (51.07%) patients had a subarachnoid hemorrhage (SAH). Thirteen cases out of 68 were added to the 71 cases with SAH because they had an arterial aneurysm or an arteriovenous malformation (AVM) which had ruptured both in the subarachnoid space and in the brain. The most frequent cause of CH was arterial hypertension. Out of 84 patients with SAH, 57 (67.85%) had a vascular malformation. Age, sex, presence of vasospasm, gravity of hemorrhage and interval between hemorrhage and neurosurgical observation were studied. Out of 139 cases, 68 (48.92%) were surgically treated. In conclusion, out of 68 operated patients, 48 (70.58%) survived and 20 died; while, out of 71 non-operated patients, 24 (23.80%) survived and 47 died. The survival rate of patients with aneurysms operated on after 14 days from the hemorrhage is 90.47%. The survival rate in patients with CH operated on after the fifth day is 89.47%.

[The soleus syndrome. Apropos of 3 cases of intermittent claudication of venous origin]

The typical case present with a unilateral, atypical claudication with discrete oedema, occurring after repeated exercise. These paradoxical features of venous pain, aggravation with attacks, resolution after prolonged rest and the absence of arterial signs are suggestive of the disease. The syndrome may present as repeated calf thromboses or recurrent varicose veins suggesting some deep obstruction. An inflammatory and oedematous process linked to exercise is associated with a congenital predisposition: a constriction of the venous arcade at the insertion of the soleus. Phlebography confirms the absence of thrombophlebitis and shows underlying stasis and poor opacification of the deep popliteal and, most importantly, anterior hooking and actual kinking of the vein on the lateral film which persists on mild flexion. A simple surgical procedure to free the vein turns this incapacitating and potentially thrombogenic pathology into a benign condition.

TITLE

Therapeutic modalities for ischaemic atrophy in its acutely painful phase or the exceptional use of corticotherapy in phlebology.

Penicillin susceptibility testing of gonococci by disc diffusion

This study investigated the use of various beta-lactam discs in the detection of penicillin sensitive, intermediate resistant and resistant strains (minimal inhibitory concentrations of penicillin G of less than 0.06, 0.06 to 0.25, and greater than 0.25 mg/l respectively). Discs containing 0.15 and 0.6 microgram of penicillin G, and 5 microgram of methicillin were the most useful in separating the three groups. Cut-off zones between sensitive, intermediate resistant and resistant strains are 12 and 24 mm for 0.15 microgram penicillin discs; 24 and 32 mm for 0.6 microgram penicillin discs; and 20 and 30 mm for 5 microgram methicillin discs. Oxacillin discs (1 microgram) were useful in separating resistant from both sensitive and intermediate resistant strains at a cut-off zone of 8 mm. Use of a combination of discs provides the best index of susceptibility group, and at least two should be used

[Occlusive rheoplethysmography in the diagnosis, surveillance and evaluation of the sequela of phlebitis]

Occlusive rheoplethysmography (RPO) constitutes a new method of quantitative tetrapolar rheography. It enables us to assess peripheral venous function by measuring distensibility (symbol of influx = IR greater than 0.6, and of drainage = IV greater than 0.7), and flow (symbol of the drainage flow = IDV greater than 0.5). Deep venous thrombosis in the receptor trunk of the popliteal vein and vena cava reduces the IDB (obstructive syndrome). Isolated thrombosis of the tibial vein modifies only the distensibility (restrictive syndrome). RPO is extremely reliable in the diagnosis of acute venous thrombosis of the receptor trunk, as well as in the diagnoses of tibial thromboses, and so it facilitates the recognition of indicants for phlebography. RPO constitutes a simple, portable, rapid, economical and totally objective examination; its use in the observation of the efficiency of treatments as well as in the quantitative assessment of phlebitic after-effects means that it makes a valuable contribution to the management of venous disorders.

[Value of electromyography in the thoracic outlet syndrome (author's transl)]

Electromyogram studies were conducted in 55 patients with the thoracic outlet syndrome, together with the motor nerve conduction velocity (M.N.C.V) in the median cubital nerves, between the Erb's point and axilla and in the upper limb. Distal S.N.C.V. was measured in 19 cases. Proximal nerve compression was confirmed in 29% of cases, with associated carpal canal compression in 22%. The proximal N.C.V. of the median and cubital in the neurological forms, and of the median in the neurovascular forms, were significantly different from normal values in 18 control subjects, but were not so in the vascular forms. Through E.M.G. examination cannot confirm the need for surgery it can supply supportive evidence. No correlation between the clinical course and the proximal N.C.V. was found in the 18 patients seen after treatment (surgery in 13 cases).

[Partial blockage of the inferior vena cava. Results apropos of 110 cases]

Rheoplethysmography with occlusion (RPO) is useful in the diagnosis of deep venous thrombosis. Bilateral phlebography with cavography performed afterwards as an emergency gives information as to the embolic potential of the thrombosis and orientates treatment towards surgical interruption of the inferior vena cava. In the C.H.U. at Grenoble 83 clips, 25 umbrella filters and 2 ligatures were placed on the inferior vena cava from 1974 to 1977. Prevention of pulmonary emboli was achieved in 99% cases with lower limb embolic foci. Follow-up by RPO and isotopic phlebography showed that the course of venous thrombosis of the lower limbs seemed to be unchanged by partial interruption of the inferior vena cava, provided that elastic stockings and adequate anticoagulant therapy adapted to venous haemodynamics are used.

Effect of a Salmonella group H1 R factor on virulence and response of infections to antimicrobial therapy

A group H1 R factor encoding resistance to chloramphenicol, streptomycin, sulfonamide, and tetracycline was transferred into Salmonella typhimurium LT-2. The virulence of LT-2 for mice, as assessed by intraperitoneal 50% lethal dose and the number of organisms in the spleen, was not affected by the R factor. On the other hand, the R factor conferred resistance in mouse infections to therapy with chloramphenicol and trimethoprim plus sulfamethoxazole.