Biomedical subjects
Publications and source records attributed to L Humair.
A case of Group G streptococcal arthritis in a previously healthy man is reported. The 2nd and 3rd metatarso-phalangeal joints of the left foot were simultaneously affected. Unusual erosive joint destruction occurred in spite of early therapy and clinical improvement. Circulating immune complexes were raised and were not completely normal at 1 year.
We report the discovery of a circulating anticoagulant in a patient suffering from CREST syndrome. The patient was first seen with a microangiopathic haemolytic anaemia which led to the diagnosis of the CREST syndrome. Several months later, prior to a cataract operation, a routine coagulation screen (prothrombin time and partial thromboplastin time) was abnormal. Investigation showed the presence of a circulating anticoagulant as well as a decrease in several clotting factors, principally factor VIII C.
A patient was recently observed who was a carrier simultaneously of the HBs antigen and the HBs antibody after hepatitis. He presented with a multisystem disease affecting the peripheral nervous system, the prostate and the bladder. Biopsy of these two latter organs demonstrated necrotizing vasculitis compatible with periarteritis nodosa. An atypical immunological response to the hepatitis B virus, as found in our patient, may induce extrahepatic lesions.
Five cases of Campylobacter fetus bacteremia are reported. This germ, found in blood cultures, induces high fever and is accompanied by either gastroenteritis with colitis or thrombophlebitis. Other, but much rarer septic sites are the meninges and endocardium. Patients already debilitated by chronic disease are more susceptible to bacteremia with Campylobacter fetus, which worsens the prognosis of the infection. Although non-debilitated patients can contract this infection, the prognosis here is more favourable. Antibiotic treatment is indicated in all cases. Campylobacter fetus bacteremias are rare and their pathogenesis still little understood. This "microaerophil" germ does not survive in air which makes culturing difficult under ordinary conditions. On the other hand, Campylobacter jejuni induces gastrocolitis with spontaneous recovery. It is found in feces and thrives in contaminated water and milk.
The hypothesis that an increase in salivary concentration of certain electrolytes (Ca X K) is a sign of digitalis intoxication was tested in 16 untreated health volunteers, 29 digitalized heart failure patients and four further healthy volunteers given digoxin. Salivary electrolyte levels were raised in only about half the digitalized patients and blood levels of digoxin were not always higher in these patients than in those with normal electrolyte concentrations. The salivary electrolyte levels of the healthy volunteers given digoxin remained normal. These findings would seem to rule out the possibility that digitalis is responsible for the changes in salivary electrolytes observed in certain cases of heart failure. A very marked correlation (P less than 0.00002 by Fisher's exact probability test) was found, however, between an increase in the product of salivary calcium and potassium (Casal X Ksal) and the presence of clinical signs of poorly compensated heart failure. It is suggested that this might be a result of adrenergic stimulation, which is known to occur in heart failure, affecting the salivary glands.
Intravenous bumetanide was tested in patients with cardiac and renal failure with creatinine clearance below 12 ml/min. Water diuresis and natriuresis occur 2 or 3 hours after the injection, this delayed activity of the drug being due to renal insufficiency. The loss of potassium caused by the diuretic is slight. Bumetanide is effective at the level of the Henle loop. The rise in filtered sodium excretion suggests that the drug may have an action on the distal tubule. One patient with pericarditis and terminal renal failure (creatinine clearance 2 ml/min) did not respond to bumetanide.
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After oral administration of 1 g 6-[D-2-amino-2-(cyclohexa 1,4-dien-1-yl)-acetamido]-penicillanic acid (epicillin Spectacillin capsules, 500 mg) in patients with renal impairment the elimination rate constant was calculated by means of the declining serum levels. There is good correlation (r = 0.83) between the elimination rate constant and the creatinine clearance. With this data it was possible to calculate the reduced loading and maintenance dose for a certain creatinine clearance and a certain dosage interval to avoid accumulation. The values could also be read from nomograms without calculation. For comparison the possibility to extend the dosage interval corresponding to the elimination rate constant in renal impairment is confronted.
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In a group of 29 patients treated with digoxin for cardiac failure, only 16 showed increased calcium and potassium concentrations in saliva. There was no correlation in the 29 patients between serum digoxin levels and concentrations of salivary electrolytes. On the other hand, in 4 normal subjects treated with digoxin no change in salivary electrolytes was noted. It is concluded that modifications in salivary electrolytes seen in patients with cardiac failure treated with digitalis are not due to this drug. However, a retrospective clinical study showed a good correlation between clinical signs of cardiac failure and increased levels of salivary calcium, potassium and CaX Kproduct. It is suggested that this phenomenon is due to the well-known adrenergic stimulation in patients with cardiac failure.
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A 45-year old developed membranoproliferative GN seven years after acute hepatitis. He was found to be a chronic carrier of HBsAg, and glomeruli contained granular deposits of immunoglobulins (Ig), complement (C) and HBsAg. Six months later, HN persisted, but HBsAg has disappeared from glomeruli; Ig and C were still present. It was concluded that GN was probably due to a hepatitis B associated antigen, but not necessarily to HBsAg.
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The prognosis in patients with glomerulonephritis can now be established with some confidence. The major advance has been the use and interpretation of renal biopsies. The different histological varieties have their own evolution and prognosis. The clinical/pathological correlations assist the physician in determining the prognosis in patients with glomerulonephritis. On the clinical side, the most important observation is the simplest: proteinuria or hematuria may persist separately for many years without alteration of renal function. However, in patients with persistent proteinuria associated with hematuria the prognosis is poor, as the evolution is towards renal failure.
This study demonstrates that in systemic lupus erythematosus (SLE), the presence of immune complexes on the glomerular basement membrane (GEM) does not invariabley result in histological and/or functional lesions of the kidney. Among a group of 29 lupus patients, six subjects were selected for thorough investigation, because their renal function was normal or only slightly altered though they had suffered from SLE for 20 months to 18 years. All patients had antinuclear factor, anti-native-DNA antibody and a low level of complement; 3 had anti-denatured-DNA antibody, 2 had denatured DNA-anti-denatured-DNA circulating complexes and 3 had anti-RNA-protein antibody. Kidney biopsies disclosed either no histological lesion or minimal changes in five of them and diffuse proliferative glomerulonephritis in one. By contrast, using the immunofluorescent technique, granular deposits containing the third component of complement (C3) were found on the GBM of all patients; IgG was present in 5 cases, IgM in 3, fibrinogen in two cases and around the tubules of one. Electron microscopy confirmed the presence of subendothelial and mesangial deposits. Our results also showed a good correlation between the importance of deposits and the presence of denatured DNA-anti-denatured-DNA circulating complexes. From the data obtained in these 6 cases as well as in the 23 other patients of the group, 3 categories of lupus patients could be distinguished with regard to kidney involvement: 1) patients with insignificant histological lesions, no immune deposits and essentially normal function; 2) patients with definite histological lesions, immune deposits and renal insufficiency and 3) patients with few if any histological lesions and little functional impairment contrasting with important immune deposits. The resistance of some patients to the mephrotoxic effects of immune deposits shows that lupus nephritis depends on intricate pathogenic mechanisms and suggests that these are possible antagonized by "protective" factors.