Reduction of Plasma Alanine Aminotransferase During Vigabatrin Treatment

Summary: In 9 drug-resistant patients with partial seizures treated with vigabatrin, Γ-vinyl GABA (VGB), alanine aminotransaminase (ALAT) activity in plasma was significantly reduced. Comparison of in vitro with in vivo measurements led us to conclude that this reduction is mainly an in vivo phenomenon, perhaps due to crossenzyme inhibition. The assessment of two biological variables linked with ALAT, glucose and alanine levels under fasting conditions, failed to show any significant metabolic alterations. VGB is an effective drug for partial epilepsy. Our observations do not suggest that reduced ALAT activity'is of clinical concern.     

Intrafamilial heterogeneous clinical presentation of the mitochondrial 3243 MELAS mutation; molecular investigations among four generations

We have identified the A3243G heteroplasmic point mutation in mitochondrial DNA from a female patient with headache as the main clinical feature. The mitochondrial origin of her disease was only suspected because of her brother with MELAS syndrome. Morphological and biochemical studies failed to reveal mitochondrial respiratory chain dysfunction in her muscle which contained 65% of mutated mitochondrial DNA molecules. Molecular studies performed among four generations (in the blood of seven subjects) showed the variable transmission of mutated molecules and pointed out the difficulty in giving genetic counsel.     

Eumycetoma caused by Cladophialophora bantiana in a dog

We report a case of eumycetoma due to Cladophialophora bantiana in a 3-year-old male Siberian Husky living in France. The dog presented a tumefaction on the thorax and deformity of the second and third subjacent ribs, which were surgically removed. Macroscopic black granules were visible on the ribs, and direct microscopic examination revealed their fungal origin. Cultures yielded pure colonies of C. bantiana. The identification of the causative agent was confirmed after amplification and sequence analysis of fungal internal transcribed spacers 1 and 2 and 5.8S ribosomal DNA regions. Surgery and antifungal treatment with oral itraconazole associated with flucytosine allowed apparent cure after a 10-month follow-up. Envenomation with pine processionary caterpillars (Thaumetopoea pityocampa) and subsequently intensive corticotherapy were considered as possible predisposing factors. This is, to the best of our knowledge, the first case in which C. bantiana is identified as the causative agent of eumycetoma.     

Activity of two Streptococcus mutans bacteriocins in the presence of saliva, levan, and dextran.

The extracellular dextrans produced from sucrose by Streptococcus mutans strains BHT and GS-5 did not prevent the synthesis or release of active bacteriocins by these two strains. In addition, several streptococci that were genetically sensitive to these bacteriocins, and that could synthesize a variety of extracellular dextrans and levans from sucrose, remained phenotypically sensitive when grown in the presence of sucrose. Bacteriocin activity was not altered by treatment with high-molecular-weight dextran or by human saliva. The bacteriocins produced by, and active against, S. mutans thus appear to be capable of acting in vivo and may play a role in regulating the bacterial ecology of the oral cavity.     

Metastatic cancers of the thyroid gland. Diagnostic difficulties

Metastatic carcinoma of the thyroid is uncommon in surgical pathology and may masquerade as primary thyroid cancer. We studied 6 cases of biopsied and/or surgically resected metastatic carcinoma of the thyroid and their corresponding primary carcinoma, with emphasis on the differential diagnosis. There were 4 men and 2 women patients aged 44 to 77. The primary carcinoma was a breast infiltrating duct carcinoma (3 cases), a colorectal adenocarcinoma (2 cases) and a bronchial oat-cell carcinoma (1 case). The interval between primary carcinoma and secondary thyroid carcinoma was 2 to 9 years in 4 cases; 2 other cases showed simultaneous occurrence. Five patients died with widespread metastases 1 to 14 months following the diagnosis of secondary carcinoma of the thyroid; 1 patient was alive after 24 months. The histological differentiation of secondary from primary thyroid cancer may be difficult in the following situations: clear-cell, Hürthle-cell and signet ring cell changes; positivity of mucins stains; production of melanin; epidermoid differentiation; very rare miscellaneous tumours ("columnar cell carcinoma" and primary thymoma of the thyroid). Immunoperoxidase methods and mucin histochemistry may help.     

STDs and family planning clinics: a regional program for Chlamydia control that works

Joint meetings between the members of the US Family Planning Services Program and the STD Program of Region X (comprising Alaska, Idaho, Oregon, and Washington) from fall 1986 through spring 1987 led to the screening and treatment of patients with chlamydia. Samples from patients were sent to state health department laboratories in Idaho, Washington, and Oregon. A direct fluorescent antibody (DFA) slide technique was used to process the cervical smears. Clinic visit record (CVR) information and laboratory results were collected by a central data management company, and sent to CDC and Region X researchers. 6 clinics in 3 of the states collected 2 cervical samples from each of 3000 patients, 1 for smear (DFA slide) and 1 for tissue culture over a 4-month period. During the 1988-1990 period, 136 clinics in the region supplied patient information and test results on over 300,000 samples. Overall, positive rates for chlamydia in the region went from a high of 10.9% in the 1st quarter of 1988 to 6.8% in the last quarter of 1990, with an overall declining trend. This amounted to an almost 37% decrease within the region. When analyzed by state, the positivity rates and decreases were relatively similar: Alaska, 12.2% to 10.0% positivity (18% decrease); Idaho, 10.5% to 8.0% (24% decrease); Oregon, 8.9% to 6.9% (22% decrease); and Washington, 9.3% to 6.6% (29% decrease). In patients 17 years of age and younger, positive rates for chlamydia fell 19%, from 12.2% in 1988 to 9.9% in 1990. In women 18-19 years old and women 20-24 years old, the rates fell 24% and 31%, respectively. Larger decreases in chlamydia rates were found among women in the 25-29 year age group (31% reduction) and in those 30 years old and older (44% reduction). Infection rates decreased in all race/ethnic groups, except Asians. Approximately 2/3 of the women with positive chlamydia tests had no apparent symptoms of disease. Conversely, the presence of certain clinical indicators seemed to correlate with the probability of a positive test result.     

From Vineberg to bypass: a "second-hand" internal mammary artery.

A patient operated upon 20 years ago for myocardial revascularization with two Vineberg procedures and one coronary artery bypass graft (CABG) on the right coronary artery had a recurrence of unstable angina due to the thrombosis of the left internal mammary artery (IMA) and the right CABG. The right IMA was patent but stenosed distally. Reoperation was performed with a direct end to side anastomosis of the patent right IMA onto the left anterior descending artery and a saphenous vein graft as a CABG on the marginal branch. We comment on the choice of this "second hand" IMA graft and the pathological appearances of the patent IMA.     

Role of adrenocortical scintigraphy in the exploration of incidentally discovered tumors]

To determine the utility of adrenocortical scintigraphy with I131-6 beta-iodomethyl-19-nor-cholesterol (NP59) in incidentally discovered adrenal masses, we studied 12 patients with a unilateral adrenal mass and without other primary tumors or signs of pheochromocytoma or hyperfunctioning adenoma. Ten patients had an adenoma (size: 12 to 35 mm), the diagnosis was made by surgery or by no change in size on repeated CT scans. The NP59 scintigraphy showed an increased uptake on the side of the tumor in 8 cases with a decreased uptake of contra-lateral gland in 7 cases. Hormonal investigations of glucocorticoid function suggested supranormal or fluctuant cortisol secretion in 5 cases as assessed by moderately elevated urinary free cortisol or by incomplete dexamethasone suppression test. These abnormalities disappeared after surgery. Two patients had normal bilateral uptake of NP59, the sizes of the tumors were 12 and 20 mm. Two patients had an extra-adrenal tumor. The NP59 scintigraphy showed a moderately decreased uptake on the side of the hematoma of one patient and a compression of the normal adrenal by ganglioneuroma of the other patient. Our results and those of other authors suggest that positive NP59 scintigraphy could confirm the cortical nature of an incidentally discovered adrenal mass, probably an adenoma that must be followed up morphologically and functionally. No uptake by a tumor greater than 2 cm suggests a primary malignancy or extra-adrenal origin which must be diagnosed by invasive methods.