The Changes in the Hypothalamo-Pituitary-Gonadal Axis of Streptozotocin-Treated Male Rats Depend from Age at Diabetes Onset

The influence of age at diabetes onset and of capillary microangiopathy on the severity and evolution of hypothalamo-pituitary-gonadal changes was studied morphologically and morphometrically in male rats 4 and 8 months after streptozotocin injection. At each time period we studied 2 groups of rats, one made diabetic before (age 1 month), the other after puberty (age 3 months), and compared them with corresponding controls. The size of hypothalamic axons, numerical density and size of pituitary gonadotrophs, size of testicular tubules, and basement membrane thickness of retinal capillaries were measured. Major differences were found at 8 months. Changes of pituitary glands (i.e. small and numerous gonadotrophs) and testes (i.e. small tubular size) were more important in pre- than in postpubertal diabetic rats. This was a consequence of the aggravating prepubertal diabetes between 4 and 8 months. On the contrary, these changes partially regressed in postpubertal diabetic animals. Pituitary and testicular changes were correlated. Other lesions, such as swollen axonal processes in the hypothalamus, increased thickness of seminiferous epithelium and of capillary basement membranes, though very evident in diabetics, were independent from age at induction. Neither microangiopathy nor glycemia were correlated with any other change which confirmed their secondary role in diabetic neuroendocrine disorders. Thus, two types of diabetic disorders of the hypothalamo-pituitary-gonadal axis could be distinguished: 1) those with irreversible effects on immature yet partially reversible effects on mature structures; and 2) those independent from age at induction.     

Clinical and morphological characteristics associated with sudden cardiac death in patients with Chagas' disease

The medical records of 24 patients with Chagas disease who diedsuddenly, between 1982 and 1988, were examined in an attemptto determine the clinical profile of sudden death in Chagasdisease. Patient age ranged from 33 to 72 years (average: 51). Seventeen(70%) were male. Five (20%) were asymptomatic. Dyspnoea at restwas observed in 16 (66%) and palpitations in eight (33%). Onphysical examination, arrhythmias were observed in 14 (58%),ankle swelling in 13 (54%) and liver enlargement in 12 (50%)patients. Twenty-three (95%) patients had an abnormal resting electrocardiogram:ventricular premature contractions were observed in 19 patients(79%) and a left anterior fascicular block in 14 (58%). Thechest X-ray revealed cardiomegaly in 20 patients (82%), whichwas moderate in three (13%) and severe in 11 (45%). At autopsy, mean heart weight was 496 g. Dilatation of all cardiacchambers was detected in 22 (91%), and apical aneurysm in 19(79%) patients. When compared with symptomatic patients, asymptomatic patientswith Chagas disease had a higher frequency of normal physicalexamination (3/5 vs 1/19, P<0.004), normal chest X-ray (3/5vs 1/19, P<0.01), and a lower heart weight (400±43g vs 521.58±146.26 g, P<0.03). The majority of patients with Chagas disease who die suddenlyhave severe underlying myocardial disease. In some of them,however, sudden cardiac death may occur in the presence of minimal,if any, heart involvement.     

Morphological Selection of Human Spermatozoa in Cervical Mucus "In Vivo"

Spermatozoa morphology at two levels in the cervical canal was compared, at the external and internal uterine orifices, in samples taken "in vivo" during 21 postcoital tests (P.C.T.s). P.C.T.s with cervical mucus, with Moghissi scores lower than 10 and exo- and endocervical pH less than 7 were excluded. At the upper level of the cervical canal, 12 of the 21 P.C.T. showed more than 5% more normal spermatozoa than at the lower level of the canal (in 5 of these P.C.T. the increase was greater than 10%). Selection for normal heads was seen in 2 and for normal tails in 4. The P.C.T. that selected for normal tails all had greater than 10% abnormal tails at the external orifice. These results confirm that there is some selection of spermatozoa during passage through the cervical canal. Above all, the selection appears to exclude those spermatozoa with defective locomotive mechanisms (abnormal tails), which indicates that the mucus acts as a "passive filter" with selection depending on the spermatozoa themselves in relation to motility.     

Fatal outcome associated with autopsy proven myocardial bridging of the left anterior descending coronary artery

Two patients with myocardial bridging of the left anterior descendingcoronary artery associated with myocar–dial infarctionare described. One of them died from acute cerebral emboli relatedto cardiac thrombosis in a left ventricular aneurysm. The otherdied suddenly while sleeping. Both patients were found to havea very long myocardial bridging of the left anterior descendingcoronary artery as well as patches offibrosis in the left anteriordescending coronary artery territory. Marked left ventricularhypertrophy was also found in the patient who died suddenly.No other cardiac abnormality was observed in either patient.These cases, together with those previously reported, suggestthat myocardial bridging of the left anterior descending coronaryartery can no longer be considered a benign coronary anomaly.     

Achromobacter xylosoxidans respiratory tract infections in cystic fibrosis patients

Achromobacter xylosoxidans is a ubiquitous Gram‐negative non‐fermenting rod, recently characterized as an emerging pathogen in cystic fibrosis (CF) patients. Its pathogenic potential and prevalent transmission routes are still unclear. This study investigated the PFGE genetic pattern and antimicrobial resistance profile of 42 A. xylosoxidans isolates obtained over 4 years from the respiratory tract of 22 CF patients. By genotypic analysis, 31 isolates were attributed to 8 distinct PFGE patterns (A–H), whereas 11 isolates were not typable because their DNA was not restricted by XbaI and DraI restriction enzymes. The majority of the isolates showed multidrug resistance; imipenem and piperacillin were the most active drugs. During the course of A. xylosoxidans chronic infection forced expiratory volume and body mass index values were not significantly lowered. The demonstration of widespread antibiotic resistance underscores the importance of antibiogram‐directed therapy. Our data suggest that in some cases the infection may have been acquired from other patients or from a common contaminated source. Further epidemiological studies may be important for the design and implementation of prophylactic measures in CF centers.     

Gonadal function in male heroin and methadone addicts

Gonadal function was elevated in 80 male heroin and/or methadone addicts by measuring basal plasma levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone. In 41 subjects semen analyses were also undertaken. Three groups were distinguished consisting of 15 heroin addicts, 42 undergoing methadone treatment but continuing to take heroin, and 23 taking only methadone. All patients had normal plasma levels of FSH, LH and testosterone. Prolactin levels were normal in all subjects except for the 15 heroin addicts, in whom they were significantly higher than in controls (P less than 0.025). Semen analyses from all of the heroin addicts and from the dual heroin-methadone users were abnormal, whereas only 10 out of 22 (45%) of the methadone takers were pathological. In all cases asthenospermia was one of the abnormalities (100%). Twenty-four per cent also showed teratospermia and hypospermia and 17% showed oligozoospermia. Such seminal pathology, especially of forward motility, even in combination with normal hormone levels, might be an early indication of heroin toxicity to the male reproductive tract.     

A Case of Congenital Atypical Haemolytic Anaemia with Pyruvate Kinase Deficiency

The authors describe a female patient with congenital non-spherocytic haemolytic anaemia (type I, DACIE).
The most characteristic biochemical properties are a markedly decreased pyruvate kinase activity and a lowered ATP content of the erythrocytes.

Résumé

Les auteurs décrivent une patiente avec une anémie congénitale non sphérocytaire (type I de DACIE).
Les propriétés biochimiques les plus caractéristiques sont une diminution marquée de l'activité de la pyruvate kinase et une contenance plus basse en ATP de ces érythrocytes.

Zusammenfassung

Die Autoren beschreiben eine Patientin mit kongenitaler nicht-sphärozytärer hämolytischer Anämie (Typ I nach DACIE). Die charakteristischen biochemischen Anomalien waren eine deutlich herabgesetzte Aktivität der Pyruvatkinase sowie ein verminderter ATP-Gehalt der Erythrozyten.     

The release of β- thromboglobulin and platelet factor 4 during extracorporeal circulation for open heart surgery

Cardiopulmonary bypass is extremely damaging to platelets and it causes a quantitative and qualitative alteration in their functions. We evaluated the release of two platelet-specific proteins, beta-thromboglobulin (beta TG) and platelet factor 4 (PF4), in patients who underwent extracorporeal circulation for open heart surgery. A parallel release (basal value beta TG: 119.6 ng/ml, PF4 30 ng/ml) was present for both proteins in a time dependent fashion until the end of extracorporeal circulation. High average levels were observed in patients in whom the bypass was stopped after about 1 h (beta TG 1606 ng/ml, PF4 745 ng/ml) and similarly in those in whom the bypass was stopped after about 2 h (beta TG 1540 ng/ml, PF 4754 ng/ml). No correlation was found either between the level of PF4 and the additional heparin administered after the initial standard dose (r = 0.29, P greater than 0.10) and between the level of PF4 and the amount of heparin consumed during the bypass (r = 0.05, P greater than 0.5).