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Background. Hypoalbuminemia commonly observed in cirrhosis is considered to be mainly related to hepatocellular dysfunction. However, the correlation between the decrease in serum albumin and liver function is far from linear and arguments in favor of an additive role of protein-losing enteropathy have been brought by a few studies. Aim. To assess the potential role of protein-losing enteropathy in a group of patients with cirrhosis, portal hypertension, and hypoalbuminemia. Design and methods. Eleven patients with documented cirrhosis, portal hypertension, and a low serum albumin level compared to liver function underwent an (111)In-transferrin scintigraphy. Results. Using this sensitive method of investigation, nine exhibited features suggestive of exudative enteropathy. Serum albumin level and digestive protein loss were even correlated (Pearson's coefficient = -0.529, one-sided p = 0.047). Protein loss were however not correlated with the degree of portal hypertension or with the extent of liver dysfunction evaluated by the aminopyrine breath test. Conclusions. Our preliminary data obtained in a small group of selected patients with cirrhosis, portal hypertension, and hypoalbuminemia indicate that protein-losing enteropathy may represent an appreciable and underestimated cause of hypoproteinemia.

The presence of the 20210A allele of the prothrombin gene has recently been shown to be a risk factor of venous thromboembolism, probably mediated through increased prothrombin levels. The aim of the study was to determine the frequency of the prothrombin 20210A allele in 193 consecutive unselected patients with venous thromboembolism and 100 healthy controls and to analyze the clinical profile associated with this new inherited thrombophilic factor. In agreement with previous reports, we found a frequency of 7.3% of heterozygous carriers of the 20210A allele among patients and 1% among controls. We confirm that plasma prothrombin levels are more elevated in the individuals bearing the prothrombin 20210A allele compared with those who do not. We did not find any relationship between the presence of the prothrombin 20210A allele and either a family history of thromboembolism, the rate of recurrences or the age at disease onset. However, the co-inheritance in the same individual of both prothrombin 20210A allele and factor V Leiden was associated with a significantly lower age at disease onset suggesting a synergistic contribution of both abnormalities.

SummaryWe report a case of endocarditis due to Lactobacillus plantarum, occuring on a mitral valve, as a complication of obstructive cardiomyopathy. The route of entrance is maxillary osteitis of a dental origin.Endocarditis due to Lactobacillus is a rare infection. Its major characteristic is an occasional resistance to treatment with /j-lactamines. In our case infection recurred in spite of chemotherapy with ampicillin (6 weeks) and gentamicin (14 days). A new treatment with penicillin and gentamicin for 6 weeks resulted in cure. We ascribe the initial therapeutic failure to a moderate sensitivity of the strain to /3-lactamines (M.I.C. 1,25 /ig/ml for penicillin G). We have not observed any tolerance to/5-lactamines.Endocarditis due to Lactobacillus should be treated with a combination of a /Mactamine with an aminoglycoside, in the event of the isolated strain being little sensitive to /3-lactamines.

SummaryThe authors report 19 cases of adult onset Still’s disease (AOSD) and compare them with 25 cases of juvenile systemic Still’s disease. They emphasize the diagnostic difficulties in the early stages of the disease, the various systemic complications and the common evolution to chronic erosive joint lesions. In the authors’ experience, AOSD represents about 5 per ccnt of cases admitted for fever of unknown origin.

SummaryIt is useful to distinguish Streptococcus bovis among the group-D streptococci. S. bovis has different culture characters and is highly penicillin-sensitive. The discovery of this agent in blood cultures is strongly suggestive of some particular pathological conditions.In one year, we observed five patients presenting positive blood culture for S. bovis.There were four cases of infective endocarditis. This confirms the great affinity of this bacterium for the endocardium. We successfully treated all four patients with penicillin alone, for five to six weeks.There is a frequent association between S. bovis bacteriaemia and colonic adenocarcinoma. We performed thus a radiographic examination of the colon in four cases. One patient actually had a colonic carcinoma, and two others had benign colonic polyps. It seems probable that benign polyps also predispose to Streptococcus bacteriaemia or endocarditis