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Biomedical subjects

G Serratrice

Publications and source records attributed to G Serratrice.

At least 73 records · Page 4Linked to original sources

[Mitochondrial diseases].

Mitochondrial diseases are very complex. Their description, recent but still in progress, makes all classifications risky. In the first part of this article we present the original character of mitochondria, which is due to their functional structure aimed to produce energy, the respiratory chain being fundamental for the phosphorylation/oxidation and ATP production processes. Beside Mendelian transmission, mitochondria have their own DNA which codes for proteins that are few but play an essential role; the nuclear DNA probably has a regulatory effect. For these reasons, explorations of mitochondrial functioning, mainly by morphological, biochemical and genetic techniques, are specific. In the second, clinical part, we analyse the whole range of symptoms and syndromes which includes purely muscular lesions, predominantly nervous lesions and multisystemic lesions. Some syndromes can be individualized on a biochemical basis, whereas other are individualized on a genetic basis involving mainly mutations of mitochondrial DNA. Finally, we merely list lesions the origin of which might be mitochondrial but remains unknown.

Humans↗

[Nociceptive flexion reflex of the leg. Use after surgical treatment of herniated disk].

In patients suffering from acute sciatica due to herniated disk Lasegue's manoeuvre inhibits the leg flexion nociceptive reflex (RIII reflex) in either the ipsilateral or the contralateral limb. This is thought to be due what is called "diffuse noxious inhibitor control" modulating the activity of a group of convergent spinal neurons. The purpose of this study was to determine whether surgical resection of the herniated disk in patients suffering from sciatica might relieve this so-called "counter-irritation". Among 10 patients whose sciatica resulted from herniated disk, the decrease in amplitude of the RIII response observed when Lasegue's manoeuvre is applied disappeared in 7 patients, 6 to 8 days after surgical resection of the herniated disk. These results suggest that this test might be a useful tool for postoperative prediction of radicular compression.

Adult↗

Regression of allopurinol-induced peripheral neuropathy after drug withdrawal.

A patient experienced an axonomyelinic peripheral neuropathy during a long-term allopurinol treatment. The symptoms and signs regressed after drug withdrawal, and the nerve conduction velocities and distal latencies improved. The incidence of allopurinol-induced peripheral neuropathy is very low. Thus, facilitatory factors have to be sought.

Allopurinol↗

Motor neuropathies and antiglycolipid antibodies.

This paper describes patients with demyelinating motor neuropathies associated with conduction blocks, pure motor neuropathies and intermediate forms with resemblances to amyotrophic lateral sclerosis, in persons with raised titres of anti-GM1 antibodies. The specificity of the abnormal anti-GM1 antibody titres is discussed, and the possibilities of immunosuppressive therapy mentioned.

Antibodies↗

[Association of post-radiation focal muscular atrophy and hypertrophy].

We report a 48 year old woman who had radiotherapy for uterine carcinoma and who developed amyotrophy and muscle hypertrophy in one lower limb. Very few cases of post-radiation monomelic amyotrophy have been reported. On the other hand denervation hypertrophy was presumed to be well known. The seat of the lesions was presumed to be radicular and spinal. The mechanism of atrophy and hypertrophy is discussed.

Adenocarcinoma↗

[Camptocormia in the elderly patient: myopathy or muscular dystonia?].

Two cases of camptocormia in elderly patients are reported. Both patients presented with an anterior curvature of the trunk which disappeared in the decubitus position. Computed tomography demonstrated hypodensity of the muscles which preceded atrophy. Histological changes were of low specificity and diverse with irregular and a trophic muscle fibers and occasionally endomysial fat or mitochondrial abnormalities. These findings suggest that camptocormia may be the consequence of a disease of spinal muscles. Pathophysiological hypotheses include neurogenic atrophy of spinal muscles, spinal amyotrophy, and delayed primary myopathy. None of these hypotheses was consistent with findings in our two patients. The terms "muscular dystrophy" and "mitochondrial myopathy" occasionally used seem inappropriate in view of the lack of specificity of the lesions. A better term may be "muscular insufficiency", the mechanism of which is still unclear.

Electromyography↗

[New methods of analysis of gait in the evaluation of the action of anti-inflammatory drugs. Apropos of naproxen].

Two nontraumatizing and reproducible tools for quantitative gait analysis as part of the objective evaluation of nonsteroidal antiinflammatory drugs are reported. The Bessou gait analyzer is a simple mechanical device which measures spatiotemporal and kinematic parameters (stride length; duration of stride, weight-bearing, and forward swing; speed and peak speed of swing; and overall speed of walking). The ELITE system is a considerably more complex instrument for analyzing three-dimensional motions through high-speed shape recognition. Computerized data management allows not only to determine the spatiotemporal parameters listed above but also to study displacements of selected landmarks in several planes and to derive joint angles and angular speeds. Coupling of the ELITE system to a force platform and to telemetric transmission surface electromyography substantially expands the range of data provided. The mechanical gait analyzer was used to evaluate the effects of naproxen in 11 patients with osteoarthritis of the knee; another similar study in 13 patients with osteoarthritis of the hip is ongoing. Gait was recorded before and after daily administration of naproxen for seven days. After treatment, walking speed was significantly increased as a result of increased stride length and decreased stride duration. Durations of monopodal and bipodal weight-bearing decreased concomitantly with the increase in speed, whereas duration of forward swing remained unchanged. These data demonstrating improved kinematic gait parameters show that naproxen is effective in reducing the adverse mechanical effects of pain. This study also demonstrates the usefulness of gait analysis for evaluating drugs.

Aged↗

Autonomic nervous system involvement in rheumatoid arthritis. 50 cases.

OBJECTIVE: To investigate the involvement of the autonomic nervous system (ANS) in rheumatoid arthritis (RA), which is rarely discussed. METHODS: Fifty cases of RA were selected, excluding all patients liable to develop dysautonomia or having a treatment interfering with ANS. They were investigated by cardiovascular tests of heart rate variations in deep breathing, Valsalva maneuver and orthostatic change in posture. These quantified tests were reported as ratios: breathing, Valsalva and 30/15. A control series of 82 healthy subjects was tested to determine the abnormal threshold for each one of the 3 tests and allowed a correlative study. Dysautonomia was defined when 2 of the 3 tests were pathological. According to these criteria, 30 patients with RA with ANS dysfunction were retained. RESULTS: The clinical examination of these patients showed no neurological sign or autonomic sign but there was an inflammatory syndrome. Rheumatoid factors (RF) were frequently present as were slowly progressive articular destructions. The statistical study revealed a significant difference between the series of RA patients and the control series, only for the Valsalva maneuver (p < 0.01) and there was no obvious correlation between ANS dysfunction in RA and markers of inflammation, presence of RF, duration of disease or degree of articular destructive lesions. CONCLUSION: Our study is in agreement with the literature which reports an ANS involvement in RA with a same frequency but remaining primarily subclinical and probably isolated from other peripheral or central nervous system damage. The physiopathology of this form of dysautonomia is discussed and an immunological mechanism is suggested.

Adult↗

[Iatrogenic axonal neuropathy and erythroderma induced by piroxicam. Manifestations of hypersensitivity?].

A case of peripheral neuropathy following treatment with piroxicam is reported. The patient developed muscle pain and asymmetrical sensory distal neuropathy of the lower limbs a few months after the onset of the treatment. Piroxicam was withdrawn and full recovery was achieved within one year. The simultaneous appearance in the same patient of erythroderma with microvasculitis on nerve and skin biopsies suggests a common type III hypersensitivity mechanism in the pathogenesis of these two side-effects of piroxicam.

Aged↗

Nociceptive threshold in hypothyroid patients.

The purpose of this study was to measure the nociceptive threshold in hypothyroid patients by determining when the nociceptive flexion reflex of the lower limb occurs under percutaneous electrical stimulation of the sural nerve, given that this threshold is well correlated with pain sensation. Twelve hypothyroid patients and twelve control subjects participated in the study. In the case of the hypothyroid patients, the nociceptive flexion reflex (or RIII reflex) was measured before and six weeks after the onset of substitution treatment. The results clearly indicate that the nociceptive threshold of the patients with hypothyroidism was significantly higher than that of the control subjects. After six weeks of substitution treatment, the RII threshold return to normal. The analgesia observed in the hypothyroid patients in this study do not appear to be correlated with the blood TSH level. The possible mechanisms of these analgesic effects are discussed.

Aged↗

[Polyneuritis, polyradiculoneuritis, polyneuropathies: development of a concept].

The concept of polyneuritis, polyradiculoneuritis and polyneuropathy has changed considerably since the last century. Charcot-Marie-Tooth disease has been dismembered into hypertrophic, neuronal and spinal forms. Within the group of hereditary sensory neuropathies, to Thévenard's ulcero-multilating acropathy have been added recessive forms of early onset and various types of congenital analgesia. Other hereditary polyneuropathies result from inborn errors of metabolism; in adults, these are chiefly Refsum disease, Fabry's disease, porphyria, amyloidosis and adrenoleucodystrophy. Guillain-Barré acute primary polyradiculoneuritis has come to be associated with chronic and recurrent forms and, more recently, with multifocal demyelinating neuropathy with persistent conduction blocks and antibodies to GM1. Young and Adams acute pandysautonomia is close to polyradiculoneuritis. Finally, many polyneuropathies, formerly labelled polyneuritis, are subsequent to an ever increasing number of known causes, notably infections (e.g. borreliosis or HTLV viruses) and drug-induced or industrial toxicity. Advances in explatory techniques have generated new concepts, including small and large fibre neuropathy, distal and central degenerations, myelin diseases and neuronal diseases.

Adult↗

A double-blind placebo-controlled trial of L-threonine in amyotrophic lateral sclerosis.

Fifteen patients with the unequivocal diagnosis of amyotrophic lateral sclerosis (ALS) completed a 1-year randomized double-blind placebo-controlled trial of L-threonine (2 g daily). During the study, patients in the placebo group showed a decline in functional status consistent with the natural history of ALS, which was not statistically different from outcome in the patients in the L-threonine group.

Aged↗

Nociceptive threshold in patients with epilepsy.

Clinical practitioners have often observed in the course of their daily work that the pain thresholds of epileptic patients seem to differ from those of healthy subjects. These patients can suffer from quite severe traumatic lesions without apparently experiencing any pain. Since they are usually under treatment for epilepsy, it is difficult to determine whether the absence of pain is due to these patients' epileptic condition or to its treatment, since most antiepileptic drugs also have analgesic effects. In the present study, it was proposed to assess the pain thresholds of 15 epileptic patients (10 with tonic-clonic seizures generalized at outset and 5 with temporal lobe epilepsy), by measuring the leg flexion nociceptive reflex (or RIII reflex) threshold: the stimulation threshold at which this reflex is triggered is known to be correlated with the pain threshold. The nociceptive threshold of the patients with generalized epilepsy was not found to differ from that of the control population, whereas that of the patients with temporal lobe epilepsy was spontaneously high and was not reversed upon injecting naloxone. These data are discussed from the point of view of the pain pathways and mechanisms possibly involved.

Adolescent↗

Identifying the afferents involved in movement-induced pain alleviation in man.

It has been clearly established that the perception of nociceptive stimulus decreases in intensity when movement is initiated in the part of the body to which the stimulus is applied. The pain alleviation is probably at least partly due to the activation of afferents which occurs during the movement. The present experiments were carried out with a view to investigating which groups of afferent fibres is mainly responsible for the gating of the nociceptive messages which occurs during movements. In eight volunteers we investigated the changes in the amplitude of the nociceptive leg flexion reflex (RIII) when the subjects were at rest, when they were performing active or passive ankle movements and when the spindle proprioceptive pathway was mobilized by applying vibratory stimulation to the Achilles tendon. Similar experiments were also carried out with eight other volunteers after anaesthetizing the ankle skin mechanoreceptors. This method was chosen because a clear-cut correlation is known to exist between the amplitude of the nociceptive motor reflex and the intensity of the pain perceived by the subject. The data obtained clearly show that anaesthesia of cutaneous mechanoreceptors connected to the large diameter afferent fibres prevented the decrease in the motor response which otherwise accompanied both active and passive movements. Activation of the Ia fibre group by tendon vibration resulted on the contrary in an increase in the amplitude of the motor response. Movement-induced pain alleviation therefore does not mainly involve the activation of the Ia group of fibres.

Adult↗

Analgesic effect of indomethacin shown using the nociceptive flexion reflex in humans.

This study investigated whether indomethacin has an analgesic effect on the central nervous system. As analgesics which affect the central nervous system produce a correlated decrease in the subjective sensation of pain and in the nociceptive reflex in humans, the amplitude of the nociceptive flexion of the biceps femoris was studied. Eight patients (six men, two women) aged 35-70 years (mean 51) with rheumatic diseases were included in the study. Each patient was his or her own control and was given a single intramuscular injection of either 50 mg of indomethacin or a placebo. A placebo controlled, double blind experimental design was used. Patients were evaluated before and 30, 60, and 75 minutes after the injection. Seventy five minutes after injection, indomethacin gave a 54% decrease in the amplitude of the nociceptive reflex, whereas the placebo produced a decrease of only 12%. This suggests that indomethacin exerts a depressive effect on the amplitude of the nociceptive reflex and affects the central nervous system as part of its analgesic action.

Adult↗