Biomedical subjects
Publications and source records attributed to H Petit.
Diaphragmatic paralysis is rare in neuralgic amyotrophy. Total quick recovery is usual. We report a case with a diaphragmatic paralysis still present more than 30 years after the onset of a bilateral and recurrent neuralgic amyotrophy. Neuralgic amyotrophy should be considered as a possible cause of chronic diaphragmatic paralysis.
A 38 year old alcoholic patient presented meningitis, loss of consciousness, pneumopathy and multiple cerebral lesions on a CT scan. He improved with ofloxacin and corticosteroid therapy, before the administration of anti-tuberculin treatment. Magnetic resonance imaging was used to follow the course of the lesions once the CT scan had become normal. This case demonstrates the efficacy of ofloxacin against central nervous system tuberculosis.
A 19 year-old man developed an acute syndrome of the anterior horn of cervical spinal cord during a primo-infection with toxoplasma. The neurological syndrome was completely regressive after treatment with 1 600 mg/day of trimethoprim-sulfamethoxazole for three months.
Brain CT's of 30 patients with early onset probable Alzheimer's disease (according to NINCDS-ADRDA work-group criteria), were compared to those of 30 sex- and age-matched control subjects. This study has confirmed that patients with Alzheimer's disease have higher cerebral atrophy than control subjects, and that cerebral atrophy is correlated with the severity of the disease appreciated with the mini-mental state and the global deterioration scales. It revealed that patients were more different from control subjects for the subjective index and for the third ventricle index. CT has a good predictive value in differentiating groups, but has a poor predictive value in differentiating individuals.
Pulmonary embolism was first described by Laennec in 1819. After introduction of the Trendelenburg surgical technique, Kirschner, in 1925, performed the first successful embolectomy. In a review of the literature, in 42 patients, survival rate was 45% on use of a modified Trendelenburg method employing cross-clamping of the vena cava. The use of this intervention can still be considered justified if extracorporeal circulation is not available. Establishment of the indication and anatomical fundamentals The indication for surgical embolectomy is considered established in the presence of massive pulmonary arterial obstruction with pending death of the patient. The difficulty lies in identification of the patient with massive pulmonary embolism who will succumb and in defining the extent of pulmonary arterial obstruction which will lead to death. Limitation of the indication to only those patients in shock led to mortality rates up to 93%. Immediate death after pulmonary embolism is not the rule. Of 52 patients with massive pulmonary embolism, 50% survived more than two hours; in those with no preexistent cardiopulmonary disease up to eight hours. Surgical intervention can be considered accordingly. Anatomically, massive pulmonary embolism implies at least 60 to 70% obstruction of the pulmonary arterial bed. In 85 of 100 patients who died of pulmonary embolism, voluminous emboli were found in both pulmonary arteries. In the presence of preexistent cardiopulmonary disease, lesser degrees of obstruction can lead to a critical condition. In consideration of the indication as above, the following comments are considered appropriate: 1. Quantification of the obstruction: Pulmonary angiography remains the most appropriate diagnostic examination. The degree of obstruction can be quantified according to a number of indices. As of 60%-obstruction, surgical intervention can be considered. 2. Justification of embolectomy: The classical indication can be established in 2 to 6% of the patients based on treatment-refractory hypotension. In Table 1, the classical stages of massive pulmonary embolism are shown with the indication for embolectomy being considered as of stage IV but these characteristics are unreliable in everyday practice. If surgery is delayed until vasoactive drugs are no longer effective, an irreversible condition is frequently incurred in spite of operative removal of the obstruction. More favorable results can be achieved when the indication for surgery is based only on the degree of obstruction since, in this case, the condition of shock will not be prolonged and a hemodynamically-stable patient can be subjected to surgery. 3. Thrombolytic treatment
Single photon emission tomography with Hm PAO Tc99m was used in 27 patients with probable Alzheimer's disease, 9 patients with multi-infarct, dementia, and 11 healthy volunteers. The data were quantified in 4 regions of interest (using the basal ganglia as an internal standard): left and right prefrontal areas (Fg and Fd), and left and right parietal areas (Pg and Pd). Pg and Pd indices were lower in patients with Alzheimer's disease than in patients with multi-infarct dementia, and healthy volunteers (p less than 0.05). The ratio (Fd + Pd)/(Fg + Pg) was lower in patients with dressing apraxia (p less than 0.02), anosognosia (p less than 0.001), spatial agnosia (p less than 0.01), ideomotor apraxia (p less than 0.02), ideatory apraxia (p less than 0.01), and constructive apraxia (p less than 0.01). No correlation could be established between this ratio and the severity of aphasia, or between the indices and mini mental state scores. With Pg and Pd indices lower than 0.90, sensitivity for Alzheimer's disease was 70 p. 100 and specificity, 75 p. 100.
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Two outbreaks of trichinosis occurred in France in August and October of 1985 and 1,073 cases in all were identified. In the first outbreak, two localities were involved: the town of Melun and the 14th district of Paris. To determine the origin of the contamination, three case-control studies were carried out: among patients' families, among the populations of these two areas, and among the inmates in the prison of Melun. In the second outbreak, cases again occurred in Paris but in a different district (the 12th), in the city's suburbs, and in other towns scattered throughout France. Although no parasites were found in any of the meat examined in either outbreak, results of the study indicate that infection was due to horsemeat consumption and led to the incrimination of two carcasses, one imported from a slaughterhouse in the United States and the other from West Germany. These findings led the French Ministry of Agriculture to order the inspection for trichinosis of all meat from horses slaughtered both in France and in countries exporting horsemeat to France.
Tau proteins are the major components of Paired Helical Filaments (PHF) of Alzheimer's disease. Using the immunoblot technique and an antiserum against PHF, we have studied the distribution of Tau proteins in the different areas of normal human brains and Alzheimer brains. Tau proteins were clearly present in cortical grey matter but were difficult to detect in the white matter. In Alzheimer brains, we observed two differences: first, there is an important background due to the partial dissociation of the lesions containing Tau aggregates. Second, the profile of Tau proteins is modified, due to abnormal phosphorylation. Thus, Tau proteins are found in large amounts in the grey matter of the cortical areas and are not exclusively distributed in the axonal domain. The normal cortical distribution of Tau in the human brain correlates well with the distribution of histological lesions that contain PHF (neurofibrillary tangles and neuritic plaques) in the Alzheimer cortex.
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A study of the isthmus and ligament in unionid mussels was undertaken employing methods specifically designed to preserve the in vivo relationships of these interrelated structures. Serial sections of the hard and soft tissues were used for two-dimensional analysis. From these, a tridimensional computerized reconstruction was developed. Special dissections of the undisturbed isthmus were also utilized. By using such methodologies, a new description of the ligament has been developed employing such terminology as the foliated ligament and the posterior folding laminae. Similarly, for the isthmus, an anterior lyre, a pallial crest, a pallial peduncle, and a posterior lyre are described. Such entities are both morphologically and physiologically related to the shell and ligament.
Three patients developed chorea while receiving oral contraceptives. Two were young patients whose chorea developed long after treatment had been started and disappeared soon after it had been discontinued. The third patient had acute amphetamine-induced chorea after prolonged oral contraception. Prolonged administration of female sex hormones is a possible cause of chorea in women who have not previously had chorea or rheumatic fever.
A previously healthy 35-year-old man suddenly developed vertebrobasilar ischaemia while playing tennis. Cerebral arteriography revealed a dissecting aneurysm of the cervical portion of both vertebral arteries. The neurological deficit and the angiographic features resolved with anticoagulant treatment alone. Only 15 patients with non-traumatic extracranial vertebral artery dissection have been previously reported. It is necessary to recognize the condition very quickly, because the authors consider that anticoagulation is required as an emergency.
Phytanic acid accumulation has for more than 20 years been used as a diagnostic criterion of Refsum's disease. Recently, however, phytanic acid has also been found in peroxisomal disorders (Zellweger's syndrome, neonatal adrenoleukodystrophy, infantile Refsum's syndrome, rhizomelic chondrodysplasia punctata). The 17 patients with Refsum's disease in the present study had serum phytanic acid values differing from 73 to less than 0.5 mg/dl (normal). alpha-Oxidation of phytanic acid in skin fibroblast cultures showed a defective capacity in all, with only small differences in residual activity. Phytanic acid determinations in serum from 3 of the 7 patients with peroxisomal disorders showed slightly elevated levels in 2. The alpha-oxidation capacity in the fibroblasts was defective in all, with a residual activity similar to that of Refsum's disease. An assay of the alpha-oxidation capacity may be useful in the diagnosis of both Refsum's disease and the peroxisomal disorders. The distinction between Refsum's disease and the peroxisomal disorders can easily be done on a clinical basis.
The patient reported had had a continuous headache involving the whole skull for 7 years. Many drugs had failed to relieve the pain, but with indomethacin the headache completely disappeared within 3 days. Nine months later the treatment was discontinued without any relapse. This variety of headache, not previously reported, was quite similar to the "hemicrania continua" except for its localization.
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