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Biomedical subjects

M Barat

Publications and source records attributed to M Barat.

At least 19 recordsLinked to original sources

Unilateral diaphragmatic paralysis: an electrophysiological study.

An electrophysiological study was carried out on four patients with unilateral diaphragmatic paralysis. Whereas neurogenic involvement of the paralysed hemidiaphragm was roughly similar in all cases, neurogenic patterns could be detected in the normally moving contralateral hemidiaphragm in three cases, and the degree of involvement could be correlated with the respiratory state of the patients. EMG also showed that the neuropathic process affected the limb muscles. Thus unilateral diaphragmatic paralysis may be, at least in some cases, the localised expression of a more diffuse neuropathy, perhaps a peculiar form of neuralgic amyotrophy.

Adult

[Central pontine myelinolysis after hepatic transplantation].

We report two cases of central pontine myelinolysis (CPM) following liver transplantation. The incidence may well be underestimated as in the past the diagnosis of CPM was based on postmortem findings. Malnutrition, poor clinical condition, encephalopathy are common features of transplanted patients developing CPM. The clinical course is characterized by a biphasic pattern; after normal recovery from anesthesia, there is a subsequent and gradual deterioration in the neurological state. The complex syndrome associates loss of consciousness, flaccid quadriplegia and pseudobulbar palsy. Among the many factors suspected of inducing CPM, a rapid correction of natremia (> 12 mmole/l/day) seems most probable. With regards to liver transplantation, CPM presents rather specific problems. Delaying transplantation to correct hyponatremia carries a risk of severe hepatic encephalopathy. On the other hand, the intraoperative compensation of blood losses with high sodium content blood products tends to induce an abrupt rise in sodium serum concentration. Moreover, renal capacity to excrete sodium is often impaired, due to hepatic insufficiency and surgical procedure. Transplantation should not be delayed, but as infusion of large amounts of sodium cannot be avoided (fresh frozen plasma, human albumin, red blood cells), natremia may be controlled by continuous veno-venous hemofiltration with low sodium content substitution fluids.

Adult

[Parkinson disease and communication].

Communication abilities imply multifactorial analysis. These disorders in Parkinson's disease involve speech, graphism, functional and paraverbal gestures. The patient's isolation in a major form of disease is dramatic. Functional study requires an analysis of each factor; progress should be realized for an objective approach. With a therapeutic objective in view, the most impaired features, and the patients real situation and way of life must be evaluated. Some training measures are useful especially for social adjustment and motivational reinforcement.

Communication

Peripheral neuropathies and lymphoma without monoclonal gammopathy: a new classification.

Recent progress in immunopathological studies of peripheral nerve and lymph node fragments together with 16 personal cases and numerous clinicopathological reports have suggested a new classification of peripheral neuropathies (PN) and lymphomas. These are: (1) PN due to local infiltrations by a T-cell lymphoma: (2) acute polyradiculoneuritis due to active demyelination and associated with infiltrates of a T-cell lymphoma in the epineurium, resembling Marek's disease (which is a T-cell lymphoma); (3) B-cell lymphoma proliferation which may be restricted to or predominate in the peripheral nervous system, with a large clinicopathological heterogeneity ranging from localized forms to ascending polyradiculoneuropathies; (4) angiotropic lymphoma, which is a B-cell lymphoma and may present as an acute mononeuropathy; (5) patients with acquired immunodeficiency syndrome due to lymphomatous infiltrates in the endoneurium, of which 2 cases of PN have been reported; (6) PN associated with organomegaly, endocrinopathy, M-component and skin lesions, certain cases being associated with a plasmocytoma and sometimes Castleman's disease but without any monoclonal gammopathy: (7) classic Guillain-Barré syndrome, prone to develop in patients with extraneural lymphoma but without any lymphomatous infiltrates in the peripheral nervous system; (8) certain cases (4 out of 16 in our series) where there is no clear relationship between PN and lymphoma, and there are mainly features of axonal degeneration. Inflammatory perivascular infiltrates were sometimes present in the epineurium.

Aged

Initial factors predicting functional performance in patients with traumatic tetraplegia.

The authors present a prospective analysis of the functional outcome in 99 patients with traumatic tetraplegia consecutively admitted to the Pellegrin Hospital (University Hospital, Bordeaux, France). There was a 29% death rate. Eighteen months after injury, 33% of the patients were dependent (not able to perform activities of daily living without the presence of a helping individual), 38% were independent. Two predictors of independence (age and initial Yale Scale Score) were found by a statistical analysis of the course of the disorder.

Activities of Daily Living

Initial factors predicting survival in patients with a spinal cord injury.

A study is presented of a prospective analysis of survival rates in 157 patients with spinal cord injury consecutively admitted to the Pellegrin Hospital (University Hospital, Bordeaux, France). There was a 20% death rate, occurring in the first three months after injury. Three independent predictors of survival in patients with spinal cord injuries (age, initial conscious level and respiratory assistance) were found by analysis of the course of the disorder.

Adolescent

Fibrous dysplasia masquerading as chronic maxillary sinusitis.

Fibrous dysplasia is a rare disease of unknown cause that affects one or multiple bones. In its monostotic form, only one bone is involved. The maxilla is the most commonly affected facial bone. Facial deformity with or without pain is the most common presentation of fibrous dysplasia affecting the craniofacial bones. In certain cases the disorder can present clinically as chronic maxillary sinusitis. The clinical, radiologic, and histologic findings, as well as the differential diagnosis and treatment of this condition are reviewed.

Adult

Early prognostic factors for walking in spinal cord injuries.

The authors present a prospective analysis with 1 year follow-up of about 157 consecutive spinal cord injured patients admitted to the Bordeaux CHU, over a 3 year period (1982-1985). They present a method of analysing the walking status recovery in patients with spinal cord injuries from the early factors recorded on initial clinical examination. Twenty eight per cent of all patients are 'functional walkers', 1 year after injury. Three early factors were selected: age; the level of injury; and the initial Yale Scale Score. Only the age and the initial Yale Scale Score are independent predictive factors, according to the Cox model. The authors present a model of walking status recovery, 1 year after the injury, predicted from age and the initial Yale Scale Score.

Adult

Metastatic thymoma to the head and neck.

Malignant thymoma is a mediastinal tumor which spreads primarily by local invasion. Spread to regional lymph nodes and distant organs is variable. The most common sites of metastasis in the head and neck region are the supraclavicular nodes and the brain. Cervical lymph node metastasis as the presenting symptom of malignant thymoma has not yet been reported in the otolaryngologic literature. We present three cases of metastatic thymoma to the neck from a series of 28 thymomas, ten of which were malignant. The clinical presentation, histopathological features, therapy, and prognosis of malignant thymomas are discussed.

Adult

Uncompacted lamellae in three patients with POEMS syndrome.

Three patients with POEMS syndrome were studied: two of them had myeloma, whereas the third had M protein without myeloma. Peripheral nerve biopsies showed no deposits of anti-Ig sera at direct immunopathological examination. Ultrastructural study revealed myelino-axonal degeneration in all three cases. This was associated in the first case with a dramatic loss of myelinated fibers and there were lesions consistent with acute degeneration in the second case. In addition, all three had some fibers showing uncompacted myelin lamellae. This peculiar modification has previously been reported only in cases of dysglobulinemia, lymphoma and inflammatory demyelinating polyneuropathy, but its mode of formation remains unclear.

Aged

[Polyneuropathies during prolonged stays in resuscitation].

Extensive multiple neuropathies were observed in four patients after prolonged stay in intensive care units. Date of onset of the multiple disorders was difficult to determine due to disturbed consciousness of all patients during the first few weeks of intensive care: it was probably between the 10th and 30th days. Electrophysiological examinations in the 4 patients, and ultrastructural study of musculocutaneous nerve of leg in 2 cases, suggested an acute axonal lesion. All patients survived the causal affection which had justified prolonged intensive care, 3 recovering from the multiple neuropathy within 3 to 4 months, the last patient having marked neuromuscular sequelae. Several factors can be incriminated at the origin of this multiple neuropathy. Whereas retrospective studies allowed exclusion of a toxic, infectious or drug-related cause, severe nutritional deficiencies existed; proteins in all cases and vitamins in one patient despite enteral re-nutrition judged as satisfactory. Additionally, a role for a previous lesion of peripheral nerves from chronic hypoxia was possible in 2 cases as well as for a non-insulin dependent diabetes in one of these two patients. A rarely reported but probably not exceptional complication, diagnosis is assisted by early electrophysiologic exploration. Correction of nutritional disorders may require parenteral feeding exclusively, this possibly accelerating neurologic recovery, as proposed in the several rare studies reported in the literature.

Aged

Characterization of a Xenopus laevis mitochondrial protein with a high affinity for supercoiled DNA.

A DNA binding protein of 31 Kd -mtDBPC- has been isolated from X. laevis oocyte mitochondria. It is present in large amounts in the organelle and does not show any enzymatic activity. Its binding to the superhelical form of a DNA is higher than for any other form, or for RNA. No sequence specificity could be found for any mtDNA fragments tested, including both origins of replication. It is able to introduce superhelical turns into relaxed circular DNA in the presence of a topoisomerase I activity. It could be a component of the mitochondrial nucleoids.

Animals

Characterization of a mitochondrial protein binding to single-stranded DNA.

A DNA-binding protein from Xenopus laevis oocyte mitochondria which has been found associated with the D-loop also shows a strong preference for single-stranded DNA. The binding to polynucleotides is dependent on the base composition, but no sequence specificity was found. This protein, called mtSSB, binds tightly and cooperatively to single-stranded DNA. By its amino-acid composition and its binding properties it appears to be similar to the single-stranded DNA-binding proteins found in prokaryotes.

Amino Acids