Biomedical subjects
Publications and source records attributed to P Morin.
The idea of alternative resources is a fashion able one; however, those resources are still fighting for their financial survival and what is more, they are handicapped by power games. The alternative resources'state of affairs is described with the help of examples taken from the Montreal district and from a report on the < > presented to an Inquiry Commission on mental health and social services.
Nine patients with peripheral neuropathy and monoclonal gammapathy are presented (4 multiple myeloma, 5 Waldenström's macroglobulinemia). Two patients had tremor and ataxia. All patients had delayed nerve conduction and increased cerebrospinal fluid protein. Symptoms of neuropathy preceded detection of serum protein abnormalities in seven cases. Nerve fiber lesions involved myelin and axons. Biphasic myelopathy with uniform separation of myelin lamellae was observed in one case of Waldenström's disease. Amyloid stains were negative. Treatment was successful in one of four patients. 185 cases of peripheral neuropathy with monoclonal gammapathy are reviewed. Pathogenic role of microvascular changes, amyloid depositions, antimyelin antibody is discussed. The role of anti MAG antibody remains unresolved. Nerve damage due to another cause is possible. The paraprotein and the neuropathy may not be directly related but both caused by the underlying condition.
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An oriented phase II trial of D-Trp6-LH-RH was conducted according to Gehan's statistical method on 25 patients suffering from prostatic carcinoma. LH and testosterone serum levels decreased rapidly. Pain disappeared during the third month in 14 out of the 21 patients and markedly decreased in 5. Prostatism completely regressed in 10 out of the 22 subjects presenting it and markedly decreased in 9. Prostate hypertrophy regressed, as shown by ultrasonography, in 84% and by more than 50% in 37% of the patients. The overall regression rate of bone scintigraphy images was 43%; a regression of more than 50% was only registered in 12.5% of the patients; this may be explained by the long time which is necessary before bone image disappearance occurs. Prostatic acid phosphatase levels regressed in 75% and by more than 50% in 66.7% of the patients.
A patient presented with visual and tactile agnosia due to a spontaneous left occipito-temporal hematoma. Major memory and spatial orientation disorders were also noted, but language, gestures, auditory and olfactory perception, and interior visual imagerie were unaffected. A review of the literature since 1970 found 6 cases of an association of this type among 17 patients with visual agnosia. There appears to be no relationship between the presence of tactile agnosia and the global or partial character of the visual agnosia, the severity of memory disturbances, the presence of visuoverbal disconnection or visual imagery disorders. In contrast, these cases differed in that the lesions were more extensive and extended beyond the internal occipital regions: they were widespread in 3 cases and in the left internal occipital and parietal region in 1 case. In the patient reported in this paper there was a wide lesion of the posterior white matter of the left hemisphere.
Serum ceruloplamin levels were measured and Badin's cetrimonium tests (selective precipitation of serum glycoproteins with cetrimonium bromide) were performed after delivery in 72 out of 350 sera previously collected during the 4th-5th months of pregnancy. Thirty-six of the 72 sera were obtained from women whose pregnancy ended with toxaemia, and 36 from women chosen at random whose pregnancy ended normally. In women who developed toxaemia at 8-9 months, ceruloplasmin levels and cetrimonium test values were often higher at 4-5 months than in correlation between assays and tests. Ceruloplasmin determinations and cetrimonium tests therefore provide different types of information on the latent pathological condition which precedes toxaemia, but their predictive values must be taken jointly.
Delirium following heart surgery with extra-corporeal circulation recently has been the subject of several studies that show a syndrome with variable diagnostic criteria and incidence which tend to confuse the entity. The diagnostic criteria proposed by the recent DSM-III of the American Psychiatric Association allow a better circumscription of the syndrome but exclude a group of patients manifesting visual hallucinations, sometimes paranoid features and cognitive functions that are less disturbed. Heller's and Kornfeld's less rigid criteria, on the other hand, have the disadvantage of including functional psychotic states that can arise after surgery without a true delirium with organic brain syndrome. We suggest the use of standard criteria that could include only delirium following cardiac surgery with E.C.C. and subdivision of the patients following the kind of surgery. In a retrospective study of the last four years at the Montreal Heart Institute, our clinical observations show an incidence of delirium after heart surgery with E.C.C. of 3%. a finding much lower than that reported in other centres which show an incidence between 13 and 67%. The more important factors found, were the kind of surgery (valve replacement more than coronary bypass), the age of the patients, and the degree of sickness after surgery during the stay in the intensive care unit. Those risk factors were also found in other recent studies. We describe the clinical syndrome and discuss its etiology in reviewing the more common risk factors before, during and after surgery. We underline the importance of the quality of the relationship with the patient before and after surgery in discussing prevention and treatment.
Description of a cervical intradural extramedullary neurenteric cyst in a fifty eight years old female. After a sudden onset of right brachial paresis, spinal hemiplegia during the following few days. The tumor was situated at C6 and C7 in front of the spinal cord. It could be completely removed by means of laminectomy.
The recent literature still reports a high incidence of delirium in patients operated with extracorporeal circulation. This syndrome is found more often in patients over 50 years and in patients with a previous history of delirium, alcoholism, drug addiction or cerebral damage and is more frequent after valvular than after coronary surgery. It is also often observed in patients who present major post-operative complications. Attention and concentration capacity are characteristically modified (diminished most of the time) with or without faulty perception (hallucinations), sleep alterations, incoherent language, apathy or agitation. Disorientation and memory troubles are common. Delirium appears within a few hours or a few days of the surgery, its evolution is fluctuant and generally benign. A retrospective study at the Montreal Heart Institute showed an incidence of 2.98 per cent (84 cases/2811 open heart surgery cases) over the last four years. The mean age of these patients was 57.5 years (versus 50.4 for patients without delirium). Major post-operative complications were found in 37 (44 per cent) of these 84 patients. The incidence was lower (1.45 per cent) in coronary than in valvular (4.6 per cent) surgery cases. Several explanations are presented to explain this low incidence.
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A data collection tool was developed to teach nursing students basic principles of nutritional assessment. The tool was used to help nurses coordinate and interpret data they routinely collected so they would be more aware of real and potential nutritional problems. Emphasis was on those aspects of nutritional care relevant to the nurse's advocates in communicating these concerns to the dietitian. Observation and early referral of potential diet-related problems enables the dietitian to more effectively provide for nutritional care.
Increased spin-lattice T1 and spin-spin T2 proton relaxation times of malignant tissues are by now well documented phenomena. A "systemic effect" of cancer, evidenced by NMR, has been demonstrated in different experimental models. The present study was undertaken to examine systemic effect in man by measuring serum relaxation times and related biochemical variables in 224 healthy control individuals and 311 patients with solid tumors at different stages of growth. The increase in T1 values is statistically significant in the advanced cancer group but not in the nonevolutive disease group, compared to healthy control group. Variations of T2 values are not significant in this study. There is no correlation of T1 increase with serum ions, total proteins or protein fractions.
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The study of a personal series of five pregnancies and the review of 130 cases published enabled us to recall the physiological, clinical and therapeutic sides of the "pregnancy-heart valve prothesis" combination. Maternal mortality remains at 3%; morbidity, essentially in the form of haemorragic or thrombo-embolic accidents, comes to 45%. We insist on the importance of a pregnancy planned and accepted both by the cardiologist and the obstetrician as contraception is a difficult problem with these patients, classical oestroprogestative methods and intra-uterine devices being too much of a risk. An intake of a progestagen in small doses combines efficiency with innocuity.
Clinical and pathological findings in a case of hereditary degenerative disease of the nervous system are reported. The clinical picture associated cerebellar signs with an action hypertonia, which was the cause of severe hypertonic paroxysms in the terminal stages of the illness. Pathological lesions were found in the cerebellar cortex, the external part of the pallidum, Luys' body, and the substantia nigra which included Lewy bodies. The relationships of this case with atrophic lesions of the pallidum and Luys' body are discussed.
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1H NMR and ORD were used to characterize the respective variations of tertiary structure and secondary structure of parvalbumins with calcium content ((Pa(O), without calcium and PaCa2 calcium saturated) and temperature. It has been observed that the tertiary structure can be lost without significant variation of the helical content. Cooperative binding of calcium to Pa(O) has been shown by NMR spectroscopy under low ionic strength conditions and at neutral pH. The present study shows that the calcium binding affinity of parvalbumin is dependent on the tertiary structure. Calcium binding and calcium release functions of parvalbumins in the muscle may be controlled by their tertiary structure.