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Biomedical subjects

R Dumas

Publications and source records attributed to R Dumas.

At least 253 records · Page 14Linked to original sources

[Neurophysiological study of peripheral nerves in newborn infants with congenital hypothyroidism. Value in the surveillance of replacement therapy].

The authors studied prospectively with electrophysiological means, peripheral nerve maturation of 18 neonates with congenital hypothyroidism compared to 18 controls. Before replacement therapy, a large reduction of sural nerve action potential amplitude and of Hoffmann's reflex was observed. It was accompanied by a moderate reduction in nerve conduction velocity. These results imply a myelinic and even more an axonal pathology. It is related to the anatomical type of hypothyroidism and to serum T4 deficiency. It is transient and disappears after 6 months of hormonal replacement therapy. In conclusion, this study gives new informations on the consequences of congenital hypothyroidism on peripheral nerves.

Congenital Hypothyroidism↗

[Dystonia caused by putamino-capsulo-caudate infarction in a child].

Three cases of stroke in childhood are reported. In the 3 cases, an infarct involved the territory of the striato-lenticular arteries. Clinically, there was a pure motor hemiplegia and a dystonia which appeared while the hemiplegia was disappearing. The dystonic syndrome due to stroke appears only if an ischaemic lesion involves the putaminal-capsular-caudate territory, and more often in childhood.

Caudate Nucleus↗

[Hyperglycemia in the initial phase of cerebral vascular complication. Index of bad prognosis].

The short-term prognostic value of hyperglycemia in acute stroke has been evaluated from the results of the first year of activity of the Stroke Registration unit in Dijon. In 188 patients admitted to hospital for acute hemiplegia blood glucose levels were measured on admission and daily for 7 days thereafter, and a CT scan was performed within a fortnight. Mortality was significantly higher in hyperglycemic patients (more than 2 g of glucose per litre) than in normoglycemic patients. In hyperglycemic patients the increase in blood glucose level was correlated with the initial disturbances of consciousness, the severity of hemiplegia and the presence at CT of an haemorrhage or an infarct with oedematous reaction. Thus, hyperglycemia in acute stroke is related to the severity of the cerebral damage. As a factor of bad prognosis, it is as sensitive as disturbances of consciousness or severe brain lesions at CT.

Aged↗

[Neuroendocrine disorders observed in the post-critical phase in epileptic patients].

In 10 epileptic patients with generalized seizures, plasma levels of ACTH, prolactin, FSH, LH, TSH, were measured first within 60 minutes after the crisis, then 3 to 5 days later without changes in antiepileptic drugs. Within 1 hour after the seizure, a significant rise of ACTH and prolactin 3 - 4 folds the levels observed in the 2nd measure was present. This was compared to measures made within 1 hour after a syncope in which case it was not present. The post-critic rise of ACTH and prolactin would appear to be a characteristic of generalized epileptic seizures.

Adolescent↗

[Intestinal malformations and congenital heart diseases].

A series of 21 patients with both congenital heart disease and intestinal malformation seen over a 12-year period is reported. The intestinal malformations were: anorectal malformations (11 cases), duodenal atresia (5), omphalocele (4) and common mesentery (1). Congenital heart diseases consisted of: atrial septal defect (ASD) (10 cases), ventricular septal defect (VSD) (2), tetralogy of Fallot (2) and miscellaneous cardiopathies. In patients with anorectal malformations ASD and VSD predominated (6/11 cases) and multiple malformations syndromes were present in 8 cases, including trisomy 13, Vater syndrome, skeletal (4), neurological (3) and renal abnormalities (3); 3 children died. Duodenal atresia was always associated with left-to-right shunt: VSD (3), ductus arteriosus (2), complete atrioventricular canal (1) and trisomy 21 (2); one child died. Omphalocele coexisted with VSD (2), tetralogy of Fallot (1), dual outlet right ventricle (1), trisomy 21 (1) and multiple malformations syndromes (3); 2 children died. The patient with common mesentery had left-to-right shunt. Comparison of this series with data from the literature showed that children with congenital heart disease have a much higher incidence of intestinal malformations than those with normal heart and that they frequently present with multiple malformations (chromosome aberrations or multiple organ lesions). This multiple malformation complex is particularly common in anorectal malformations where the incidence of congenital heart diseases is 9 to 14%, with predominance of VSD and tetralogy of Fallot. In patients with duodenal atresia trisomy 21 is extremely frequent, and the incidence of cardiopathies is 18%; in the absence of trisomy 21 the cardiopathy is complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗

[Somnambulism and migraine in children. A non-fortuitous association].

Looking for frequency of somnambulism in 3 homogeneous groups of children, a first group of migrainous children, a second group of epileptic children and a third group of normal children, the authors have observed that an antecedent of somnambulism existed in 28% of migrainous children, when it was found in only 6% of epileptic children, and in 5% of normal children. This significant difference demonstrates that the association of migraine and somnambulism is real. The possibility that migraine and somnambulism appearing in the same patient at different ages might be the expression of a same neurochemical disorder is discussed. The practical interest to know this association is that somnambulism may be a real clinical marker of migrainous background that should be searched for in every patient presenting with chronic cephalalgia.

Adolescent↗

[Crossed alexia-agraphia in a right-handed patient].

A right-handed man, born of a right-handed family, presented an infarct in the territory of the right middle cerebral artery, with a left hemiplegia, a left lateral homonymous hemianopsia and an expression aphasia. The oral trouble disappeared in some weeks, but later a permanent linguistic deficit persisted, affecting mainly the written language and realizing a clinical picture of alexia-agraphia with Gerstmann's syndrome. The neurolinguistic study showed a preferential alteration of the phonologic system in the written language, and at a lesser degree in the oral modality. The extent of the lesion and the relative integrity of oral expression and comprehension, suggested that these functions were localized in the left hemisphere, whereas lecture, writing, calculation, body-parts notion, laterality notion, had been simultaneously implanted during the ontogenesis in the right hemisphere. The latter was probably also responsible for phonological aspects of written and spoken language, according to a scheme opposite to that of usual right-handers.

Agraphia↗

[Etiological diagnosis errors corrected by x-ray computed tomography in acute hemiplegia].

Correlations between the clinical diagnosis on admission and the aetiological diagnosis revealed by computerized tomography (CT) were studied in 248 cases of acute hemiplegia. In 15% of the cases, hemiplegia was not due to a cerebral vascular accident. This mechanism was overestimated in 9% of the cases and missed in 14%. Ischaemia was overestimated in 15% of the cases and haemorrhage in 45%. With regard to transient deficit, CT scans showed that ischaemia was responsible for only 72% of acute hemiplegias, 28% of them being due to haematoma, tumour or subdural haematoma. In many cases where subdural haematoma or tumour was suspected on clinical grounds, CT confirmed that the suspicion was founded.

Acute Disease↗

[Post-crisis elevation of adrenocorticotropic hormone and prolactin in epileptic children].

In six children, aged from 8 to 12 years, presenting with primary generalized epilepsy a significant rise in plasma ACTH and prolactin levels (as compared with levels measured 5 days later) was observed either during a generalized seizure demonstrated by EEG (3 cases) or within 1 hour of a generalized seizure (3 cases). The neurophysiological basis for these post-epileptic endocrine disturbances is a sudden depression of dopaminergic and GABA-ergic pathways. As a result, these endocrine changes, already well documented in adults, may be regarded as a good biological marker of the epileptic origin of a paroxysmal attack.

Adrenocorticotropic Hormone↗

[Elevation of gamma-glutamyltransferase levels in treated epileptic patients].

Plasma levels of gamma-glutamyl transpeptidase were measured prospectively in 75 epileptic patients treated with one of the following drugs: phenobarbitone (n = 20), phenytoin (n = 23), carbamazepine (n = 18) or sodium valproate (n = 14). A significant increase in gamma-glutamyl transpeptidase levels was observed from the 7th day of treatment onward. The increase was particularly pronounced in the phenytoin group, with mean and maximum values of 104.10 and 215 mU/ml respectively, followed by the phenobarbitone group (mean 68.15, max. 124 mU/ml), the carbamazepine group (mean 49.83, max. 100 mU/ml) and the sodium valproate group (mean 35.42, max. 70 mU/ml). This was due to enzyme induction being highest with phenytoin and phenobarbitone which are strongly liposoluble and have prolonged half-life. Any epileptic patient with plasma gamma-glutamyl transpeptidase levels higher than those found in this study may be suspected of having viral or alcoholic hepatitis.

Adult↗