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Biomedical subjects

R Gherardi

Publications and source records attributed to R Gherardi.

At least 91 records · Page 5Linked to original sources
PubMed1990

A cocaine body packer with normal abdominal plain radiograms. Value of drug detection in urine and contrast study of the bowel.

Drug packets are usually detected by ordinary abdominal radiographs, which is of major importance in the apprehension and prosecution of drug body packers, but false negatives may occur. We report the case of a cocaine body packer who had used the prograde route and in whom the initial abdominal plain films were normal. The diagnosis of cocaine body packing was assessed by seldom-described complementary methods of detection, including drug detection in the urine and contrast study of the bowel.

Adult↗
PubMed1990

Inclusion body myositis in French patients. A clinicopathological evaluation.

In order to establish the frequency of inclusion body myositis (IBM) in a European neuropathological unit and to evaluate the specificity of IBM pathology, we reviewed the 850 muscle biopsies performed in our laboratory over the past 7 years. Clinical histopathological and ultrastructural evaluation of all cases showing rimmed vacuoles, a constant histopathological feature of IBM, was done and the diagnosis of IBM was assessed using the clinico-pathological criteria of Calabrese, Mitsumoto & Chou (1987). Among the nine cases showing rimmed vacuoles, five were classified as IBM (group 1), either definite (3/5) or probable (2/5), and four suffered from a chronic denervating process of muscle (group 2). The overall frequency of IBM (0.6% of all muscle biopsies) was similar to that reported by North American authors. IBM represented 16% of adult idiopathic inflammatory myopathies investigated in our laboratory. Clinical and histopathological findings in group 1 were homogeneous and distinctive. Muscle biopsy was consistent with an inflammatory myopathy in all patients in group 1 and with a non-inflammatory denervating process in 3/4 patients in group 2. Typical intrasarcoplasmic inclusions were detected by electron microscopy in 3/5 cases in group 1 and 1/4 in group 2, which raises questions about the specificity of the 16-18 nm tubulofilaments. Failure to demonstrate inclusions in two patients with otherwise typical IBM, was probably related to the paucity of rimmed vacuoles observed in these cases.

Adult↗
PubMed1990

[Lesions of the spinal cord and spinal roots in human immunodeficiency virus infection].

Spinal cord lesions, although far less frequent than brain lesions, are not uncommon in AIDS. Almost all diffuse or multifocal pathological processes involving the central nervous system and/or leptomeninges may also affect the spinal cord. However, some of them involve it predominantly causing specific, clinically overt, myelopathic diseases. The most characteristic of these is vacuolar myelopathy which usually manifests as progressive spastic ataxia. Its incidence varies in different pathological series and its pathogenesis is still controversial. Acute meningomyeloradiculitis in AIDS patients presents a remarkably uniform and distinct clinical and cerebrospinal fluid profile although they might be due to various causes including cytomegalovirus infection, syphilis, mycobacterial infection or leptomeningeal malignancy. Tumoral focal syndromes have exceptionally been recorded due to epidural lymphomas, intraspinal gliomas or toxoplasma abscesses. Spinal cord ischemic lesions have been documented in two cases: they were related to inflammatory lesions of the blood vessels in one case and to diffuse intravascular coagulation in the other. An ascending myelitis syndrome, secondary to spinal cord infection by both herpes simplex virus type 2 and cytomegalovirus, without significant vasculitis has also been reported.

HIV Infections↗
PubMed1990

The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel.

The questionable reliability of the conventional procedures for detection of ingested drug packages triggered us to evaluate the accuracy of a method of contrast study of the bowel in 23 nonsurgically managed cocaine body-packers. A single dose (60 mL) of a water-soluble contrast compound (amidotrizoate + meglumine) was given orally after initial clinical examination and drug detection in urine. Thereafter, roentgenograms were performed daily after spontaneous passage until obtaining two packet-free stools and negative views. Roentgenograms showed packages when performed at least 3 h after the ingestion of the contrast compound. Sensitivity and specificity of the method with respect to the detection of residual packets in the body, assessed by subsequent examination of stools, was good and did not diminish as the number of packages decreased during the time spent in ward. No side-effects were observed. We conclude that oral administration of a water-soluble contrast compound is an easily performed, efficient, and safe method for the nonsurgical management of cocaine body-packers.

Cocaine↗
PubMed1990

Prognostic factors and predictive signs of malignancy in adult dermatomyositis. A study of 32 cases.

Dermatomyositis (DM) is an inflammatory myopathy with a severe prognosis mainly determined by its association with malignancy. We present the results of a study of 32 adults with DM. Our aim was to define predictive signs of cancer and establish prognostic factors according to patient survival. Thirteen (41%) of the 32 patients had DM associated with malignancy. After 7 years of follow-up, the overall mortality rate was 52%. Mortality was higher for patients with malignancy. Cutaneous necrosis and an elevated erythrocyte sedimentation rate appeared as potential markers of associated malignancy. Classic signs of poor prognosis, such as age and association with cancer were found. Interestingly, extensive cutaneous lesions on the trunk and an elevated erythrocyte sedimentation rate were also more frequent among the patients who died. Our results demonstrate that selected groups of patients with DM, in part defined by cutaneous signs, have a poor prognosis.

Adult↗
PubMed1989

Focal myelin thickenings in a peripheral neuropathy associated with IgM monoclonal gammopathy.

Nerve biopsy in peripheral neuropathies associated with an IgM monoclonal gammopathy may occasionally display focal myelin thickenings. In a patient with such an IgM neuropathy, in whom an anti-myelin-associated glycoprotein (MAG) antibody activity was present in the serum, single-fiber preparations revealed 34% of internodes bearing myelin swellings. The morphometric, morphological and ultrastructural findings were reminiscent but not identical to those of the hereditary tomaculous neuropathy with liability to pressure palsies. Atypical features for tomacula included lack of spiralization of the redundant loops of myelin around the axons and their predominant external situation with regard to the myelin sheath. The frequent colocalization of myelin thickenings and the widening of myelin lamellae typical of IgM neuropathies, are highly suggestive of some pathogenetic link between the two abnormalities. The redundant loops of myelin in IgM neuropathies possibly result from a defect in the axon-myelin adhesion secondary to the binding of IgM on an epitope of MAG directly involved in cell-cell adhesion.

Aged↗
PubMed1989

Diffuse "encephalitic" cerebral toxoplasmosis in AIDS. Report of four cases.

Four patients with AIDS presented with a rapidly fatal global neurological illness. CT did not show any focal lesion and gross post mortem examination of the brain was normal in three of the four cases. Microscopic examination revealed numerous widespread microglial nodules in the brain parenchyma, most containing central toxoplama cysts or free tachyzoites. Such diffuse, non-necrotic, "encephalitic" forms of cerebral toxoplasmosis appear unique to AIDS and, to our knowledge, have not been documented previously. They represent a treatable, often misdiagnosed cause of diffuse neurological involvement in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature.

Four cases of infranuclear facial palsy associated with infection by the human immunodeficiency virus in young heterosexual African patients are reported. Two cases were healthy HIV carriers, one patient manifested AIDS-related complex, and one case fulfilled the CDC criteria for AIDS. Two patients had a typical Bell's palsy, one presented with manifest cephalic Herpes zoster infection and one, who suffered from facial diplegia, could be considered to have a cephalic form of Guillain-Barré syndrome. A review of the literature confirmed that peripheral facial palsy can occur at any stage of HIV infection and in various clinical contexts. In stages I and II of the HIV infection, patients may develop either Bell's palsy or Guillain-Barré syndrome. In stages III and IV, when the cellular immunity has begun to decline, Herpes zoster-related facial paralysis, seventh cranial nerve involvement secondary to meningeal lymphomatosis, and peripheral facial paralysis as one aspect of widespread chronic peripheral neuropathy may also occur.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Extensive oxidative metabolism of dextromethorphan in patients with almitrine neuropathy.

Almitrine bismesylate can induce a stereotypical sensory peripheral neuropathy probably through a toxic mechanism. High plasma concentrations of almitrine have been reported in a patient with neuropathy. Since large inter-individual variations in plasma drug concentrations are found it is possible that the development of toxicity may be linked to genetically determined polymorphic oxidation of the drug. Oxidation phenotyping was performed in fifteen patients with almitrine neuropathy using dextromethorphan, a test compound subject to oxidative metabolism similar to that of debrisoquine. All patients were of the extensive metaboliser phenotype. This result shows that, in contrast to perhexiline neuropathy, almitrine neuropathy is not related to slow oxidation of the compound with regard to the particular P-450 iso-enzyme involved in dextromethorphan and debrisoquine metabolism.

Aged↗
PubMed1989

Peripheral neuropathy, coagulopathy and nodular regenerative hyperplasia of the liver in a patient with multiple serologic auto-antibody activities and IgM B-cell lymphoma.

A patient with IgM-secreting B-cell lymphoma developed demyelinating peripheral neuropathy, nodular regenerative hyperplasia of the liver, coagulopathy, and terminal miliary lymphomatous spreading. Serologic auto-antibody activities directed against myelin associated glycoprotein, prothrombinase complex (i.e. lupus anticoagulant) and smooth muscle cells were detected. It is suggested that there is a link between the IgM gammopathy, the immunological abnormalities and the various clinico-pathological conditions.

Autoantibodies↗
PubMed1989

Acute myeloradiculitis due to cytomegalovirus as the initial manifestation of AIDS.

A 26 year old male intravenous drug abuser presented with rapidly progressive paraplegia and total incontinence. CSF examination showed elevated protein level and pleocytosis. HIV testing was positive. Anti CMV titres were mildly elevated in serum and CSF. Death occurred 26 days after the onset of neurological signs. Necrotic and inflammatory lesions with numerous inclusion bodies characteristic of CMV were found in the roots of the cauda equina, conus terminalis and lumbar segments of the spinal cord. CMV subependymal encephalitis and HIV encephalitis were also present.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Vertebral hemangioma. Definition, limitations, anatomopathologic aspects].

Vertebral hemangiomas are benign, malformative vascular tumours composed of newly formed blood vessels with normal (capillary, venous, or veno-capillary) structure and without arterio-venous shunt; they involve firstly the vertebra and may secondary extend to the epidural space. These features allow to separate vertebral hemangiomas from bone lymphangiomas, from true neoplastic vascular tumours such as hemangioendotheliomas, hemangiopericytomas, angiosarcomas, from hemangioblastomas and from arteriovenous malformations with shunt. The latter are usually associated with other vascular malformation of the skin and spinal cord in the same metameric segment(s) (metameric angiomatosis or Cobb syndrome). There are two microscopic types of vertebral hemangiomas which frequently coexist. Cavernous angiomas are composed of large dilated blood vessels closely clustered together, so that they are not separated by normal bone tissue. Capillary angiomas are formed of thin-walled capillary vessels of various sizes separated by normal bone tissue. The vascular malformation is not separated from the bone tissue by a capsule; the surrounding osseous lamellae usually show secondary osteolysis and osteocondensation, and the bone marrow undergo fibrous and/or adipose involution.

Arteriovenous Malformations↗
PubMed1988

[Intracorporeal concealment of narcotics. Experience of medicolegal emergencies at the Hôtel-Dieu Hospital in Paris: 100 cases].

One hundred cases of intracorporeal concealment of narcotic drugs were observed over a 6-month period at the medico-judicial emergency centre of the Hotel-Dieu hospital, Paris. Twelve cases concerned dealers who had ingested packs at the time they were arrested. The other subjects had been carrying the drug in their digestive tract, rectum or vagina for transportation. The illicit drugs thus transported were cocaine in 20 cases (ingestion), heroin in 65 cases (ingestion 7, rectal or vaginal cavity 58) and cannabis in 3 cases. Packs for sale being fragile, the dealers were particularly exposed to overdosage. Their management prior to intoxication was the same as that of acute ordinary drug poisoning, i.e. washing out of the stomach. In carriers, the risk of severe poisoning was associated with ingestion. The lack of antidote makes cocaine poisoning particularly dangerous. Surgical extraction is now reserved to cases with intestinal mechanical complications and to those increasingly rarer cases of fragile transportation packs.

Adult↗