Uncommon early-onset neuropathy in diabetic patients.

An acute neuropathy rarely occurs early in the course of diabetes mellitus. Five cases are described of adult patients who developed a peripheral neuropathy at the time or shortly after the onset or discovery of diabetes mellitus. Patient 1, an 80-year-old woman who developed a subacute tetraparesis with proximal and distal muscle weakness with normal cranial nerves, proved to have insulin-requiring diabetes mellitus. In the other patients, all men aged 23-34 years, symptomatic neuropathy occurred simultaneously (patient 2) or 1-6 months after the onset of insulin-dependent diabetes mellitus (IDDM) (patients 3-5). Patients 2 and 3 developed a symptomatic multifocal neuropathy; patients 4 and 5, a painful distal symmetrical sensory polyneuropathy (DSSP) shortly after beginning treatment with insulin. Nerve biopsy showed active axonal lesions in patients 2 and 5 and mixed axonal and demyelinating lesions in the others, with severe axon loss in patients 4 and 5. Vasculitic lesions were found in patient 2, who improved without additional treatment. Neurological examination remained unchanged after 2 years in patients 3-5. Although a coincidence cannot be excluded for patients 1-3, whose neuropathy was not of the pattern commonly found in diabetes, it is suggested that acute disequilibrium in the diabetic status may facilitate the occurrence of a variety of neuropathies. Alternatively, the autoimmune process which led to IDDM may also trigger an autoimmune neuropathy with vasculitis (patient 2) or demyelinative nerve lesions. Only the distal symmetrical sensory polyneuropathy with severe axonal lesions observed in patients 4 and 5 seems directly related to diabetes mellitus. In spite of their occurrence shortly after beginning insulin therapy, the role of treatment with insulin in the onset is uncertain.

[Slowly progressive motor neuron disease associated with paralysis of the abductor muscles of the vocal cords]. / Atteinte motrice périphérique lentement progressive associée à une paralysie des muscles abducteurs des cordes vocales.

Some cases of slowly progressive motor neuron disease with bilateral paralysis of the vocal cord abductor muscles have recently been published. We report a case with a more than forty year's course occurring in a family in which one brother and probably 2 cousins died of motor neuron disease.

[Treatment of vascular pain of the face by methylprednisolone injection into the area of the greater occipital nerve: 16 cases]. / Traitement des algies vasculaires de la face par injection de methylprednisolone dans la région du grand nerf occipital: 16 cas.

Sixteen patients suffering from cluster headache received an injection of 160 mg methylprednisolone into the region of the greater occipital nerve ipsilateral to the pain, when free of headache. In episodic cluster (n = 8), attacks ceased in 2 cases and decreased in severity and frequency in one other. Three patients failed to respond at all. Two became headache-free, but the injection had possibly been performed towards the time when the episode might have been expected to end spontaneously. In chronic cluster (n = 8), four patients failed to respond at all. Four others improved, but only partially and transiently. On the whole, the present results are not as favourable as those obtained by Anthony, who advocated this technique.

Inter-observer variability in the interpretation of mammograms.

Inter-observer agreement was tested in the interpretation by 8 radiologists of mammograms from 45 women (for a total of 180 films per radiologist). The radiologists were representative of the whole range of those involved in mammography in the town of Torino, with a number of films read per year ranging from 100 to 4000. Out of the 45, 9 women were affected by breast cancer (histologically proved), 25 had benign disease (diagnosed with fine-needle aspiration) and 11 had normal breasts. Weighted kappa values were in the range 0.27-0.82 (median 0.60) for parenchymal patterns; 0.33-0.67 (0.48) for diagnosis in five categories; and 0.22-0.57 (0.38) for indications for further diagnostic tests. These values are comparable with those reported from other investigations.

[Pseudomembranous colitis caused by antibiotics]. / Colite pseudomembranosa da antibiotici

Six cases of pseudomembranous colitis caused by antibiotics are presented. The endoscopic, radiological and clinical picture and the aetiopathogenesis of this unusual disease are discussed. Lincomycin was incriminated in one case only. In the remainder, various antibiotics of different chemical structure were responsible. Carcinoma of the colon was a common feature and it is suggested that a full examination of the large intestine should be made whenever this syndrome appears. While radiological suspicion may be forthcoming, pseudomembranous colitis is diagnosed only by endoscopy and biopsy.