Major intra-abdominal complications following extracorporeal shockwave lithotripsy (ESWL) in a patient with Ehlers-Danlos syndrome.

A retroperitoneal bleeding is an unusual complication of extracorporeal shockwave lithotripsy (ESWL), which can be treated in a conservative way most of the time. However, an intra-abdominal bleeding after ESWL is extremely rare, which can cause life-threatening situations and requires an immediate intervention. Probably, only patients with a certain tissue fragility or connective tissue disorder are at risk to develop such an intra-abdominal bleeding. We present a case of a serious intra-abdominal bleeding due to a rupture of the vena mesenterica superior in an Ehlers-Danlos patient, evoked by an ESWL.

Urinary excretion of tubular proteins and the technetium-99m dimercaptosuccinic acid (DMSA) absolute renal uptake in partial ureteral obstruction in rats: a functional evaluation of hydronephrotic kidneys.

The aim of this longitudinal study was to evaluate tubular proteinuria in rats with unilateral (UPO) and bilateral (BPO) partial ureteral obstruction with the dimercaptosuccinic acid (DMSA) scan as the gold standard for measuring renal tubular damage. We studied 70 female Wistar rats: 28 animals with UPO, 28 animals with BPO, 7 sham-operated animals, and 7 controls. All animals with obstructed ureters showed renal dilatation on the diethylenetriaminepentaacetic acid DTPA images 1 and 5 weeks postoperatively. One week following UPO and BPO, tubular proteinuria and urinary N-acetyl-beta-D-glucosaminidase (NAG) activity increased (P < 0.01) and the absolute DMSA uptake decreased (P < 0.01). Persistently (week 6) high tubular proteinuria was found in 29% of the animals and was related to severe damage on the DMSA scan (P < 0.01) and to albuminuria (P < 0.05). Renal tubular damage was demonstrated by measuring renal enzymes, tubular proteins, and DMSA uptake after UPO and BPO. Persistent elevated tubular proteinuria was related to severely damaged kidneys.

Differential renal function measured by 99Tcm-DTPA and 99Tcm-DMSA in a complete unilateral renal obstruction rat model.

We performed a prospective study to determine whether 99Tcm-DTPA differential renal function (DRF) in the case of acute obstruction in a unipapillary kidney rat model shows a similar pattern of results as 99Tcm-DMSA in a multipapillary kidney model, and to exclude recirculation or a block of tubular transport of DMSA which might explain the discrepancy reported by Kelleher et al. In 15 male and 4 female Wistar rats (weight 300-350 g), 99Tcm-DMSA renal uptake was measured 24 h before complete obstruction of the right ureter, which served as reference values. Twenty-four hours after obstruction, 99Tcm-DTPA (18.5 MBq) renography and 99Tcm-DMSA (111 MBq) non-depth-corrected renal uptake measurements were performed in the 15 male rats; in the 4 female rats, 740 MBq of 99Tcm-DMSA were injected and absolute, non-depth-corrected renal uptake measured at 24, 48 and 72 h. 99Tcm-DMSA DRF of the right kidney ranged from 48 to 55% (mu: 51%; sigma: 2%) before obstruction and from 14 to 35% (mu: 24%; sigma: 6%) after obstruction, whereas 99Tcm-DTPA DRF ranged from 16 to 30% (mu: 25%; sigma: 4%). No significant differences were found between DRF measured by 99Tcm-DMSA and 99Tcm-DTPA (P = 0.18), or between DRF of the obstructed kidney as measured by 99Tcm-DMSA at 24, 48 and 72 h (P > 0.2). Hypothetically, the discrepancy between our findings and those of Kelleher et al. may be due to intratubular pressure. In conclusion, the present findings and those of Kelleher et al. suggest the differences in DRF following complete unilateral renal obstruction, as determined by DTPA and DMSA, are probably species-specific. Furthermore, recirculation and block of tubular transport are unlikely to contribute significantly to differences in DRF as measured by the two radiopharmaceuticals.

[Neuropsychological observations and clinical neurology]. / Neuropsychologische bedenkingen en klinische neurologie.

The term "neuropsychology" covers the study of the higher functions of man with respect to the structure and the functional organisation of the nervous system, and therefore clearly belongs to the neurological sciences. The nervous system forms a whole, composed of innumerable integrating mechanisms, ordered into a hierarchy of levels ranging from the most elementary activities, which are the most genetically determined and the most permanent, to the activities that are predominantly acquired, which are the most mobile and the most reversible ones. All parts of the nervous system--ranging from the simplest to the most complex--contain reflecting cycles, which maintain themselves in relationships of mutual dependence. The impairment of one or other activity does not mean that the function resides in the damaged part of the nervous system, but merely implies that this part is essential for its completion. The perception of an agnosia patient, the locomotor system in the case of disturbed apraxia, the reactions of a patient with disturbances in the state of consciousness, the mental capacities of a demented person, all these are the result of the global activity of a nervous system which has been depleted of certain capacities and which is curbed by new limitations. In the infinite tangle of the cerebral system, the lesion cancels one or more links which fulfil a physiological role. Depending on where the broken link is situated, the remaining functional organisation coming to the surface in this way expresses itself in a pattern of behaviour which is not strictly related. According to the principle introduced by Jackson, the lesion eliminates certain activities, and releases others, which integrate themselves into underlying levels. In this way the activities of the nervous system regress according to the opposite direction of the hierarchic evolution of their structure: from the most complex to the simplest, from the most propositional to the most automatic, from the least to the most organised.(ABSTRACT TRUNCATED AT 400 WORDS)

Acid phosphatase activity of cerebrospinal fluid cells in bacterial and abacterial meningitis.

Acid phosphatase staining is performed on cerebrospinal fluid cells of 365 samples from 105 patients with various types of meningitis. This enzyme activity is strongly positive in the early samples of bacterial meningitis, as far as the patients had not received a pretreatment with antibiotics for more than 24 h. It allows monitoring the response to therapy in subsequent samples. Acid phosphatase activity is positive in 2 cases of cryptococcus meningitis. It is negative in all cases of aseptic and Mycoplasma pneumoniae meningitis. The results in herpes encephalitis are variable, depending on the clinical state and the degree of brain destruction. Acid phosphatase staining is a useful and rapid cytological technique for determination of the nature of the meningitis and for monitoring the therapeutical response.

Cerebrospinal fluid cytology in acute ischaemic stroke.

Quantitative and/or qualitative changes in cerebrospinal fluid (CSF) cytology were observed in 31.5% of 225 samples, obtained from patients with recent non-haemorrhagic cerebral infarctions. These changes were variable and did not correlate with the stroke pattern or with the topography of the softening. The CSF cytological abnormalities were statistically different according to the aetiology of the stroke. In those infarctions, due to vasculitis lesions, either of infectious or of auto-immune nature, an abnormal cytology pattern was more frequently observed than in those of atherosclerotic thrombo-embolic origin.

Early changes in experimental denervated rat gastrocnemius muscle. A semi-automatic quantitative study.

Computer-aided image analysis of EM images reveals important morphometric alterations after only 10 days of rat gastrocnemius denervation. The increasing importance of early quantitative changes in human diagnostics is stressed.

Intracranial bilateral symmetrical calcification on CT-scanning. A case report and a review of the literature.

The case of a 57-year-old woman with idiopathic hypoparathyroidism is presented. A CT-scan showed extensive bilateral symmetrical calcification in the region of the basal ganglia, nuclei of the cerebellum and the cerebral and cerebellar white matter. A review of the literature showed that bilateral symmetrical calcification detected by CT is usually small in extent and is most often confined to the globus pallidus. It is most commonly found in patients older than 50 years, who only rarely have symptoms associated with it. The finding is, though, non-specific and may occur in a variety of pathological conditions both with and without an aetiological relationship. Further study of the cerebral parathormone responsive adenylate cyclase enzyme proves hopeful to elucidate the aetiology of idiopathic bilateral symmetrical calcification.

Acid phosphatase activity of cerebrospinal fluid cells in leptomeningeal haemorrhage.

One hundred and twenty samples of haemorrhagic spinal fluid were examined by acid phosphatase staining. This enzyme activity starts to appear in mono-histiocytic cells 2 days after bleeding and increases up to the 5th day. After 1 week the activity decreases rapidly. Similar results are found in mixtures of incubated clear spinal fluid, to which blood is added. Acid phosphatase staining is a useful additional method for determination of the age of a leptomeningeal bleed.

The use of semiautomatic morphometry in the study of normal rat gastrocnemius muscle fibers.

Based on a fixed number of EM photomicrographs, a semiautomatic image analysis is made of normal gastrocnemius muscle fibers to obtain reference values for comparison with pathologic data. Z disc, mitochondria, tubular system, and sarcoplasmic reticulum are measured. It is stated that no definite fiber type differentiation is possible based on these quantitative data. However, measurements of Z disc and mitochondria are suggestive of such a differentiation. On the other hand, all data reach a Gaussian distribution on a logarithmic scale after a 5% correction factor is introduced.

Radicular lesions in tuberculous meningitis. A clinicopathological study.

In the present work, the involvement of cranial and spinal nerve roots in tuberculous meningitis was studied. Cranial nerves of 11 cases and the spinal roots of three patients were examined by means of serial sections of the base of the brain, brainstem and spinal cord. Although entrapment of the nerves by the tenacious inflammatory exudate was prominent, vasculitis lesions of the cranial nerves and spinal roots were also frequently observed. The latter could be an additional cause of nerve palsies in tuberculous meningitis.

Intracerebral osteoma: a clinicopathologic and neuropsychologic case study.

This case report deals with a 16-year-old girl, admitted for headache and Jacksonian seizures. The clinical examination showed no gross disturbances, but the neuropsychologic examination revealed difficulties in speech-linked abstract thinking. Extensive radiologic investigations revealed the presence of a frontal intracallosal bony tumor, protruding into the lateral ventricles. Histologic examination of the surgical specimen showed a large benign osteoma, without any connection with dura or skull. In view of the paucity of symptoms, a dysontogenetic etiology of the tumor seems obvious.

Brain maturation and types of perinatal hypoxic-ischemic encephalopathy.

The degree of brain maturation and the location of hemorrhage in the germinal layer and of periventricular leukomalacia were analyzed in 85 newborn brains. The average age of the premature brains with hemorrhage was 31 weeks and of those with leukomalacia 37 weeks. Hemorrhage was more frequently found in the frontal regions, while periventricular leukomalacia predominated in the parieto-occipital regions. This study confirms that the type and the location of the hypoxic-ischemic perinatal cerebral damage are dependent on the rate of regression of the embryonic type of periventricular arterial vascularization in the premature brain.

Influence of stretch on the target phenomenon in the tenotomized and immobilized gastrocnemius muscle of the rat.

The influence of traction on the target phenomenon was analysed in the tenotomized gastrocnemius muscle of Wistar rats. Target fibres were constantly observed at the medial side of the heads of the non-immobilized and tenotomized gastrocnemius muscles used as control. In the muscles fixed in flexion, no target fibres could be detected, while in the muscles fixed in hyperextension some target fibres were seen. The latter were less numerous than those present in the non-immobilized muscles. This experiment proves the importance of stretch mechanisms in the pathogenesis of the target phenomenon.

Ocular lateropulsion in Wallenberg's syndrome: a prospective clinical study.

In order to evaluate the occurrence and clinical value of ocular lateropulsion in Wallenberg's syndrome, a prospective study was carried out. Lateropulsion of the horizontal and vertical refixation saccades was a rather regular finding, especially in complete Wallenberg's syndrome. Lateral ocular deviation after elimination of fixation was present in nearly all cases. The tonic lateral vector was always directed to the involved side. It is concluded that ocular lateropulsion is an easily elicited sign with a lateralizing value in lateral bulbar infarction. Further systematic search of ocular lateropulsion in other posterior fossa disorders is needed to determine its topographical significance.

Inhibition of the target phenomenon in tenotomized rabbit muscle by medullary lesions.

Target fibres were demonstrated in the gastrocnemius muscles following section of the Achilles tendon of two rabbits. In five other animals with tenotomized gastrocnemius muscles, a subarachnoid phenol block of the lumbar and sacral spinal cord was performed. Large and small medullary lesions inhibited the occurrence of target fibres in the tenotomized muscles, the smallest one being neurolysis of the dorsal roots. This final experiment suggests that the target phenomenon is the morphological expression of an increased stretch sensitivity of the tenotomized muscle.

Granulomatous angiitis of the nervous system: a clinicopathological study of one case.

The clinical history is presented of a 69-year-old man with a disease starting with a herpes zoster infection and an acute ascending myelopathy, and ending with an intracerebral hemorrhage. The postmortem examination revealed multiple angiitis lesions, restricted to the central nervous system. In review of the 31 previously described cases there were four other patients in whom the granulomatous angiitis of the nervous system (GANS) was associated with a herpes zoster infection. The relation between both disorders is discussed.