[Gabab paraneoplastic encephalitis : about a clinical case]. / Encéphalite limbique paranéoplasique a anticorps Anti-gabab.

The paraneoplastic limbic encephalitis is a rare disease. It is caused by the presence of autoantibodies creating an inflammatory reaction of the predominant brain parenchyma in the meso-temporal lobe and in other parts of the limbic system. Its presence requires looking for an underlying tumour. The management of this paraneoplastic syndrome includes an immunosuppressive therapy in addition to the treatment of the underlying tumour. However, the management of this disease is not yet standardized.

L'encéphalite limbique paranéoplasique est une maladie rare. Elle est causée par la présence d'auto-anticorps créant une réaction inflammatoire du parenchyme cérébral prédominant au niveau du lobe méso-temporal et dans d'autres parties du système limbique. Sa présence impose la recherche d'une tumeur sous-jacente. Le traitement du syndrome paranéoplasique comprend des immunosuppresseurs en plus du traitement de la tumeur sous-jacente. Cependant, la prise en charge de cette pathologie n'est pas encore bien codifiée.

[Asthma and tobacco]. / Asthme et tabac.

Roughly 40% of asthmatics are or have been smokers. These smoking asthmatics have been largely overlooked in the past. Tobacco is today considered as a risk factor for asthma and it seems that smoking asthmatics exhibit a different phenotype as compared to non smoking asthmatics. The inflammatory substrate differs widely, not only with respect to the type of cells present in the airways, but also with respect to the mediators brought into play. On the clinical point of view the asthma of smokers is also more severe that in non smokers, both at the symptomatic and the functional level. The asthma severity in smokers is partly linked to a resistance to inhaled corticoids, the cornerstone of maintenance treatment in asthma. This makes urgent to assess alternative treatment to inhaled corticoids for this asthma phenotype, but also emphasizes the need to support smoking cessation in asthmatics.

Failure of neuromuscular propagation during human maximal voluntary contraction.

The mechanism for fatigue of the adductor pollicis was studied in normal subjects during maximal voluntary contractions (MVC) sustained for 90-100 s, by comparing the force and electrical response of this muscle to voluntary motor drive with that obtainable with artificial stimulation of the ulnar nerve. The adequacy of nerve stimulation was checked by recording simultaneously the electrical response of a nonfatiguing muscle, the abductor of the small finger. The decrease in force and in the natural electrical activity with fatigue was accompanied by a parallel decrease in the amplitude of synchronous muscle action potentials (M waves) evoked by artificial stimulation of the ulnar nerve at different frequencies. The decline in M-wave amplitude in the adductor pollicis was not due to a submaximal nerve stimulation, since the amplitudes recorded simultaneously from the nonfatiguing abductor digiti minimi remained unchanged. The force and the electrical responses from the adductor pollicis recovered in parallel with a half time of approximately 1 min. These results suggest that the loss of force of the adductor pollicis with fatigue and its subsequent recovery are largely determined by the extent of neuromuscular propagation failure. The slow recovery of the M-wave amplitude during repetitive stimulation suggests that it may be related to some aspect of muscle metabolism.

Inspiratory muscle activity during unloaded and obstructed rebreathing in dogs.

Moving-average electromyogram (EMG) of the diaphragm (DI), scalenes, and cranial and caudal parasternals was assessed in anesthetized, supine, and head-up dogs during rebreathing. The shape of EMG trajectory was similar for all muscles and conditions; activation of different muscles could be thus compared on the basis of changes in peak activity. In intact dogs changes in peak activity were greater for the scalenes and cranial parasternals than for the caudal parasternals and greater for the inspiratory thoracic muscles (ITM) than for the DI. Posture, vagotomy, and cordotomy at C7-T1 did not affect the rate of rise of DI activity. The relations between peak activity of ITM did not change because of posture, vagotomy, and phrenicotomy. Vagotomy selectively depressed the rate of rise of ITM activity, but relative changes in peak ITM activity for a given change in peak DI activity were independent of intact vagi. Differences in the pattern of activation between inspiratory muscles with rebreathing are largely independent of proprioceptive inputs and likely reflect properties of central control mechanisms. However, airway occlusion at end expiration caused a reflex fall of DI activity and reflex increase of ITM activity in intact and vagotomized dogs. Cordotomy at C7-T1 did not change DI response, whereas reduction of ITM activity occurred after phrenicotomy, indicating that both facilitatory and inhibitory segmental inputs are involved in ITM response to loading.

Effect of hyperinflation and equalization of abdominal pressure on diaphragmatic action.

We tested the hypothesis that the mechanical arrangement of costal (COS) and crural (CRU) diaphragms can be changed from parallel to series when direct or indirect transmission of tension occurs. Ratio of rib cage to abdominal displacement (RC/AB) resulting from separate COS and CRU stimulations were used to measure RC expanding action. Hyperinflation in six dogs caused RC/AB with COS and CRU stimulations to change progressively from 0.53 +/- 0.07 (SE) and 0.03 +/- 0.05 at functional residual capacity (FRC) to -0.48 +/- 0.08 and -0.46 +/- 0.05 at 68% inspiratory capacity, respectively. Liquid substitution of abdominal contents in six other dogs equalized abdominal pressure swings (delta Pab), without changing chest wall elastic properties or geometry, or costal RC/AB (0.35 +/- 0.07 before and 0.33 +/- 0.06 after) but caused crural RC/AB to change from 0.01 +/- 0.05 to 0.31 +/- 0.01. We conclude that hyperinflation changes fiber orientation, allowing direct transmission of tension between COS and CRU, which become linked mechanically in series (the diaphragm acts as a unit with RC deflating action); and equalization of delta Pab causes indirect transmission of tension between COS and CRU, which become linked in series (the diaphragm acts as a unit with RC inflating action).

Is the macroscopic aspect of the esophagus at endoscopy indicative of reflux esophagitis?

Gastroesophageal reflux was looked for in 51 children with chronic obstructive respiratory disease (CORD) using prolonged pH monitoring. An index of reflux aggressivity dependent on both duration and acidity of refluxed material was calculated. This index was significantly related to the macroscopic endoscopic findings, patients with an elevated acidity index having more severe "endoscopic esophagitis" than patients with a normal acidity index. We conclude that the finding of normal, erythematous or destructive esophagitis at endoscopy has at least some clinical relevance.

Hemodynamic effects of nifedipine on secondary pulmonary hypertension in man.

We evaluated the hemodynamic effects of the calcium antagonist nifedipine in 13 consecutive patients admitted to the intensive care unit with secondary pulmonary hypertension. Etiology of secondary pulmonary hypertension was: chronic obstructive pulmonary disease (n = 9), pulmonary emboli (n = 2), pulmonary fibrosis (n = 2). We obtained the resting hemodynamic parameters before, and 60, 120, 180 minutes after the sublingual administration of nifedipine 20 mg. All patients had normal pulmonary artery wedge pressure before nifedipine. After 60 minutes, systolic pulmonary artery pressure fell from 72.3 +/- 7 to 57.3 +/- 5.4 mm Hg (p less than 0.005) and mean pulmonary artery pressure from 44.6 +/- 4.0 to 33.6 +/- 3.2 mm Hg (p less than 0.001). Cardiac output rose from 6.36 +/- 0.56 to 7.65 +/- 0.64 l/min (p less than 0.005). The pulmonary vascular resistance fell from 431 +/- 58 to 238 +/- 36 dynes. sec. cm-5 (p less than 0.001). Heart rate, mean systemic arterial pressure, pulmonary artery wedge pressure, total systemic vascular resistance and arterial partial pressure of O2 (PaO2) remained unchanged. In this heterogenous population we were unable to reproduce the results of other authors, showing a correlation between PaO2 and fall of pulmonary vascular resistance. These findings confirm the pulmonary vasodilating effect of nifedipine in patients with secondary pulmonary hypertension.

Pulmonary regional ventilation. C15O2 single breath method. New technical improvements.

After a single inhalation of C15O2 labelled air, from residual volume to total lung capacity, followed by a few seconds apnea, it is possible to record in four or six lung zones the regional activity changes on a time basis. A first fast rise in activity is seen during the inhalation phase, corresponding to the ventilation in the region of interest (ROI). During the apnea, a slower decreasing component is observed in the different ROI, proportional to the regional blood flow, as almost instantaneously C15O2 is converted to labelled water. After the pioneer work of West & Dollery (1962) very few papers appeared on the subject despite technical improvements as, for instance, coincidence counting of radioactive events. We thus decided to improve the reproducibility and accuracy of the method which were of such a poor quality that no individual measurements were possible in the past. Were of critical importance: a careful positioning of the patients between the counters, a faster electronics improving true coincidence counting. In six healthy volunteers (age 22-35) the values obtained for regional ventilation with the C15O2 single breath were compared to the values given by the inhalation of a poorly soluble gas (Nitrogen13). The correlation between the two sets of measurements is high (r = 0.975). The slope of the regression line is 0.859, ordinate at origin is 2.35. This reveals a systematic error. A mathematical model was therefore developed to take into account the "washout" occurring during the constitution of the ventilation peak, and to correct its value.(ABSTRACT TRUNCATED AT 250 WORDS)