[Neonatal botryomycosis]. / Tuméfactions multiples chez un nouveau-né révélant une botryomycose.

Botryomycosis is an uncommon bacterial infection. It occurs in two forms: cutaneous and visceral. Fewer than 30 pediatric cases have been reported. We present the first case of a 14-day-old newborn with botryomycosis revealed by four tumefactions located in the inguinal and popliteal hollows, without a biological inflammatory syndrome. Pathological examination of the sample demonstrated botryomycosis. The culture collection found Staphylococcus aureus. Progression was favorable with appropriate prolonged antibiotic therapy. Predicting factors such as immunodeficiency or cystic fibrosis were excluded.

Effect of age on MSLT results in patients with narcolepsy-cataplexy.

OBJECTIVE: To measure the effect of age on Multiple Sleep Latency Test (MSLT)characteristics, sleep latency, and number of sleep-onset REM periods (SOREMP) in two large populations of narcoleptic patients with similar genetic backgrounds. METHODS: Clinical and polygraphic information on the severity of the condition was obtained on 236 well-defined narcolepsy-cataplexy-human leukocyte antigen DR2-positive patients from Montpellier (France) and on 147 similar patients from Montreal (Canada). RESULTS: The results show a progressive decrease in the number of SOREMP with age and a progressive increase in the mean sleep latency on the MSLT as a function of age. This finding is also related to the severity of cataplexy as assessed from the clinical history with a progressive decrease in the frequency of cataplexy attacks with age. These results may reflect the progressive increase in sleep latency seen in normal aging and suggest that clinical improvement might be due to changes in the neural mechanisms responsible for SOREMP, which may weaken with age. CONCLUSIONS: The progressive decrease in the number of SOREMP and increase in the mean sleep latency on the MSLT as a function of age suggest that the current criteria used for diagnosis may be too stringent in older patients. The major influence of age on MSLT results should therefore be taken into account when diagnosing a narcoleptic patient.

Inhibition of poliovirus RNA synthesis as a molecular mechanism contributing to viral persistence in the mouse central nervous system.

Many survivors of poliomyelitis, several decades after the acute phase of the disease, develop a set of new muscle symptoms called post-polio syndrome. The persistence of poliovirus (PV) in the central nervous system (CNS) may be involved in the aetiology of this syndrome. By using a mouse model, we have shown that PV persists in the CNS of paralysed mice for over a year after the acute disease. Detection of PV plus- and minus-strand RNAs in the spinal cord of paralysed mice suggested continuous PV RNA replication in the CNS. However, infectious PV particles could not be recovered from homogenates of CNS from paralysed mice beyond 20 days post-paralysis, indicating that PV replication was restricted. In an attempt to identify the molecular mechanism by which PV replication was limited, PV plus- and minus-strand RNA levels were estimated in the CNS of persistently infected mice by a semi-quantitative RT-nested PCR method. Results revealed that RNA replication was inhibited at the level of plus-strand RNA synthesis during persistent infection. Similar results were obtained in neuroblastoma IMR-32 cell cultures persistently infected with PV Restriction of PV RNA synthesis could be involved in persistence by limiting PV replication.

EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses.

OBJECTIVE: To investigate other physiologic changes that occur with periodic leg movements during sleep (PLMS) that might be considered to be more sensitive indices of sleep fragmentation. BACKGROUND: Although PLMS are associated with recurrent microarousals (MA), the frequency of PLMS with MA does not correlate with objective daytime sleepiness. It is postulated that the lack of correlation results from the low sensitivity of the standard criteria used to score MA. METHODS: Ten drug-free patients with a polygraphic and clinical diagnosis of restless legs syndrome (RLS) and PLMS were examined. The EEG correlates of PLMS were analyzed by visual scoring and spectral analysis during PLMS that ended in a visible microarousal (PLMS with MA) or not (PLMS without MA). The R-R interval in the EKG signal was also examined. RESULTS: A total of 34% of PLMS were associated with MA lasting >3 seconds, and 3% of PLMS were associated with MA lasting <3 seconds. Although PLMS with MA were associated with an increase in alpha activity, for PLMS without MA a significant increase in delta and theta activity was present. Both types of PLMS induced a shortening of the R-R interval; this was particularly more marked for PLMS with MA. CONCLUSIONS: First, visual scoring of MA that include a duration of less than 3 seconds has little effect on the detection of PLMS with MA. Second, EEG activation and tachycardia are present during both types of PLMS. Third, a hierarchy in the arousal response is present-going from autonomic activation to bursts of delta activity to alpha activity to a full awakening.

Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome.

Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left anterior tibialis muscles for an hour (Suggested Immobilization Test [SIT]); in the second test, the legs are immobilized in a stretcher (Forced Immobilization Test [FIT]). In the current study, the SIT and the FIT were compared in patients with RLS and normal control subjects matched for age and sex. More leg movements were seen in patients than in controls during immobilization tests, especially the SIT. These movements were periodic, occurring at a frequency of approximately one every 12 seconds. The SIT (index > 40) was found to discriminate between RLS and control subjects better than the FIT (index > 25). Patients were also recorded during two consecutive nights to measure periodic leg movements in sleep (PLMS). A SIT index greater than 40 and a PLMS index greater than 11 (highest PLMS index of 2 consecutive nights) were found to discriminate patients with RLS from control subjects with similar power. With each of these two measures, the clinical diagnosis was correctly predicted in 81% of patients and 81% of the control subjects. The SIT has several advantages over the measure of the PLMS index; it does not require an all-night polygraphic recording and can be administered several times a day to measure circadian fluctuation of motor restlessness.

[A protocol of in vivo 3D experimental evaluation of global posture and motion of the spine]. / Protocole pour l'évaluation expérimentale 3D in vivo de la posture et de la cinématique globale du rachis.

PURPOSE: The aim of his study was to assess 3D global posture and movement of body segments, especially for scoliotic subjects. As scoliosis is a three-dimensional deformity, it needs three-dimensional evaluation and correction, but there is no mean today to get 3D dynamic examination of the whole body. MATERIAL AND METHODS: Using opto-electronic methods, an experimental protocol was established to compare the pre- and post-operative results of treatment. Firstly, the reliability of the protocol was tested in healthy adult subject. Secondly, a reference group of 15 healthy teenagers was analysed Besides, first scoliotic subject in pre- and post-operative situations were followed. The markers fixed on the skin allowed us to calculate the position of the head, the pelvic, the shoulders and the spinal axis, during a static trial and motions. RESULTS: The reliability of the protocol was satisfactory (standard deviation (s) < 5.4 degrees in a flexion movement). The inter-subject variability was greater for the position of the head than for the pelvis, the shoulders or the spinal axis. The scoliotic patient showed a straightening of the whole body in the three anatomic planes. One month after treatment, the range of motion were reduced (+13.8 degrees for the pelvic flexion during a flexion movement), but six months after surgery they were greater than before (+14.7 degrees). CONCLUSION-DISCUSSION: Many systems have been proposed to measure the motion of the trunk, but they were not three-dimensional. The opto-electronic method is a non invasive, external and dynamic system.

Persistence of repetitive EEG arousals (K-alpha complexes) in RLS patients treated with L-DOPA.

Compared to normal control subjects, patients with primary restless legs syndrome (RLS) have an increased number of K-complexes, followed by bursts of electroencephalographic (EEG) alpha activity-together these are referred to as K-alpha complexes. In the present study, a large proportion of K-alpha complexes was found to be temporally associated with periodic leg movements in sleep. Because many K-alpha complexes precede the onset of movements, they cannot be considered secondary to the movements themselves. The persistence of K-alpha complexes after suppression of leg movements by means of L-DOPA further supports the hypothesis that these EEG events are a primary phenomenon. The results may have clinical implications because a large proportion of RLS patients complain of non-restorative sleep even after treatment with L-DOPA.

Electrophysiologic characteristics at initiation of ventricular tachycardia and ventricular fibrillation in a canine infarct model.

Local ventricular activation time and the conduction time during sinus rhythm at the induction of ventricular tachycardia (VT) and ventricular fibrillation (VF) were investigated using a canine model of chronic myocardial infarction. Of 26 dogs studied, 15 had inducible VT, 10 had inducible VF, and 1 had no inducible arrhythmias. Bipolar local ventricular electrograms were recorded during sinus rhythm from 136 sites in 10 dogs with VT and 164 sites in 11 dogs with VF. Mean activation time in dogs with inducible VT was significantly longer than in dogs with inducible VF. Furthermore, simultaneous local ventricular electrograms were recorded during the induction of VT (74 episodes) or VF (38 episodes) from the infarct border zone at the endocardium (B-EN), the epicardium (B-EP), and normal sites (N-EN, N-EP). During VT induction, the activation time at N-EN and N-EP was significantly longer than during VF induction (N-EN: 94 +/- 21, 70 +/- 19 ms; N-EP: 83 +/- 21, 64 +/- 10 ms; p < 0.05). Conduction time was measured at the initiation of VT or VF induced by orthodromic or antidromic pacing. The conduction times of the last paced beat between N-EN and B-EP (35 +/- 11, 62 +/- 24 ms), N-EN and N-EP (35 +/- 12, 14 +/- 13 ms), B-EN and B-EP (16 +/- 10, 38 +/- 25 ms), and B-EP and N-EP (77 +/- 27, 44 +/- 12 ms) were significantly different in dogs with inducible VT (p < 0.05), but not in dogs with VF.(ABSTRACT TRUNCATED AT 250 WORDS)

Variations of intestinal motor activity in bladder replacements and in the intestine.

Urinary reservoirs are made from intestinal segments. The motor activity of the intestinal tract is regulated by hormonal and neurological controls. This study compares the motor activity of intestine in situ with those of a neobladder, following oral intake. The changes in motor activity before and after ingestion of standardized 570 Kcal meal were measured simultaneously in the duodenum and in the neobladder of 4 patients who underwent a Camey tubularized ileocystoplasty. Similar motor movements were produced in the graft and in the duodenum. Modifications due to oral intake were then measured in 14 patients with various types of urinary reservoirs (ilea, ileo-colic or colic; and tubularized or detubularized) by measuring the pressure inside the graft. After oral intake the compliance of the detubularized colic and ileocolic reservoirs was greater than that of ileal reservoirs, even after detubularization, since the motor activity and the basal pressure increased greatly in the tubularized or detubularized ileal bladders and much less in the detubularized colic and ileocolic bladders. It is well known that digestion is maximal in the second half of the night, therefore this link between intestinal and neobladder motor activity might explain one of several mechanisms involved in nocturnal increase in reservoir pressure and urine incontinence.

Constipation after rectopexy for rectal prolapse. Where is the obstruction?

The pathophysiology of constipation after rectopexy remains unclear: acquired anorectal dysfunction or preoperative colonic state are, by turns, the supposed culprit. The aim of this prospective study was to characterize the colorectal motility abnormalities encountered after such a surgical procedure. Twelve patients (10 females, 2 males, aged 50.5 +/- 5.2 years) complaining of severe constipation or its worsening after Orr rectopexy (OR) for rectal prolapse were studied. Each underwent detailed interrogation as to their symptoms, left colonic manometry (basal and postprandial motor indexes and their caudad gradients in the sigmoid), anorectal manometry, evacuation proctography, and colonic transit time with radiopaque markers. Results were compared to those obtained in two control groups: 10 healthy volunteers (HV) and 12 patients complaining of a rectal prolapse (RP) observed consecutively during the same period of evaluation (June 90 to December 91). Before surgery, the OR and RP groups were similar with respect to mean age, sex ratio, weekly stool frequency, subjective dyschezia and manual anal supplies, constipation symptoms, and anal incontinence. OR patients differed significantly from the RP group in having a lower weekly stool frequency (2.5 +/- 2.2 vs 5.2 +/- 3.7, P < 0.01) and a higher prevalence of abdominal pain (7 vs 1 patients, P < 0.05). Above the rectopexy, global (135.9 +/- 38 vs 51 +/- 30.5 hr, P < 0.01) and left (61.6 +/- 10 vs 18.2 hr, P < 0.01) colonic transit times were significantly higher in OR patients; moreover, the basal motor index gradient was negative in all but one case (-94.1 +/- 101 vs 177.3 +/- 131, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Observations on the initiation of sustained ventricular tachycardia by programmed stimulation.

We analyzed the initiation of sustained monomorphic ventricular tachycardia (VT) by programmed ventricular stimulation (PVS) in 50 consecutive patients who had clinical VT or aborted sudden cardiac death with remote myocardial infarction. In 25 of 50 patients, the first induced QRS complex of VT was morphologically identical to the succeeding QRS complexes of VT (type I). In 25 other patients, the first VT beat had a different morphology (type II). Type I had a significantly longer VT cycle length than type II (333 +/- 65 msec and 293 +/- 66 msec, P = 0.036). Type II VT initiation required more aggressive stimulation protocol than type I (type I: type II; number of extrastimulus required for induction 2.5 +/- 0.9 : 3.0 +/- 0.6, P = 0.026; shortest extrastimuli coupling interval 244 +/- 28 msec : 220 +/- 23 msec, P = 0.002). The interval between the last extrastimulus and the onset of the first VT beat was 408 +/- 88 msec in type I and 336 +/- 75 msec in type II (P = 0.004). Furthermore, there was good correlation between the VT cycle length and the interval from last extrastimulus to the onset of nonpaced beat in type I but not in type II.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intestinal motility and its variations in replacement bladder and intestine]. / La motricité intestinale et ses variations dans les vessies de remplacement et l'intestin en place.

Urinary reservoirs replacing the bladder are made of intestine. The digestive tract motor activity is regulated by hormonal and neurologic mechanisms. The purpose of this work is the comparison of the motor activity in intact bowel with that of the new urinary reservoir during and after an oral intake. The modifications of pre- and post-prandial motor activities are recorded simultaneously in duodenum and neobladder by 4 patients with a tubular entero-cystoplasty (Camey I); standard meal (570 Kcal) triggers a similar activity in both segments. The modifications induced by an oral intake are then recorded by 14 patients with various reservoirs (ileum, ileum-cecum, cecum) and with different shapes (tubular or non-tubular). The compliance of non-tubular colic or ileocolic reservoirs appears greater than that of ileal reservoirs, even after detubularization. After oral intake, basal pressure and motor activity increase clearly in ileal bladders and much less in colic or ileocolic bladders. Nocturnal leak observed in many urinary reservoirs may be linked to the persistence of an intense motor activity in the neobladder with a marked increasing during the second part of the night.

The effect of dopexamine HCl upon collateral perfusion of the acutely ischemic myocardium in anesthetized dogs.

The effects of low-dose (10(-9) and 3 x 10(-9) mole/kg/min) infusions of dopexamine HCl, a new synthetic catecholamine with beta 2-adrenergic and DA1-dopaminergic agonostic actions, was tested in anesthetized dogs, with and without acute ligation of the left anterior descending coronary artery. The infusions caused diastolic arterial blood pressure to fall by 12 +/- 4 and 23 +/- 5 mmHg, respectively. Microsphere-estimated collateral blood flow to the ischemic myocardium did not change significantly during the drug infusions. The findings suggest that low doses of dopexamine HCl do not cause coronary "steal" from acutely ischemic myocardium.

[The value of pharyngo-esophageal manometry in the study of deglutition disorders]. / Intérêt de la manométrie pharyngo-oesophagienne dans l'étude des troubles de la déglutition.

Pharyngoesophageal manometry is an excellent tool for the study of pharyngeal swallowing disorders, and allows quantifying the various anomalies. The comparison of pre- and postoperative results allows better differentiation of the indications for myotomy or myectomy of the cricopharyngeal muscle. On the basis of a series of 10 cases with sufficient distance in time, the operation can be regarded as even more beneficial as the manometric anomalies are confined to the sole upper esophageal sphincter.

The cardiovascular effects of the surfactant pluronic F68 in anesthetized dogs.

We tested the cardiovascular actions of the surfactant Pluronic F68 by infusing it into anesthetized dogs, in doses approximating those which would be received when Fluosol-DA were used to resuscitate moderate or severe hemorrhage (0.66 and 1.11 g/Kg). In order to alleviate the reactions to Pluronic, the surfactant was purified by treatment with activated charcoal and the dogs were pretreated with corticosterone. Pluronic F68 caused dose-dependent increments in cardiac filling pressures and in systemic and pulmonary arterial blood pressure. Heart rate and contractility remained unchanged. There was an increase in the cardiac output which was dose-dependent and unrelated to the filling pressures. Regional blood flow, as determined by radionuclide-labelled microspheres, tended to increase, but only that to the heart, kidney cortex and lung (bronchial arterial) increased to a statistically significant extent. It would appear that Pluronic F68, when purified with charcoal and after steroid prophylaxis, possesses significant hemorheologic and cardiovascular effects, indicating the need for further investigation of various purification methods and the effects of purified preparations.