[Concomitant anosmia and ageusia: a case report]. / Anosmie et agueusie: è propos d'un cas.

Olfactory loss due to head trauma is a frequent finding. It is attributed to the tearing or severing of the olfactory fibers at the cribriform plate. In contrast, posttraumatic gustatory loss is observed and reported rarely and the underlying mechanism is less understood. Here we present a case of a concomitant post-traumatic anosmia and ageusia. Imaging showed a considerable frontobasal brain damage and it is speculated that the gustatory impairment is due to a central injury of the secondary taste cortex. Based on this observation, we believe that this clinical presentation might be much more frequent than previously reported.

Potential value of vestibular evoked myogenic potentials in paediatric neuropathies.

PURPOSE: Showing the interest of vestibular evoked myogenic potentials in paediatric neurological vestibulospinal pathology detection and followup. MATERIALS AND METHODS: The vestibular evoked myogenic potentials testing apparatus presented is now commonly used in ENT clinics for patients from 1 month of age. Our system and protocol permits control to evoke and select the best EMG level and makes possible a comparison of data from different sides or level of stimulation or different sessions. Normal vestibular evoked myogenic potentials latencies obtained with tone bursts were remarkably stable (P: 13 +/- 0.8 ms, N: 19.6 +/- 1.6 ms). The reported case illustrates abnormal vestibular evoked myogenic potentials latencies in neuropathy. RESULTS: A 6 y.o. child with progressive imbalance was referred to the ENT department for vestibular functional evaluation. Abnormally long latencies in the vestibular evoked myogenic potentials and neurological examination oriented the diagnosis towards Guillain-Barre syndrome and immediate referral to a neurology department. Vestibular evoked myogenic potentials also helped to monitor the neurological recovery. CONCLUSION: The present case shows the potential value of vestibular evoked myogenic potentials in diagnosis and evaluation of descending brainstem pathways in neuropathies like Guillain-Barre syndrome in complement to neurological evaluation.

[Seasonal variations of blood pressure in normal subjects and patients with chronic disease]. / Variations saisonnières de la pression artérielle chez des sujets normaux et des malades chroniques.

The characteristics and determining factors of seasonal variations of the blood pressure (BP) were studied in 20 normal subjects and 219 chronic stable chronically all patients, most of whom were ambulatory. The BP was measured repetitively over twelve months and measurements in the lying position repeated after one minute of orthostatism were performed in Winter and in Summer. In normal subjects, the BP decreased from June to reach its lowest value in August to return to the Winter values from October. The mean BP of the three Winter months was 130/79 mmHg and the seasonal lowering averages 5 +/- 5/5 +/- 6 mmHg (m +/- SD) (p < 0.01), with marked individual differences. The Summer decrease in BP was observed both lying down (3/4 mmHg) (p = 0.01) and standing (5/6) (p = 0.0001). In the patient group, the Summer decrease in BP was 4/3 mmHg. During the orthostatic measurements, it was 4/4 mmHg lying down and 6/5 mmHg when upright. Symptoms of orthostatic hypotension were reported spontaneously 10 times during the Winter and 21 times during the Summer months (p = 0.04) and occurred in the upright position in 12 patients (6%) in Winter and 25 patients (12%) in Summer (p = 0.025). The Summer decrease was greater in women than in men. Blood pressure lowering drugs increased this effect and the association of several drugs had an additive effect. It increased with age but disappeared after 70-80 years of age. The very elderly patients on antihypertensive therapy showed a marked decrease in BP during the Summer, especially in the upright position. The Summer decrease in BP is important for the management of elderly patients with hypertension or cardiac failure. It may favorize symptoms of orthostatic hypotension and increase the risk of malaise.

[Emergencies in diabetic patients]. / Les urgences du diabétique.

In this article emergencies are presented from the view of the practitioner. At first, hypoglycemias caused by insulin and sulfonylurea are analyzed, emphasizing in particular the necessity for surveillance of hypoglycemias due to sulfonylurea drugs in hospital. Hyperosmolar and ketoacidotic decompensations are reviewed and the limits of the ambulatory care stressed. Finally, some less classical but nevertheless frequent situations like podiatric, ophthalmologic and neurologic urgencies of diabetics are described.

[Seasonal variations in arterial pressure in hypertensive patients]. / Variations saisonnières de la pression artérielle chez des patients hypertendus.

Blood pressure (BP) was measured once every month during one year in 80 hypertensive outpatients. An orthostatic test was performed in winter and another during summer. The collective was aged 65 +/- 13 years (m +/- SD) and presented an elevated prevalence of diabetes mellitus, cardiac failure, and coronary, cerebral and arterial insufficiency. Diuretics, betablockers, converting enzyme inhibitors and calcium channel blockers were used by 31 patients as monotherapy and by 49 patients in association. During summer a significantly lower seated BP was found (144.1/79.4 mm Hg vs 150.8/82.9 mm Hg in winter, p < 0.001). One fourth of the patients did not show this diminution. On the basis of the WHO criteria of BP definition, 31% of the patients could be considered hypertensive in winter vs 16% in summer and 28% as normotensive in winter vs 43% in summer (p < 0.05). The summer reduction in BP depended on position. It was less marked in seated position (-5.3/-2.7 mm Hg) than in lying (-6/-5.1 mm Hg) or even in standing position (-10.8/-5.1 mm Hg). The orthostatic test induced a greater immediate fall in systolic BP in summer than in winter (-14.4 vs -9.6 mm Hg, p < 0.001), more orthostatic hypotensive episodes defined as a systolic BP fall of 20 mm Hg or more (34% of patients vs 20% in winter, p = 0.05) and more signs of reduced cerebral perfusion (14% vs 7.5% in winter, NS). Diabetic patients and patients treated by diuretic and vasodilator drugs are particularly exposed to orthostatic hypotension in summer. Betablockers can minimize this risk.(ABSTRACT TRUNCATED AT 250 WORDS)

[The diabetic foot]. / Le pied diabétique.

The socio-economic, medical and psycho-social consequences of lower-limb injuries in diabetic patients are enormous. The risk of lower extremity amputation is 15 times greater in diabetic patients than in the age-matched non-diabetic population. About 1000 diabetic patients undergo a disabling amputation annually in Switzerland. Implementation of appropriate educational and foot-care programmes by motivated pluridisciplinary teams may reduce major amputations by as much as 50%. Regular examination of the feet of diabetic patients, therefore, deserves the same priority in diabetes care as control of the optic fundus and of kidney function, but unfortunately this is seldom the case. These guidelines summarize the physiopathology, the diagnosis and the treatment of diabetic foot problems. Emphasis is placed on simple preventive measures which should help protect the majority of high-risk patients.

Comparative study of isomalt and sucrose by means of continuous indirect calorimetry.

Isomalt (Palatinit) an equimolar mixture of alpha-D-glucopyranosido-1,6-sorbitol and alpha-D-glucopyranosido-1,6-mannitol, was compared to sucrose in a prospective double-blind controlled crossover study. The acute effects of oral ingestion of 30-g loads of isomalt or sucrose on plasma glucose, insulin, free fatty acids (FFA), lactic acid, and carbohydrate (CHO) and lipid oxidation were studied over six hours by means of continuous indirect calorimetry in ten healthy normal-weight subjects. Unlike sucrose, whose ingestion was followed by significant changes in plasma glucose, insulin, and lactic acid during the first 60 minutes of the test, no significant changes in these parameters were observed following the administration of isomalt. The increase in CHO oxidation occurring between 30 and 150 minutes was significantly lower (P less than 0.01) following isomalt than after sucrose. Conversely, the decrease in lipid oxidation was significantly less (P less than 0.01) after isomalt in comparison to sucrose. It is concluded that the rise in CHO oxidation and in plasma glucose and insulin levels is markedly reduced when sucrose is replaced by an equal weight of isomalt. In contrast to other sugar substitutes, no increase in plasma lactic acid was observed after isomalt administration.

Energy cost of glucose storage in human subjects during glucose-insulin infusions.

The effect of graded levels of hyperinsulinemia on energy expenditure, while euglycemia was maintained by glucose infusion, was examined in 22 healthy young male volunteers by using the euglycemic insulin clamp technique in combination with indirect calorimetry. Insulin was infused at five rates to achieve steady-state hyperinsulinemic plateaus of 62 +/- 4, 103 +/- 5, 170 +/- 10, 423 +/- 16, and 1,132 +/- 47 microU/ml. Total body glucose uptake during each of the five insulin clamp studies was 0.41, 0.50, 0.66, 0.74, and 0.77 g/min, respectively. Glucose storage (calculated from the difference between total body glucose uptake minus total glucose oxidation) was 0.25, 0.29, 0.43, 0.49, and 0.52 g/min for each group, respectively, and represented over 60-70% of total glucose uptake. The net increment in energy expenditure after intravenous glucose was 0.08, 0.10, 0.14, 0.17, and 0.23 kcal/min, respectively. Throughout the physiological and supraphysiological range of insulinemia, there was a significant relationship (r = 0.95, P less than 0.001) between the increment in energy expenditure and glucose storage, indicating an energy cost of 0.45 kcal/g glucose stored. However, at each level of hyperinsulinemia, the theoretical value for the energy cost of glucose storage (assuming that all of the glucose is stored in the form of glycogen) could account for only 45-63% of the actual increase in energy expenditure that was measured by indirect calorimetry. These results indicate that factors in addition to glucose storage as glycogen must be responsible for the increase in energy expenditure that accompanies glucose infusion.