Impact of thrombolysis in acute ischaemic stroke without occlusion: an observational comparative study.

BACKGROUND AND PURPOSE: The impact of intravenous recombinant tissue plasminogen activator (IV-rtPA) in patients with acute ischaemic stroke (AIS) but no arterial occlusion is currently a matter of debate. This study aimed to assess functional outcome of such patients with respect to IV-rtPA use. METHODS: A retrospective case-control analysis was performed comparing the outcome of AIS patients without arterial occlusion with or without IV-rtPA use. Patients were selected from prospective consecutive observational registries of five European university hospitals. The primary study outcome was excellent outcome at 3 months after stroke, as defined by a modified Rankin Scale (mRS) 0-1. RESULTS: A total of 488 patients without arterial occlusion documented by angiography were included in the present study; 300 received IV-rtPA and 188 did not. No between-group difference was found for excellent outcome before and after adjustment for baseline characteristics (adjusted odds ratio for no IV-rtPA use 0.79, 95% confidence interval 0.51-1.24, P = 0.31). Similar results were found for favourable outcome (defined as a 90-day mRS of 0-2) whereas a higher rate of early neurological improvement was found in IV-rtPA-treated patients (adjusted odds ratio 1.99; 95% confidence interval 1.29-3.07, P = 0.002). Sensitivity analyses yielded similar results. CONCLUSIONS: Our study suggests that AIS patients without visible arterial occlusion treated with IV-rtPA may have no better outcome at 3 months than those untreated. However, only a randomized controlled trial would provide a definitive answer about the impact of rtPA in acute stroke patients without occlusion. Until then, these patients should be treated by rtPA as recommended.

[Dural-cavernous fistulas revealed by bilateral alternating third and sixth nerve palsies]. / Fistule durale carotido-caverneuse révélée par une paralysie bilatérale à bascule des troisièmes et sixièmes nerfs crâniens.

A 74-year-old male was referred for disequilibrium, associated with right third and sixth nerve palsies observed 2weeks after head trauma with no loss of consciousness. On clinical examination, 4months after the injury, contralateral (left) third and sixth nerve palsies were observed, while ocular motility was now normal on the right side. The remainder of the ophthalmological examination was normal. Upon further history, tinnitus was found to have been present since the trauma, and auscultation of the preauricular area demonstrated a systolic bruit. Cerebral angiogram confirmed the presence of bilateral dural-cavernous fistulas. Clinical features of indirect or dural-cavernous fistulas and therapeutic options proposed in the literature are reviewed.

[An unrecognized cause of myelopathy associated with copper deficiency: the use of denture cream]. / Une cause méconnue de myélopathie par carence en cuivre: l'utilisation de pâte adhésive dentaire.

We report two patients with myelopathy associated with copper deficiency and pancytopenia. Excessive intake of zinc can lead to a severe deficiency of copper reducing the absorption of ingested copper. The patients had in common consumption of denture adhesive paste containing zinc. In both patients, laboratory tests showed a combination of copper deficiency, hyperzincemia and increased urinary zinc level. The use of a denture cream was stopped. Copper supplementation, initially subcutaneously then oral corrected the copper deficiency and pancytopenia. Clinically, the pain faded but the gait disturbance persisted. Copper deficiency associated with the use of denture cream rich in zinc is an unrecognized cause of myelopathy associated with pancytopenia which should be diagnosed early to establish appropriate therapeutic measures to minimize neurological complications.

L1503R is a member of group I mutation and has dominant-negative effect on secretion of full-length VWF multimers: an analysis of two patients with type 2A von Willebrand disease.

Type 2A von Willebrand disease (VWD) is characterized by decreased platelet-dependent function of von Willebrand factor (VWF); this in turn is associated with an absence of high-molecular-weight multimers. Sequence analysis of the VWF gene from two unrelated type 2A VWD patients showed an identical, novel, heterozygous T-->G transversion at nucleotide 4508, resulting in the substitution of L1503R in the VWF A2 domain. This substitution, which was not found in 60 unrelated normal individuals, was introduced into a full-length VWF cDNA and subsequently expressed in 293T cells. Only trace amount of the mutant VWF protein was secreted but most of the same was retained in 293T cells. Co-transfection experiment of both wild-type and mutant plasmids indicated the dominant-negative mechanism of disease development; as more of mutant DNA was transfected, VWF secretion was impaired in the media, whereas more of VWF was stored in the cell lysates. Molecular dynamic simulations of structural changes induced by L1503R indicated that the mean value of all-atom root-mean-squared-deviation was shifted from those with wild type or another mutation L1503Q that has been reported to be a group II mutation, which is susceptible to ADAMTS13 proteolysis. Protein instability of L1503R may be responsible for its intracellular retention and perhaps the larger VWF multimers, containing more mutant VWF subunits, are likely to be mal-processed and retained within the cell.

Tubular seminoma of the testis.

A case of tubular seminoma in a 33-year-old man is reported. The tumor occurred in his right testis, measuring 7 x 6 x 6 cm in size. Microscopically, most of the tumor cells were arranged in solid or hollow tubular patterns. The tumor cells had round nuclei with vesicular chromatin and clear or granular cytoplasm, characteristic features of seminoma cells. A classic seminoma component and intratubular atypical germ cells occupying approximately 5% of the tumor area were noted. Immunohistochemical staining revealed that the tumor cells were diffusely placental alkaline phosphatase and vimentin positive, and focally cytokeratin positive. These findings are consistent with a tubular seminoma. The differential diagnoses are discussed.

Solitary fibrous tumor of the prostate.

A case of solitary fibrous tumor of the prostate is reported. A 42-year-old man had been complaining of difficult voiding and constipation for 8 years. Urological and radiological examinations showed a large prostatic mass, and a total cystectomy and prostatectomy were performed. The tumor was 14 x 13 x 11 cm in size, solid with a fibromuscular capsule, and gray-tan in color. Histologically, the tumor was composed of short spindle-shaped and polygonal cells with mild to moderate nuclear atypia, predominantly arranged in the so-called 'patternless pattern' in a fibrocollagenous background. Mitoses were occasionally seen. Vascular invasion was also observed. Immunohistochemically, these cells were strongly positive for CD34 and vimentin, and occasionally for desmin. The maximum Ki-67 labeling index of the tumor cells was 4.5%. These findings are consistent with a solitary fibrous tumor. To our knowledge, this is the first report of a solitary fibrous tumor of the prostate in the English medical literature.

Rupture of pararenal pseudocyst in a patient with Down's syndrome.

A rare case of Down's syndrome with spontaneous rupture of a pararenal pseudocyst has been reported. The rupture of the pararenal pseudocyst was treated nonsurgically. The presence of this cyst in conjunction with Down's syndrome may be due, in part, to muscular hypotonia.

[Studies on the usefulness of a long-term, high-dose treatment of methylcobalamin in patients with oligozoospermia].

Methylcobalamin (CH3-B12) was administrated in a dose of 6 mg per day (group A, 16 cases) or 12 mg per day (group B, 23 cases) for 16 weeks to patients with oligozoospermia. There was no difference between group A and group B regarding vitamin B12 concentrations in the serum or seminal fluid. CH3-B12 appeared to be transported to seminal fluid very efficiently. However, results from group A and group B did not differ with respect to this parameter. The efficacy rate for group A was 37.5% and that for group B was 39.1%. From these results, it was concluded that a long-term, high dose treatment of CH3-B12 was useful for the treatment of patients with oligozoospermia. Since the efficacy rates were not different between the two groups, 6 mg per day would be the recommended dose. Clinical adverse reactions were observed in one patient in each group. Drug-related laboratory adverse reactions were observed in only one patient in group B.

[Combined administration of human chorionic gonadotropin and human menopausal gonadotropin in idiopathic male infertility].

Clinical experiences of HCG-HMG therapy for 56 cases of idiopathic male infertility were studied. Serum levels of LH, FSH and testosterone were measured before therapy. Sperm density improved in 25% of all cases. In the low FSH group, sperm density showed a high rate of improvement. The basal FSH was the best indicator to predict the prognosis of fertility. Additional measurements of LH and FSH response to GnRH gave further information on the prospect of fertility.