Qualitative and semi-quantitative value of a modified 13C-urea breath test for identification of Helicobacter pylori infection.

OBJECTIVE: The 13C-urea breath test (13C-UBT) is the method of choice in evaluating the success of therapy for eradication of Helicobacter pylori infection. For reasons of cost efficiency and practicability, urea dose and measurement duration have been reduced and the DOB (delta over baseline) cutoff level with the highest predictive value determined. Further, the efficacy of the modified 13C-UBT as a semi-quantitative test method was evaluated by comparison with histologically determined bacterial infiltration. METHODS: In a prospective study, a modified 13C-UBT with reduced urea dose (75 mg) and shortened measurement duration (30 min) was administered to 145 patients. The DOB cutoff with the highest predictive value was determined using relative operating characteristic analysis. Reference methods included histology, bacterial culture and the rapid urease test. The DOB value was compared with the histologically determined grade of bacterial infiltration and the correlation evaluated using the Spearman ranking method. RESULTS: Reduction of the DOB cutoff level from 5.0 per thousand to 3.5 per thousand led to significant improvement in sensitivity (78.9% vs. 91.2%) and accuracy (88.6% vs. 90.2%) of the 13C-UBT. Only five of 57 infected patients were incorrectly reported as non-infected after modification of the DOB level. In two of three patients in whom histological findings were negative but the 13C-urease test positive, bacterial growth was observed at culture. The DOB level correlated significantly with histological grade of bacterial infection. CONCLUSION: The modified 13C-UBT proved to be a sensitive, practicable and cost-effective method for detecting H. pylori infection and permits a semi-quantitative estimation of bacterial infiltration.

Preliminary results of a magnetic resonance imaging (MRI) study of the pig brain placed in stereotaxic conditions.

Magnetic resonance imaging (MRI) of two pig brains was realized. The animals were placed in the stereotaxic conditions currently used in experiments. To allow the positioning of the animal in the MRI instrument, landmarks were previously traced on the snout of the pig. To avoid movements, animals were deeply anesthetized. MRI were taken in frontal, horizontal and sagittal directions. Afterwards, the brains of the pigs were frozen and cut into sections, frontal for one animal and sagittal for the other. Histologic and MR images were compared. The usefulness of this technique is discussed.

[Eye movements: initial dynamic approach in high resolution magnetic resonance imaging]. / Mouvements oculaires: première approche dynamique en imagerie par résonance magnétique (I.R.M.) de haute résolution.

New MR softwares allow a dynamic display of different fonctionnal anatomical regions. This work is a first attempt to visualize the ocular movements. A video tape constitute the support of our results. Technically, the work is performed on a Signa 1,5 T GE CGR System. During each MR acquisition, the subject is asked to fix his gaze successively on each spot of a scale set inside the bore of the magnet. Twenty four images are performed to show the entire lateral course of the globes. The examination time is about half an hour. The video display show the movements of agonist and antagonist muscles, the eyeballs and the optic nerves displacements, in the axial neuro-ocular plane (NOP). Different clinical applications of this new method are discussed (muscular surgery...).

[Semi-automated quantification of MRI high signals observed in multiple sclerosis]. / Quantification semi-automatisée des zones de haut signal IRM observées dans la sclérose en plaques.

MR T2 Weighted sequences on the brain demonstrate disseminated "high signal zones" (HSZ) in patients with Multiple Sclerosis; these morphological alterations are corresponding to the plaques. From the very beginnings of MR in 1981, everybody recognizes the main importance of this fact. MR appears as the most sensible exploration in patients with M.S. But the signal alteration is not specific; the clinical considerations and the evolution are requested. The aim of this work is to give a reference tool for evolutive evaluation of the disease. A work station with a specially developed software are presented. The HSZ thresholding is partially automatic. The edition of a cerebral mapping is developed. These results are discussed.

[Cerebral MRI in the study of prognostic factors in AIDS. Hypotheses from tests on 15 patients]. / Apport de l'IRM cérébrale à l'étude des facteurs pronostiques du SIDA. Hypothèses à partir de l'examen de 15 patients.

In an attempt to determine factors of predictive value in HIV (human immuno-deficiency virus) seropositive patients, particular attention was payed to symptoms indicating early involvement of the central nervous system (CNS). A cohort of healthy carriers was thus constituted. Follow-up will be carried out every six month including clinical, biological as well as CNS imaging by NMR. Among the first 15 of them, abnormalities could be observed in 4 individuals. Lesions consisted in nodules of high signal in T2 which were localized either in the white matter or thalamic nuclei. No relationship could be demonstrated between the existence of these lesions and various criteria such as age, sex, risk factors and T4 cells count. Such lesions appeared similar to the localizations observed in multiple sclerosis or to the scars of limited vascular accidents. The nature of these lesions is not clear. They certainly indicate early involvement of CNS after primary infection by the HIV virus. They may either represent sequellae of this primary infection or early alterations announcing developing encephalopathy.

[Magnetic resonance imaging of the head compared with the CT scan]. / IRM de la tête comparée avec le CT scan.

After the description of the normal head anatomy in MRI and its exploration plans, the images observed in benign and malignant tumours of the brain, in cerebral ischaemic attacks, in the diseases of the orbit, face and skull base, are considered. The limits and present indications of the technique are defined.

Somatomotor manifestations in temporal lobe seizures.

Some authors include somatomotor manifestations (SMM) among the clinical features of temporal lobe seizures in man; however, data are limited and conflicting. This study describes 101 seizures recorded during stereo-EEG explorations in 50 patients, selected on the basis of the demonstration of onset in temporal lobe structures (stereo-EEG) and the presence of lateralized SMM and/or secondary generalization (SG). SMM and SG were present in about 20% of our population of patients with temporal seizures explored with stereo-EEG, and were only rarely observed during the first 10 s (early SMM) of the seizures (less than 10%). Seizures characterized by early SMM were generally induced by electrical stimulation or chemical activation and only exceptionally spontaneous. In all cases the ictal electrical discharge also involved at an early stage extratemporal structures such as the rolandic operculum, the parietal lobe, or contralateral temporal structures. In most cases (greater than 90%) SMM represented a late (greater than 10 s) event in the ictal symptomatology. The face and the upper limb were by far the most frequently involved segments. Thirty-eight percent of seizures ended up in SG. The associated ictal symptomatology was rather poor and differed from our previous findings in temporal lobe seizures: oroalimentary automatisms were relatively rare, whereas an impairment of consciousness was observed in more than 50% of seizures. The critical electrical discharge had a long duration and always involved extratemporal structures in one or both hemispheres. The involvement of the central region could be demonstrated in all patients with deep electrodes in that region. In conclusion, SMM are not characteristic of temporal lobe seizures, and their presence indicates spreading of the critical discharge beyond the temporal lobe.

[Motor and postural manifestations of temporal lobe epilepsy seizure]. / Manifestations motrices et posturales dans les crises d'épilepsie d'origine temporale.

This study reports on 73 epileptic seizures (in 36 patients) originating in the temporal lobe (stereo-EEG) presenting motor or postural signs. Motor symptoms occur rarely in the early phase of seizures (less than 10% of our series) and they are exceptional during spontaneous seizures. The critical electrical discharge always affects extra-temporal structures such as the rolandic operculum, the cingulate gyrus, etc. The occurrence of motor symptoms during the late phase of seizures is associated with a long duration of the critical discharge and, again, with the involvement of extra-temporal structures. The characteristics of the associated clinical signs (e.g., frequent loss of contact with the environment, relatively rare oroalimentary automatic activities), together with the high frequency of secondary 'generalizations' are consistent with the stereo-EEG findings and indicate that these seizures also affect extra-temporal regions.

[Cerebral concentrations of anticonvulsants in patients with epilepsy of tumoral origin (author's transl)]. / Concentrations cérébrales des médicaments anti-comitiaux chez les malades ayant une epilepsie tumorale.

(1) The concentrations of various anticonvulsants (PB, PHT, CBZ, VPA) were measured in brain specimens from 7 patients who had undergone neurosurgery for a therapy resistant epilepsy of tumoral origin (astrocytoma) in 6 cases, glioblastoma in 1 case). (2) Great interindividual variability of the mean brain/plasma concentration ratios was observed for PB in 5 patients (range: 0.4-1.0). A mean brain/plasma ratio of 1.0 was recorded for PHT and CBZ (one patient each). (3) In the different tissue specimens (7-14) from the same patient AED concentrations varied greatly, even in neighboring areas. (4) Intraindividual variations were more marked in the present group of patients than in previously studied non-tumoral epileptics. (5) No correlation was found between the localization of the lesions and the variations in AED concentrations. (6) Brain AED concentration appeared to be higher in the few samples of non-tumoral tissue and lower in the 'epileptogenic' areas as defined by stereo-EEG seconding. (7) On the basis of these data, the hypothesis can be formulated that the therapy resistance of these patients may be at least partly explained by the presence of low AED concentration (even in presence of 'therapeutic' AED plasma levels) in the epileptogenic areas.

[Genital and sexual manifestations occurring in the course of partial seizures in man (author's transl)]. / Manifestations génitales et "sexuelles" lors des crises epileptiques partielles chez l'homme.

The literature only rarely mention the genital and sexual manifestations occurring in the course of partial seizures in man. The authors presently describe 42 seizures of this type recorded with E.E.G. and Stereo-E.E.G. techniques in 15 patients. The results of this study indicate that the genital and sexual paroxystic manifestations do have a specific semeiology, and there can be related to the initial localization of the electrical discharge which may begin in one of three different regions (perisylvian region, anterior part of the cingular gyrus and the paracentral lobule). Penile erection is observed in only one seizure starting in the central region. Orgasm occurs in the only one female patient in the course of the seizures beginning in the perisylvian region (temporal region). Early sensitive symptomatology characterizes very often the seizures beginning in the perisylvian region but also in the paracentral lobule. Post-ictal or peri-ictal true masturbation occurs at the end of the ictal discharge beginning either in the perisylvian region or in the anterior part of the cingular gyrus. The sexual dyspraxic (i.e. fondling the genitals) characterizes only the post-ictal phase of the seizures beginning in any of the three regions.

The subependymal veins of the posterior portions of the lateral ventricles.

The Authors studied the subependymal veins of the posterior portions of the lateral ventricles: medial atrial vein (MAV), direct medial vein (DMV), direct lateral vein (DLV), lateral atrial vein (LAV), and inferior ventricular vein (IVV). A detailed description of the normal radiological feature of these veins is reported. Percentages of visualization in normal angiography and diagnostic utilization are also reported.

Angiography of incomplete lobulation of the cerebellar virmis with small fourth ventricle associated with callosal hypoplasia.

A case of imcomplete lobulation of the cerebellar vermis with a high insertion of tentorium, associated with a hypoplastic corpus callosum and a small fourth ventricle is presented. The pneumographic and angiographic findings of these malformations are correlated.