Neurological improvement and rehabilitation potential following toxic myelopathy due to intrathecal injection of doxorubicin.

STUDY DESIGN: Case report of a 31-year-old woman who presented with toxic myelopathy due to intrathecal administration of doxorubicin. OBJECTIVE: To describe the pathology and the rehabilitation of an uncommon complication of intrathecal drug administration during the oncologic treatment of acute lymphoma. SETTING: Spinal cord rehabilitation center, University Hospital. METHOD: Clinical and radiological observations during a rehabilitation program. RESULTS: Evidence of neurological improvement and rehabilitation potential after severe myelopathy due to intrathecal injection of doxorubicin. CONCLUSION: This is, to our knowledge, the first report of severe myelopathy following accidental intrathecal administration of doxorubicin. Despite early complete paraplegia, some neurological and functional recovery was observed.

Subdural catheter migration may lead to baclofen pump dysfunction.

OBJECTIVES: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. STUDY DESIGN: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. SETTING: Regional spinal cord injuries centre in Geneva (Switzerland). METHODS: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. RESULTS: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. CONCLUSIONS: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.

["Sunshine at school": a network for training on sun exposure. Assessment of knowledge among 683 children]. / Le soleil à l'école: réseau d'éducation à l'exposition solaire. Evaluation des connaissances chez 683 enfants de CM1 et CM2.

INTRODUCTION: The protection of children from sun exposure appears inadequate. We assessed the knowledge of pre-teenagers, before and after they attended a training session on sun exposure. This investigation was carried out in Orléans and in 5 surrounding cities, from September 2000 to April 2002. MATERIAL AND METHODS: A didactic slide show on sun exposure and photoprotection was presented to 683 children in grade 4 and 5 by a nurse and a dermatologist during 30 informative sessions. The children filled in questionnaires at each training session and then one month later. The questionnaires contained 10 closed questions involving 32 cognitive and behavioral items. RESULTS: Forty-five percent of the children claimed that they were exposed to the sun more than one hour a day during holidays, 14 p. 100 more than 3 hours a day; 26 p. 100 declared they had never been sunburnt; 46 p. 100 said they had been less than 5 times, 15 p. 100 from 5 to 10 times and 12 p. 100 more than 10 times; 74 p. 100 of the children claimed they enjoyed getting sun-tanned; 80 p. 100 knew that sun exposure could lead to serious diseases, while 73 p. 100 realized that contracting sunburns during childhood increases the risk of subsequent skin cancers; 89 p. 100 knew of the necessity of sun-screen use prior to exposure, 94 p. 100 knew that they help to protect the skin whereas 78 p. 100 knew it must be applied on a regular basis; 77 p. 100 of the children had been informed of the importance of sun protection factor; 92 p. 100 of them were aware of the relevance of a cap and sunglasses for protection from the sun, whereas only 45 p. 100 knew of the need for a tee-shirt. DISCUSSION: Our study showed that children are generally aware of the dangers of sun exposure. This might be the result of previously initiated information and prevention campaigns on skin cancers. This study suggests the efficiency of such projects, and the lasting effects of the information received within one month. However, large numbers of children are still overexposed and subsequently suffer from traumas. The appeal of sun embellishment appears to go back to childhood, and should be taken into account from the early stages of childhood in future preventive actions. An efficient policy of education on sun exposure - including teaching tools relevant to each age--still has to be developed.

Modulation by sex hormones of the membranous transducing system regulating fatty acid mobilization in adipose tissue.

This review summarizes recent animal studies performed to determine the possible role played by sex hormones in the sex- and site-related differences characterizing adipocyte lipolytic activity. In both normal female rats and male hamsters, fat cells from deep intra-abdominal sites elicit higher catecholamine-stimulated lipolytic responses than subcutaneous adipocytes. By using ovariectomized rats, it was found that estradiol 'in vivo', while having no effect in subcutaneous cells, promotes catecholamine-stimulated lipolysis in deep intraabdominal adipocytes by increasing their adenylate cyclase catalytic activity. By using castrated hamsters, it was found that both deep intra-abdominal and subcutaneous fat cell lipolytic activities are equally sensitive to testosterone. In these cells, testosterone treatment promotes not only the beta-adrenergic lipolytic responses by increasing both the adenylate cyclase catalytic activity and the Gs alpha level, but also enhances the alpha 2-adrenergic antilipolytic responses through a transcriptional activation of the alpha 2-adrenoceptor expression. These experiments demonstrate that in some, but not all, white adipocytes the adrenergic signal transducing system regulating lipolysis is a target for sex hormones. This finding may have potential importance in the understanding of the mechanisms underlying the sex-related regional specificities of adipose tissue metabolism and distribution.

Increased adenylate cyclase catalytic activity explains how estrogens "in vivo" promote lipolytic activity in rat white fat cells.

Estradiol administration (5 micrograms per day x 4 days) to ovariectomized rats resulted in a 60-70% increase in the maximal lipolytic response of their white adipocytes to isoproterenol, epinephrine, IBMX and forskolin. These altered lipolytic responses were accompanied by parallel changes in the intracellular cyclic AMP levels found in response to 1 mM IBMX alone (+ 106%) or combined with submaximal concentrations of isoproterenol (+205%), epinephrine (+190%) and forskolin (235%). Studies of the adenylate cyclase activity revealed an overall increase in the stimulatory responsiveness of the enzyme (+150 to +200%) after the estradiol-treatment, regardless of the stimulatory agents tested (GTP, GppNHp, fluoride, isoproterenol, ACTH, forskolin). Finally, the finding of a 2-fold enhancement of the Mn2+ (+/- GDP beta S)-stimulated adenylate cyclase activity after the estradiol-treatment strongly suggests that increased activity of the catalytic subunit of this enzyme is the likely mechanism whereby estrogens promote lipolysis in rat fat cells.

[Study of cellular immunity in the course of nephro-epithelioma. Preliminary study concerning 12 cases (author's transl)]. / Etude de l'immunité cellulaire dans l'évolution du néphro-épithéliome Etude préliminaire à propos de douze cas

The cellular immunity of 12 adult subjects suffering from nephro-epithelioma was studied by means of lymphoblastic transformation tests repeated regularly. Perhaps a certain agreement could be observed between the clinical course and the subject's sensitization to the tumor antigens.