Assuntos
Síndrome de Opsoclonia-Mioclonia/diagnóstico , Síndrome de Opsoclonia-Mioclonia/etiologia , Choque Séptico/complicações , Infecções Urinárias/complicações , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Síndrome de Opsoclonia-Mioclonia/tratamento farmacológicoAssuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Confusão/etiologia , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico , Alcoolismo/complicações , Neoplasias Encefálicas/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Linfoma de Células B/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/efeitos adversos , Resultado do TratamentoAssuntos
Antígenos de Neoplasias/sangue , Encefalite Límbica , Militares , Proteínas do Tecido Nervoso/sangue , Neoplasias Testiculares/complicações , Adulto , Diagnóstico Diferencial , Humanos , Encefalite Límbica/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Orquiectomia , Neoplasias Testiculares/imunologia , Neoplasias Testiculares/cirurgiaRESUMO
INTRODUCTION: Influenza virus outbreaks occur each year, in France, during autumn and winter. Influenza-associated acute encephalitis were reported during epidemics or pandemics. Sporadic cases are rarely identified probably because influenza virus is not searched among etiology of febrile encephalitis. EXEGESIS: We report a case of influenza-associated encephalitis complicated by adrenal insufficiency in a young woman. Diagnosis was based on seroconversion of serum influenza virus A antibodies (complement fixation test). Follow up of the patient showed a total recovery. CONCLUSION: Influenza must be searched for any febrile encephalitis occurring during winter. Reverse transcriptase polymerase chain reaction (RT-PCR) on cerebrospinal fluid should be assessed. It is not actually a routine technique and we do not know yet if it is accurate enough for diagnosis. So, it is important to identify influenza virus and obtain documentary evidence concerning neurological impairment. Nevertheless, a better understanding of pathogenesis and use of vaccination are needed to improve prognosis.
Assuntos
Encefalite Viral/virologia , Influenza Humana , Adulto , Encefalite Viral/diagnóstico , Feminino , Humanos , Influenza Humana/diagnósticoRESUMO
A new clinicopathological case of Devic's neuromyelitis optica, including unusual predominant clinical features (fatal dysautonomia) is described herein: pathological examination showed extensive and severe demyelination mainly involving the optic nerves, the medulla, and spinal cord, which was particularly pronounced in the thoracic segments, and thus explained the unusual vegetative symptomatology. In a review of 45 clinicopathological cases described in the literature as Devic's disease (DD), it turned out that only 22 cases, including the patient described here, fulfilled the recently defined diagnostic criteria [Devic 1980]. Among the other 23 cases, 15 did not fulfill the criteria because of the occurrence of relapses, 3 others had 2 separate pathological locations within the spinal cord, and the remaining 5 showed evidence that a disease other than DD was involved. Among the 22 cases which were definitely taken to be DD, the mean age at clinical onset was 39 years (+/- 14); it was characterized by acute bilateral visual loss and transversal myelitis which gradually led either to death or to partial or complete recovery. The pathological lesions, which mostly were located along the optic tracts and the spinal cord, were characterized by demyelination with inflammation and necrosis; in some cases the pathological process diffused into the medulla (8/22 cases) or the whole brainstem (4/22 cases). The cavitation of the spinal cord was not a key feature of the diagnosis, since it was observed on only 9/22 cases. Devic's neuromyelitis optica may be a separate nosological entity which differs from multiple sclerosis.
Assuntos
Doenças do Sistema Nervoso Autônomo/patologia , Neuromielite Óptica/patologia , Tronco Encefálico/patologia , Evolução Fatal , Feminino , Humanos , Bulbo/patologia , Pessoa de Meia-Idade , Bainha de Mielina/patologia , Nervo Óptico/patologia , Medula Espinal/patologiaRESUMO
We recently showed that peripheral blood cell supernatants from multiple sclerosis (MS) patients, containing reverse transcriptase activity and retroviral RNA from the newly human identified multiple sclerosis retrovirus (MSRV), also secrete a cytotoxin which induces death of primary mouse cortical glial cells. We have hypothesized that macrophages could release this cytotoxin in the cerebrospinal fluid. The cerebrospinal fluid cytotoxicity from 166 patients with various neurological diseases (including MS patients) was tested on glial cells in vitro. Our bioassay shows that a glial cytotoxic activity is significantly present in cerebrospinal fluid from patients with relapsing-remitting MS at relapse. Since this cytotoxic activity seems to correlate with active cases of MS, it may represent a critical pathogenic factor in the neuropathology of MS.
Assuntos
Citotoxicidade Imunológica , Citotoxinas/líquido cefalorraquidiano , Esclerose Múltipla/líquido cefalorraquidiano , Neuroglia/fisiologia , Adulto , Animais , Bioensaio , Feminino , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Esclerose Múltipla/imunologia , RecidivaRESUMO
Classic ergolines, such as bromocriptine, methysergide and ergotamine, can induce chronic pleuropneumonitis. We present the cases of eight patients who developed similar changes whilst on other ergolines. In this retrospective case study spanning 1985-1995, clinical data, radiological material, pulmonary function, bronchoalveolar lavage and histopathology were reviewed. Earlier literature on ergoline-induced pleuropulmonary changes was reviewed. Eight middle-aged to elderly individuals of both sexes developed pleuropulmonary changes during long-term therapy with regular dosages of nicergoline (n = 4), dihydroergocristine (n = 3), or dihydroergotamine (n = 1). Bibasilar pleural thickening with or without pleural effusion was present on chest radiographs and computed tomographic (CT) scans in six cases. Increased erythrocyte sedimentation rate was seen in most. Pure interstitial pneumonitis developed in two patients on dihydroergocristine and was reversible in each. Bronchoalveolar lavage was performed in four cases and was abnormal in all, but demonstrated no consistent pattern. Most patients exhibited lung restriction. The outcome was favourable showing slow improvement in all cases following discontinuation of the ergoline. Slight residual pleural thickening was seen in five out of the six cases with pleural involvement. Nicergoline and dihydroergotamine can induce a syndrome of chronic pleural thickening/effusion that slowly improves after drug withdrawal. Dihydroergocristine can induce reversible interstitial pneumonitis.
Assuntos
Ergolinas/efeitos adversos , Pneumopatias/induzido quimicamente , Doenças Pleurais/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Lavagem Broncoalveolar , Ergolinas/uso terapêutico , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Doenças Pulmonares Intersticiais/induzido quimicamente , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/patologia , Prognóstico , Testes de Função Respiratória , Taxa de Sobrevida , Tomografia Computadorizada por Raios XAssuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Dermatomicoses/patologia , Histoplasmose/patologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Biópsia , Dermatomicoses/microbiologia , Dermatoses Faciais/patologia , Evolução Fatal , Humanos , MasculinoRESUMO
By reviewing a series of 50 patients operated on using the Foucher technique for a closed isolated fracture of the neck of the fifth metacarpal bone, the authors determine efficiency of this surgical technique which gives satisfactory results when the operation performed is early enough (before 10 days). They explain the modification of the technique, insisting on the importance of a post-operative follow-up which guarantees a good result and they propose other surgical indications whether they concern fractures of the neck of the fifth metacarpal bone with a relatively small displacement, mainly in young subjects and labourers or indications concerning special cases.
Assuntos
Fios Ortopédicos/normas , Fixação Interna de Fraturas/métodos , Fraturas Fechadas/cirurgia , Metacarpo/lesões , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Fixação Interna de Fraturas/normas , Fraturas Fechadas/diagnóstico por imagem , Fraturas Fechadas/terapia , Humanos , Masculino , Manipulação Ortopédica/métodos , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.
Assuntos
Retalhos Cirúrgicos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia PlásticaRESUMO
Eleven patients with by polycystic liver disease were operated according to Lin's procedure. All cases were symptomatic forms. Sonography was diagnostic examination in 9 cases. Lin's procedure was not associated with any postoperative mortality or morbidity and no recurrences were observed after an average follow up of 4 years. Rarely, a feminale predominance and association with polycystic kidney disease are noted. Sonography establishes the diagnosis and reveals complications (most intracystic bleeding frequently). Lin's procedure is better than sonographic aspiration which must be repeated and can be complicated by severe infection. Operative aspirative drainage is necessary. Hepatectomy is rarely justified.
Assuntos
Cistos/cirurgia , Hepatopatias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/complicações , Feminino , Seguimentos , Humanos , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , Doenças Renais Policísticas/complicações , Estudos RetrospectivosRESUMO
The authors present their experience with the very distal reimplantations: an homogenous series of 38 cases is presented. G. Foucher at SOS Mains Strasbourg showed this technique to the authors in 1980. The authors present their technique, which is adapted with the level of distal amputation, then their postoperatively attitude is presented in detail, particularly for "the bleeding maintained" and for the iterative surgery when necessary. Then the failures are precised. Finally functional results are studied: mobility is often good, sensibility is precised with the Weber test, cold pain is frequent, stop of work average is two months. Finally unsatisfactory nail and distal tip are precised.