Prevalence and distribution of Helicobacter pylori cagA and vacA genotypes in the Moroccan population with gastric disease.

Helicobacter pylori infection is the etiologic agent of various gastric pathologies. The severity of disease outcome has been attributed to some H. pylori genotypes, which varies geographically. In Morocco, there are no data regarding the pattern of H. pylori genotypes; therefore, this is the first prospective study conducted in our country to investigate the genotype profiles (vacA and cagA) of H. pylori in patients with gastric pain. Endoscopic biopsies were obtained in patients attending the gastroenterology department of the Hospital University Hassan II of Fez for gastric pain and were directly used for H. pylori detection and genotyping by polymerase chain reaction (PCR). The SPSS software program was used to study the genotype correlation to different clinical outcomes. A total of 429 patients were included in this study, with an infection rate of 69.9%. cagA was detected in 42.3% of cases. However, vacA genotyping reveal a large predominance of s2m2. Infection with multiple strains was detected in 10.8% of cases and incomplete vacA was observed in 31.5%. In Morocco, vacA s1m1 was significantly associated to peptic ulcer diseases, while s2m2 was associated to gastritis. Moroccan H. pylori vacA genotype profiles differ from the Latin American, European, and South African profiles, with more similarities to the North African profile. Because of the small number of cases with gastric cancer, no correlations with H. pylori have been studied, so, further studies will be required in order to highlight the effects of those genes on this disease.

Pain as the presenting symptom of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).

Numerous clinical forms of CIDP have been described, but pain is generally considered a rare or secondary sign. We describe here the clinical, electrophysiological and neuropathological characteristics of five patients with CIDP and pain as the main presenting symptom, and their course with treatment. Between January 2003 and December 2004, we selected five patients with prominent or isolated pain among 27 patients diagnosed with CIDP. All patients were subjected to clinical and electrophysiological examinations, and had a complete laboratory work up to exclude other causes of neuropathy. In view of the atypical clinical presentation, all five patients underwent nerve biopsy. There were two men and three women. The mean age at onset of neuropathy was 70+/-7.39 years. All patients initially presented with pain in the lower limbs associated with modest motor impairment (1 case), distal paresthesia (4 cases), cramps (1 case) and fatigue (2 cases). CSF was normal in three cases. On electrophysiological examination, three patients had nerve conduction abnormalities with subtle or clear signs of demyelination: three (case 1, 2 and 4) fulfilled the criteria of Rotta et al. and two (case 2 and 4) the criteria of both Nicolas et al and the INCAT group. Patients were all given symptomatic treatment and four patients received an immunomodulatory treatment, which was constantly effective. Pain may be a major and disabling symptom in patients with CIDP, so this diagnosis has to be considered in patients referred for a painful polyneuropathy. Moreover, immunomodulatory treatment has to be considered in such patients as symptomatic therapy may be ineffective.

Polyneuropathy with demyelinating features in mixed cryoglobulinemia with hepatitis C virus infection.

Peripheral neuropathy can arise from various mechanisms during hepatitis C virus (HCV) infection, mainly involving associated mixed cryoglobulinemia. The frequency of demyelinating polyneuropathy is probably underestimated in these patients. We report two cases of demyelinating polyneuropathy in HCV-infected patients. The first case concerned a 76-year-old woman followed for hepatitis C associated with a mixed cryoglobulinemia (type II), who developed a chronic progressive distal motor weakness and sensory disturbances concomitant with a raise in serum aspartate aminotransferase (GOT/AST) and alanine aminotransferase (GPT/ALT) levels. Other laboratory studies were normal except for a decrease in the hemolytic fraction of complement to 75 IU (n = 400-520). The second case was a 68-year-old woman followed for hepatitis C associated with a mixed cryoglobulinemia (type II), who had sensory disturbances in the lower limbs. Laboratory studies were otherwise unremarkable. Cerebrospinal fluid studies showed a normal protein content without pleocytosis in both patients. In both cases nerve conduction studies were suggestive of a mixed axonal and demyelinating sensorimotor neuropathy. Sural nerve biopsy showed segmental demyelination and severe loss of large myelinated fibers as well as some onion bulb formation in both cases. The two patients subsequently improved, the first with an antiviral treatment and the second with oral steroids.

[Autonomic nervous system involvement in chronic inflammatory demyelinating polyneuropathy]. / Polyradiculonévrite inflammatoire démyélinisante chronique et atteinte du système nerveux autonome.

INTRODUCTION: Involvement of the autonomic nervous system during Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is rare. Localised hyperhydrosis and Claude Bernard Horner (CBH) syndrome have never been reported in patients with CIDP. CASE REPORT: We report the case of a 65-year-old right handed man who presented with hyperhydrosis localised to the right hemithorax and hemiface and a left CBH syndrome. After an extensive workup, the patient was found to have CIDP as the only cause of autonomic nervous system involvement. The symptoms resolved slowly after three courses of intravenous immunoglobulins. CONCLUSION: Signs of autonomic nervous system involvement can be observed in CIDP as in Guillain-Barré syndrome. This case report shows that immunomodulatory treatment can be effective against dysautonomia in CIDP.

[Involvement of the peripheral nervous system in multiple sclerosis]. / Sclérose en plaques et atteinte du système nerveux périphérique.

Multiple sclerosis is a demyelinating disease limited to the central nervous system, but the literature has provided recurring evidence which raises the question of associated peripheral nervous system abnormalities. The prevalence of peripheral neuropathy during multiple sclerosis remains controversial without prospective study. Nevertheless, some data have reported well documented case reports describing the co-occurrence of multiple sclerosis and radiculopathy or mononeuropathy or polyneuropathy in the same patients. By contrast, more frequent subtle nerve abnormalities may be found by using electrophysiological and neuropathological examinations. Some hypotheses have been proposed by Waxman to decipher the electrophysiological and neuropathological findings. The mechanisms for demyelinating disease and peripheral nerve pathophysiology may imply the antigenic properties or the presence of diffusing factors between peripheral nervous system and central nervous system myelin and the molecular plasticity of myelinated fibers.

[Contribution of corticosteroid to the treatment of pain in the acute phase of Guillain-Barré syndrome]. / Interêt de la corticothérapie dans le traitement de la douleur à la phase aiguë du syndrome de Guillain-Barré.

INTRODUCTION: Pain is a common problem in both adults and children with Guillain-Barré Syndrome (GBS). Corticosteroids are rarely used in the treatment of pain in the course of GBS, although some authors have pointed out their value for the treatment of neuropathic pain. We report four patients with GBS whose pain was rapidly relieved by administration of corticosteroids. METHODS: We reviewed retrospectively a series of four patients with GBS seen from September 2001 to February 2003. All patients had plexual (Case 3), trunkular (case 1), radicular (case 2) or focal (case 4) pain. Pain was treated with corticosteroids via oral (cases 1 and 2) or intravenous routes (cases 3 and 4). Corticoids where used after failure of other analgesic agents. RESULTS: Pain relief was obtained after the first administration and persisted even after tapering off steroid treatment. No particular complication was observed during treatment course. CONCLUSION: Our experience suggests that controlled studies should be set up to evaluate the place of corticosteroid treatment for the management of pain in patients with GBS.

Atypical electrophysiologic findings in chronic inflammatory demyelinating polyneuropathy (CIDP)--diagnosis confirmed by nerve biopsy.

OBJECTIVES: Numerous sets of electrophysiological criteria of chronic inflammatory demyelinating polyneuropathy (CIDP) have been proposed, among which the criteria established by an ad hoc subcommittee of the American Academy of Neurology (AAN) in 1991 (Neurology 41 (1991) 617) are the most widely used. As they seemed rather restrictive, the Inflammatory Neuropathy Cause and Treatment (INCAT) group (Ann. Neurol. 50 (2001) 195) proposed modifications of these electrophysiological criteria. However, even using these criteria, some cases of CIDP may not be recognized. In such cases, nerve biopsy has proven useful for confirmation of the diagnosis by demonstrating specific abnormalities. The objective of the study was to determine the profile of electrophysiological abnormalities in patients with atypical electrophysiologic criteria of CIDP and the diagnostic value of multiple A waves and a low median to sural amplitude ratio. PATIENTS AND METHODS: Over a period of 3 years, we classified 44 patients into two categories: those presenting the strict AAN and/or INCAT criteria and those who we regarded as cases of CIDP not meeting these criteria. All patients benefited from one or more clinical and electrophysiological examination. Extensive biological workup and genetic study when appropriate excluded other causes of neuropathy. Nerve biopsies were taken from all patients and samples were included in paraffin and epon for systematic light, teasing and electron microscopic examination. RESULTS AND CONCLUSION: Out of 44 patients, 36 fulfilled the INCAT or AAN criteria. In eight other patients, the diagnosis of CIDP was suspected on clinical and EMG examinations and confirmed by nerve biopsy. In these cases, the electrophysiological exploration showed some abnormalities such as multiple A waves in four out of eight patients or an abnormal pattern of the sensory responses of the median and sural nerves in four out of eight patients that were more indicative of an initial demyelinating process. Six of our patients received immunomodulatory treatment, and five responded favorably.

[Acute polyradiculoneuropathy. Guillain-Barre syndrome]. / Les polyradiculonevrites aigues "syndrome de Guillain-Barre". Experience de 'l'Institut National de Neurologie (INN).

A retrospective study of 120 cases of acute polyradiculoneuropathy hospitalized in the National Institute of Neurology, since 1974. We analysed the clinical and neurophysiological pictures, the course of the disease and the prognosis. All ages and sex were affected. The mean age of onset was 34 years. There were a predominance of male 2.5:1. Weakness, particularly of the lower limbs, was the initial complaint of patients. A rise in the level of cerebro-spinal fluid protein in the absence of pleiocytosis was found in 80% of patients. Electrophysiological data showed most frequent sensory motor demyelinating polyradiculo-neuropathies (60%). Conduction blocks were found in 90% of cases. The last 6 years, gammaglobulin (0.4g/kg per day for 5 days) was given for the first days of the disease and has been shown to improve the vital and functional prognosis.

[Central nervous system involvement in patients with hepatitis C infection]. / Virus de l'hépatite C et atteinte neurologique centrale: à propos d'une observation.

Central nervous system involvement in patients with hepatitis C infection have been rarely reported. Stroke and encephalopathic syndromes have been frequently attributed to the ischemia or hemorrhage associated with mixed cryoglobulinemia and anticardiolipin antibodies. We describe the case of a 31-year-old woman with cerebral ischemia who had hepatitis C infection confirmed by polymerase change reaction detection of HCV RNA but who was negative for cryoglobulinemia. Cerebral involvement may be the initial manifestation of hepatitis C infection.