A case-control epidemiological study of MS in the Paris area with particular reference to past disease history and profession.

A retrospective case-control study was carried out on 230 patients with multiple sclerosis (MS) and 230 controls matched for year of birth and sex. The geographical distribution of residence of MS patients and controls was similar. Two peak ages of onset of MS were observed among woman patients (20-24, 30-34 years). There was no difference in histories of infectious diseases and autoimmune diseases between the two groups. A greater number of hairdressers was noticed among the patient group (p less than 0.05) and three patients (no control) had had professional contact with pathology specimens.

[Role of cyclic AMP in gastric secretion. The secretion and mechanism of action of gastrin]. / Le rôle de l'AMP cyclique dans la sécrétion gastrique. Sécrétion et mécanisme d'action de la gastrine.

The present study involved evaluation of the role played by cyclic AMP on the secretion and mechanism of action of gastrin in man. On the basis of the results obtained, gastrin secretion induced by an excessive rise in gastric pH is accompanied by a simultaneous increase in plasma cyclic AMP concentrations (p less than 0.05) as well as a tissue cyclic AMP in the region of the fundus (p less than 0.001). By contrast, no significant change was seen regarding antropyloric AMP. As a result, it is felt that cyclic AMP does not play a direct role in the secretion of gastrin by G cells but is a mediator of the mechanism of action of gastrin in terms of the secretion of HCl by the parietal cell.

Cerebrospinal myelin basic protein in multiple sclerosis. Identification of two groups of patients with acute exacerbation.

The myelin basic protein concentration in the cerebrospinal fluid (CSF) of 125 patients with multiple sclerosis was measured using a radioimmunoassay technique with a detection level of 200 pg/mL and was correlated with the clinical course of the disease. Myelin basic protein was detected in the CSF of some patients with an active progressive form of the disease and in the CSF obtained during exacerbations with the presence of signs or symptoms not previously experienced by the patient (26 of 29 cases were positive during the period of maximal symptoms). Myelin basic protein was not detected in any patient with an inactive or slowly progressive form of the disease, nor in any patient during exacerbations with only recurrence of old signs or symptoms. These results are consistent with the hypothesis that the two clinical forms of exacerbation defined above may be associated respectively with the absence or presence of an acute demyelination.

[Nearly asymptomatic disseminated tuberculosis of the central nervous system detected by a CT scanner]. / Tuberculose disséminée du névraxe presque asymptomatique décelée par le scanner X.

A grand mal seizure in a 29 year old man without any relevant past medical history revealed the presence of a diffuse miliary cerebral tuberculosis. Objective evidence of complete recovery after treatment was obtained by serial CT scan imaging.

[Direct interaction of tricyclic antidepressants with opiate binding sites in the bovine adrenal medulla]. / Les antidépresseurs tricycliques interagissent directement avec les sites de liaison opiacés dans la médullosurrénale bovine.

This note reports the interaction of three currently used tricyclic antidepressant drugs (clomipramine, imipramine and amitriptyline) with delta, mu and kappa opioid binding sites in the bovine adrenal medulla. Clomipramine was the only drug interacting with delta and mu sites. On the contrary, all three drugs showed a significant interactions with subtypes of the kappa binding site. Clomipramine was the most active on the kappa 2 and kappa 3 subtypes while amitriptyline showed the highest interaction with the kappa 1 subtype. On the contrary the tricyclic cyproheptadine did not present any interaction with opioid binding sites in our system. This interaction between tricyclic antidepressants and opioid binding sites might be the origin of their analgesic action.

[Intracranial artery stenoses 44 years after craniofacial radiotherapy]. / Sténoses des artères intracrâniennes 44 ans après radiothérapie crânio-faciale.

A 58 year-old patient experienced several ischemic strokes in the carotid arteries territories. History revealed a nasal epithelioma, for which he had received, at age 14, an irradiation through an anterior field (5500 rads), and two lateral fields (4550 rads each). He had a nasofacial atrophy as apparent sequellae. Angiograms showed stenoses of the cavernous portion of both internal carotid arteries and of the proximal portion of the left anterior cerebral artery. The ophthalmic arteries were narrowed and irregular. Despite the very long delay and the patient's age (that of common atherosclerosis) and the lack of specificity of the lesions, the relationship between the arterial lesions and radiotherapy was accepted: the site of the arterial lesions corresponded to that of irradiation; other carotid segments, and particularly the bifurcations of the common carotid arteries, appeared normal on angiograms. The X-rays dose delivered in the region of the Willis arterial circle had been very high. A review of the rare reported cases of intra-cranial post-irradiation arteriopathy is presented.

[Motor neglect of thalamic origin]. / Négligence motrice d'origine thalamique.

The clinical picture of thalamic motor neglect is identical to those of motor neglect in general, the major symptom of which being an underutilization of one side of the body in the absence of sensory-motor defect. Several thalamic nuclei can be implicated on the grounds of pathological and experimental data, most frequently the ventro-lateral nucleus. The prevalence of left neglect is not so obvious in the case of thalamic than in the case of other sites of lesions. Motor neglect appears as a disorder in the triggering of the brain structures network which program and prepare movement in several circumstances; attentional tasks are only a particular circumstance. Some thalamic nuclei are the site of hypoactivity in the case of frontal motor neglect in the monkey, as shown by anatomical and functional studies; this emphasizes the strong participation of thalamus to the motor network, the dysfunction of which can induce a motor neglect.

[Side effects of antiepileptic therapy. Study of 197 cases]. / Les effets secondaires des traitements antiépileptiques. Etude de 197 cas.

A study of 197 epileptic outpatients consecutively observed by one Neurologist allowed a prospective study of the side effects of antiepileptic drugs. This study shows essentially that a clinical improvement comparable to that generally reported can be obtained with side effects limited in their number and intensity. The main principle is the routine search of these effects which are not always spontaneously mentioned by the patients, especially intellectual slowness and loss of sexual activity. The detection of the side effects through history and physical examination is far more fruitful than are plasma concentrations of drugs which can be doubly misleading: some plasma concentrations lower than recognized therapeutical levels are efficient however while others are higher and nevertheless necessary and well tolerated. Among the side effects specific to certain antiepileptic drugs, shoulder-hand syndrome due to phenobarbital was noted in 10 per cent of the cases. Furthermore, the frequency of scapulo-humeral periarthritis was significantly higher in the epileptic group than in the controls. Dupuytren's disease was less frequent (8 per cent) and the difference with the controls was not significant. Among the non-specific side effects, nystagmus is a somewhat useful sign in treatments by phenytoin but as with drugs dosages, it must be weighed within the whole clinical picture.

[Pure spinal cysticercosis. Note on the cerebrospinal fluid]. / Cysticercose spinale pure. Note sur le liquide céphalo-rachidien.

A patient from Benin experienced bilateral sciatic pain, followed by a progressive sensori-motor defect of the lower limbs. Five years after, he displayed symptoms and signs of a thoracic spinal cord compression, but no definite level could be determined. Myelography showed numerous intrathecal cysts from the cauda equina to the cervical cord. The diagnosis of cysticercosis was made by examination of the cysts removed after lumbar laminectomy. The search for another localisation of the parasite was negative. Repeated examination of cerebrospinal fluid (CSF) showed the presence of eosinophils, a high protein concentration, and a local synthesis of immunoglobulin G with an oligoclonal profile on electrophoresis. An accidental cyst punction revealed a fluid with protein migration in the alpha, beta and gamma ranges and a local synthesis of immunoglobulin A. Treatment with Praziquantel was uneffective.