[Sudden death occurring after anti-Hu associated paraneoplastic cerebellar degeneration and dysautonomia revealing a small cell lung carcinoma]. / Mort subite au cours d'une dégénérescence cérébelleuse subaiguë paranéoplasique avec dysautonomie associée aux anticorps anti-Hu révélant un cancer bronchique à petites cellules.

INTRODUCTION: Paraneoplastic syndromes are a rare cancer complication with a frequent subacute evolution. OBSERVATION: A 62-year-old man was admitted presenting with a cerebellar syndrome and orthostatic hypotension with dysautonomia. Anti-Hu antibody research was positive. A subcarinal adenopathy biopsy found out a small cell lung carcinoma. Despite a treatment with immunoglobulin and chemotherapy, the patient died suddenly, after a raise of dysautonomia symptoms. CONCLUSION: Sudden death observations represent exceptional complications of paraneoplastic syndrome. They might be secondary to arrhythmias, ictal asystol or laryngospasm. Systematic research of paroxystic heart arrhythmias with holter-ECG in paraneoplastic syndrome may prevent sudden deaths.

[Compression of the spinal cord revealing a seronegative rheumatoid arthritis]. / Compression médullaire révélatrice d'une polyarthrite rhumatoïde séronégative.

INTRODUCTION: Craniocervical junction damages may result in a compression of the spinal cord. They may be caused by infectious, tumoral or inflammatory processes. Rheumatoid arthritis is probably among rheumatic diseases the most frequent cause of atlantoaxial arthritis. Nevertheless involvement of the craniocervical junction as the presenting symptom of rheumatoid arthritis is a very rare feature. EXEGESIS: We report the case of a 61 years old woman who presented with atlantoaxial involvement and spinal cord compression one year before the diagnosis of a seronegative rheumatoid arthritis. CONCLUSION: Symptomatic craniocervical junction damages may appear. Patients with damages of the craniocervical junction and negative investigations should be followed long-term; an underlying inflammatory disease may become evident after significant delay.

[Cranial pachymeningitis]. / Les pachyméningites crâniennes.

INTRODUCTION: Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS: We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS: Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.

[Neuropathy caused by necrotizing vasculitis in HIV-1 infection]. / Neuropathie par vasculite nécrosante au cours de l'infection par le VIH1.

A 33 year-old male homosexual infected with human immunodeficiency virus type I developed an asymmetrical and painful neuropathy in the lower limbs. Neuro-muscular biopsy showed a necrotizing vasculitis. There were no clinical features indicative of systemic vasculitis. Prednisone therapy dramatically improved the neuropathy, without adverse effects. Although rare, necrotizing arteritis must be considered in HIV-1 patients with neuropathy, especially in case of mononeuropathy multiplex and when immunodepression is mild or absent, since a successful corticosteroid therapy can be prescribed.

[Chorea disclosing polycythemia and renal adenocarcinoma]. / Chorée révélatrice d'une polyglobulie et d'un adénocarcinome rénal.

A 79-year-old woman had chorea complicating polycythaemia. The polycythaemia and the chorea disappeared after surgical removal of a renal carcinoma. The literature on polycythaemic chorea is reviewed and its pathophysiology discussed.

[EGF receptors (epidermal growth factor) and steroid receptors in human meningioma]. / Récepteurs d'EGF (epidermal growth factor) et de stéroïdes dans les méningiomes humains.

Epidermal growth factor receptor (EGF-R) were assayed by 125I-EGF binding in 28 surgical samples of human meningiomas. High affinity EGF-R were found in 26/28 tumors (92 p. 100) at concentrations ranging from 20 to 410 femtomoles per mg of membrane protein (fmol/mg prot. mb.). In 18/26 cases (64 p. 100), the EGF-R concentration was between 95 and 230 fmol/mg prot. mb. No relationship was found between the EGF-R level and the site or histopathology of the tumor. The only noticeable observations were the low levels of EGF-R in the 3 anaplasic meningiomas as compared to the whole population and the undetectable level of EGF-R in the angiomatous tumors. In addition, no correlation was found between EGF-R levels and the hormonal status of the patients, nor between EGF-R levels and the intratumoral concentration of progesterone receptors assayed simultaneously. The biological relevance of EGF-R in meningioma is discussed in this context.

[Prognosis of herpes simplex encephalitis. Retrospective study of 19 cases]. / Le pronostic des encéphalites herpétiques. Etude rétrospective de 19 cas.

The vital and functional prognoses of 19 patients admitted for herpes simplex encephalitis between rate was 26%, a figure close to those reported in the literature. Death occurred before the 4th month in patients with prolonged coma, and it was due to respiratory disorders. The functional prognosis was favourable in one-half of the survivors, but one-third of these remained with severe neurological and behavioural sequelae, predominantly Korsakoff's syndrome and Klüver-Bucy syndrome. Hemiplegia and aphasia, when present, usually regressed within a few months. The prognosis of herpes simplex encephalitis has improved owing to advances in intensive care and to the advent of antiviral treatments, notably acyclovir the effectiveness of which has been demonstrated by several therapeutic trials. In view of its low toxicity, acyclovir should be tried when the disease is suspected on clinical ground, without waiting for the diagnosis to be confirmed by serological tests; treatment can thus be instituted before the patient becomes comatose.

[Transient ischemic attack in amyloid angiopathy]. / Accès ischémiques transitoires au cours d'une angiopathie amyloïde.

Two cases of cerebral amyloid angiopathy with transient ischemic attacks are reported. Both patients died of cerebral hemorrhage. Transient ischemic attacks seem to having been due to the cerebral angiopathy a disease in which small infarcts are frequently mentioned at post-mortem examination. However only 6 other cases of transient ischemic attacks with cerebral amyloid angiopathy have yet been reported.

[Thrombopenia and disseminated intravascular coagulation during treatment with heparin: 2 cases with neurological complications]. / Thrombopénie et coagulation intravasculaire disséminée au cours d'un traitement par l'héparine: deux cas avec complications neurologiques.

We report two cases of heparin-induced thrombocytopenia (H.T.) associated with a disseminated intravascular coagulopathy (DIC). Heparin was prescribed after a cerebral infarct in the first case and after an orthopedic surgical procedure in the second case. The DIC induced neurological complications and the death of both patients. Heparin-induced thrombocytopenia is common but is exceptionally associated with neurological symptoms. Heparin-induced DIC is quite uncommon, since only 20 cases have been reported but neurological complications (focal deficits or disturbances of consciousness) are noted in about one third of the cases and the outcome is fatal in 60 percent of the cases. The treatment of heparin-induced DIC and thrombocytopenia is disappointing. Monitoring of the platelets count is warranted during heparin treatment to prevent this severe complication.

[Pituitary abscess. Study of a case and review of the literature]. / Abcès hypophysaire. Etude d'un cas et revue de la littérature.

The authors report one case of pituitary abscess; the diagnosis of which was particularly difficult due to its association to a multiple sclerosis that began twelve years before. A review of thirty-one pituitary abscess reported in the literature from 1970 to 1985 is made. Opto-chiasmatic compression is observed in fifty-five per cent of the cases, pituitary insufficiency in fifty-five per cent, and meningitis in sixty per cent of the cases. Although the characteristic association of meningitis and pituitary tumor symptoms occur in thirty per cent of the cases, the diagnosis is made at surgery. Pituitary adenoma and craniopharyngioma were the most frequent preoperative misdiagnosis for pituitary abscess. The extended use of cerebral C.T. Scan will allow an easier recognition of this rare entity. The discussion includes life and visual prognosis. The etiology remains unexplained in nearly half of the cases.

[2 cases of Waldenstrom's disease associated with a glioblastoma]. / Deux cas associant une maladie de Waldenström à un glioblastome.

The association of Waldenström disease and glioblastoma was observed in two patients. Both diseases were diagnosed almost simultaneously. In the first patient the diagnosis of glioblastoma was made on cerebral biopsy. In the second case, the diagnosis was confirmed at autopsy. The association of Waldenström's disease and glioblastoma is rare but it does not seem to be coincidental. The physiopathological problems related to this coexistence are discussed.

Diclofenac binding to albumin and lipoproteins in human serum.

The binding of diclofenac to human serum albumin (HSA) and to lipoproteins was studied in vitro by equilibrium dialysis. Binding to HSA is characterized by two classes of sites with one site each (K1 = 5 X 10(5) M-1 and K2 = 0.6 X 10(5) M-1). The binding to lipoproteins was shown to be saturable with a larger number of binding sites and low association constants. The evidence of two specific binding sites on HSA was confirmed by circular dichroism data. In addition, an identification of those sites was performed by displacement of fluorescent probes. The data show that the high affinity site (K1 = 5 X 10(5) M-1) is likely to be shared by benzodiazepines while the second one (K2 = 0.6 X 10(5) M-1) is common with the warfarin site.

[Spinal cord congenital epidermoid cyst (a dorsal case)]. / Kyste epidermoïde congénital médullaire (un cas dorsal).

A 18 year-old man had a progressive paraparesis over a two months period due to a thoracic intramedullary epidermoid cyst. Surgical removal of the cyst was followed by a dramatic improvement. The frequency, the clinical manifestations and the congenital or acquired nature of the dermoid and epidermoid intraspinal cysts are reviewed. The possibilities and the limits of the surgical treatment of this rare intraspinal benign tumors are discussed.

Equilibrium dialysis, ultrafiltration, and ultracentrifugation compared for determining the plasma-protein-binding characteristics of valproic acid.

Equilibrium dialysis, ultrafiltration, and ultracentrifugation were compared to determine their reliability and applicability in the study of binding of an anticonvulsant drug, valproic acid, by plasma proteins. We studied drug binding with pooled serum and with solutions of human serum albumin at physiological concentrations. We compared binding characteristics such as number of binding sites, affinity constants, and percent of binding as measured by each method in the therapeutic range for valproic acid. Results by ultracentrifugation differed from those by equilibrium dialysis and ultrafiltration, which agreed reasonably well with each other.