Impaired modulation of quadriceps tendon jerk reflex during spastic gait: differences between spinal and cerebral lesions.

In healthy subjects, functionally appropriate modulation of short latency leg muscle reflexes occurs during gait. This modulation has been ascribed, in part, to changes in presynaptic inhibition of Ia afferents. The changes in modulation of quadriceps tendon jerk reflexes during gait of healthy subjects were compared with those of hemi- or paraparetic spastic patients. The spasticity was due to unilateral cerebral infarction or traumatic spinal cord injury, respectively. The modulation of the quadriceps femoris tendon jerk reflex at 16 phases of the step cycle was studied. The reflex responses obtained during treadmill walking were compared with control values obtained during gait-mimicking standing postures with corresponding levels of voluntary muscle contraction and knee angles. In healthy subjects the size of the reflexes was profoundly modulated and was generally depressed throughout the step cycle. In patients with spinal lesion the reflex depression during gait was almost removed and was associated with weak or no modulation during the step cycle. In patients with cerebral lesion there was less depression of the reflex size associated with a reduced reflex modulation on the affected side compared with healthy subjects. On the 'unaffected' side of these patients reflex modulation was similar to that of healthy subjects, but the reflex size during gait was not significantly different from standing control values. These observations suggest that the mechanisms responsible for the depression of reflex size and the modulation normally seen during gait in healthy subjects are impaired to different extents in spasticity of spinal or cerebral origin, possibly due to the unilateral preservation of fibre tracts in hemiparesis.

[Isolated congenital diverticulum of the left ventricle disclosed by ventricular tachycardia in a 72-year-old woman]. / Diverticule congénital isolé du ventricule gauche découvert par une tachycardie ventriculaire chez une femme de 72 ans.

A 72-year-old woman presented with poorly tolerated ventricular tachycardia reduced by intravenous amiodarone. The possibility of an ischaemic aetiology led us to perform coronary angiography. The coronary arteries were pathological. Left ventricular angiography revealed limited anterior hypokinesia and a large contractile apical pouch appended to the left ventricle by a long narrow neck. Despite the appearance suggestive of congenital left ventricular diverticulum (contractility, narrow neck) and because of the coexistence of ischaemic heart disease, we preferred to confirm the muscular nature of the diverticulum by myocardial thallium scintigraphy, which showed reversible decreased uptake in the anterior zone related to coronary artery disease, and confirmed the muscular nature of the diverticulum which showed normal thallium uptake. MRI clearly visualized the ventricular ectasia attached by a narrow neck to the rest the left ventricle. This long narrow neck indicated that this muscular diverticulum constituted a congenital diverticulum. The contribution of ultrasonography was limited by a poorly defined point during the examination. This congenital diverticulum, discover during adulthood, and previously asymptomatic, is a rare lesion, in the light of a review of the literature.

Relevance of serum ECP measurements for monitoring acute asthma in children.

To evaluate the role of serum eosinophil cationic protein (ECP) concentration as a monitoring parameter in acute bronchial asthma, 11 children (mean age 10.2 years) were studied during an acute exacerbation of their disease. Under an appropriate anti-inflammatory therapy, FEV1 increased significantly at day 1 (p < 0.05), day 14 (p < 0.05), day 28 (p < 0.03), and day 56 (p < 0.03) compared to baseline values at referral to hospital. Serum ECP concentration decreased in the group of patients significantly at day 28 (p < 0.02) and day 56 (p < 0.04). However, considering the individual serum ECP time courses, most of the patients did not show a uniform pattern of continuously decreasing values. From our data, we conclude that measuring serum ECP concentration during acute asthma episodes in children may play a role in some patients, whereas in others--probably those without acute eosinophil inflammation--monitoring by serum ECP concentration is of limited value.

Synthesis and cardiotonic activity of novel biimidazoles.

A series of substituted 2,2'-bi-1H-imidazoles and related analogues was synthesized and evaluated for inotropic activity. Structure-activity relationship studies based on a nonclassical bioisosteric approach indicated the necessity of a cyano group on one of the imidazole rings to obtain the desired pharmacological profile. 4(5)-Cyano-2,2'-bi-1H-imidazole (15a) was the most potent inotropic agent in the series. It produced a 25% increase in left ventricular dP/dt at 0.16 mg/kg iv (ED25% = 0.16 mg/kg) and increased left ventricular contractile force 60% at 1 mg/kg iv in anesthetized dogs. Compound 15a is a good inhibitor of type IV cyclic nucleotide phosphodiesterase isolated from dog heart having a potency similar to that of amrinone. Neither 5'-cyano-2,4'-bi-1H-imidazole (44) nor 4-cyano-2,4'-bi-1H-imidazole (48) demonstrated inotropic activity. In addition, the two possible 1,1'-dimethylcyano-2,2'-bi-1H-imidazoles (24 and 25) were inactive, indicating that an acidic NH as well as a cyano group are essential for inotropic activity.

Renal growth in patients nephrectomized for Wilms tumour as compared to renal agenesis.

Compensatory growth in 27 undiseased congenital solitary kidneys and in 31 solitary kidneys in patients with Wilms tumour was monitored in long-term follow-up studies by ultrasound volume biometry. In congenital solitary kidneys hypertrophy was not detectable at the time of birth. Parenchymal mass increase achieved 188% of the volume of a healthy kidney within at least 4 years of life and afterwards paralleled the physiological growth documented in healthy kidney pairs. Disease-free kidneys in Wilms tumour patients all developed a similar 180% volume augmentation within 2-4 years after nephrectomy, irrespective of the chosen mode of radiation and single or triple chemotherapy. The age of the patient at onset of surgical and concomitant conservative therapy determined slight differences in kinetics but not in degree of compensatory growth.

[Transmural myocardial infarction and Prinzmetal's syndrome in an allergic reaction to glafenine. Physiopathological discussion. Apropos of a case]. / Infarctus myocardique transmural et syndrome de Prinzmetal au cours d'une réaction allergique à la glafénine. Discussion physiopathologique. A propos d'un cas.

The authors report the case of a 38 year old man who experienced at two month' interval, hypersensitivity reactions to the ingestion of 200 mg tablets of glafenine, complicated on the first occasion by a transmural anterior wall myocardial infarction as the first manifestation of coronary artery disease and on the second occasion by Prinzmetal angina due to posterior wall ischaemia. Coronary angiography was more or less normal. The timing of the symptoms in the context of an anaphylactic reaction and their repetition when the same molecule was reintroduced are strong arguments in favour of the pathogenic role of glafenine, even in the absence of biological criteria which are always variable. The mechanism of the coronary problems is discussed with reference to mediators released during the anaphylactic reaction: coronary vasoconstriction due to histamine and leukotriene release; inhibition of prostaglandin synthesis causing potentiation of the effects of histamine; lowering of the vasodilatory and antiaggregant prostacyclin enhancing the vasoconstrictor and platelet aggregant action of thromboxane A2. All the conditions favouring the initiation of coronary spasm with eventual coronary thrombosis, the one aggravating the other, are therefore present.

Kidney size in childhood. Sonographical growth charts for kidney length and volume.

Kidney size was determined in a sonographic study of 325 children without kidney pathology. Real-time ultrasound equipment adjusted for the pediatric age group, provided standardized renal biometry. Outer kidney diameters showed a linear correlation to somatic developmental parameters. Renal volume was established by the formula for an ellipsoid and showed good correlation to body weight. Growth charts for kidney length and volume in childhood are constructed and provide the basis for objective intra- and interindividual determination of renal size.

Role of intravenous hyperalimentation as an adjunct to intensive chemotherapy for small cell bronchogenic carcinoma.

Forty-nine patients with small cell bronchogenic carcinoma (23 limited and 26 extensive disease) received their first two of three courses of intensive remission induction chemotherapy with (21 patients) or without (28 patients) intravenous hyperalimentation (IVH). The chemotherapy included six remission induction courses with ECHO (epipodophyllotoxin VP-16-213, cyclophosphamide, hydroxydaunorubicin, oncovin), followed by six courses of maintenance with PRIME (procarbazine, ifosfamide, methotrexate). Prophylactic brain irradiation (3000 r/2 weeks) was given to all patients and those with limited disease received chest irradiation (5000 r/5 weeks) at the completion of ECHO. Thus far, all 30 patients who have completed three courses of ECHO have responded with complete (70% CR) or partial (30% PR) remissions. The CR rate was higher for patients receiving IVH (85% vs 59%, P = 0.25). Myelosuppression was pronounced and predominantly in the form of neutropenia. Median lowest neutrophil counts were zero during each of the three courses of ECHO and lasted a median of 5 days at levels less than 500/mm3. Major infections occurred in 21% of courses. The administration of IVH did not ameliorate the hematologic, gastrointestinal, and infectious morbidity of ECHO chemotherapy. However, it resulted in preservation of body weight (P less than 0.01) and improved skin reactivity to a battery of six skin antigens (P = 0.03). The administration of intensive therapy with ECHO +/- IVH was well tolerated and resulted in high CR rates in patients with small cell bronchogenic carcinoma. The administration of IVH was most helpful in preventing severe weight loss and augmenting response to a battery of skin antigens. The long term survival effects of these observations are yet to be determined.