Prognostic value of preoperative border-zone (watershed) infarcts on the early postoperative outcomes of carotid endarterectomy after acute ischemic stroke.

OBJECTIVES: To evaluate the prognostic value of cerebral border-zone infarctions (watershed infarctions) on the early postoperative outcomes of patients undergoing carotid endarterectomy (CEA) after acute ischemic stroke (AIS). METHODS: Sixty-six (66) patients with symptomatic carotid stenosis (SCS) that underwent ipsilateral CEA after AIS from January 2007 to March 2012 were included in this study. They were divided into two groups according to the topographic patterns of the stroke: group 1, Territorial Cerebral Ischemic Strokes (TCIS) caused by emboli of carotid origin; group 2, cerebral border-zone infarctions (CBZI) related to an SCS associated with hemodynamic impairment. All data was collected in a prospective database and analyzed. Outcome measures included postoperative neurological morbidity and 30-day mortality. RESULTS: Forty-three (43) patients (65.15%) experienced TCIS and were included in group 1, 23 patients (34.85%) had a CBZI and were included in group 2. There were no postoperative deaths. The postoperative neurologic morbidity rate was significantly higher in the CBZI group (22% vs. 2%, p = 0.02). Multivariate analysis demonstrates that CBZI was the only independent predictive factor of neurologic morbidity after CEA for AIS related to an SCS. Furthermore, the risk of postoperative neurologic morbidity remained significantly higher for patients with CBZI after adjustment for age, sex, initial NHISS scores, and associated contralateral carotid occlusion (HR: 0.059, 95% CI 0.004-0.85; p = 0.03). CONCLUSION: CBZIs, compared to TCIS, were associated with a higher neurological complication rate during the postoperative period after CEA for SCS in cases of AIS. Further studies are required to better define the timing and the best treatment modality for patients with CBZI related to an SCS in order to reduce associated procedural complications.

Endovascular angioplasty before resection of a sphenoidal meningioma with vascular encasement.

We describe a case of sphenoid wing meningioma presenting with cerebral infarction due to extended vascular encasement in which endovascular angioplasty was performed before surgery to avoid perioperative ischemia. A severe stenosis involved the intracranial internal carotid artery and the proximal segments of the middle and anterior cerebral arteries. Endovascular dilatation was followed by complete surgical resection. Preoperative mild aphasia and hemiparesia resolved completely after surgery. Endovascular angioplasty of arterial trunks and their branches can be proposed before the resection of skull base meningiomas encasing these arteries to decrease the risk of perioperative brain ischemia related to their surgical manipulation or vasospasm.

[Stroke, HIV and meningovascular syphilis: study of three cases]. / Infarctus cérébral, infection VIH et syphilis méningovasculaire : étude de trois cas.

INTRODUCTION: Various clinical manifestations can occur in syphilis, especially meningovascular syphilis. We report three cases of ischemic stroke related to meningovascular syphilis and HIV infection. CASE REPORTS: Three men, aged 30, 31 and 41, presented typical neurologic deficit leading to the diagnosis of ischemic stroke. Radiographic investigations showed internal carotid thrombosis in two patients, and a basilar stenosis in the third. CSF analysis and blood samples revealed meningovascular syphilis associated with HIV infection. The other explorations were normal. CONCLUSION: Due to the reemergence of syphilis, search for Treponema pallidum infection should be systematic in young stroke victims.

[Intravenous thrombolysis with rt-PA in stroke: experience of the Nice stroke unit]. / Thrombolyse intraveineuse par rt-PA des accidents vasculaires cérébraux ischémiques : l'expérience de l'unité neurovasculaire de Nice.

INTRODUCTION: Intravenous thrombolysis with rt-Pa in stroke has been approved in France since 2002. We report an evaluation of our practice. We have tried to identify predictive factors of dependence and death, and to compare our results with the data of the literature. PATIENTS AND METHOD: All patients treated with intravenous rt-PA within the first 270min after the stroke onset were included. Univariate, then multivariate analyses were performed to determine the variables influencing the functional outcome at 3 months follow-up, according to a dichotomy established from the modified Rankin scale. RESULTS: One hundred and forty-two patients were included in this study (mean initial National Institute of Health Stroke Scale [NIHSS]: 15). Fifty percent had a Rankin score higher than 2 at 3 months follow-up. NIHSS above 12, glycemia of at least 120mg/l, and systolic blood pressure above 160mmHg at admission were identified as independent predictive factors of poor functional outcome. Less than 4 points decrease of NIHSS proved to be a simple and early predictor of poor functional outcome at 3 months follow-up. CONCLUSIONS: In terms of safety and efficacy the data issuing from the daily activity of our stroke unit are comparable with those of clinical trials.

[Mills' syndrome: a rare clinical entity]. / Syndrome de Mills: une entité clinique rare.

INTRODUCTION: Mills' syndrome is a rare motor neuron disease, initially described by Mills in 1900 as a progressive ascending or descending hemiplegia without significant sensory involvement. This syndrome is of uncertain nosological status, and is supposedly due to unilateral primary degeneration of corticospinal pathway. Some authors have suggested that it could represent a variant of primary lateral sclerosis. METHODS: We retrospectively studied the clinical and paraclinical data from eight patients with suspected Mills' syndrome hospitalized for diagnosis. RESULTS: For all patients, the clinical course was slowly progressive, with motor deficiency, unilateral pyramidal signs (or bilateral with asymmetry), without bulbar signs, fasciculations or sensory deficit. Final diagnosis was Mills' syndrome (n=3), primary lateral sclerosis (n=1), myelitis of unknown origin (n=2), progressive primary multiple sclerosis (n=1), and antiphospholipid syndrome (n=1). The main arguments for final diagnosis were brought by electrophysiology and brain and spinal MRI. CONCLUSION: Mills' syndrome is a rare clinical diagnosis, requiring exhaustive investigations.

Improved antibacterial activities of coumarin antibiotics bearing 5',5'-dialkylnoviose: biological activity of RU79115.

A new series of coumarin inhibitors of DNA gyrase B bearing a N-propargyloxycarbamate at C-3' of various 5',5'-dialkylnoviose, including RU79115, were synthesised and their antibacterial activities have been delineated. Introduction of dialkyl substituents at 5'5'-position of noviose leads to coumarin analogues with improved in vitro and in vivo antibacterial activity.

Synthesis and antibacterial activity of HMR 3647 a new ketolide highly potent against erythromycin-resistant and susceptible pathogens.

In the search for new ketolides with improved activities against erythromycin-resistant S. pneumoniae and H. influenzae we synthesized a new 11,12 carbamate ketolide substituted by an imidazo-pyridyl side chain: HMR 3647. This compound demonstrated a potent activity against erythromycin susceptible and resistant pathogens, including penicillin G/erythromycin A-resistant S. pneumoniae and H. influenzae. In vivo, HMR 3647 displayed good pharmacokinetic parameters (Cmax = 2.9 microg/ml, bioavailability=49%, AUC0.8 = 17.2 microg.h/l, t1/2=1h) and was shown to have a high therapeutic efficacy in mice infected by various respiratory pathogens, including multi-resistant S. pneumoniae and Gram negative bacteria such as H. influenzae. HMR 3647 appears to be a very promising agent for the treatment of respiratory infections and is currently in clinical trials.

Structure and functions of the vascular cambium.

Following a general outline on the functioning of the cambium, the authors review the data acquired over the last 20 years. The interest is focused on: i) the ultrastructural characteristics of the two kinds of initials; ii) the early structural, metabolic and molecular modifications occurring during the first stages of daughter cell differentiation into either xylem or phloem; iii) the complex rhythmic changes of structure, metabolism and activity undergone by cambial cells during the seasonal cycle; iv) the characteristics and control of the cessation of cambial activity in autumn and of its reactivation in spring; v) the main research approaches in cell and molecular biology presently open to the students of the cambial meristem.

Synthesis and antibacterial activity of ketolides (6-O-methyl-3-oxoerythromycin derivatives): a new class of antibacterials highly potent against macrolide-resistant and -susceptible respiratory pathogens.

In the search for new antibiotics active against macrolide-resistant pneumococci and Haemophilus influenzae, we synthesized a new class of 3-oxo-6-O-methylerythromycin derivatives, so-called "ketolides". A keto function was introduced in position 3 after removal of L-cladinose, a sugar which has long been thought essential. Further modifications of the macrolactone backbone allowed us to obtain three different series of 9-oxime, 11,12-carbamate, and 11, 12-hydrazonocarbamate ketolides. These compounds were found to be very active against penicillin/erythromycin-resistant pneumococci and noninducers of MLSB resistance. The 11,12-substituted ketolide 61 (HMR 3004) demonstrated a potent activity against multiresistant pneumococci associated with a well-balanced activity against all bacteria involved in respiratory infections including H. influenzae, Mycoplasma catarrhalis, group A streptococci, and atypical bacteria. In addition HMR 3004 displayed high therapeutic activity in animals infected by all major strains, irrespective of their resistance phenotype.

Seasonal variations in the polar-transport pathways and retention sites of [(3)H]indole-3-acetic acid in young branches ofFagus sylvatica L.

Branches were cut from young beeches (Fagus sylvatica L.) at various stages of the annual cycle and [(3)H]indole-3-acetic acid (0.35 nmol) was applied to the whole surface of the apical section of each branch, just below the apical bud. The labelled pulse (moving auxin) and the following weakly radioactive zone (auxin and metabolites retained by the tissues) were localized by counting: microautoradiographss were made using cross sections from these two regions. During the second fortnight of April, auxin was transported by nearly all the cells of the young primary shoot, but the label was more concentrated in the vascular bundles. Auxin transport became the more localized: the cortical parenchyma appeared to lose its ability to transport the hormone (end of April), followed in turn by the pith parenchyma (May). Polar auxin movement at that time was limited to the outer part of the bundle (cambial zone and phloem) and to the inner part (protoxylem parenchyma). Later protoxylem parenchyma ceased to carry auxin. During the whole period of cambial activity, auxin was transported and retained mainly by the cambial zone and its recent derivatives. In September, before the onset of dormancy, and in February, at the end of the resting period, the transport pathways and retention sites for auxin were mainly in the phloem, where sieve tubes often completely lacked radiolabel. When cambial reactivation occurred in the one-year shoot, auxin was mainly carried and retained again in the cambial zone and differentiating derivatives.