[Intraspinal hemangioblastoma. Apropos of a recent series of 20 cases]. / Les hémangioblastomes intra-rachidiens. A propos d'une série récente de 20 cas.

This report deals with a series of 20 patients admitted for a spinal hemangioblastoma between 1970 and 1993, 18 of whom between 1978 and 1993. There are 8 men and 12 women and the onset of spinal symptoms is before the age of 50 years for 76% of the patients. Nineteen patients have an intra-dural tumor (extramedullary 15.5%, intramedullary 75% with 62.5% close to the dorsal surface, 37.5% partly out, none totally enclosed with spinal cord) and only one patient has an extra-dural tumor. Cysts are present in 70% of our cases. Two cases have been revealed by an hemorrhagic syndrome. Ten cases belong to a von Hippel-Lindau (vHL) disease. Nineteen patients were operated on, one patient died. Total resection of the tumor was performed in 17. Symptoms improved postoperatively in 8 patients, were inchanged in 6, and worsened temporary in 4. MRI with gadolinium is the best procedure for both the diagnosis and the follow-up. After surgery, the prognosis is very good for sporadic cases with a single spinal lesion whereas it is very poor in case of vHl disease. For these patients (50% of our cases), half of them died because of the evolution of multifocal lesions even if they were operated on several times. Thus, each patient should have a precise check-up (SNC and visceral lesions). The gene causing vHL disease located on the short arm of the chromosome 3 has just been characterized. This will help to elaborate a presymptomatic diagnosis and a better screening of the patients with the hope of a specific treatment.

[Type II carnitine palmitoyl transferase deficiency complicated by acute respiratory failure]. / Déficit en carnitine palmityl transférase type II complique d'une insuffisance respiratoire aiguë.

Carnitine palmitoyl transferase (CPT) deficiencies can realise distinct clinical presentations. The best known is the muscular form with episodic muscle necrosis and paroxysmal myoglobinuria after prolonged exercise, in young adults, and results from decreased CPT II activity. In this paper, we report on an observation of a patient with a severe CPT II deficiency who presented a respiratory failure during an attack of muscle necrosis. The severity of the symptomatology were associated with a conspicuous reduction of CPT II residual activity in leucocytes and in fibroblasts. Fasting test showed an hypoketogenesis. These results support the concept that CPT II deficiency is ubiquitous, even though injury is restricted to the skeletal muscle.