[Occupational exposure to cadmium and renal cancer. Apropos of a case]. / Exposition professionnelle au cadmium et cancer du rein. A propos d'un cas.

INTRODUCTION: Cadmium is a carcinogenic substance and bronchial and prostatic cancer may be readily identified as professional diseases. It is also a nephrotoxic substance but renal carcinoma are rarely imputed to this kind of intoxication. CASE REPORT: We report the observation of a 59-year-old woman with a long unprotected professional exposure to cadmium. She developed an epidermoid carcinoma of the kidney and later of the lung. Levels of cadmium in blood samples were abnormally high, confirming the existence of a chronic impregnation. CONCLUSION: We have judged cadmium to be responsible for her renal disease: the fact of a long unprotected professional exposure, the scarcity of renal epidermoid carcinoma, the well established nephrotoxicity of this substance and the association with other cancers, appear to us as convincing evidence, and the kidney cancer of our patient has been considered a professional disease.

[Gastroesophageal reflux during++ sleep in obese patients]. / Reflux gastro-oesophagien pendant le sommeil chez l'obèse.

Evidence of relationship between gastrooesophageal reflux (GER) and obstructive apneas in some near-miss children, led us to investigate its possibility in adults. Our purpose was to look for 1) sleep stages of GER occurrence, and 2) the possible chronological link between sleep apneas and GER. Eight obese patients were investigated. Esophageal pHmetry was carried out on two consecutive nights. On the second night, sleep polygraphy was performed including EEG, EOG, EMG, nasal and buccal flows, thoracic and abdominal motions. Esophageal pHmetry was analyzed between the onset of sleep and the definite waking. Fifteen GER episodes occurred in 4 of the 8 patients. Fourteen of them occurred during wakefulness or transient arousals. Only 1 occurred during REM sleep. Four hundred forty five apneas were recorded in 7 patients. None of the obstructive apneas, or mixed apneas followed or preceded a GER. In 1 patient, 2 central apneas succeeded to GER during REM sleep. We conclude that 1) GER, as in healthy subjects, occurs essentially during wakefulness or transient arousals; 2) in these patients, we did not establish a causal relationship between GER and obstructive apneas nor between apneas and GER.

[Gastro-esophageal reflux and nocturnal sleep in the adult: method and results obtained in healthy subjects]. / Reflux gastro-oesophagien et sommeil de nuit chez l'adulte: méthode et résultats obtenus chez les sujets sains.

Esophageal pH has been studied at night in six healthy subjects. A pH electrode was placed 5 cm above the low esophageal sphincter and sleep state was monitored. The subjects were connected to the recording devices during two nights, but the recording was performed only during the second night. A pH drop superior to 2 units and lasting longer than 30 sec was estimated as a gastro-esophageal reflux (GER). GER episodes were determined from beginning of sleep to definite waking. Ten GER appeared in four of the six subjects. They occurred both during transient arousals or complete wakefulness, but never in NREM or REM sleep. These results are consistent with those previously reported in normal subjects. On the contrary, GER were reported during REM sleep or NREM sleep in 'near miss' sudden infant death infants and in asthmatic children. Thus, the dysfunction of the esophagus might be considered either as the origin of the diseases, or as one of their consequences.

[Flash-pattern visual evoked potentials and limited lesions of the occipital lobe]. / Potentiels évoqués visuels au flash damier et lesions limitées du lobe occipital.

Four patients with restricted lobe lesions and one patient with large occipital lesions were selected for VEP studies to full-field and half-field flash pattern stimuli. The abnormalities of the responses were more important with full-field stimuli. In three patients with inner side occipital lobe damage, the P100 component disappeared ipsilaterally to the lesion, but N140 remained normal on bilateral occipital leads. In one patient with outer side occipital lobe damage, P100 was normal on bilateral occipital leads, but N140 disappeared ipsilaterally to the lesion. In one patient with large occipital lesion, P100 and N140 both disappeared ipsilaterally to the lesion. It appears that the P100 component is related to the inner and that N140 is related to the outer area of the occipital lobe.

[EEG sleep patterns in post-traumatic coma (author's transl)]. / A propos de tracés de comas-sommeils post-traumatiques.

EEG sleep patterns were observed in 44 cases of cranial injuries examined within 24 hours of the traumatic incident. Young people were involved, as more than half of these cases were noted in patients under 15 years of age. Two main types of tracing were observed: EEG sleep pattern with slow waves were seen mainly in children; but sleep patterns of low amplitude appeared generally in adolescents and adults. There was usually a favourable outcome in this series, as there was only one death the day after the accident, in a pateint with multiple injuries and only two cases of post-traumatic epilepsy.

[Normal children sleep E.E.Gs from 5 months to 3 years old (author's transl)]. / Electroencéphalogramme du sommeil de l'enfant normal entre 5 mois et 3 ans.

The sleep E.E.G. of the child under 3 years old is characteristic from several points of view: Drowsiness: The hypersynchrony is always observed. It is more continuous in younger children, than in the older one, where only bursts of hypersynchrony are seen. The fast rhythms of low amplitude may exist, during stage 2 sleep, but they are rare. Calm Sleep (C.S.): The vertex humps are more and more acute and sharper from 18 months. The sleep spindles are of high amplitude and frequent at 6 and 8 months. They diminish later. It may be for that reason that III and IV sleep stages seem to be more important after 12 months than before. From 21 months, we have observed an unusual pattern during C.S.: rhythmic and diffuse thêta rhythms of about 6 c/s. Paradoxal sleep (P.S.): If it is possible to observe P.S. during day-naps 8 or 9 months, it is rare later and for recording P.S., it is necessary to record E.E.G.s at night. The E.E.Gs are either a little like stage I E.E.G, or consistent of high and monomorphic delta waves. If it is possible to observe at least 3 complete sleep cycles, the proportion of P.S. is about 20 p. 100 of the total length of the sleep. At least, it is very important, even in medical practice, to record not only E.E.G. but also polygraphic leads: breathing, electro-myogram, electrocardiogram, and to notice also the rapid eyes movements.