Opsoclonus as a manifestation of Hashimoto's encephalopathy.

We present a 59-year-old male with early manifestation of opsoclonus associated with gait ataxia as a rare clinical presentation of Hashimoto's encephalopathy. Empiric use of intravenous immunoglobulin followed by intravenous high dose methylprednisolone was initiated with subsequent remittance of opsoclonus, encephalopathy, ataxia, and tremor. Extensive workup for infectious, autoimmune, and paraneoplastic etiologies were undertaken and all studies were negative. Thyroglobulin antibodies (312 U/mL) and thyroid peroxidase antibodies (457 U/mL) were elevated (normal <60 U/mL) with a euthyroid state (thyroid stimulating hormone 3.13 µIU/mL). Three months after intravenous steroid therapy, the concentrations of thyroglobulin and thyroid peroxidase antibodies were retested and found to have decreased considerably. Thus, with steroid therapy, the patient's opsoclonus and encephalopathy improved. We have presented a patient with a rare case of opsoclonus as the principal presenting feature of Hashimoto's encephalopathy that was incompletely responsive to intravenous immunoglobulin and resolved with corticosteroids. This report underscores the importance for clinical practitioners to maintain a high index of suspicion for Hashimoto's encephalopathy in cases of opsoclonus, especially when accompanied by an atypical presentation.

Lower limb influence on standing arm-cranking ('grinding').

Standing arm-cranking ('grinding') is predominantly an upper-body exercise, however, the contribution of the legs to this activity is unknown. The purpose of the study was to examine the influence of normal lower-limb movement on physiological strain during arm-cranking. Eight elite professional America's Cup grinders performed two exercise trials, on an adjustable standing arm-crank ergometer with SRM powercrank, in a cross-over design. Each trial comprised of two 5-min stages at the same work rate ( approximately lactate threshold) with the knee joint splinted or normal movement available. Vertical ground reaction forces (VGRF) and knee joint angle were determined from two force plates and sagittal plane video, respectively. Work rate was identical for the two conditions (246 (14) vs. 246 (13) W, p=0.7). Knee joint range of motion and unilateral VGRF amplitude were greater during normal compared with splinted arm-cranking (both p<0.01). There was no difference in VO2 (p=0.2) between the two conditions, however, there was greater VCO2 (8%, p=0.001), RER (11%, p<0.001), V(E) (17%, p<0.001) and HR (7 (3) beats.min(-1), p<0.001) during splinted compared with normal arm-cranking. Furthermore, the rise in BLa was greater after splinted than normal arm-cranking (4.8 (0.8) vs. 3.7 (1.0) mmol.L(-1), p=0.04). These data suggest that the lower-limbs play an integral role in standing arm-cranking, and restricted leg movement markedly affects the cardiovascular and metabolic responses to this activity.

Perception of self motion during and after passive rotation of the body around an earth-vertical axis.

We investigated the perception of self-rotation using constant-velocity chair rotations. Subjects signalled self motion during three independent tasks (1) by pushing a button when rotation was first sensed, when velocity reached a peak, when velocity began to decrease, and when velocity reached zero, (2) by rotating a disc to match the perceived motion of the body, or (3) by changing the static position of the dial such that a bigger change in its position correlated with a larger perceived velocity. All three tasks gave a consistent quantitative measure of perceived angular velocity. We found a delay in the time at which peak velocity of self-rotation was perceived (2-5 s) relative to the beginning or to the end of chair rotation. In addition the decay of the perception of self-rotation was preceded by a sensed constant-velocity interval or plateau (9-14 s). This delay in the rise of self-motion perception, and the plateau for the maximum perceived velocity, contrasts with the rapid rise and the immediate decay of the angular vestibuloocular reflex (aVOR). This difference suggests that the sensory signal from the semicircular canals undergoes additional neural processing, beyond the contribution of the velocity-storage mechanism of the aVOR, to compute the percept of self-motion.

[Comparative study of 2 series of cases of uterine rupture collected at the Averroès Hospital in Casablanca from 1979 to 1981 and from 1984 to 1986]. / Etude comparative de 2 séries de ruptures utérines colligées au C.H.U. Averroès de Casablanca de 1979 à 1981 et de 1984 à 1986.

There were 156 uterine ruptures collected out of 34,807 deliveries in the gynaecological and obstetrical department of the University Hospital of Averroes in Casablanca. This is a rate of 1 per 223 deliveries. The factors that predispose to this complication are low socio-economic status of the patients, multiparity and, above all, a scarred uterus. Surgical abnormalities of the pelvis and dystocia due to malpresentations and above all inappropriate manoeuvres which continue to be practised are all responsible for the condition. The rupture usually occurs in the lower segment. When the lesions are extensive the cervix and the bladder are most often damaged. Treatment should be as conservative as possible to maintain the woman's fertility but at the same time doing whatever is necessary for her.