[Hyperhomocysteinemia and schizophrenia: case control study]. / Hyperhomocystéinémie et schizophrénie : étude cas-témoin.

OBJECTIVES: Homocysteine (Hcys) is a sulphur-containing amino acid that has been widely investigated for its putative role in neuropsychiatric disorders. Elevated plasma homocysteine levels have been associated with schizophrenia. Among other factors, low folate and vitamin B12 levels have been implicated in the increase in homocysteine. The aim of the study was to determine plasma Hcys, folate and vitamin B12, and the frequency and severity of hyperhomocysteinemia in patients with schizophrenia, and to investigate the association between Hcys and clinical features and its relationship with folate and vitamin B12 levels. METHODS: This was a case-control study carried out on 61 (54 males and seven females, mean age=33.3 ± 9.2) inpatients with chronic schizophrenia according to DSM-IV criteria and 46 (25 males and 21 females, mean age=45.9 ± 14.2) healthy controls. Most of patients (90.2%) were treated by first generation antipsychotics with a mean daily dosage of 401.6 mg chlorpromazine equivalents. Total homocysteine serum levels were determined quantitatively by fluorescence-polarization immunoassay (FPIA) with an AxSYM analyzer™ (Abbott). Quantitative vitamin B12 and folate serum levels were measured with an Elecsys 2010 analyzer™ (Roche Diagnostics). Differences between patients and controls were examined using a two-way Ancova with gender and diagnosis as independent variables, adjusting for age. RESULTS: Patients with schizophrenia showed higher plasma Hycs and lower plasma folate than controls (mean=16.1 µmol/L in patients versus 10.9 µmol/L in controls; P=0.028 for Hycs and 4.2 µg/L in patients versus 8.2 µg/L in controls; P<0.001 for folate). Patients and controls did not differ in vitamin B12 levels. Both male and female patients had increased plasma Hcys compared to controls. Hyperhomocysteinemia (Hcys levels>15 µmol/L) was present in 34.4% of the patients versus 15.2% in controls. The prevalence of moderate hyperhomocysteinemia (Hcys levels: 15-29 µmo/L) was 26.2% and that of intermediate hyperhomocysteinemia (Hcys levels: 30-100 µmol/L) was 8.2%. In patients with schizophrenia, plasma Hcys was not correlated with age (r=0.07; P=0.56), duration of illness (r=-0.04; P=0.78) and did not differ with gender and clinical sub-types. Moreover, plasma Hcys was higher in patients without family history of psychiatric disorders (19.2 µmol/L) versus 12.7 µmol/L in patients with family history of psychiatric disorders (P=0.032). Concerning therapeutic features, plasma Hcys did not differ with type of antipsychotic and was not related to daily dosage of antipsychotics. A negative correlation was found between plasma Hcys and vitamin B12 levels (r=-0.26; P=0.04). CONCLUSION: These results confirm an increase of Hcys levels in schizophrenic patients and suggest that it is associated with absence of family history of psychiatric disorders and with low vitamin B12 levels. Hyperhomocyteinemia could be related to the pathophysiology of aspects of this illness. Homocysteine should be considered as a factor to consider in monitoring and management of patients with schizophrenia.

[Pseudotumoral tuberculosis of bone. About a metacarpal case report]. / Forme pseudotumorale de la tuberculose osseuse. À propos d'une localisation au métacarpe.

Metacarpal tuberculosis is a very rare form of the disease; it represents 1% of all bone sites. The diagnosis is often difficult because of the non-specific nature of the clinical examination and X-rays. Specialised morphological investigations are a capital contribution, but histology is diagnostic. Specific chemotherapy, combined with a bony debridement, generally allows desiccation of the bacilli in the lesions and the fixation of bone lesions. We report a case with the intention of pointing out the rarity of this location, the difficulty of diagnosis that may be encountered, and to highlight the severity of bone lesions that are mainly due to their late diagnosis.

[Acute acalculous cholecystitis after digestive caustic burn]. / Cholécystite aiguë alithiasique après brûlure caustique digestive.

A case is reported of acute acalculous cholecystitis in a patient who suffered a digestive burn treated by total parenteral nutrition. Pain in the right upper abdominal quadrant and fever occurred 26 days after the start of parenteral nutrition and 24 h after abruptly resuming oral feeding. Ultrasonography showed a distended gall-bladder with a thickened wall and the formation of sludge. Cholecystectomy was followed by a complete recovery. The part played by each of the corrosive burn, the total parenteral nutrition and the abrupt resumption of oral feeding in the pathogenesis of this complication is reviewed.

[Conservative treatment of injuries of the spleen in children]. / Expérience du traitement conservateur des traumatismes de la rate chez l'enfant.

Resolutely convinced of the necessity to preserve the spleen in all circumstances, the authors detail the indications and possibilities of non operative management and conservative surgery that allow the injured spleen to be salvaged. Of 55 cases observed from 1978 to 1982, only 22 required splenectomy because of our new experience; 13 of the remaining cases were treated non operatively and 20 had a conservative surgery. It is concluded that unless the child prognosis is directly and immediately involved, by the splenic injury (such cases require splenectomy or better still partial resection) every effort should be made to preserve a traumatized spleen.

[The sperm of Equisetum arvense L. I. Ultrastructural and cytochemical studies of nuclear constituents of the ripe sperm]. / Le noyau du gamète de l'Equisetum arvense L. I. Etudes cytochimiques ultrastructurales des composants nucléaries du gamète mûr.

Several ultrastructural cytochemical methods are used to determine the constituents of the ripe nucleus of Equisetum arvense L. They show that: DNA, associated with an arginine-rich histone, is localized in central region of the nucleus; nucleoplasm is reduced to a thin peripheral coat and contains a probably lysine rich histone; RNA is not detectable; non histone proteins form lenticular amounts disposed against the nuclear membrane.