[One or more functional somatic syndromes? Comparison of the health status of fibromyalgia and electro-hypersensitive people]. / Un ou plusieurs syndromes somatiques fonctionnels ? Comparaison de l'état de santé de personnes fibromyalgiques et électro-hypersensibles.

INTRODUCTION: Functional somatic syndromes, grouping somatic symptoms without an organic explanation, are defined either by their predominant symptoms or by an attribution to an, often hypothetical, cause. Due to many similarities, some authors consider that there is only one FSS due to a general phenomenon of "somatization". The objective of this work was to compare two functional somatic syndromes, one defined by its symptoms, fibromyalgia, and the other by a specific contested attribution, electro-hypersensitivity. METHOD: Fibromyalgia or electro-hypersensitive participants (EHS) were recruited from September 2016 to April 2017 through associations of patients in Auvergne-Rhône-Alpes. Home interviews included the collection of medical, psychopathological, and symptom histories. The assessment of psychological distress, quality of life and the search for other functional somatic syndromes was performed through structured questionnaires, self-administrated scales, and clinical examination. RESULTS: Sixteen fibromyalgia subjects and sixteen EHS subjects were included. There are differences in symptomatology, although many symptoms are common to both conditions. Lifetime history of psychiatric disorders and current psychological distress and psychopathology are frequent in both groups but more prevalent in fibromyalgia subjects. The experience of the symptoms, their interpretation, the diagnostic itineraries and the therapeutic behaviours differ radically according to the group, even if for all socio-professional impact is high and quality of life are altered. CONCLUSION: The health status of fibromyalgia persons is overall worse than the health status of electro-hypersensitive individuals in this small sample. Despite the overlap in symptoms and a similar impact on daily functioning, this exploratory study suggests that heterogeneous mechanisms of "somatization" may be at stake in functional somatic syndromes.

Dopamine-dependent long term potentiation in the dorsal striatum is reduced in the R6/2 mouse model of Huntington's disease.

The striatum is critically important in motor, cognitive and emotional functions, as highlighted in neurological disorders such as Huntington's disease (HD) where these functions are compromised. The R6/2 mouse model of HD shows progressive motor and cognitive impairments and alterations in striatal dopamine and glutamate release. To determine whether or not dopamine-dependent neuronal plasticity is also altered in the dorsolateral striatum of R6/2 mice, we compared long term potentiation (LTP) and long term depression (LTD) in striatal slices from R6/2 mice with that seen in slices from wild type (WT) mice. In adult WT mice (aged 8-19 weeks), frequency-dependent bidirectional plasticity was observed. High frequency stimulation (four 0.5 s trains at 100 Hz, inter-train interval 10 s) induced LTP (134+/-5% of baseline), while low frequency stimulation (4 Hz for 15 min) induced LTD (80+/-5% of baseline). LTP and LTD were significantly blocked by the N-methyl-D-aspartic acid (NMDA) receptor antagonist D(-)-2-amino-5-phosphonopentanoic acid (D-AP5) (to 93+/-6% and 103+/-8% of baseline respectively), indicating that they are both dependent on NMDA glutamate receptor activation. LTP was significantly blocked by the dopamine D1 receptor antagonist R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH-23390) (98+/-8% of baseline), indicating that LTP is dependent on activation of dopamine D(1)-type receptors, whereas LTD was not significantly different (90+/-7%). In adult R6/2 mice (aged 8-19 weeks), LTP was significantly reduced (to 110+/-4% of baseline), while LTD was not significantly different from that seen in WT mice (85+/-6%). These data show that R6/2 mice have impaired dopamine-dependent neuronal plasticity in the striatum. As dopamine-dependent plasticity is a proposed model of striatum-based motor and cognitive functions, this impairment could contribute to deficits seen in R6/2 mice.

Percutaneous retrieval of a right atrioventricular embolus.

Percutaneous retrieval of a 12-cm-long serpiginous clot lodged in the right atrium and ventricle is reported. Following bilateral common femoral vein puncture, a Bird's Nest cava filter was first positioned ready to deploy immediately below the renal veins via the right femoral vein. From the left femoral vein, a Cook intravascular retrieval basket was advanced to the right atrium. Under transthoracic echocardiographic visualization, the basket was used to engage, trap, and gently withdraw the clot in a single long strand below the prepositioned inferior vena cava filter. The filter was immediately deployed, leaving the clot trapped inferior to the renal veins, in the cava and left iliac vein. The patient remained well and asymptomatic at discharge.

Effects on cardiac performance of atrioventricular node catheter ablation using radiofrequency current for drug-refractory atrial arrhythmias.

Patients with atrial fibrillation or atrial flutter (AF) are candidates for radiofrequency (RF) catheter ablation of the atrioventricular (AV) node with the aim being to control heart rate. As patients with AF can have markedly impaired ventricular function, information concerning the hemodynamic effects of AV node ablation using RF current would be valuable. Fourteen consecutive patients (mean age 65 +/- 3 years) with drug-resistant AF underwent AV node catheter ablation with RF current and had permanent pacemaker implantation. The mean left ventricular ejection fraction (EF) by two-dimensional echocardiography immediately before ablation was 42 +/- 3% (range 14%-54%) and their mean exercise time was 4.4 +/- 0.4 minutes. Complete AV block was achieved in all 14 patients with 6 +/- 2 RF applications (range 1-18). There was no evidence of any acute cardiodepressant effect associated with delivery of RF current, and EF 3 days after ablation was 44 +/- 4%. By 6 weeks after ablation, the left ventricular EF was significantly improved compared to baseline (47 +/- 4% postablation vs 42 +/- 3% preablation; P < 0.05), and this modest increase in EF was accompanied by an improvement in exercise time (5.4 +/- 0.4 min). In conclusion, delivery of RF current for AV node catheter ablation in patients with AF and reduced ventricular function is not associated with any acute cardiodepressant effect. On the contrary, improved control of rapid heart rate following successful AV node ablation is associated with a modest and progressive improvement in cardiac performance.

Automated non-invasive measurement of cardiac output by the carbon dioxide rebreathing method: comparisons with dye dilution and thermodilution.

The accuracy and reproducibility of indirect measurement of cardiac output at rest by the carbon dioxide rebreathing (indirect Fick) method with an automated respiratory analysis system (Gould 9000IV) were compared with simultaneous measurements made in duplicate by dye dilution and thermodilution in 25 patients having cardiac catheterisation studies. Measurements of cardiac output by the carbon dioxide rebreathing method were not significantly different from those obtained with dye dilution (mean difference -0.3 l/min, SD 0.76, 95% confidence interval -0.7 to 0.1). Thermodilution significantly over-estimated cardiac output by a mean of 2.2 l/min or 39% (SD 1.5, 95% confidence interval 1.6 to 2.8) compared with the carbon dioxide rebreathing method and significantly overestimated cardiac output by 1.9 l/min or 31% (SD 1.2, 95% confidence interval 1.2 to 2.5) compared with dye dilution. The reproducibility of measurements of cardiac output in individual patients was satisfactory with the dye dilution method but was poor with carbon dioxide rebreathing and thermodilution. Indirect measurement of resting cardiac output by the Gould 9000IV automated carbon dioxide rebreathing method is more accurate but the variability inherent with this method requires that multiple measurements be taken for each determination. Measurement of cardiac output by the thermodilution method by a commercially available cardiac output computer was not satisfactory because not only was there considerable variability between repeat measurements but the method also consistently overestimated cardiac output compared with the dye dilution method.

Optimal size of cuff bladder for indirect measurement of arterial pressure in adults.

This study tested the hypothesis that a sphygmomanometer cuff bladder long enough to encircle the arm in most adults ('obese cuff') would provide a more accurate and precise estimate of intra-arterial pressure than the usual 'standard' cuff bladder. In 53 patients undergoing diagnostic coronary angiography (35 males, 18 females, aged 36-79 years), indirect blood pressure, measured in the left arm with a random-zero sphygmomanometer, was compared with simultaneously measured femoral intra-arterial pressure. Duplicate indirect measurements were made with each of two cuffs containing bladders measuring 39 x 15 cm ('obese') and 23 x 12 cm ('standard'). The obese cuff bladder encircled 80% or more of the arm circumference in all subjects, whereas the standard cuff bladder met this requirement in only 19% of the subjects. For both systolic and diastolic pressure there was marked interindividual variability in the differences between indirect and direct measurements with both cuffs. With the obese cuff there was no systematic error in the diastolic blood pressure measurement. The standard cuff consistently overestimated diastolic pressure by 7.7 +/- 8.3 mmHg (mean +/- s.d.). For both cuffs, the difference between indirect and direct diastolic pressure increased with arm size (P less than 0.05). Both cuffs underestimated systolic blood pressure, the obese cuff by 15.5 +/- 11.7 mmHg and the standard cuff by 7.6 +/- 12.1 mmHg. These systolic blood pressure underestimates were greater at higher blood pressures (P less than 0.01) and with smaller arms (P less than 0.05). Age was not related to measurement error with either cuff.(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy of the Takeda TM-2420 ambulatory blood pressure monitor.

1. The accuracy of blood pressure measurement with the Takeda TM-2420 ambulatory blood pressure monitor and the TM-2020 data recorder have been assessed by comparison with simultaneous measurements taken using auscultation and direct femoral artery measurements. 2. Systolic blood pressure was underestimated by the TM-2420 by a mean of 10 mmHg (s.d. = 6, 95% confidence interval (CI) = -13 to -7) over the range of pressures measured by auscultation. It was underestimated by 23 mmHg (s.d. = 12, 95% CI = -28 to -18) compared with direct femoral artery measurements. 3. Diastolic pressure measurements were similar to those obtained by auscultation. When compared with direct femoral artery recordings, diastolic pressure was overestimated by about 5 mmHg (s.d. = 4, 95% CI = 3.4-6.6), which is consistent with indirect readings, taken with a 'standard' cuff (inflatable bladder 23 cm X 12 cm). 4. The TM-2420/2020 is thus suitable for ambulatory measurements of blood pressure when diastolic pressure is the criterion of interest.

Renal excretion and computed tomography enhancement of iotrolan and iopamidol in dogs.

A comparison of the renal excretion and computed tomography (CT) enhancement of nonionic, monomer and dimer contrast media (CM) (iopamidol and iotrolan) was planned to determine if the latter provides additional and prolonged enhancement in dogs. The excretion studies show almost identical performance of both CM with respect to plasma concentration and renal excretion. However, the lower osmolality of iotrolan permits greater renal concentration in the medulla, papilla, and urine. The potential for this further enhancement of the kidney in CT or urography is marginal.

Examination of the nephrographic potential of iotrol by computed tomography.

The x-ray attenuation of the renal cortex of dogs, as determined by computed tomographic (CT) scanning, was measured over a three-day period after an intravenous bolus of 600 mg I/kg of iotrol or iopamidol. A slightly higher density observed 24 hours after injection of iotrol was not considered significant, and was not considered sufficient to warrant clinical application of iotrol for specific, prolonged renal enhancement.