Predominance of sialomucin secretion in malignant and premalignant pancreatic lesions.

Sialomucin and sulphomucin-secreting cells were studied in the normal and pathologic human pancreas with the high iron diamine-alcian blue technique which allows differentiation between the two types of mucin. In six normal autopsy pancreata, only sulphomucin was found. In benign lesions of either calcifying chronic pancreatitis (seven cases) or obstructed chronic pancreatitis (six cases), sulphomucins were widely predominant. In contrast, malignant lesions (pancreatic adenocarcinoma [12 cases], cystadenocarcinoma [two cases]) or premalignant lesions (mucinous cystadenoma [one case], ductectatic mucinous cystadenoma [four cases], villous adenoma of the main pancreatic duct [two cases]) showed a predominant sialomucin secretion, except for three poorly differentiated pancreatic carcinomas that did not show mucin staining. The sialomucin positivity was not observed at distance from the malignant lesions. In one case of benign enteroid cyst, sulphomucins predominated. These findings indicate a preponderance of sialomucin secretion in malignant or premalignant pancreatic lesions.

FES and spasticity.

A model of hemiplegic spasticity based on electromyographical and biomechanical parameters measured during passive muscle stretching is presented. Two components of spasticity can be distinguished--phasic and tonic. This classification depends on the pattern of stretch reflex activity which can be either phasic or tonic as well as on the muscle stretch/tension characteristic. Stretch reflex, as a control loop, is in phasic spasticity characterized by increased sensitivity to velocity of stretching. In tonic spasticity, sensitivity to length of stretching is increased. After the injury, phasic spasticity appears first and invokes monosynaptic reflex pathways. The intensity of tonic spasticity increases with the duration of disability and hence causes changes in muscle fiber biomechanical properties. The model mentioned above has been used to evaluate the effects of FES on spasticity. Hemiplegic patients with implanted peroneal nerve stimulator for gait correction were followed up for one year starting a week before implantation. Long-term use of FES resulted in decrease of tonic spasticity in both ankle joint antagonistic muscle groups. In stimulated tibialis anterior muscle, the phasic type of spasticity increased. To obtain the correlation between changes in spasticity and functional abilities of patients, the maximal voluntary isometric contraction of both muscle groups was also measured. An improvement in voluntary strength was also observed. This can be taken as additional evidence that tonic spasticity is of greater physiological and clinical significance than phasic spasticity. It may be concluded that use of FES can decrease tonic spasticity and, if applied early after the injury, can prevent the appearance of tonic spasticity.

The rehabilitation of gait in patients with hemiplegia: a comparison between conventional therapy and multichannel functional electrical stimulation therapy.

BACKGROUND AND PURPOSE: Gait rehabilitation in patients with severe hemiplegia requires substantial effort. Preliminary studies indicate potential beneficial effects of using multichannel functional electrical stimulation (MFES) for gait rehabilitation in these patients. In this study, a new method of gait rehabilitation for nonambulatory patients with hemiplegia by means of MFES added to conventional therapy was introduced. The results of the method's application were evaluated by comparing it with conventional therapeutic methods. SUBJECTS: The proposed rehabilitation method was tested on a group of 20 patients with severe hemiplegia secondary to cerebrovascular accident. Subjects were randomly assigned to one of two groups. One group received 3 weeks of MFES followed by 3 weeks of conventional therapy. The other group received 3 weeks of conventional therapy followed by 3 weeks of MFES. METHODS: The effects of each therapeutic method were evaluated by measurements of temporal-distance variables and ground reaction forces and by assessment of each subject's physical status according to the Fugl-Meyer evaluation scale. RESULTS: There was improved performance of the subjects during MFES combined with conventional therapy as compared with conventional therapy alone. CONCLUSION AND DISCUSSION: The superiority of the MFES method as compared with conventional therapy was mainly attributed to the enhanced motor learning accomplished by application of MFES. These results, however, are preliminary, and further research is needed.

Restoration of gait during two to three weeks of therapy with multichannel electrical stimulation.

Multichannel electrical stimulation was applied in 20 patients with hemiplegia secondary to stroke or head injury using a six-channel microprocessor stimulator-stride analyzer to restore independent gait and to reestablish a normal gait pattern in a two- to three-week therapy period. The therapy was followed up at every session by a stride analyzer incorporated into the stimulator. At the beginning and at the end of the therapy period, each subject's gait was measured with a ground reaction measuring system. Statistical results and observations are presented for the group of 20 subjects, and a detailed description of the results is given for one subject who is representative of the whole group. According to the measured gait characteristics, gait improved significantly in all subjects during the therapy period, resulting in a partly or completely independent gait. The subjects' posture and endurance also improved, and they spontaneously learned how to use a crutch. The measurements and visual assessment of the subjects' progress indicate that the described treatment protocol offers good prospects for faster and more efficient gait rehabilitation in severely impaired patients. To determine the efficacy of gait therapy with multichannel electrical stimulation, a comparative study of conventional therapeutic methods and the method described in this article should be conducted.

Application of a programmable dual-channel adaptive electrical stimulation system for the control and analysis of gait.

A dual-channel electrical stimulation system with a stimulator and a programmer/stride analyzer was designed for clinical rehabilitation of gait and for subsequent daily use as an orthotic aid. The stimulator, with controls to adjust amplitude only (50 mA), adapts chosen stimulation sequences to the walking rate of a patient. Pulse duration (50-500 microseconds), frequency (5-120 Hz), shape (symmetrical biphasic, monophasic), stimulation sequences (16 stride segments) and their cycle (2-12 sec), and right/left foot-switch choices are selected for each patient and programmed into a separate unit. The programming unit also statistically processes the foot-switch data collected by the stimulator. The device was evaluated with regard to the programmable parameters, effectiveness during gait, and feasibility in clinical use. It was applied to 11 stroke patients and 10 brain injury patients during gait, stimulating 22 combinations of peroneal nerve and hamstring, quadriceps, triceps brachii, and gluteus maximus muscles. Forces on both feet, equinovarus, knee extension and hyperextension, elbow flexion, and hip extension were corrected. Selection of the stimulation sequences, their adaptation, range of pulse duration, and valid statistics were verified. Improved forces and joint angles were recorded together with significant changes in the stride time, length, and velocity by the stimulation.

Postmortem findings in 22 victims due to two grain silo explosions in France.

In 1982 and 1997 there were explosions of barley-containing silos in France, one in Metz (1982) and the other in Blaye (1997). There were a total of 25 victims, including 23 fatalities (12 in Metz and 11 in Blaye). In each case there was one survivor. This report is a retrospective study of 22 victims (11 at each site); all of them had multiple lesions due to the explosion and the immediate aftermath. The lesions demonstrated direct involvement of the blast effect associated with silo destruction, the heat from the explosion, the effects of toxic gases and asphyxia. The forensic pathologist is an important member of the emergency response team. This team has the responsibility for initially assessing the damage and for identifying the victims. The role of the forensic pathologist is therefore essential and they should be included in emergency planning to facilitate the initial assessment, shorten the time taken to identify the victims and improve safety procedures. Although dust explosions in agro-business plants are occurring more frequently, postmortem data are rare.

Rigidity in parkinsonism: characteristics and influences of passive exercise and electrical nerve stimulation.

Rigidity was measured during sinusoidal passive movements of the ankle joint in 7 patients with parkinsonism. Velocity-dependent changes were observed, less marked than in spasticity and expressed in a different way in flexor and extensor muscles: a mild decrease in resistive torques at faster stretching of dorsal flexors and an increase in resistance on stretching of plantar flexors. Dorsal flexors also frequently showed shortening reactions. Passive exercises and electrical stimulation of the peroneal nerve resulted in decreased electromyographic responses to stretch, smoother passive movements and in improved voluntary contraction.

Spontaneous human combustion: a sometimes incomprehensible phenomenon.

Several cases of human combustion, the cause of which was not evident, have been described over the last few centuries. There are three intriguing elements to such cases. Firstly, although the body is destroyed, the immediate surroundings are left almost intact. Secondly, there is often no visible source of heat that might have started the fire. Thirdly, sometimes bodies are not completely destroyed, certain parts being perfectly preserved, adjacent to others that are reduced to a state of ashes.

Evaluation of gait with multichannel electrical stimulation.

Short, intensive multichannel electrical stimulation therapy was evaluated in 14 hemiplegics after stroke or head injury. The stimulation of the peroneal nerve, soleus, quadriceps, hamstring, gluteus maximus, and triceps brachii muscles with individually preprogrammed sequences was applied by surface electrodes at the beginning of gait rehabilitation. The patients started walking with the support of a therapist, gradually increased the walking distance and all reached independent ambulation with a crutch after an average of 14 stimulation sessions. A portable microprocessor six-channel stimulator/stride analyzer enabled the collection of gait parameters and recording of statistical mean values of stride time, gait symmetry, right and left stance times, and their standard deviations. Without additional equipment, several hundred stimulated strides were measured during each stimulation session.

Multichannel electrical stimulation of gait in motor disabled patients.

Effects of surface multichannel electrical stimulation of the leg muscles during gait were evaluated by a clinical kinesiological analysis of gait and measurements of average step length, gait velocity, ground reaction forces, and joint angles. Direct effects in 11 stimulated motor disabled patients showed 56% improvement at the kinesiological gait analysis during the stimulation. Long term effects of the multichannel therapy were compared in a threeyear control study with a group of ten nonstimulated patients. At the kinesiological analysis, the stimulated group improved 1.75 times better after 2.5 months of the treatment. The other measurements revealed higher and faster improvement at the stimulated group with a partial decrease of the therapeutic effects after a longer period without treatment. Orthotic multichannel stimulation was indicated after the multichannel therapy in the clinical environment, where the stimulation of proximal leg muscles was favored.

[Giant leiomyoma of the inferior vena cava]. / Léiomyome géant de la veine cave inférieure.

The authors report an uncommon case of giant leiomyoma of the inferior vena cava with intracardiac extension and arising from the external iliac vena. This case report illustrates the diagnostical problems usually encountered with this type of tumour. Indeed, despite ultrasound and transverse CT scan, the diagnosis was only assessed by histopathological analysis following a successful surgical removal of the leiomyoma. Only 7 cases of leiomyoma of the inferior vena cava are already reported in the literature. Relationship with intravenous leiomyomatosis of the uterus is also discussed.

Homovanillic acid (HVA) urinary excretion and day/night rhythm of chronic schizophrenic patients. Preliminary observations.

The authors report, as compared to healthy subjects, a higher daily excretion and a higher urinary variations of homovanillic acid (HVA) for schizophrenic chronic paranoid patients (patients with positive symptomatology predominating, CROW,s type I). Inversely, a lower HVA excretion and probably an inversion of the circadian rhythm of urinary HVA were found for schizophrenic chronic undifferentiated patients (patients with negative symptomatology predominating, CROW's type II). These results have to be confirmed by the study of a greater number of patients and the measure, for comparison among themselves, of other precursors and metabolites of monoamines.

[Primitive neuroectodermal tumor of the kidney manifested as a spontaneous hematoma]. / Hématome spontané du rein révélant une tumeur neuroectodermique primitive chez l'adulte.

Ultrasound and CT in a young man, admitted for violent left flank pain, revelead a large heterogeneous left renal mass, with hypodense collection along the psoas. The diagnosis was spontaneous renal hematoma. A check CT 3 weeks later found a large tumor of the inferior pole. After radical nephrectomy, histopathology diagnosed a primitive neuroectodermal tumor. The patient died one year later despite neoadjuvant chemotherapy. This article reports the clinical, radiological and histopathological aspect of a primitive neuroectodermal tumor of the kidney, compared with the other cases in literature.

[Gonadal function in anorexia nervosa patients in the postcritical phase]. / La fonction gonadique des anorexies nerveuses à la phase post critique.

Resuming of menstruation is generally held as a hall mark of recovery in Anorexia Nervosa. Nevertheless, fifteen young women (17 to 28 years old) consulted us about secondary amenorrhea while the acute phase of illness was over. Basal gonadotropins and Estradiol (E2) were measured and a GnRH- TRH stimulation test was performed. Two groups of patients were considered: A - 7 patients with a normal Body Weight Index; B - 8 patients with a Body Weight Index still low. (- 20% - 30%). In group A, 6 out of 7 patients had a early onset of anorexia nervosa (within two years after menarche). In group B, 6 out of 8 patients had a late onset of their disease (more than five years after puberty). As for Body Weight, it seems that the prognosis is better when Anorexia Nervosa occurs within few years after menarche. By comparison with normal women of same age explored in early follicular phase, our population of Anorexia Nervosa showed no significant difference in basal levels of F.S.H., L.H., E2. Cumulative Response F.S. H./L.H. was slightly increased (= 1) compared with normal control (= 0,34). Basal and stimulated Prl were normal. When Body Weight Index was still low, LH and E2 were decreased whereas cumulative response F.S. H./L.H. was dramatically increased. A correlation between E2 and Body Weight Index was shown, low E2 usually fitting well with Low Body Weight Index. Prognosis is poorer for recovery of normal gonadal function in late onset Anorexia Nervosa. Nevertheless, in each group, some patients escaped this rule. Induction of ovulation with Clomifene let us disappointed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Latex and pollinosis]. / Latex et pollinose.

Through the multidetection test for specific IgE to pneumoallergens (Aero-Matrix Plus, Abbott) our attention has been drawn to polysensitization to pollens. Amongst these pollen tests, plantain seems to be frequently associated with sensitization to latex. The aim of this work at first, is therefore to verify the reality of the frequency of the association between latex and plantain sensitization. However, the conclusions are difficult, since there are no patients who are only sensitive to plantain as sensitivity to this allergen is always found in a pollen polysensitization. at least associated with grass pollens; at most associated with a number of other pollens. The double profile (perhaps plantain + / grass pollen +, or perhaps plantain + / grass pollen + / other pollens +) is determinant in prediction of sensitivity to latex, which is found essentially in the group plantain + / grass pollen + / other pollens +. This study has also shown that amongst the population who have specific IgE to latex (IgEs) (sensitized or allergic): the patients who have a clinical history of allergy to latex have no profile of pollen polysensitization; the non-allergic but sensitive patients (IgE positive, but no clinical signs on contact with latex) show an extreme pollen polysensitization. This poses a problem of different antigenic determinants or perhaps two different pathways to sensitization to latex.

[Correlation between Gleason score of prostatic biopsies and the one of the radical prostatectomy specimen]. / Corrélation entre le score de Gleason des biopsies prostatiques et celui de la pièce de prostatectomie radicale.

UNLABELLED: The Gleason score obtained on prostatic biopsies is an essential element in the treatment decision for localized prostate cancer. The objective of this study was to evaluate the correlation between the biopsy Gleason score and the definitive Gleason score and to propose a classification into 3 groups in order to improve this correlation. MATERIAL AND METHODS: One hundred radical prostatectomies were performed between 1995 and 1998. Eighty four of these patients underwent 6 biopsies. The Gleason score of the biopsies and operative specimens were compared. The concordance between the biopsy Gleason score and the operative specimen Gleason score was initially analysed score by score. The concordance was then established according to three groups, well differentiated tumours (score 2-4), moderately differentiated tumours (score 5-7), poorly differentiated tumours (score 8-10). RESULTS: The concordance between the biopsy Gleason score and the operative specimen Gleason score was perfect in only 37% of cases. A 1-point difference of the score was observed in 35.7% of cases and a 2-point or greater difference was observed in 27.3% of cases. By classifying patients into 3 groups, the concordance increased from 37% to 72.6%. CONCLUSION: The classification of patients into three distinct groups (well, moderately and poorly differentiated tumours) increases the concordance between the biopsy Gleason score and the definitive Gleason score. However, the limitations of the biopsy Gleason score must be kept in mind, particularly in the case of low-grade tumours.

Increasing stability by pre-bending the nails in elastic stable intramedullary nailing: a biomechanical analysis of a synthetic femoral spiral fracture model.

Elastic stable intramedullary nailing (ESIN) is generally acknowledged to be the treatment of choice for displaced diaphyseal femoral fractures in children over the age of three years, although complication rates of up to 50% are described. Pre-bending the nails is recommended, but there are no published data to support this. Using synthetic bones and a standardised simulated fracture, we performed biomechanical testing to determine the influence on the stability of the fracture of pre-bending the nails before implantation. Standard ESIN was performed on 24 synthetic femoral models with a spiral fracture. In eight cases the nails were inserted without any pre-bending, in a further eight cases they were pre-bent to 30° and in the last group of eight cases they were pre-bent to 60°. Mechanical testing revealed that pre-bending to 60° produced a significant increase in the stiffness or stability of the fracture. Pre-bending to 60° showed a significant positive influence on the stiffness compared with unbent nails. Pre-bending to 30° improved stiffness only slightly. These findings validate the recommendations for pre-bending, but the degree of pre-bend should exceed 30°. Adopting higher degrees of pre-bending should improve stability in spiral fractures and reduce the complications of varus deformity and shortening.

Biomechanical analysis of a synthetic femur spiral fracture model: Influence of different materials on the stiffness in flexible intramedullary nailing.

BACKGROUND: Flexible intramedullary nail fixation of dislocated diaphyseal femur fractures has gained wide acceptance for children and adolescents with open physes. Studies with a special emphasis on complications reveal frequent problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing >40kg. This biomechanical study analyses how much the material of the nails influences the stiffness in a synthetic bone model. METHODS: Twenty-four composite grafts (Sawbones®, 4th generation, medullar canal of 10mm) with an identical spiral fracture were used in three configurations of eight grafts. Elastic stable intramedullary nailing was performed in a retrograde C-shaped manner with two nails of equal size (2×3.5mm). Close contact of the fragments could be achieved. We compared Group A (steel nails) with Group B and C (two types of titanium nails). All specimens underwent 4-point bending, torsion and axial compression in the 0° and 9° positions, and the results were analysed. FINDINGS: Group A (steel nails) revealed a significantly higher stiffness in all directions than Group B. Apart from compression in the 9° position this steel nail fixation showed significant higher stiffness than titanium nails of Group C. Comparing Group B and C did not show an systematic difference. INTERPRETATION: In this biomechanical study with composite artificial bones the use of steel Nails demonstrated the highest stiffness in our model when compared to two different titanium nail configurations. Apart from in cases of known allergy or planned MRI-examinations our results and data from the literature question the use of titanium nails.