Long-term memory deficits in temporal lobe epilepsy.

Memory complaints and deficits are common in patients with epilepsy, especially temporal lobe epilepsy (TLE), where memory-related brain structures are directly involved in the epileptic process. In recent years, substantial progress has been made in delineating memory impairment in TLE, challenging the traditional neuropsychological approach of the disorder. In particular, several lines of evidence have suggested that, beyond the apparent deficit demonstrable by standardized neuropsychological evaluations, TLE may also negatively interact with long-term memory, producing considerable loss of information of the patient's autobiographical history and an inability to maintain newly acquired information over a period of time. These observations have led to the development of innovative assessment techniques, and prompted a new domain of investigation focused on the relationships between interictal epileptiform activities and the integrity of anatomo-functional systems. The present paper reviews the available evidence for long-term memory deficits in TLE with respect to remote and very long-term memory, and discusses their putative pathophysiological mechanisms and the developing potential strategies to improve memory functioning.

Inhibition of fibronectin binding and fibronectin-mediated cell adhesion to collagen by a peptide from the second type I repeat of thrombospondin.

The platelet and extracellular matrix glycoprotein thrombospondin interacts with various types of cells as both a positive and negative modulator of cell adhesion, motility, and proliferation. These effects may be mediated by binding of thrombospondin to cell surface receptors or indirectly by binding to other extracellular matrix components. The role of peptide sequences from the type I repeats of thrombospondin in its interaction with fibronectin were investigated. Fibronectin bound specifically to the peptide Gly-Gly-Trp-Ser-His-Trp from the second type I repeat of thrombospondin but not to the corresponding peptides from the first or third repeats or flanking sequences from the second repeat. The two Trp residues and the His residue were essential for binding, and the two Gly residues enhanced the affinity of binding. Binding of the peptide and intact thrombospondin to fibronectin were inhibited by the gelatin-binding domain of fibronectin. The peptide specifically inhibited binding of fibronectin to gelatin or type I collagen and inhibited fibronectin-mediated adhesion of breast carcinoma and melanoma cells to gelatin or type I collagen substrates but not direct adhesion of the cells to fibronectin, which was inhibited by the peptide Gly-Arg-Gly-Asp-Ser. Thus, the fibronectin-binding thrombospondin peptide Gly-Gly-Trp-Ser-His-Trp is a selective inhibitor of fibronectin-mediated interactions of cells with collagen in the extracellular matrix.

[Long-term course of patients with Smeloff-Cutter aortic valve prosthesis]. / Evolution à long terme des malades porteurs de prothèse de Smeloff-Cutter en position aortique.

The long-term results (5 to 12 years) of 77 patients with Smeloff-Cutter aortic valve prostheses are reported. These patients were comparable in age, preoperative clinical condition and type of aortic valve replacement. The postoperative follow-up period of this series was however significantly longer. The 5 year survival rate was of 87%. The causes of death included thromboembolism, infectious endocarditis and cardiac failure. Mortality was higher in the first 5 postoperative years : 2,4% patient-years compared to 1,5% patient-years in the following years. Thromboembolism and neurological complications were particularly rare, representing a risk of 1,04% patient-years but these complications were lethal in half the cases in which they occurred. No haemolytic complications were observed. Infective endocarditis always occurred in patients with a history of infection, the complication usually being late (after 3 years). The life expectancy of patients seen after 5 years is at least 5 additional years in 80% of cases. The haemodynamic profile of the prosthesis did not degrade with time. After 5 years, 58,6% of patients in functional Class IV at operation were in Class I or II afterwards. 84,4% of patients operated in functional Class III were in Class I or II, and 93% operated in functional Class II were in Class I or III. A control of 3 prostheses carried out by the Cutter laboratory after 10 and 11 years' function shows practically no deterioration of the prosthesis. The low incidence of thromboembolism, the absence of haemolysis and long-term deterioration of the prosthesis are particularly valuable characteristics of this prosthesis in the aortic position.

[Pseudotumor of the right atrium caused by hernia of the valve of Vieussens]. / Pseudo-tumeur de l'oreillette droite par hernie de la valvule de Vieussens.

A round swelling was on the substraction films of the right side of the heart taken during angiocardiographic examination of a patient with mitral valve disease; this suggested a mass attached to the inter-atrial septum, and prolapsing into the auricle of the right atrium. Initial diagnsosi was of atrial thrombosis, but this was disproved at operation. An aneurysm of the membrane of the fossa ovalis was found, being caused by overstretching of the auricle of the left atrium under the increased pressure of the valve defect. The aneurysm was resected and the septum simply repositioned as part of the mitral valve replacement. A search of the literature shows how rare this disorder is, and that it should be reclassified with the abnormalities of the inter-atrial septum which are found only rarely in cases of mitral valve disease.

[Reinforcement cerclage of dystrophic aortic rings]. / Cerclage de renforcement dans les dystrophies de l'anneau aortique.

Reinforcement of a dystrophic aortic ring with a purse string suture makes it possible to obtain perfect coaptation between prosthesis and ring whilst inducing sclerosis. The technique described here was used by the authors in 30 patients operated upon since June, 1980, and none of these needed reoperation for leakage. These results contrast most favourably with those previously obtained in similar anatomical conditions with conventional prosthesis insertion.

[Presternal ileum and right colon for benign esophageal stenosis. Very long-term checking]. / Iléo-côlon droit présternal pour sténoses oesophagiennes bénignes. Contrôles à très longue échéance.

Long-term follow up results are analyzed of 10 patients treated by pre-sternal right ileocolic grafts for an esophageal stenosis of a benign nature. Operation in 7 cases had been performed 28 (1 case), 26 (2 cases), 19 (1 case), 16 (1 case), 11 (1 case) and 6 (1 case) years previously. Functional results were generally very satisfactory. Two cologastric anastomotic ulcers were heated by coloduodenal and colojejunal reimplantation respectively. One patient operated upon for stenosis due to chemicals developed malpighian cancer of the cervical esophago-ileal anastomosis 12 years later, but secondary malnutrition did not occur following a gastric bypass operation. Although overall functional results could be considered as very satisfactory, there is a risk of anastomotic cologastric ulcers developing (2 cases), but the risk can be eliminated by routine implantation of colon into duodenum or jejunum. The gastric bypass achieved failed to produce any clinical manifestations in patients operated upon, some of whom have been followed up for nearly 30 years.

[Cancers of the thoracic esophagus in gastrectomized patients. Technical problems]. / Cancers de l'oesophage thoracique chez les gastrectomisés. Incidences techniques

The authors report three cases of carcinoma of the thoracic part of the esophagus who had previously undergone gastrectomy. They study, in the absence of a stomach, the possibilities of restoration of digestive continuity after esophagectomy and describe three possibilities: -- mobilisation and use of the remaining gastric stump; --esophageal resection and anastomosis restoring continuity; -- colonic interposition. Of the three procedures used, only the first and last are advised by the authors.

[Pre-operative irradiation in the treatment of cancers of thoracic esophagus]. / L'irradiation pré-opératoire dans le traitement des cancers de l'oesophage thoracique

The authors analyse an homogeneous series (2 operators) of 650 patients operated on for thoracic oesophageal carcinoma, of which 185 were submitted to pre-operative irradiation with cobalt. Irradiation led to a definite increase in the resectability rate 74 p. 100 as against 62 p. 100. There was an increase in the mid-term survival rate, especially an increase of 5 p. 100 at 2 years, 8 p. 100 at 3 years, 6 p. 100 at 4 years; The 5 survival rate was little modified. It was 12 p. 100 for 290 cases, resection alone, and 15 p. 100 for 137 resections after irradiation.

Evaluating physical activity: the AQAP questionnaire and its interpretation software.

OBJECTIVES: Updating Baecke physical activity questionnaire in French, validating this version named AQAP and developing software for a personalized interpretation of the results. METHOD: Validation conducted on 702 consultants in health prevention centers aged 18-79 years: reliability of the questionnaire when self-administered, validity according to the energy expenditure per interview and reproducibility after two weeks (n=31). After two months, assessment of the questionnaire's impact on knowledge and behaviors in 320 young adults aged 18-29 years. RESULTS: The results from self- and interviewer-administered questionnaire were correlated (Kappa>0.60). Furthermore, the total physical activity index was correlated to the energy expenditure (rho=0.39, P<0.0001). The four physical activity indexes calculated from self-administrated questionnaires barely varied at the two-week interval (P ≥ 0.23, power ≥ 77%, accepted difference ± 10%). Two months later, 80% of the participants had read the interpretation software report, 55% became conscious of their physical activity level, 43% increased their physical activity level and 42% reported being aware of the relationship between physical activity and health. CONCLUSION: AQAP characteristics are satisfactory and thus this questionnaire can be used on the general population in complement of an individual or collective action to promote physical activity and in epidemiological studies for analyzing the links between individual behaviors and health.