[Emphysematous pyelitis and pyelonephritis: unrecognized clinical entities]. / Pyélite et pyélonéphrite emphysémateuses: entités cliniques méconnues.

A case of emphysematous pyelitis occurring in an old diabetic woman is described. The data of the literature about the pathologic agents, the epidemiology and the physiopathology of the disease are reviewed. The approach for diagnosis and the therapy are discussed.

Further observations showing the impact of the probenecid test in movement disorders.

Two patients with movement disorders are described and neurochemically studied. The first subject concerns a central anticholinergic syndrome in a 83 years old man treated with l-dopa and amantadine for red nucleus tremor. The second one is an association of parkinsonism and chorea in a 76 years old woman presenting with FAHR's syndrome. In both cases, CSF HVA levels were measured before and after oral probenecid load. The observations confirm the usefulness of this neurochemical strategy in order to classify aging patients with parkinsonism into dopasensitive and doparesistant groups.

[Aging and cerebral vascular sclerosis: myth or reality?]. / Vieillissement et sclérose vasculaire cérébrale: réalité ou utopie?

The most important aspects of normal and pathological brain ageing are considered from a structural, cellular, hemodynamical, chemical and clinical point of view. It seems admitted that cerebral blood flow and cerebral consumption for oxygen decrease with age but when severe health criteria are used to select normal old subjects, no significant differences exist between normal young and optimally healthy elderly. The question arises whether the blood flow reductions are responsible for the alterations in metabolism, or whether it is simply an autoregulatory response to the lesser metabolic demands of the tissue. The part of cerebral arteriosclerosis is questioned on cerebral flow drop accompanying clinical signs in senile mental impairment. Among some cardiovascular risk factors, hypertension seems to play a leading part in acute and chronic neurological diseases associated with age and with certain types of senile dementia (multi-infarct). However in all other cases, hypertension and cerebral vascular insufficiency, for all that this syndrome exists, seem to have been overestimated to explain chronic senile brain deterioration.

[Ageing and cerebral vascular sclerosis: myth or reality? (author's transl)]. / Viellissement et sclérose vascularie cérébrale: réalité ou utopie?

The most important aspects of normal and pathological brain ageing are considered from a structural, cellular, hemodynamical, chemical and clinical point of view. It seems admitted that cerebral blood flow and cerebral consumption for oxygen decrease with age but when severe health criteria are used to select normal old subjects, no significant differences exist between normal young and optimally healthy elderly. The question arises whether the blood flow reductions are responsible for the alterations in metabolism, or whether it is simply an auto-regulatory response to the lesser metabolic demands of the tissue. The part of cerebral arteriosclerosis is questioned on cerebral flow drop accompanying clinical signs in senile mental impairment. Among some cardiovascular risk factors, hypertension seems to play a leading part in acute and chronic neurological diseases associated with age and with certain types of senile dementia (multi-infarct). However in all other cases, hypertension and cerebral vascular insufficiency, for all that this syndrome exists, seem to have been overestimated to explain chronic senile brain deterioration.

[Use of the probenecid test for the diagnosis and treatment of Parkinsonism. Review of the literature and personal experience (author's transl)]. / Apports du test au probénécide au diagnostic et à la thérapeutique des parkinsoniens. Revue de la littérature et études personnelles.

After describing the clinical picture of Parkinsonism, other Parkinson and depressive syndromes, the authors clarify ascending dopaminergic and serotoninergic pathways in the central nervous system as well as current knowledge on the nigro-striatal pathway. They also underline the interest of the probenecid test in the diagnosis of Parkinsonsism with or without depression. Neurochemical criteria of dopa-sensititivy and dopa-resistance are proposed as well as criteria aimed at serotoninergic therapy. Finally, the use of this neurochemical test in treatment and follow up is illustrated by a clinical case report.

Comparative study of the clinical effects of vincamine + glycerol versus glycerol + placebo in the acute phase of stroke.

The treatment of the acute phase of stroke creates a difficult problem to the clinician. The presently used drugs lead to controversial results. The progress in knowledge of the pathogenesis of cerebral damage underlines the determinant role of the metabolic deficits in the ischemic areas. The effect on the clinical symptomatology of patients in the acute phase of stroke was studied during a double-blind comparative clinical trial with an alcaloid of Vinca minor (Pervincamine) which acts favorably against disturbances of oxydative glucose metabolism and of cerebral microcirculation. 20 patients divided into two homogeneous groups received during 5 days either Pervincamine (4 ampoules of 3 ml = 60 mg vincamine p.d.) + glycerol, or glycerol + placebo administered by i.v. infusion. Clinically the results indicate a greater improvement of the neurological status (objectivated by a neurological scale) with vincamine treatment than with placebo. Statistically the analysis confirms the highly significant effect of vincamine on motility of lower and upper limbs (p less than 0.02) and the significant effect on cranial nerves (homonymous hemianopsia and conjugated deviation of eyes) (p less than 0.05) and on the sphincter control level (p less than 0.05).

Cerebral vasoreactivity in senile dementia.

A group of clinical senile dementia patients underwent a series of cerebrovascular examinations. Some of them were standard examinations (fundus oculi, electroencephalogram, rheoencephalogram, cerebral angiogram and pneumonencephalogram) while the others were studying regional cerebral blood flow (rCBF) and modification of flow under fonctional tests (hypercapnia, hypocapnia and intravenous injection of 50 mg chl. papaverine) using the 133Xe clearance technique. The senile dementia group (III) was compared with 'normal' old patients group (I) and with patients suffering from sequelae of a previous stroke or from minor mental disorders (group II). Elderly subjects regarded as 'normal' often present alterations in usual vascular examinations but reveal a relative integrity of cerebral autoregulation. Some patients considered irreversibly 'sclerotic' still have a good grey matter flow (r1CBF) with real vasomotor possibilities. In each of the three groups of elderly subjects, there seemed to be a lack of correlation between the clinical symptoms and certain specific vascular examination.

Comparative study of cerebral vasoactivity in vascular sclerosis of the brain in elderly men.

Thirty-five elderly patients underwent a systematic series of cerebrovascular examinations. The patients were divided into three groups on the basis of clinical criteria: normal patients (Group 1), patients with sequelae of a previous stroke or with minor mental disorders (Group 2), and patients with arteriosclerosis dementia (Group 3). The vasomotor reactions of the cerebral arteries were investigated by estimating regional cerebral blood flow (133Xe clearance technique). The authors emphasize the existence of cerebral vasoreactivity in subjects with clinical symptoms of senile dementia. Furthermore, in each of the three groups of elderly patients, there seemed to be a lack of correlation between the clinical symptoms and certain specific vascular examinations.

[Quantitative rheoencephalographu in normal and pathological ageing (author's transl)]. / La rhéoencéphalographie quantitative dans le vieillissement normal et pathologique

A method of quantitative rheoencephalography estimating the rapid cerebral blood flow, defined by the clearance of Xe 133 is applied to normal, hemiplegic and demented subjects. In the normal child the flow is twice that of the elderly. In adults a decrease of 13% is observed in the fifties. The flow is decreased in both hemispheres of the hemiplegics. The cerebral flow is decreased in the two clinical groups of demented patients (vascular and non-vascular); different values of flow are obtained in these two groups.