Demonstration of the metaphylactic use of gamithromycin against bacterial pathogens associated with bovine respiratory disease in a multicentre farm trial.

On five commercial cattle rearing sites across Europe, a total of 802 young cattle at high risk of developing bovine respiratory disease (BRD) associated with the bacterial pathogens Mannheimia haemolytica or Pasteurella multocida and/or Mycoplasma bovis were enrolled into a multicentre, controlled field trial. Half were treated with a single dose of gamithromycin at 6 mg/kg bodyweight by subcutaneous injection and half received an injection of a saline placebo as the control. All animals were observed daily for 14 days for signs of BRD as defined by set criteria. The proportion of metaphylactic preventive treatment successes, defined as animals surviving to day 14 without signs of BRD, in the gamithromycin-treated group (86 per cent) was significantly (P=0.0012) higher than in the saline-treated controls (61 per cent). Morbidity among the treated animals was reduced by 64 per cent compared with the controls.

Splenic abscess secondary to a colosplenic fistula in Crohn's disease.

Colosplenic fistula associated to splenic abscesses is a rare condition in Crohn's disease (CD). Diagnosis is difficult and a computed tomography (CT) scan is helpful. Treatment includes surgical procedure. Atypical locations of fistulas and abscesses should not be overlooked in CD.

Serum crosslaps in comparison to serum osteocalcin and urinary bone resorption markers.

In this study we evaluated the routine practice and clinical application of serum crosslaps to urinary-crosslaps, -N-telopeptide-related fraction of type 1 collagen, -deoxpyridinoline, -totalpyridinoline and serum osteocalcin. The utility of both the serum and urine immunoassays for bone formation and resorption marker were tested in a cohort of 593 female and male patients from our outpatient clinic for osteology and rheumatology and compared to important osteoporosis risk factors like age, gender, E2 deficiency, bone density and chronic renal failure. The biochemical maker of bone formation, serum osteocalcin exhibit significant correlations to all five tested serum and urinary markers of bone resorption (p < 0.0001) crosswise to all different groups of patients. The group of chronic renal failure patients showed no significant correlation between the tested bone turnover parameters and the serum creatinine level except a significant increase and correlation for serum crosslaps and for the ratio of serum and urinary crosslaps. Associations between the age of the patients and the markers of bone turnover were rather poor. We found a significant, negative association between serum and urinary bone turnover markers and bone density and were interested, whether in patients with bone density < 2.5 SD an enhanced bone turnover could be detected in the same way as for E2 deficiency. Applying a discriminant analysis it was possible to discriminate between the patient with BD < 2.5 SD and those with BD > 1.0 SD with a sensitivity of 70% and a specificity of 65% using serum crosslaps. In case of urinary crosslaps the discriminatory power was slightly lower (sensitivity: 65.6%, specificity: 67.5%) and for serum osteocalcin the discriminatory power was negligible higher (sensitivity: 79%, specificity: 56%). The highly significant correlation between the urinary and serum crosslinked peptides by ELISA and serum osteocalcin supports the concept that these respective indices of bone formation and resorption both in urine and serum reflect a coupled process in vivo with sensitivity and specificity to pathological bone density, estrogen deficiency and chronic renal failure.

Serum osteocalcin and urinary crosslaps are suitable markers of bone turnover in response to short-term hormone replacement therapy.

In this study we evaluated the effect of short-term hormone replacement therapy (HRT) on bone formation (serum osteocalcin) and resorption markers (urinary type I collagen peptides (crosslaps), urinary total free pyridinoline (TPYRI) and urinary free deoxypyridinoline (DPYRI)) as well as female sex hormones (serum estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH)) in a group of early postmenopausal women with severe estrogen deficiency. The 46 healthy postmenopausal women with serum estradiol levels < 10 ng/l were subsequently divided into two groups, according to their compliance with HRT. In the group taking HRT significant changes from baseline values could be observed in estradiol, FSH, urinary crosslaps and serum osteocalcin levels after 6 months, whereas no changes could be observed in LH, TPYRI and DPYRI from baseline values. In the group which refused HRT all values were increased relative to baseline values, indicating increased bone turnover. Serum osteocalcin and urinary crosslaps were significantly decreased in women taking HRT in comparison to the group refusing HRT. After 6 months the treated patients showed a decrease in urinary crosslaps of 42% (SD 12%) and in serum osteocalcin of 24% (SD 6%) in comparison with baseline values. In patients who refused HRT, urinary crosslaps were increased by 43% (SD 20%) and serum osteocalcin levels decreased by 2% (SD 9%) compared to baseline values. In postmenopausal women suffering from severe estrogen deficiency (estradiol < 10 ng/l) serum osteocalcin and urinary crosslaps are significantly increased, indicating a clear correlation between estrogen deficiency and an increase in bone resorption as well as bone formation. The recommended HRT dose was sufficient to reduce the rate of bone turnover to premenopausal values. Serum osteocalcin and urinary crosslaps are suitable candidates not only for the assessment of a high postmenopausal bone turnover, but also for monitoring the response to and for verifying the actual intake of HRT or other antiresorptive treatment.

Association between female sex hormones and biochemical markers of bone turnover in peri- and postmenopausal women.

In an epidemiological study, markers of bone formation (serum osteocalcin and C-terminal propeptide of type I collagen) and bone resorption [urinary type I collagen peptides (Crosslaps), urinary total pyridinoline (TPYRI), urinary deoxypyridinoline (DPYRI) as well as female sex hormones (serum estradiol)], follicle-stimulating hormone (FSH) and luteinizing hormone were measured in 237 women. This cohort aged 44-66 years, came for their first medical examination since menopause to the outpatient menopause clinic at the Kaiser-Franz-Josef-Hospital, Vienna. The women were all 0.5-5.0 years since cessation of menses and were not taking medications other than hormone replacement therapy [52 cases, 21.9%)] and had no diseases known to affect bone and mineral metabolism. The best correlation was found between urinary DPYRI and urinary TPYRI (r = 0. 63, P = 0.0001), followed by urinary Crosslaps and urinary DPYRI (r = 0.47, p = 0.0001). Only weak but significant correlations between E2 and urinary Crosslaps (r = -0.21, P < 0.0001) as well as serum E2 and serum osteocalcin (r = -0.16, P = 0.0007), were observed. Of the 237 women 53% suffered from a severe E2 deficiency (E2 < 10.0 ng/liter). In these patients, urinary Crosslaps (+48%) and serum osteocalcin (+22%) were significantly higher (P < 0.0001) compared with those patients with E2 levels > 10 ng/liter. Women with E2 levels >10 ng/liter were further subdivided into those with and without sex hormone replacement therapy, whereby no statistical differences in any of the biochemical markers could be observed between these groups. We could clearly demonstrate that in postmenopausal women suffering from severe E2 deficiency (E2 < 10 ng/liter), urinary Crosslaps and serum osteocalcin are significantly increased, indicating in principle a clear correlation between E2 deficiency and these markers of bone turnover.

Occupational environment as risk factor for unemployment in multiple sclerosis.

INTRODUCTION: Few studies have examined the factors of occupational environment related to unemployment in multiple sclerosis (MS). MATERIAL AND METHODS: A case control-study was carried out. Cases were patients unemployed for less than five years before the study (n = 77); controls were patients currently employed (n = 94). The odds ratios of the relationship under study adjusted for sex, age, disease form and educational level, were estimated. RESULTS: Employment in the public sector, sedentary jobs and possibility of obtaining specific improvements in the work environment were found to be protective factors, while jobs needing force, rigid work schedule, manual precision, frequent moves and a daily work duration over 8 h were found as risk factors. Multivariate analyses showed that the only remaining factors were public sector jobs as protective factor (OR = 0.4), and strenuous work as risk factor (OR = 4.5). Factors were slightly different in male and female patients. CONCLUSION: This study suggests that simple and early changes in the occupational environment could maintain MS patients at work.

Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients.

The relationship between pregnancy and multiple sclerosis (MS) was assessed in a clinic-based, prospectively followed, population of 125 patients with a remittent onset of MS who had been followed for a mean (SD) of 10.3 (0.1) years. Thirty three women had a total of 49 pregnancies of which 32 had been full term and 17 terminated. There was a three-fold increase in the relapse rate per year during the first three months following delivery, compared with the baseline period of the same patients [1.62(0.38) vs 0.51(0.08) p = 0.05]. During pregnancy itself, the relapse-rate was not different from baseline. The overall relapse rate of the pregnancy group was lower than that of a control group without pregnancies after MS onset, but similar to that of patients who had children after MS onset, but no pregnancy during follow up. Pregnancy did not lead to increased disability. These results confirm that post partum increase in relapse rate is the main event related to pregnancy in MS and underline the difficulties of undertaking prospective studies in this field.

[Münchhausen syndrome. A study of 8 cases of neurologic manifestations]. / Le syndrome de Münchhausen. Etude de 8 cas à expression neurologique.

Eight cases of Münchhausen syndrome were registered within two years in two hospital neurological departments. Summaries of their clinical history were obtained following an enquiry in 58 hospitals of Paris and suburbs. All patients met Asher's description for the emergency presentation, the truculence-evasiveness manner, the luxuriance of tales, the eclecticism of the alleged symptoms, the vehement request of dangerous or painful procedures and the apparent senselessness. The paucity of scars and modesty of peregrinations recorded are discussed, as well as the lack of self-inflicted injury. Ethical implications and traps set by these tricky patients against consistent medical strategies are developed.

Infarction in the territory of the medial branch of the posterior inferior cerebellar artery.

We report 10 cases of cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA). Axial sections on MRI through the middle of the medulla and the cerebellum showed the infarction as a triangular area with a dorsal base and a ventral apex directed towards the fourth ventricle. The infarct also involved the lateral and dorsal medulla when the mPICA supplied all or part of these regions. Three clinical patterns were observed: 1) pseudolabyrinthine signs with or without dysmetria and ataxia when the medulla was spared; marked axial lateropulsion was present in most cases; 2) complete or incomplete Wallenberg's syndrome, when the medulla was involved; 3) silent infarction. These syndromes are precisely those previously attributed to PICA occlusion without distinction of the branch involved. No alteration of consciousness was recorded and spontaneous recovery was the rule. Cerebellar infarction in the distribution of the mPICA can be regarded as a benign condition with a good prognosis.

Vermal infarct with pursuit eye movement disorders.

Severe deficits of foveal smooth pursuit and optokinetic nystagmus in all directions were electro-oculographically recorded in an 80 year old woman. Magnetic resonance imaging (MRI) showed an infarct involving the postero-inferior part of the vermis (lobules VI to X) and a portion of the left cerebellar hemisphere, with apparent preservation of the flocculus and the brainstem. The role of the vermal lesion in these pursuit eye movement disorders is discussed.

[Lateral inferior pontine infarction: 2 clinical aspects]. / Infarctus pontin inférolatéral: deux aspects cliniques.

Cases of lateral inferior pontine infarction are rare in the literature. We report two cases with MRI correlations. One involved the whole territory, the other the tegmental area only. Both also involved the middle cerebellar peduncle and one of them the adjacent lobules of the cerebellum. The first case emphasizes the classical alternate syndrome. The second case shows that acute vertigo mimicking a labyrinthine lesion can occur when involving the territory of the anterior inferior cerebellar artery.

Nonathymulin treatment of multiple sclerosis: double-blind pilot study.

We carried out a randomized, double-blind, placebo-controlled trial of Nonathymulin (NT, synthetic serum thymic factor) in patients with evolutive multiple sclerosis (MS) and moderate disability. Forty matched patients were treated with subcutaneous NT or placebo for 6 months and followed for another 6 months. There was no significant difference in treatment and control groups in the Kurtzke. Disability scores, Ambulation Index and Functional Scale. No significant side effects were recorded. NT is not effective in treating evolutive and moderately disabled MS.

[Late neurosyphilis: a current disease]. / Neurosyphilis tardive: maladie d'actualité.

We report 7 cases of neurosyphilis observed over a 13-month period in a Parisian University Hospital. Four patients had meningo-encephalitis and 3 had arteritis with meningitis. Serology for the human immuno-deficiency virus was negative in all cases. The problems raised by the interpretation of serological data are discussed and the criteria of progressive neurosyphilis are underlined.

[The Minimal Record of Disability and multiple sclerosis. Results of the evaluation of 200 patients]. / Echelle Minimale d'Invalidité et sclérose en plaques. Résultats de l'évaluation de 200 patients.

The Minimal Record of Disability (MRD) for Multiple Sclerosis (MS) evaluates impairment in MS through 4 sets of data: Demographic Data, Kurtzke Disability Status Scale (DSS), Incapacity Status Scale (ISS) and Environmental Status Scale (ESS). We assessed with the 1985 version of MRD 200 consecutive patients attending our MS clinic during a 6 months period. 170 were out-patients and 30 inpatients. Diagnosis was definite in 197 and probable in 3. ESS and ISS were rated by a medical student according to a planned interview. The validity and internal consistency of DSS, ISS and ESS were evaluated by dependence analysis of each item to the sum of all items, and multivariate analysis was carried out on the first 15 items of ISS. Main clinical data were: age 43.0 +/- 11.8 years; age at onset of MS: 27.3 +/- 10.3; sex ratio (F/M): 1.75/1; mean DSS score: 4.6 +/- 0.1. Administration of MRD was easy and general acceptance was good. Some refinement in wording is needed for 5 items of ISS--mainly for "mood and thought disturbances" and "mentation" which do not score adequate mood and intellectual impairment in MS--and for 2 items of ESS. These 2 scales are otherwise of practical use and cover all the area of disability and handicap in MS. The levels of internal consistency of DSS, ISS and ESS are high, as well as correlations between the 3 scales (p less than 0.001). Correlations with age and duration of MS were established for total scores of DSS but not ISS and ESS. Our data confirms the validity of MRD as an evaluation tool of MS patients; they show that MRD can be applied with minor modifications to MS patients and support its use in therapeutic trials, rehabilitation and socio-economic inquiries.

Oculo-facio-skeletal myorhythmia as a cerebral complication of systemic Whipple's disease.

A fifth case of oculomasticatory myorhythmia associated with cerebral Whipple's disease is reported. This peculiar abnormal movement has never been described in association with cerebral dysfunction other than Whipple's disease. The present case exhibited rhythmic convergence of the eyes and synchronous (1-2 Hz) contractions of the masticatory muscles and of the proximal and distal skeletal muscles. These abnormal movements occurred 13 years after the beginning of the disease. They were persistent and unchanged until the death of the patient 3 months later. No treatment was effective to suppress the involuntary movements (clonazepam, baclofen, antibiotics). Associated neurological signs included global supranuclear ophthalmoplegia, facial weakness, bilateral ptosis, absent gag reflex, and intellectual deterioration.