[Vitamin D and multiple sclerosis. A prospective survey of patients of Poitou-Charentes area]. / Vitamine D et sclérose en plaques. Étude prospective d'une cohorte de patients de la région Poitou-Charentes.

INTRODUCTION: Recent reports demonstrate the implication of vitamin D in multiple sclerosis (MS). METHODS: In a multicentric regional study (Poitou-Charentes area) during the first trimester 2010, we measured the 25-OH vitamin D serum level in 170 consecutive MS patients, and in 170 controls matched for age (±4 years), sex and date of blood sample analysis. We searched for correlations between 25-OH vitamin D serum levels and the MS form, the disability (EDSS), the relapse rate during the previous year and the presence and number of enhancing lesions on T1-weighted MRI dating less than 12 months in relapsing MS. RESULTS: Hypovitaminosis D was very frequent in MS patients and 25-OH vitamin D serum level was significantly lower (14.5 ± 9.2 mcg/mL) in MS patients than in the control group (16.7 ± 9.6 mcg/mL). This serum level was inversely correlated with the degree of disability measured with EDSS score and was lower in secondary progressive (RR-SP) and primary progressive (PP) MS than in relapsing MS (RR). No correlation was found between 25-OH vit D serum level and relapse rate during the previous year in RR MS and the presence and number of enhancing lesions on T1-weighted MRI dating from less than 12 months. CONCLUSION: 25-OH vit D serum level is very low in MS, mainly in RR-SP and PP MS and is correlated with disability. This suggests MS patients should be screened for vitamin D deficiency and given supplementation systematically when hypovitaminosis D is discovered.

[Multiple sclerosis: immunomodulators, education, and self-injection]. / Sclérose en plaques: immunomodulateurs, éducation et auto-injection.

One hundred and sixty four patients of the Poitou-Charentes area suffering from multiple sclerosis (MS) and treated with an immunomodulating agent for more than 3 months completed a self-administered questionnaire. More than 60p.cent of the patients performed self-injection. For both modes of injection studied (subcutaneous or intramuscular), self-injection was significantly more frequent among patients who were received training and followed via telephone assistance conducted by a nurse with specialized training in MS. Our study demonstrated that waste disposal (needles), especially among patients performing self-injections, remains an important problem. Efforts must be taken concerning this important healthcare issue.

Granular cell tumor of the pituitary stalk. Case report.

The case is described of a granular cell tumor of the pituitary stalk in a 40-year-old woman with secondary amenorrhea. A computerized tomography scan showed a large contrast-enhancing mass, and T1-weighted magnetic resonance images demonstrated a tumor isointense to the brain parenchyma with nonhomogeneous enhancement after intravenous administration of gadolinium diethylenetriamine penta-acetic acid. Histopathological examination, especially immunocytochemical and electron microscopic studies, showed elements supporting an astrocytic origin for this type of tumor, a hypothesis advanced by many authors but still controversial.

Aspergillosis of ethmoid sinus and optic nerve, with arteritis and rupture of the internal carotid artery.

A 54-year-old woman had been treated 26 years previously for Hodgkin's disease. Eight months before presentation, the disease had recurred and the patient had received cytotoxic drugs and steroids. She presented with loss of vision of the right eye and died 5 months later from extensive subarachnoid hemorrhage. Postmortem examination revealed an aspergillus abscess of the ethmoid sinus, extending to the right frontal lobe and optic nerve, and to the wall of the right internal carotid artery (ICA). Death was due to rupture of the ICA. Such a presentation of aspergillosis is unusual. Three cases of aspergillus arteritis causing rupture of the ICA have been reported previously.

Minimal focal dermal hypoplasia in a man: a case of father-to-daughter transmission.

Focal dermal hypoplasia is a rare genetic disorder characterized by diffuse and specific cutaneous lesions. Multiple visceral abnormalities are frequently associated. A minimal form of the disease (only cutaneous and localized to one thigh) is reported in the father of a woman who had typical focal dermal hypoplasia.

Migraine and angina pectoris by coronary artery spasm.

A migrainous patient who experienced chest pain attributed to angina pectoris by coronary artery spasm during a migraine attack is reported. Previous reports have already mentioned the association of these two conditions and suggested that it might be the manifestation of a generalized vasospastic disorder. This new report offers an opportunity to review and discuss the available data on such an association.