Detection of a gliotoxic activity in the cerebrospinal fluid from multiple sclerosis patients.

We recently showed that peripheral blood cell supernatants from multiple sclerosis (MS) patients, containing reverse transcriptase activity and retroviral RNA from the newly human identified multiple sclerosis retrovirus (MSRV), also secrete a cytotoxin which induces death of primary mouse cortical glial cells. We have hypothesized that macrophages could release this cytotoxin in the cerebrospinal fluid. The cerebrospinal fluid cytotoxicity from 166 patients with various neurological diseases (including MS patients) was tested on glial cells in vitro. Our bioassay shows that a glial cytotoxic activity is significantly present in cerebrospinal fluid from patients with relapsing-remitting MS at relapse. Since this cytotoxic activity seems to correlate with active cases of MS, it may represent a critical pathogenic factor in the neuropathology of MS.

Devic's neuromyelitis optica: a clinicopathological review of the literature in connection with a case showing fatal dysautonomia.

A new clinicopathological case of Devic's neuromyelitis optica, including unusual predominant clinical features (fatal dysautonomia) is described herein: pathological examination showed extensive and severe demyelination mainly involving the optic nerves, the medulla, and spinal cord, which was particularly pronounced in the thoracic segments, and thus explained the unusual vegetative symptomatology. In a review of 45 clinicopathological cases described in the literature as Devic's disease (DD), it turned out that only 22 cases, including the patient described here, fulfilled the recently defined diagnostic criteria [Devic 1980]. Among the other 23 cases, 15 did not fulfill the criteria because of the occurrence of relapses, 3 others had 2 separate pathological locations within the spinal cord, and the remaining 5 showed evidence that a disease other than DD was involved. Among the 22 cases which were definitely taken to be DD, the mean age at clinical onset was 39 years (+/- 14); it was characterized by acute bilateral visual loss and transversal myelitis which gradually led either to death or to partial or complete recovery. The pathological lesions, which mostly were located along the optic tracts and the spinal cord, were characterized by demyelination with inflammation and necrosis; in some cases the pathological process diffused into the medulla (8/22 cases) or the whole brainstem (4/22 cases). The cavitation of the spinal cord was not a key feature of the diagnosis, since it was observed on only 9/22 cases. Devic's neuromyelitis optica may be a separate nosological entity which differs from multiple sclerosis.

[A case of Influenza virus encephalitis in south of France]. / Un cas d'encéphalite grippale dans le sud de la France.

INTRODUCTION: Influenza virus outbreaks occur each year, in France, during autumn and winter. Influenza-associated acute encephalitis were reported during epidemics or pandemics. Sporadic cases are rarely identified probably because influenza virus is not searched among etiology of febrile encephalitis. EXEGESIS: We report a case of influenza-associated encephalitis complicated by adrenal insufficiency in a young woman. Diagnosis was based on seroconversion of serum influenza virus A antibodies (complement fixation test). Follow up of the patient showed a total recovery. CONCLUSION: Influenza must be searched for any febrile encephalitis occurring during winter. Reverse transcriptase polymerase chain reaction (RT-PCR) on cerebrospinal fluid should be assessed. It is not actually a routine technique and we do not know yet if it is accurate enough for diagnosis. So, it is important to identify influenza virus and obtain documentary evidence concerning neurological impairment. Nevertheless, a better understanding of pathogenesis and use of vaccination are needed to improve prognosis.

[Polycystic liver. Is Lin's operation still justified?]. / Polykystose hépatique. L'intervention de Lin est-elle encore justifiée?

Eleven patients with by polycystic liver disease were operated according to Lin's procedure. All cases were symptomatic forms. Sonography was diagnostic examination in 9 cases. Lin's procedure was not associated with any postoperative mortality or morbidity and no recurrences were observed after an average follow up of 4 years. Rarely, a feminale predominance and association with polycystic kidney disease are noted. Sonography establishes the diagnosis and reveals complications (most intracystic bleeding frequently). Lin's procedure is better than sonographic aspiration which must be repeated and can be complicated by severe infection. Operative aspirative drainage is necessary. Hepatectomy is rarely justified.

[The saphenous flap called the Acland's flap. Report of 2 cases]. / Le lambeau saphène dit lambeau d'Acland. A propos de deux cas.

The authors present two cases of Acland's flap. This flap described and published in 1981, is a very good flap, but the myocutaneous flaps have limited its use. However, the authors believe that there are indications for this saphenous flap. The vascular supply for this flap is a saphenous artery, the last branch of the femoral artery, before it becomes the popliteal artery. The authors report two cases: one neurovascular island flap for the posterior side of the knee, and the other case is a free flap for forearm. This flap is part of a particularly rich arterial network on the medial side of the thigh and of the knee. Masquelet, in 1986, showed that it is possible to raise a periosteal flap or a vascularized tendon flap.

[Is it necessary to continue to reimplant all or part of the terminal phalanx of the finger? Apropos of a homogenous series of 38 cases (35 patients)]. / Faut-il continuer à replanter tout ou partie de la dernière phalange des doigts? A propos d'une série homogène de 38 cas (35 patients).

The authors present their experience with the very distal reimplantations: an homogenous series of 38 cases is presented. G. Foucher at SOS Mains Strasbourg showed this technique to the authors in 1980. The authors present their technique, which is adapted with the level of distal amputation, then their postoperatively attitude is presented in detail, particularly for "the bleeding maintained" and for the iterative surgery when necessary. Then the failures are precised. Finally functional results are studied: mobility is often good, sensibility is precised with the Weber test, cold pain is frequent, stop of work average is two months. Finally unsatisfactory nail and distal tip are precised.

[Bundled wiring in fractures of the neck of the fifth metacarpal. 5 cases]. / L'embrochage fasciculé en bouquet dans les fractures du col du cinquième métacarpien. A propos d'une série de cinquante cas.

By reviewing a series of 50 patients operated on using the Foucher technique for a closed isolated fracture of the neck of the fifth metacarpal bone, the authors determine efficiency of this surgical technique which gives satisfactory results when the operation performed is early enough (before 10 days). They explain the modification of the technique, insisting on the importance of a post-operative follow-up which guarantees a good result and they propose other surgical indications whether they concern fractures of the neck of the fifth metacarpal bone with a relatively small displacement, mainly in young subjects and labourers or indications concerning special cases.

Pleuropulmonary changes induced by ergoline drugs.

Classic ergolines, such as bromocriptine, methysergide and ergotamine, can induce chronic pleuropneumonitis. We present the cases of eight patients who developed similar changes whilst on other ergolines. In this retrospective case study spanning 1985-1995, clinical data, radiological material, pulmonary function, bronchoalveolar lavage and histopathology were reviewed. Earlier literature on ergoline-induced pleuropulmonary changes was reviewed. Eight middle-aged to elderly individuals of both sexes developed pleuropulmonary changes during long-term therapy with regular dosages of nicergoline (n = 4), dihydroergocristine (n = 3), or dihydroergotamine (n = 1). Bibasilar pleural thickening with or without pleural effusion was present on chest radiographs and computed tomographic (CT) scans in six cases. Increased erythrocyte sedimentation rate was seen in most. Pure interstitial pneumonitis developed in two patients on dihydroergocristine and was reversible in each. Bronchoalveolar lavage was performed in four cases and was abnormal in all, but demonstrated no consistent pattern. Most patients exhibited lung restriction. The outcome was favourable showing slow improvement in all cases following discontinuation of the ergoline. Slight residual pleural thickening was seen in five out of the six cases with pleural involvement. Nicergoline and dihydroergotamine can induce a syndrome of chronic pleural thickening/effusion that slowly improves after drug withdrawal. Dihydroergocristine can induce reversible interstitial pneumonitis.