Neonatal transient hypophosphatemic hypercalciuric rickets in dizygous twins: A role for maternal alendronate therapy before pregnancy or antireflux medications?

BACKGROUND: Bisphosphonates (BP) are sometimes used in children and young women, but their use requires expertise and caution due to the relative lack of long-term efficacy and safety data. CLINICAL CASES: We report on two dizygotic male twins with a past of mild prematurity who presented at the age of 2 months with moderate clinical craniotabes, hypophosphatemia, normal circulating calcium, severe hypercalciuria, and low parathyroid hormone levels. Following supplementation with oral phosphorus and native vitamin D, the clinical and biological abnormalities disappeared within 2 months. Since the twins were dizygotic and were identical in terms of clinical presentation and progression, the only likely explanation for these transient mineral abnormalities was prenatal or neonatal exposure to a toxic agent. Taking into account their medical past, two drugs were possibly involved: either oral alendronate that their mother had received before pregnancy for misdiagnosed osteoporosis or antireflux medications, or both. DISCUSSION: We believe that these two cases could correspond to the first description of a potential mother-to-fetus transmission of alendronate, inducing early and transient hypophosphatemic rickets, the clinical picture being worsened by the antireflux drugs impairing intestinal phosphate absorption. For pediatric rheumatologists, this raises the question of more clearly defining the indications for BP in female children and teenagers; for rheumatologists, this also demonstrates the importance of correctly diagnosing osteoporosis and not using BP off-label, especially in women of child-bearing age.

Functional magnetic resonance imaging at 1.5 T during sensorimotor and cognitive task.

Functional activations of the human brain cortex were observed with a standard 1.5-tesla MR imaging system using a long time echo fast low-angle shot sequence. Neural activation increases regional cerebral blood flow resulting in increased capillaries and venous blood oxygenation. Processing requires adapted algorithms because the time course of intensity signal showed fluctuations of the baseline. The use of a 'follow-up' method to generate activation maps is proposed. Brain activation was detected in striate cortex during photic stimulation and in sensorimotor areas while subjects were moving their hands. In mental imagery tasks, we observed a primary and secondary visual cortex activation during memory recall of the flashing light. Motor ideation showed an activation of the rolandic areas.

[Functional cerebral neuro-imaging at 1.5 Tesla. The results of visual, sensorimotor and auditory stimulations]. / Neuro-imagerie fonctionnelle cérébrale à 1,5 Tesla. Résultats de stimulations visuelles, sensitivo-motrices et auditives.

Functional activation of the cerebral cortex can be observed with a standard 1.5 Tesla MRI magnet. We used a repeated FLASH 2D one-section sequence with a long echo (TE = 60 ms) and a small passing band. Modification of regional cerebral oxygenation due to neurone activation seems to be the main source of contrast. Sensorimotor stimulation was effected by an unusual mobilization of the fingers. Visual stimulation was performed by intermittent lightings at a frequency of 8 Hz. Auditory stimulation relied on listening to speech sounds. Signal increases were localized on the cerebral cortex with precise anatomico-functional correlation. Using a clinical 1.5 Tesla magnet requires an adequate treatment of data. Thus, stimulated cerebral activity can be portrayed by MRI therapy opening a new way for anatomico-functional cerebral studies.

Anatomy of the thalamoperforating arteries with special emphasis on arteriography of the third ventricle: Part I.

The thalamoperforating arteries are divided into 2 distinct groups, an anterior and a posterior. The PTPAS are retromammillary branches of the precommunicating segments of the posterior cerebral arteries. The PTPAS may be divided into interpeduncular, mesencephalic and thalamic segments and are not directly related to the third ventricle. They are primarily midbrain and thalamic arteries. The main trunk of the PTPA (mesencephalic segment) normally does not undulate, but assumes a characteristically straight configuration. The ATPAS arise from the posterior communicating arteries anterior and lateral to the mamillary bodies. The ATPAS are primarily diencephalic vessels. Interpeduncular, paraventricular (hypothalamic) and thalamic segments may be identified. The major segment of the ATPAS is para third ventricular in location at the level of the massa intermedia.