Hypothalamic hamartomas: with special reference to gelastic epilepsy and surgery.

This study presents six patients with hypothalamic hamartomas diagnosed on the basis of magnetic resonance imaging. Histological confirmation was performed in three patients who underwent surgery. Immunohistological assays were used to determine the neurosecretory pattern. Four patients presented with epilepsy, including gelastic seizures. Other symptoms included behavioral abnormalities in four patients and precocious puberty and visual impairment in two patients. One patient presented associated developmental defects. Good results without morbidity were achieved with surgical resectioning in two patients with large hamartomas associated with behavioral abnormalities and gelastic epilepsy that was unresponsive to conventional medical treatment and in one patient with visual impairment. We propose a classification of the hypothalamic hamartomas based on topographical and clinical data obtained from 36 selected cases in the literature and six of our own cases. This classification should help to classify the various treatment methods and the surgical risks into four subgroups (Types la, lb, lla, and llb). We conclude that the surgical approach is a realistic alternative in certain cases, including large and broad-based Type llb hamartomas associated with gelastic epilepsy and behavioral disorders.

The sensitizing capacity of Compositae plants. I. Occupational contact dermatitis from Arnica longifolia Eaton.

Three patients with occupational contact dermatitis due to Arnica longifolia Eaton and Arnica montana L. are reported. During cultivation, harvesting of the flower heads, chemical investigation of the sesquiterpene lactone constituents and preparation of therapeutic tinctures, they had frequent contact with the plant materials. Patch tests with the two sesquiterpene lactones carabron and helenalin, isolated during investigation from A. longifolia Eaton, were positive in all three patients, though the second patient had never shown visible allergic reactions of the skin. Sensitization experiments with carabron in five guinea pigs were successful. The investigation results revealed that carabron, helenalin and the acetyl derivative of helenalin must be considered as the sensitizers of A. longifolia, and helenalin acetate and properly arnifolin as sensitizers of A. montana. Studies on cross reactivity in the sensitized animals with six related sesquiterpene lactones showed that only those compounds gave a positive test response which contain an alpha-methylene gamma-lactone group. Cross reactions were obtained with a crude extract of Chrysanthemum indicum L. The case reports supported by the patch test and investigation results demonstrate that persons handling a new drug from the Compositae family run a risk of developing an allergy after intensive contact with the plant and its constituents.