Marian apparitions: A multidisciplinary approach. The case of Île Bouchard.

Discussing Marian apparitions in the light of current knowledge in neuroscience is a challenge: the testimonies are often old and indirect, and the "visionaries" could not be questioned or even examined according to current neurological or psychiatric standards. In doing so, we are not unaware of the heterogeneity of seers and the facts they reported: there is not necessarily a single hypothesis. It is the appearances of Île Bouchard that will be discussed here. Our interpretation calls on two non-exclusive "mechanisms": on the one hand, mental imagery, which we know can be unconscious and is modulated or generated by frontal "top-down" mechanisms; on the other hand, the sociological consideration of events, using the concept of enchantment.

What you feel is not always what you've got. Jean Lhermitte (1877-1959) and the phantom limb phenomenon.

Jean Lhermitte (1877-1959), the French neurologist and psychiatrist, is most often associated with the sign he described in three patients with multiple sclerosis, back in 1927. In 1937, Lhermitte analytically studied a series of 28 amputees experiencing phantom limb sensations further to amputations dating between 1891 and 1934. After having described the main clinical characteristics of this unpublished series, we will detail the ideas advanced by Jean Lhermitte regarding the phenomenon of the phantom limb. Lhermitte will use these observations to develop conceptions of consciousness and the body schema encompassing very modern resonances.

Voices from the past: The pioneering use of the phonograph in neurology.

Since its discovery by the American inventor and industrialist Thomas Alva Edison (1847-1931) in 1877, the phonograph attracted much interest in the field of medicine. This article describes the earliest pioneering examples of the use of the phonograph in neurology. In France, the use of the phonograph for obtaining audio recordings of delusions and speech or language disturbances was first proposed by Victor Maurice Dupont (1857-1910) in 1889 and in Italy by the physician Gaetano Rummo (1853-1917), who had studied at La Salpêtrière under Jean-Martin Charcot (1825-1893). The applicability of the phonograph to the record of speech disturbances was illustrated in England by John Hughlings Jackson (1835-1911) and William Halse Rivers (1864-1922), and by William Hale White (1857-1949) and Cuthbert Hilton Golding-Bird (1848-1939) in 1891. Since then, audio recordings have been used rarely in neurology, a branch of medicine where the visual aspects dominate, to the extent that inspection can be enough to reach a definite clinical diagnosis. In the mid-20th century, the advent of audio and video recordings supplanted audio recordings alone, relegating them to a very marginal role.

Jean-Alexandre Barré: Babinski's brilliant student.

Guillain-Barré Syndrome, (GBS), is a popular eponym that comes from a paper written in 1916 by Doctors. Guillain, Barré, and Strohl. Its spectrum has been enlarged considerably since the first description of it. Jean Alexandre Barré was a French neurologist, whose name is still widely associated with that of Georges Guillain, (1876-1961). He is also known for the leg manoeuvre. As Joseph Babinski's brilliant student, (1857-1932), we wanted to briefly retrace his biography in order to highlight some of the salient points within it and subjects that are topical for young neurologists today.

Peduncular hallucinosis according to Jean Lhermitte.

Peduncular hallucinosis (PH) is a rare clinical syndrome with dream-like visual hallucinations intruding normal consciousness. It was initially reported in a 72-year-old woman by Jean Lhermitte in 1992. We uncovered the medical file of this patient with handwritten notes by Lhermitte and commented on it in the light of neurological knowledge that was common at that time. All along his career, Lhermitte has always been fascinated by consciousness disturbances, dreams and hallucinations. He had here the brilliant intuition of linking PH to awareness mechanisms located in the mesencephalic area. This PH case represented a good opportunity to him to emphasize the close relationships between neurology and psychiatry.

Maupassant's folie, from unpublished letters.

Guy de Maupassant (1850-1893) was one of the most important storytellers of all times. We analysed some unpublished handwritten letters of Maupassant and provide, from a neuro-psychiatrical point of view, a new medical hypothesis.

Demonic possession by Jean Lhermitte.

The name of the French neurologist and psychiatrist Jean Lhermitte (1877-1959) is most often associated with the sign he described back in 1927 in three patients with multiple sclerosis. We are reporting unpublished handwritten notes by Jean Lhermitte about 'demonic possession', which date from the 1950s. Drawing from his experiences in neuropsychiatry, Lhermitte gathered notable case reviews as well as individual case histories. For him, cases of demonic possession are of a psychiatric nature with social background exerting a strong influence. Like Freud did earlier, Lhermitte believes that the majority of those possessed people have been subjected to sexual trauma with scruples, often linked to religion. Demonic possession cases were not so rare in the 1950s but their number has nowadays declined substantially with the development of modern psychiatry.

Amiodarone reduces transmural heterogeneity of repolarization in the human heart.

OBJECTIVES: The present work was designed to test the effects of amiodarone therapy on action potential characteristics of the three cell types observed in human left ventricular preparations. BACKGROUND: The electrophysiologic basis for amiodarone's exceptional antiarrhythmic efficacy and low proarrhythmic profile remains unclear. METHODS: We used standard microelectrode techniques to investigate the effects of chronic amiodarone therapy on transmembrane activity of the three predominant cellular subtypes (epicardial, midmyocardial [M] and endocardial cells) spanning the human left ventricle in hearts explanted from normal, heart failure and amiodarone-treated heart failure patients. RESULTS: Tissues isolated from the ventricles of heart failure patients receiving chronic amiodarone therapy displayed M cell action potential duration (404+/-12 ms) significantly briefer (p < 0.05) than that recorded in tissues isolated from normal hearts (439+/-22 ms) or from heart failure patients not treated with amiodarone (449+/-18 ms). Endocardial cells from amiodarone-treated heart failure patients displayed longer (p < 0.05) action potential duration (363+/-10 ms) than endocardial cells isolated from normal hearts (330+/-6 ms). As a consequence, the heterogeneity of ventricular repolarization in tissues from patients treated with amiodarone was considerably smaller than in the two other groups, especially at long pacing cycle lengths. CONCLUSIONS: These findings may explain, at least in part, the reduction of ventricular repolarization dispersion and the lower incidence of torsade de pointes observed with chronic amiodarone therapy as compared with other class III agents.

Electrophysiologic characteristics of cells spanning the left ventricular wall of human heart: evidence for presence of M cells.

OBJECTIVES: The present work was designed to provide an initial characterization of M cells in the normal human heart. BACKGROUND: Recent studies have uncovered a unique population of cells in the midmyocardial region of the canine ventricle. These cells, named M cells, were found to possess electrophysiologic features and a pharmacologic responsiveness different from those of other myocardial cells. Although well characterized in the dog, their presence or absence in the human heart is unknown. METHODS: Standard microelectrode techniques were used to map slices of ventricular free wall obtained from normal human hearts (n = 4). Preparations were paced at cycle lengths ranging from 1 to 10 s. RESULTS: We identified three cell subtypes: endocardial, subepicardial (M cells) and epicardial cells. The principal features differentiating M cells from the other cell subtypes were their longer action potential duration, more accentuated action potential duration rate relations and greater maximal rate of increase in action potential upstroke (Vmax). Our findings suggest that M cells represent approximately 30% of the cellular mass of the left ventricular wall. Concordance between changes in their repolarization and changes in QTU interval provide support for the role of M cells in the generation of the electrocardiographic (ECG) U wave. CONCLUSIONS: This study provides evidence for the existence of M cells in the human heart that contribute to heterogeneity of repolarization within the ventricular wall. Our findings provide strong support for the hypothesis that M cells contribute importantly to the manifestation of the U wave on the ECG.

Early after/depolarizations and triggered activity: mechanisms and autonomic regulation.

An early after/depolarization (EAD) is an abnormality of the repolarization process of an action potential which causes an interruption or a retardation of normal repolarization. Two types were described: phase 3 EADs occur at a takeoff potential of approximately-60 mV and phase 2 EADs occur at the end of a prolonged plateau at a takeoff potential of between-10 and-30 mV. EADs can result from an increase in inward current, a reduction of outward current or both. EADs show cycle-length dependence: as cycle length increases and repolarization lengthens, EADs occur, and their magnitude increases, at a critical cycle length, can trigger the action potential of these EADs. The autonomic nervous system can also modulate EADs and trigger activity. In cesium-intoxicated Purkinje fibers, beta-adrenergic stimulation increases EAD magnitude and the occurrence of triggered activity. Cholinergic stimulation decreases EAD magnitude and suppresses triggered activity occurring after beta-adrenergic stimulation. Alpha 1-adrenergic stimulation has no effect on phase 3 EADs but induces phase 2 EADs. In normal Tyrode's solution (0 cesium), phenylephrine prolongs action potential and induces EADs. This effect seems to depend on alpha 1 A stimulation. These electrogenic abnormalities are supposed to be responsible for long QT and torsades de pointes. As our experimental data have shown that both the rate of stimulation and the autonomic nervous system could modulate EADs and trigger activity, we can speculate on the therapeutic implications of such modulations and the role of pacing as well as alpha- and beta-adrenergic antagonists.

Eosinophilic esophagitis in children: symptoms, histology and pH probe results.

AIM: To review the authors' experience with eosinophilic esophagitis. METHODS: Between 1993 and 2001, the authors identified 12 patients with eosinophilic esophagitis defined on histologic criteria (> or = 20 eosinophils per high-power field in the distal esophageal epithelium). The authors reviewed medical records for details of clinical presentation; laboratory data; radiologic, endoscopic, and histologic findings; and the results of continuous esophageal pH probe monitoring. RESULTS: Seventy-five percent of the patients were male. The median age at presentation was 10.8 years (range, 1-17 years). Commonly reported symptoms were dysphagia with solid food (66%), epigastric pain (42%), food impaction (50%), and vomiting (8%). Food allergy was reported in 50% and asthma in 33%. Peripheral eosinophilia (> 700/mm3) was found in 42%. Upper gastrointestinal series performed in eight patients, showed esophageal luminal narrowing in three. Computed tomography, performed in two patients, revealed thickening of the esophageal wall. Esophageal pH probe monitoring, performed in nine patients, revealed no abnormal acid reflux. All of the monitored patients had episodic alkalinization of the esophagus. Upper endoscopic analysis revealed white specks on the esophageal mucosa in 42%, esophageal narrowing in 33%, esophageal rings in 25%, and esophageal furrowing in 8%. The mean eosinophils per high-power field was 65 (range, 20-200). Histologic characteristics included juxtaluminar (33%) and peripapillary clusters of eosinophils (33%), increased papillary height (50%), and basal cell hyperplasia (34%). CONCLUSION: Solid food dysphagia was the most common feature of eosinophilic esophagitis in our patients. Alkalinization of the esophagus was found in all nine pH probe recordings of eosinophilic esophagitis patients and may represent a previously unreported characteristic of the condition.

Development of baroreflex control of heart rate in preterm and full term infants.

AIM: To study baroreflex maturation by measuring, longitudinally, baroreflex sensitivity in preterm (gestational age 24-37 weeks) and full term infants. METHODS: Baroreflex sensitivity was quantified once a week, one to seven times, by a totally non-invasive method. RESULTS: Baroreflex sensitivity at birth was lower in the preterm infant and increased with gestational age. It also increased with postnatal age, but the values for the preterm infants at term still tended to be lower than the values for full term babies. CONCLUSION: Baroreflex control of heart rate is present in the premature infant, but is underdeveloped and increases with postnatal age. Ex utero maturation seems to be delayed compared with in utero maturation assessed by full term values. These results may reflect sympathovagal imbalance in preterm infants and could identify a population more vulnerable to stress.

Feasibility of using finger arterial pressure in neonates.

The feasibility of using a Finapres device to reproduce the beat to beat signal of arterial blood pressure in eight neonates was assessed and compared with intra-arterial measurement of arterial blood pressure in the umbilical artery, using a catheter. The two methods gave similar results. Continuous recording of arterial blood pressure in neonates using Finapres is feasible and reliable.

Assessment of spontaneous baroreflex sensitivity in neonates.

AIMS: To determine whether it is possible to assess baroreflex sensitivity in neonates by studying only spontaneous variation in systolic blood pressure and heart rate. METHODS: ECG and non-invasive blood pressure signals were continuously studied in 14 preterm neonates (term 29-32 weeks) and five term neonates (term 40-41 weeks). Non-invasive blood pressure measures were obtained using a Finapres placed around the child's wrist. Both signals (ECG and blood pressure), sampled at 400 Hz, were digitised by an A/D converter and stored in a binary mode on magnetic disk. An inhouse software QRS detection algorithm was used to define R peaks of the QRS complexes with an accuracy greater than 2 ms. Four 4 minute periods were recorded in each infant. The slope of the linear regression of RR intervals versus systolic blood pressure was calculated in each period and the mean value of the four slopes was then considered as the index of baroreflex sensitivity (in ms/mm Hg) in each neonate. RESULTS: Spontaneous baroreflex sensitivity was lower in preterm neonates than in term neonates (mean(SD): 4.07 (2.19) ms/mm Hg vs 10.23 (2.92) ms/mm Hg). CONCLUSION: Baroreflex sensitivity can be assessed in term and preterm neonates by studying spontaneous variations in systolic blood pressure alone. This method could be useful for studying the ontogeny of baroreflex sensitivity and might therefore provide information about the maturation of the autonomic nervous system.