Alzheimer CSF biomarkers in routine clinical setting.

OBJECTIVES: Our work was aimed to evaluate Alzheimer's disease diagnosis improvement using cerebrospinal fluid biomarkers (CSF) in neurological daily practice. MATERIALS AND METHODS: For this purpose, 150 patients clinically and neurochemically classified as having AD or cognitive impairment with or without other dementia type were included in the study. The following CSF peptides were studied, blindly to the clinical diagnosis: beta-amyloid(1-42) peptide (Aß(1-42)), Tau (T-tau), threonine-181 hyperphosphorylated tau protein (P-tau(181)), and beta-amyloid(1-40) peptide (Aß(1-40)). From these measurements, Innotest® Amyloid Tau Index (IATI) was calculated for each patient. RESULTS: This assessment allowed to separate 83 biochemical profiles of AD and 67 non-Alzheimer's disease (non-AD), both AD and non-AD categories match with clinical data amounting to 73% and 90%, respectively. Among mild cognitive impairment (MCI) patients, CSF biomarkers led to discriminate those who are likely to be AD. We devoted a special section to Aß(1-40) which is not a routine parameter but can help to confirm a pathological amyloid process as Aß(1-42)/Aß(1-40) ratio underlining the real decline of the Aß(1-42). CONCLUSIONS: The interest of biomarkers and their ability to solve awkward cases were carefully noticed all the more when a discrepancy between clinical and CSF biological data was involved. The final proposed algorithm allowed to identify pathogenic forms of AD according to the prevailing role of hyperphosphorylated tau or amyloid beta peptide.

[Quality of medical records in the "Medical Information System Program": application of the lot quality assurance sampling method]. / Qualité des données P.M.S.I. au CHU de Limoges: application de la méthode L.Q.A.S.

BACKGROUND: The aim of this study was to validate a new method of quality control of medical records of the "Medicalisation of Information System Program" (P.M.S.I.) in Limoges university hospital. METHODS: Lot quality assurance sampling (L.Q.A.S.), developed to meet industrial quality control needs, has been applied. This method allows to give an opinion on the quality of a lot from a sample randomised in this lot. Ten hospital units have been randomised. During three months, these medical units have recoded ten medical units abstracts (R.U.M.) which were randomised each month within their stays. If five or more R.U.M. had been modified on Principal Diagnosis (D.P.), Associated Significant Diagnosis (D.A.S.) or Diagnosis Related Group (D.R.G.), the lot was rejected. The hospital unit had then less 70% R.U.M. of good quality (alpha=5%). The global errors rates were compared to the results of usually performed quality control (1998). RESULTS: Nine hospital units were included. Hospital units which already had a low quality rate during the 1998 quality control had also an insufficient quality by L.Q.A.S. method. Among these, 33.7 [CI(95%): 21.6-45.8] R.U.M. have been modified. Medical units had a poorer data quality than surgical ones. No statistically significant difference was shown between 1998 errors rates and L.Q.A.S. rates, except for D.P. (p=0.002). CONCLUSION: L.Q.A.S. is easy to apply, could be repeated more frequently than usual controls, and allows to detect hospital units which require a faster action. This process could be applied to P.M.S.I., in which the search of quality is necessary because of the new cost model which includes secondary D.R.G.

Parkinson's disease and environmental factors. Matched case-control study in the Limousin region, France.

The study included 140 patients with Parkinson's disease (PD) and 280 non-Parkinson age-matched controls to evaluate environmental risk factors associated with PD. The effect of exposure to environmental and dietary factors was determined using conditional logistic regression. This multivariate analysis showed that PD in first-degree relatives and tea drinking were the main risk factors for PD. Smoking appeared to be a protective factor. Exposure to toxic compounds was not a significant risk factor. Further research is needed to validate that tea consumption increases the risk of PD.

Estimation of the amyotrophic lateral sclerosis incidence by capture-recapture method in the Limousin region of France.

Amyotrophic lateral sclerosis (ALS) is a rapidly fatal degenerative neurological disease categorized among motor neuron diseases. In the literature, the incidence of ALS varies between 0.7 and 2.4 per 100, 000 inhabitants. A study using the capture-recapture method (multiple records system analysis) was undertaken in Limousin (France) ascertaining all patients having onset of definite or probable ALS during the period 1994-1995. Three information sources able to identify these new ALS cases were selected: the first source was a computerized database of the Neurology Department of the University Hospital of Limoges; the second source consisted of the neurologists of the Limousin region and neighboring provinces (county-sized regions); the third source grouped the hospitals of the Limousin region and neighboring provinces (county-sized regions). During this period, 46 new cases of ALS were seen, corresponding to an observed mean annual incidence of 3.2 (+/-0.6) per 100,000 inhabitants. After standardization for age, the annual incidence was 2.5 per 100,000 inhabitants. The number of new cases estimated by the capture-recapture method was 70, corresponding to an estimated mean annual incidence of 4.9 (+/-1.0) for 100,000 inhabitants. Hence, statistical modeling utilizing partially overlapping information sources permitted a more exhaustive compendium of the new cases of ALS and may be a truer reflection of actual disease incidence than has been previously reported.

Estimation of the prevalence of epilepsy in the Benin region of Zinvié using the capture-recapture method.

BACKGROUND: The prevalence of epilepsy was estimated in two villages of 3134 inhabitants, in Benin, in April and May 1997 using the capture-recapture method. METHODS: Information was obtained from (i) a door-to-door cross-sectional study, (ii) a non-medical source consisting of key informants (traditional practitioners, teachers, village leaders, and religious representatives) and (iii) a medical source through evaluation of medical records in health centres. In all the three situations, the diagnosis of epilepsy was confirmed by a neurologist. RESULTS: The door-to-door survey found 50 epileptics, i.e. a prevalence of 15.9 per 1000. The non-medical source found 26 patients. The medical source found only four patients. In total, 66 epileptics were found by combining the three sources, giving a prevalence of 21.1 per 1000. After application of the capture-recapture method, the estimated number of cases from the door-to-door survey and non-medical source was 105, and 110 cases when the medical source was considered as well. The respective prevalences were 33.5 per 1000, and 35.1 per 1000. CONCLUSIONS: The door-to-door survey has been usefully improved by using key informants. The epilepsy prevalence estimate found by capture-recapture is clearly higher than that found by traditional cross-sectional methods, and could better depict the frequency of epilepsy in Africa.

[Postoperative incisional hernias: intra- or extraperitoneal prosthesis implantation?]. / Eventrations postopératoires: prothèse intra- ou extrapéritonéale?

STUDY AIM: The aim of this retrospective study concerning the repair of postoperative incisional hernia using Dacron mesh was to compare results according to the extra- or intraperitoneal mesh position in order to assess the respective indications of each option. MATERIALS AND METHODS: From January 1985 to December 1996, 172 patients (mean age: 61.3 years) were operated on using Dacron mesh extraperitoneally (n = 99) or intraperitoneally located (n = 73). For statistical analysis, both groups were compared using Chi square test or Fisher's test. RESULTS: There were no postoperative deaths in the group with extraperitoneal mesh and two postoperative deaths in the group with intraperitoneal mesh. There were no significant differences when results comparing parietal complications (sepsis: 2% vs 2.7%, pain: 9.1% vs 16.9%), secondary intestinal disorders (2% vs 4.2%) and recurrence rate (4% vs 5.6%) were assessed between extraperitoneal and intraperitoneal mesh. Recurrences were related to pareital infection treated by partial removal of the mesh (n = 2) or to the lateral detachment of the mesh (n = 6). CONCLUSIONS: In the group of patients receiving extraperitoneal mesh there were no postoperative deaths and morbidity was low (this technique is generally used in the treatment of large incisional hernia). In the group of patients receiving intraperitoneal mesh, similar parietal and general complications were observed. But the risk of serious complications and postoperative death is higher; this technique must be limited to the most serious incisional hernia and to high risk patients.

Intrafamilial clustering and 4-year follow-up of asymptomatic human T-cell leukaemia virus type I (HTLV-I) infection in Benin (West Africa).

BACKGROUND: Few data exist concerning familial human T-cell leukaemia virus type I (HTLV-I) carrier states and transmission in African countries. Two previous surveys performed in Benin in 1989 and 1990 using a three-level cluster sampling method allowed us to identify HTLV-I positive subjects. The evolution of HTLV-I within the families of these subjects is described over a 4-year period, 1991-1995. METHODS: Since 1991, 37 HTLV-I seropositive subjects, six subjects with indeterminate Western-Blot pattern, and their relatives have been followed up once a year clinically and biologically. RESULTS: Twenty-three mothers in the study group gave birth to 27 children between 1991 and 1995. Among the 13 infants born to the 12 seropositive mothers, two seroconverted before their second birthday. One adult woman whose husband was seropositive developed seropositivity 4 years after marriage. In March 1992, a family case-control study (proband study) was conducted. A seroprevalence of 27.5% was found among 138 relatives of 32 infected subjects and 1.4% among 142 relatives of 32 control subjects. CONCLUSIONS: There is clearly an intrafamilial clustering of HTLV-I in Benin. The annual incidence density of HTLV-I in this cohort is estimated at 6 per thousand.

B cell compartments in multiple myeloma: flow cytometric analysis of their labelling indices and Bcl-2 protein expression.

Because recent reports have suggested that non plasmacytic tumor B cells are very rare in Multiple Myeloma (MM), we tried to characterize the B lineage in this disease by comparing by flow cytometry in the PB and BM of MM patients and of controls the proliferative activity (BrdU incorporation) and the Bcl-2 expression of different B cell subsets defined by cytoplasmic light chain, CD19 or CD10 antigen expression. The labelling indices (LI) of CD19+ and CD10+ BM cells in treated patients were higher than in controls and untreated patients. Plasma cell LI (PCLI) were close to previously published values of PCLI flow assays and did not correlate with the LI of BM B cells. Bcl-2 expression by BM CD19+ and CD10+ cells in patients was inferior to controls. These results agree with previously published data about the likely polyclonal nature of most pre PC B cells in MM.

Survival prediction in sporadic amyotrophic lateral sclerosis. Age and clinical form at onset are independent risk factors.

Amyotrophic lateral sclerosis is a progressive neurological disease of unknown etiology and fatal outcome. Patient management can be aided by careful assessment of prognostic factors. A prospective study of 158 patients was carried out to examine the prognostic significance of age and clinical form at onset. The overall 5-year survival rate was 14.7%. The higher the age was at first symptoms, the worse the prognosis. The bulbar and common forms had a worse prognosis than the pseudo-polyneuritic forms. After adjustment for age, the clinical form at onset remained a prognostic factor. In a multivariate analysis using the Cox model, these two factors remained independent despite the later onset of the bulbar forms. In view of the discrepancies between the different published studies, the evaluation of the survival of an individual patient is of doubtful value.

Prevalence of neurological disorders in Haute-Vienne department (Limousin region-France).

The Limousin region had at present one of the largest elderly populations in France and in Europe. To determine the frequency of certain neurological disorders in the elderly, a neuroepidemiological survey was conducted in 1986-1987 on a representative sample of the population in Haute-Vienne (the most population-dense department in the Limousin region). This study used a WHO protocol which was first introduced at the beginning of the 1980s. It had been previously tested in France on a pilot population in 1984. The prevalences of the principal neurological disorders encountered per 100,000 inhabitants were as follows: nonmigraine headache 5,059, migraine 4,270, epilepsy 788, completed stroke 1,445, transient ischemic attacks 657, neuropathy 1,642, Parkinson's disease 328, and dementia 197.

[Anticardiolipin antibodies and Horton disease]. / Anticorps anti-cardiolipine et maladie de Horton.

A prospective study, including 86 patients with giant cell arteritis proven by temporal artery biopsies, was performed to determine the prevalence of anticardiolipin antibodies, the antibody isotype, the relationship of antibodies to ischemic involvement and their evolution during corticosteroid treatment. Controls were obtained from 50 subjects without vasculitis or autoimmune disorders. Before treatment, 50% of patients' sera contained anti-cardiolipin antibodies (vs 8% in controls, p < 0.0001). These antibodies were IgG-ACL in 36% of patients and IgM-ACL in 17% of patients (vs respectively, 4% and 2% in controls). No significant association was observed between the incidence of ischemic ocular complications and the levels of anti-cardiolipin antibodies. During corticosteroid treatment, the level of anti-cardiolipin antibodies, mostly IgG class, decreased to become negative in 2 months. An increase of these antibodies was observed with the occurrence of relapses in four patients, after the end of corticosteroid therapy. The significance of IgG and IgM antibodies is different in giant cell arteritis. IgG antibodies may be markers of the course of this vasculitis.

[Clinical course of Horton disease. Apropos of 42 cured patients]. / Evolution de la maladie de Horton. A propos de 42 malades guéris.

We report a prospective study of 42 patients with biopsy-proven giant cell arteritis (CGA) who recovered for more than one year (mean follow up of 71 months since withdrawal of steroid treatment). It was used the same regimen of prednisone and well closely monitored along the whole treatment. In 22 patients, dapsone was given concomitantly with prednisone. Mean duration of steroid therapy was 23.1 months (range: 6-57 months); it was significantly decreased with treatment by dapsone (12 months and 12 days). Age, sex, initial clinical and biological (acute phase reactants) findings did not provide useful information for predicting steroid treatment needed for recovery. Thirty-six relapses were observed in 22 patients (60%) during treatment or after its withdrawal. Incidence of relapses declined during steroid treatment and relapses were (only) observed over first 6 months after steroid withdrawal. Three amaurosis fugax occurred at the beginning of treatment and an axillar bilateral stenosis was also observed. Forty-eight side effects of corticosteroids were recorded in 26 patients (63%): myopathy (n = 12), bone complications (n = 11), metabolic complications (n = 9). Twelve patients (63%) had experienced side effects of dapsone. This study emphasized the difficulty in treating CGA. Close monitoring is required. A steroid regimen is recommended.

[Lymph node involvement and prognosis in medullary cancers of the thyroid gland]. / Envahissement ganglionnaire et pronostic des cancers médullaires de la thyroïde.

Involvement of regional lymph nodes is extremely common in medullary carcinoma of the thyroid gland (MTC). The aim of the present study was to determinate the prognostic of MTC correlated with the regional lymph node involvement. From 1975 to 1994, 23 MTC patients were treated. The surgical protocol included a total thyroidectomy with bilateral dissection of the jugulocarotid chain and of the paratracheal groove. We have distinguished two groups: group N+ (histological lymph nodes involvement) and group N- (absence of histological lymph nodes involvement). In each group we have evaluated the prognostic significance of age, sex, palpable lymph nodes, histological capsular effraction and presence of distant metastasis. The data were analyzed with the exact Fisher test and comparisons by Student t test. Significance was defined as p > 0.05. Survical curves were based on the method of Kaplan Meier. In Group N+ (n = 15), 9/15 patients died: they had palpable lymph nodes, histological capsular effraction and distant synchronous or metachronous metastasis. The median survival was 8 months, when patients have distant metastasis. Six patients are alive, 2 with an elevated thyrocalcitonin level without metastasis, and 3 with resection of metastatic MCT to regional lymph nodes. In groupe N- (n = 8), all patients are alive: 2/8 patients had palpable lymph nodes, 1/8 had histological capsular effraction, but none had distant metastasis. 2 patients underwent resection of regional lymph metastasis and one of pulmonary metachronous metastasis. Gender did not appear to affect the lymph involvement. Factors significantly associated in the group N+ included the following: age (p = 0.003), palpable lymph nodes (p = 0.015), capsular effraction (p > 0.00025), distant synchronous metastasis (p < 0.013). The regional lymph node metastasis had significant influence on the 5-year survival, 48% vs 100% (p = 0.006), and on disease free survival, 16.6% vs 62.5% (p = 0.018). The median time from resection of the primary tumor to the development of metastasis disease was 37 months for patients N+ vs 169 months for patients N-. Involvement lymph node did not affect the metastasis disease, regional involvement or distant metastasis (p > 0.05).

Prevalence of headache in a representative sample of the population in a French department (Haute-Vienne-Limousin).

In 1986-1987, a neuroepidemiologic survey was undertaken to study the prevalence of the most frequently encountered neurologic disorders, and in particular headache, in a representative sample of the population in the Haute-Vienne Department (Limousin). A door-to-door survey was made using a protocol developed by the W.H.O. at the beginning of the 1980's. The calculated prevalences (according to Poisson's distribution) per 100,000 inhabitants were 5,059 for nonmigraine headache, and 4,270 for migraine headache. This disorder preferentially affected young adults and essentially involved females. It was the most frequently encountered disorder (50%) during the different surveys of similar methodology.

[Pain during peritoneum pinching, a pathognomonic sign of peritoneal disease. Clinical research. Semiological value]. / La douleur au pincement du péritoine, signe pathognomonique d'affection péritonéale. Recherche clinique. Valeur séméiologique.

Pain induced by pinching the peritoneum betrays a pathology of that membrane. It is absent when the peritoneum is perfectly healthy. Pain is elicited by a special palpation technique. Clinically and statistically, the presence of this pain is pathognomonic, but it does not inform on the aetiology. In the present study the most frequent causes of positive abdominal peritoneal pinching test were peritoneal tuberculosis, followed by portal hypertension with or without liver cirrhosis.

[A neuro-epidemiologic survey in a Limousin town]. / Enquête neuro-épidémiologique dans un bourg du Limousin.

One characteristic of the Limousin district is the raised average age of its population. Given the growing average age found in France and the ensuing potential problems, it was thought useful to undertake a neuro-epidemiological study of the distribution of neurological diseases in this region. The initial step involved checking the techniques to be used and the form of questionnaire relevant to this type of study. Following W.H.O. recommendations, the total population of one small town was surveyed, and the distribution of various neurological ailments was thus measured (headaches, migraine, cluster headaches: 12.73 p. 100, transient ischemic attack: 1.89 p. 100, stroke: 1.36 p. 100, epilepsy: 1.68 p. 100. Parkinson's disease 1.47 p. 100, dementia: 0.31 p. 100, misc: 0.84 p. 100). These figures were compared with the results from similar pilot projects carried out elsewhere around the world. The results obtained in this preliminary study enabled us to perfect the methods, and to perform a more extensive survey of a representative cross section of the Limousin population. This larger study will be published later.

[Reference values for maximal midexpiratory flow in black females]. / Valeurs de référence pour le débit expiratoire maximal médian chez la femme noire.

The aim of this publication is to contribute to the establishment of reference values for the forced expiratory flow between 25 and 75% of the vital capacity (FEF25-75) among black females in West Africa. 316 of them, aged between 10 and 70 years, were submitted to this test. They were considered free from cardiopulmonary disease after a questionnaire and clinical examination. FEF25-75 in absolute value was lower than in the white Euro-americans. It increased up to 18-19 years of age, then decreased steadily thereafter. The main equations of regression for the FEF25-75 (l X s-1) were: 10-18 years, 0.177A + 1.058 and 0.157A + 0.826H + 0.005; 19-70 years, -0.028A + 4.211 and -0.025A + 2.206H + 0.512, (where A is the age in years and H the height in metres). The results are compared with the reference values published in Black Africa, Europe and the United States.

[Spirometric reference values in black females]. / Valeurs de références spirométriques des femmes mélanodermes.

The aim of this paper is to give spirometric reference values for black females. Having eliminated those with abnormal hemoglobin, we studied 298 females aged between 10 to 70 years: 15 from bordering countries of the Ivory Coast and the others being Ivorian. That is, they are all from West Africa. It is shown that FVC and FEV1 are reduced in the black population when compared with European whites. Volume and flow values are also lower than those in Ivorian men. Correlations and linear regression equations were calculated between FVC, FEV1 and age, height, and weight. FVC and FEV1 (l BTPS) were found as a function of height H (m) and age A (years) as follows: from 10 to 25 years, FVC = 0.465 H3 + 0.01735 A + 0.58; FEV1 = 0.451 H3 + 0.0035 A + 0.61; from 25 to 70 years, FVC = 0.450 H3 - 0.02002 A + 1.54; FEV1 = 0.309 H3 - 0.02050 A + 1.44.

[Reference values of cardiac volume in children and adults of the Ivory Coast]. / Valeurs de référence du volume cardiaque d'enfants et d'adultes ivoiriens.

The cardiac volume in decubitus was measured by Rohrer radiological method in 229 subjects, of which 150 were children of both sexes, aged 4 to 16 and 79 were adult males, 17 to 50 years old. Anthropometric parameters and maximum O2 consumption were also measured. Considering that the size of thorax in Ivory Coast natives is significantly smaller than that of a Caucasian, an eventual influence over the cardiac volume was looked for. Results showed that: -- in the child, the cardiac, volume increased linearly with age: 162 ml at 4 and 680 ml at 16; -- significant positive correlations were found between the cardiac volume, the body-weight andusrface, and the measurements of the thorax; -- when compared to data found in the literature, the cardiac volumes of children and adults of the Ivory Coast in relation with the body weight or surface are lower than the values found in Caucasians; -- children who have been swimming for two years and adults from the national swimming team have a cardiac volume significantly superior to that of Ivory controls; for these subjects, results are equivalent to those of Caucasians; -- there is a highly significant positive correlation between the cardiac volume and the maximum oxygen consumption. To compare values of cardiac volume in different populations, it is necessary that the groups of subjects be very homogeneous and have a comparable level of activity.