Relation between right-to-left shunts and spinal cord decompression sickness in divers.

The role of right-to-left shunting (RLS) in spinal cord decompression sickness (DCS) remains uncertain and could differ according to the distribution of lesion in spinal cord with a higher risk of upper spinal cord involvement in divers presenting a large patent foramen ovale. The aims of this study were to assess the prevalence of RLS with transcranial doppler ultrasonography in 49 divers referred for spinal cord DCS and compare it with the prevalence of RLS in 49 diving controls, and to determine a potential relation between RLS and lesion site of spinal cord. The proportion of large RLS was greater in DCS divers than in healthy control divers (odds ratio, 3.6 [95 % CI, 1.3 to 9.5]; p = 0.017). Shunting was not associated with the increased incidence of cervical spinal cord DCS (OR, 1.1 [95 % CI, 0.3 to 3.9]; p = 0.9) while a significant relationship between large RLS and spinal cord DCS with thoracolumbar involvement was demonstrated (OR, 6.9 [95 % CI, 2.3 to 20.4]; p < 0.001). From the above results, we conclude that the risk of spinal cord DCS in divers with hemodynamically relevant RLS is higher than in divers without RLS, particularly in their lower localization.

[Devic's neuromyelitis optica: diagnosis after 10 years of bilateral severe relapsing optic neuritis]. / Neuromyélite optique de Devic: discussion diagnostique après dix ans d'évolution d'une neuropathie optique bilatérale sévère.

INTRODUCTION: Neuromyelitis optica, also known as Devic's disease, is a severe idiopathic inflammatory demyelinating disease of the central nervous system that preferentially affects the optic nerve and spinal cord. Neuromyelitis optica has long been thought of as a variant of multiple sclerosis; however, clinical, laboratory, immunological, and pathological characteristics that distinguish it from multiple sclerosis have now been recognized. CASE REPORT: A young man presented isolated severe bilateral relapsing optic neuritis. After having evolved over 10 years, the appearance of multiple sclerosis-like lesions on the brain led to the diagnosis of multiple sclerosis. Acute myelitis and the presence of NMO-IgG antibodies in the serum finally led to the diagnosis of neuromyelitis optica. CONCLUSION: This case is an illustration of the new criteria in the diagnosis of NMO, underscoring the importance of the positive serum NMO-Ig G antibody to distinguish multiple sclerosis from NMO. It also emphasizes that asymptomatic brain lesions are common in NMO on brain MRIs and symptomatic brain lesions do not exclude its diagnosis.

[Gastroduodenal intussusception complicating Menetrier's disease]. / Maladie de Ménetrier révélée par une invagination gastro-duodénale.

The authors report a very rare case of gastroduodenal intussusception complicating Menetrier's disease. This uncommon condition of unknown aetiology is characterized by hyperplasia of the gastric mucosal folds. Computed Tomography (CT) in high resolution mode can be helpful for diagnosis by showing the cerebriform surface of the giant mucosal folds. Filling the gastoduodenal tract with water is useful in non complicated cases.

[Subacute combined degeneration of the spinal cord: contribution of MRI]. / Sclérose combinée médullaire: apport de l'IRM.

The authors report a case of subacute combined degeneration of the cervicothoracic spinal cord involving the dorsal and lateral spinal columns, extending to the brainstem, due to cobalamin deficiency in an elderly patient. Symptoms of this subacute myelopathy are potentially reversible with early diagnosis. Presenting symptoms of this myelopathy, involvement of the lateral columns and brainstem have rarely been documented by magnetic resonance imaging (MRI) studies. MRI showed increased T2-weighted signal in the spinal cord. The patient's background and history and the posterior location of the abnormalities increased the specificity of MRI, and the resolution of clinical symptoms with vitamin supplementation confirmed the diagnosis.

Continuous assay of serum 5-nucleotidase activity with inosine 5'-monophosphate as substrate and total automation using a transfer-analyzer (Kem-O-Mat).

The continuous spectrophotometric assay of 5'-nucleotidase originally described by Heinz et al. ((1980) J. Clin. Chem. Clin. Biochem. 18, 781-788) was modified and fully automated on a Kem-O-Mat transfer analyzer, using inosine 5'-monophosphate as substrate. The reaction product was hydrogen peroxide and the reduction of NADP was observed for 10 minutes at 340 nm and at a reaction temperature of 30 degrees C. The different factors involved in the enzyme reaction were checked, including the substrate concentration, reaction rate, linearity and substrate preservation. Normal values ranged from 1 to 13 U/l. Between-day reproducibility was estimated with two different commercial control sera, and the coefficient of variation was 5% for the upper limit of normal activity (23 U/l). There was good agreement between the present method and a semi-automatic colorimetric technique (for 100 sera tested by both methods, the correlation coefficient was 0.974 and the regression line equation, y = 0.85 x- 1.5). Despite the lengthy reagent mixture preparation procedure, the method permitted assay of 50 samples per hour. The occurrence of high serum blanks in certain pathological states is discussed.