Diagnosis of growth hormone deficiency after pituitary surgery: the combined acipimox/GH-releasing hormone test.

OBJECTIVE: Reduction of plasma free fatty acids leads to enhanced GH response after stimulation by GH-releasing hormone (GHRH). We studied the clinical usefulness of combined administration of acipimox and GHRH for the diagnosis of GH deficiency. DESIGN: We evaluated 35 patients [mean age 53.0 years; mean body mass index (BMI) 26.7 kg/m2] after pituitary surgery. We compared GH responses after acipimox and GHRH with the GH response during an insulin tolerance test (ITT) and, in a subgroup of 12 patients, with the GHRH/arginine test. The acipimox/GHRH test was additionally performed in 21 control subjects (mean age 53.8 years; mean BMI 24.7 kg/m2). RESULTS: In the patients, the mean (+/- SEM) peak GH was almost four-fold higher after acipimox/GHRH (6.94 +/- 1.07 microg/l, range 0.46-23.1; P < 0.001) and after GHRH/arginine (8.32 +/- 1.23 microg/l, range 1.1-49.2; P < 0.001) than after ITT (1.84 +/- 0.46 microg/l, range 0.01-11.9). According to the ITT, 29 patients were severely GH deficient (peak GH < 3.0 microg/l). Peak GH levels after acipimox/GHRH in controls ranged from 7.5 to 78.4 microg/l (mean 29.3 +/- 3.5). GH peak values during the acipimox/GHRH test were significantly correlated with values from the ITT (r = 0.63, P < 0.01) and GHRH/arginine test (r = 0.87, P < 0.001). Areas under the curve were also correlated. According to generally accepted cut-off peak GH levels for the ITT and GHRH/arginine test, a GH peak exceeding 11.2 micro g/l excludes severe GH deficiency after acipimox/GHRH. Our control data indicate that the cut-off level is lower at older age. CONCLUSIONS: The acipimox/GHRH test leads to GH responses similar to those of the GHRH/arginine test, and to higher peak GH values if compared with the ITT. The acipimox/GHRH test is a potential additional tool to detect GH deficiency in patients with pituitary disease, in particular in patients with a perturbation of fatty acid metabolism.

Shoulder and hand displacements during hitting, reaching, and grasping movements in hemiparetic cerebral palsy.

In this study, we examined the degree and timing of shoulder displacements during hitting, reaching, and grasping movements performed by young adults with hemiparetic cerebral palsy. The participants performed unimanual and bimanual arm movements towards targets and objects of different sizes. On the basis of the assumption that shoulder displacement due to trunk translation and rotation is a successful adaptive reaction to reduced joint mobility in the affected arm, the fluency of hand displacements was expected to remain invariant under variations of shoulder displacement as is also the case in healthy participants. The results point in this direction. With respect to the timing of shoulder displacement, prior research suggested that hemiparetic movements can be characterized by inconsistent motion-timing patterns-that is, the timing of the of shoulder and hand-displacement onsets varied between trials. Therefore, the within-subject variability of the movement-onset asynchrony between hand and ipsilateral shoulder displacement was expected to be larger on the impaired side than on the unimpaired side. This prediction was not confirmed, which challenges these earlier conclusions. Additionally, we also examined the peak-velocity asynchrony of the hand and shoulder. Contrary to the onset asynchrony, the peak asynchrony varied between the hitting and reaching task and between the hitting and grasping task. For the reaching and grasping tasks, there were also significant differences between hands. Again, variability of the (peak-velocity) asynchrony was not significantly increased when comparing the impaired hand with the unimpaired hand. The results suggests that the hemiparetic participants were capable of flexibly recruiting and sequencing the various degrees of freedom of their impaired side required for successful task completion, albeit in different magnitudes and sequenced differently.

Kinematics of fast hemiparetic aiming movements toward stationary and moving targets.

The aim of the present study was to gain insight into the control that hemiparetic subjects have over fast, unimanual aiming movements. Twelve hemiparetic subjects with cerebral palsy and twelve healthy subjects were asked to hit, as quickly as possible, stationary and moving targets projected onto a frontoparallel screen. The task was performed with the nonpreferred (spastic/nondominant) and preferred (nonspastic/dominant) arm. Although the pattern of kinematics of hemiparetic subjects generally corresponded with that reported in earlier reaching and grasping studies, the commonly observed prolonged movement time of the nonpreferred arm as compared to the preferred arm was absent. The spatial variability of the lateral hand displacements toward stationary targets was highest in the spastic arm of the hemiparetic subjects, indicating diminished motion stability. Even though hemiparetic subjects were expected to be unable to adjust their movements flexibly to the position and the velocity of a moving target, they used an initial estimate of where moving targets would be hit in the same way as the healthy subjects did, i.e., they started aiming toward a position in front of the target. In both subject groups, this spatial estimate and the movement time (MT) varied as a function of target velocity, suggesting that the use of target-velocity information in hitting moving targets is unaffected in spastic hemiparetic subjects. The results are related to possible deficits in the regulation of cocontraction underlying movement stability.

Path curvature in workspace and in joint space: evidence for coexisting coordinative rules in aiming.

In this study we tried to establish whether point-to-point aiming movements are planned in workspace, joint space, or both. Eight right-handed subjects performed horizontal, vertical, and diagonal aiming movements on a transversal plane. Movements were performed at several speeds. Curvature variations of the hand and corresponding joint-space paths were investigated as a function of position, direction, and speed. Straightness of hand paths predominated for vertical movements but was systematically violated for horizontal and top-right to bottom-left movements. Furthermore, the hand-path curvature of the latter movements increased with speed. Joint-space paths showed more deviation from a straight line than hand paths except for top-left to bottom-right movements in which the paths were equally curved. A comparison of normalized path curvatures at the hand and joint level indicated that in aiming, the coordinative rule of straight-line production seems to apply to both workspace and joint-space planning. The present findings confirm Kawato's (1996) views that optimization processes operate concurrently at the two control levels of arm-trajectory formation under study.

A case of mediastinal teratoma with CT and MRI correlation.

A case of mediastinal teratoma is described with emphasis on its magnetic resonance aspect. All the components of the mass were well defined. The major interest of magnetic resonance imaging in this case consisted in the good delineation of the pericardium and visualization of the absence of pericardial invasion.

[Short- and long-term prognosis of myocardial infarct. Contributions and limitations of the clinical aspects and non-invasive technics]. / Pronostic à court et à long terme de l'infarctus du myocarde. Apports et limitations de la clinique et des techniques non invasives.

Clinical variables and those obtained by non-invasive techniques were recorded in a series of 306 patients discharged from hospital after an acute myocardial infarction. We studied the prognostic value at 2 and 12 months of these variables (alive/dead). The results of simple clinical data were as discriminant as those from more elaborated techniques. When the prognostic value of the same data at 12 months was studied in those surviving for two months, most of the predictive variables lost their discriminant power. The study shows that the predictive value of many of the predischarge variables usually taken into account in the assessment of long term risk, does not extend beyond the first two months.

High-dose intravenous thrombolytic therapy in acute myocardial infarction: efficiency, tolerance, complications and influence on left ventricular performance.

Ten patients with acute myocardial infarction (AMI) underwent coronarographic studies before, immediately after and ten days after an intravenous infusion of 1 500 000 I.U. streptokinase (STK). Mean time between onset of symptoms to initiation of STK infusion was 03 hours 34 minutes. Occlusion of the infarct-related vessel was present in all of them and successful thrombolysis was obtained in 8 of the patients. Systemic fibrinolytic activity was present in 9 patients, one of whom required a transfusion of blood because of severe bleeding. At ventriculography, the global left ventricular ejection fraction and the regional ventricular ejection fraction, whatever the area involved, showed no significant improvement 10 days after the procedure. This suggests that high-dose intravenous STK in AMI, although causing an effective thrombolysis, does not seem to improve early myocardial function.

[Appearance on effort of an image of a sub-epicardial lesion in the absence of signs of myocardial necrosis. Clinical, electrocardiographic and coronographic studies of 10 cases]. / L'apparition à l'effort de l'image de lésion sous-épicardique en l'absence de signes de nécrose myocardique. Etude clinique, électrocardiographique et coronographique de 10 cas.

A clinical, electrocardiographic and coronarographic study of ten cases shows that surelevation of ST-segment during exercise (without any signs of infarction) correspond to very different clinical situations of anatomical state of coronary vessels, occurrence of coronary spasm and evolution of the ischemic disease. "Inversed coronary Insufficiency" is proposed to design this syndrome. Practical recommandations are formulated.