Nephrocalcinosis in juvenile farmed Atlantic Salmon (Salmo salar) may be linked to osmoregulatory stress.

Nephrocalcinosis is a widespread challenge in intensive production of salmon smolt. There is however no consensus on its aetiology, which makes it problematic to implement proper measures to limit its development. We performed a survey of nephrocalcinosis prevalence and environmental factors in 11 different hatcheries in Mid-Norway as well as a 6-month monitoring in one of the hatcheries. A multivariate analysis indicated that the most influencing factor for the prevalence of nephrocalcinosis was the supplementation of sea water during smolt production. In the 6-month monitoring, the hatchery introduced salinity in the production water prior to the change in day length. Mismatch in those environmental signals may increase the risk for developing nephrocalcinosis. Salinity fluctuations prior to smoltification can cause osmotic stress and result in unbalanced levels of ions in fish blood. This was clearly illustrated in our study, as the fish experienced chronic hypercalcaemia and hypermagnesaemia. Both magnesium and calcium are excreted over the kidneys and it is possible that their prolonged, elevated levels in plasma resulted in an oversaturation of the urine when finally excreted. This again could have led to the aggregation of calcium deposits within the kidney. This study indicates a relationship between osmotic stress induced by salinity changes in juvenile Atlantic salmon and the development of nephrocalcinosis. Other factors that may affect the severity of nephrocalcinosis are currently subjects for discussion.

[Vitamin D and multiple sclerosis. A prospective survey of patients of Poitou-Charentes area]. / Vitamine D et sclérose en plaques. Étude prospective d'une cohorte de patients de la région Poitou-Charentes.

INTRODUCTION: Recent reports demonstrate the implication of vitamin D in multiple sclerosis (MS). METHODS: In a multicentric regional study (Poitou-Charentes area) during the first trimester 2010, we measured the 25-OH vitamin D serum level in 170 consecutive MS patients, and in 170 controls matched for age (±4 years), sex and date of blood sample analysis. We searched for correlations between 25-OH vitamin D serum levels and the MS form, the disability (EDSS), the relapse rate during the previous year and the presence and number of enhancing lesions on T1-weighted MRI dating less than 12 months in relapsing MS. RESULTS: Hypovitaminosis D was very frequent in MS patients and 25-OH vitamin D serum level was significantly lower (14.5 ± 9.2 mcg/mL) in MS patients than in the control group (16.7 ± 9.6 mcg/mL). This serum level was inversely correlated with the degree of disability measured with EDSS score and was lower in secondary progressive (RR-SP) and primary progressive (PP) MS than in relapsing MS (RR). No correlation was found between 25-OH vit D serum level and relapse rate during the previous year in RR MS and the presence and number of enhancing lesions on T1-weighted MRI dating from less than 12 months. CONCLUSION: 25-OH vit D serum level is very low in MS, mainly in RR-SP and PP MS and is correlated with disability. This suggests MS patients should be screened for vitamin D deficiency and given supplementation systematically when hypovitaminosis D is discovered.

[Multiple sclerosis: immunomodulators, education, and self-injection]. / Sclérose en plaques: immunomodulateurs, éducation et auto-injection.

One hundred and sixty four patients of the Poitou-Charentes area suffering from multiple sclerosis (MS) and treated with an immunomodulating agent for more than 3 months completed a self-administered questionnaire. More than 60p.cent of the patients performed self-injection. For both modes of injection studied (subcutaneous or intramuscular), self-injection was significantly more frequent among patients who were received training and followed via telephone assistance conducted by a nurse with specialized training in MS. Our study demonstrated that waste disposal (needles), especially among patients performing self-injections, remains an important problem. Efforts must be taken concerning this important healthcare issue.

[Intracranial hypertension and hydrocephalus caused by spinal cord tumors. Apropos of 3 cases]. / Hypertension intracrânienne et hydrocéphalie par tumeurs médullaires. A propos de trois observations.

Three cases of spinal cord tumor, revealed by hydrocephalus, are reported. Two patients showed symptoms of increased intracranial pressure and the third one presented himself with ataxic gait without intellectual impairment nor incontinence. In two cases ventriculo atrial shunt was initially inserted and the correct diagnosis was made only later on myelogram because lombosciatalgia or syndrome of the cauda equina. Clinical outcome was satisfying after surgical removal of the tumor. The nature of which was a neurinoma of the cauda equina; a lumbar intradural granuloma and an ependymoma of the cauda equina. The mechanism by which spinal cord tumors raised intracranial hypertension is discussed.

[Cutaneous ulcerations and osteolysis in the carpal tunnel syndrome]. / Ulcérations cutanées et ostéolyse dans le syndrome du canal carpien.

A case of carpal tunnel syndrome with skin ulcerations and osteolysis is reported. Such cases are unusual. There was a sensory and motor deficit with chronic ulcerations on the palmar surface of the third phalanx of the medius. The distal phalanx of the forefinger had been lost due to osteolysis. Surgical treatment is said to be followed by a healing of the ulcerations.

[Neurological manifestations of Rendu-Osler-Weber disease. Apropos of 4 cases]. / Manifestations neurologiques de la maladie de Rendu-Osler-Weber. A propos de 4 observations.

Rendu-Osler-Weber disease is a generalized vascular dysplasia which also involves the central nervous system. The neurological manifestations of the disease are due either to primary intracranial or spinal vascular lesions or to neurological complications of other visceral lesions, notably those of the lung (arteriovenous fistulae). The prevention of ischaemic or infectious cerebral accidents rests on the anatomical (excision) or functional (selective embolization) exclusion of pulmonary arteriovenous fistulae, when present.

[The blink reflex and stimulus detection by the facial nerve in 50 cases of Guillain-Barré polyradiculitis]. / Réflexe de clignement et stimulo-détection du nerf facial dans 50 cas de polyradiculonévrite de Guillain-Barré.

The blink reflex combined with stimulo-detection of the facial nerve was studied in 50 patients presenting Guillain-Barré polyradiculoneuritis. The reflex was normal in more than half the cases. The most frequent electrological picture consisted in bilateral lengthening of the early and late reflex responses of the blink reflex with unilateral or bilateral increase of motor facial latency. The blink reflex showed various abnormalities in slightly more than one third of the cases of polyradiculoneuritis presenting no clinical signs of facial involvement, thus constituting subclinical lesional evidence of the reflex arc.

[Spontaneous rupture of intracranial dermoid cyst. Clinical and radiological study]. / Rupture spontanée d'un kyste dermoïde intra-crânien. Etude clinique et radiologique.

A 22 year old woman had a seizure, and the skull X-ray showed an intracranial arched calcification. CT scan permitted diagnosis of dermoid cyst. Rupture of the cyst was testified by low density areas disseminated on the cortical surface and intra-ventricular fat level. Surgical removal confirmed dermoid cyst with rupture and fat fluid inside. Authors underline infrequency of such intra-ventricular fat level. CT scan, with low density of lipidic origin promote considerably such diagnosis both of the real nature of the cyst and of its rupture.

[Brief losses of consciousness of unknown origin. The contribution of echocardiography and of Holter monitoring]. / Les pertes de connaissance bréves de nature inconnue. Apport de l'échocardiographie et du Holter.

67 patients presented with a syncope of unknown origin following the usual exploration and were the subject of a more elaborated study: echocardiography (echo 2D) and Holter. 3.5 per cent of the Holter recordings enabled to ascribe to the heart the cause of the syncope. More than half of the Holters disclosed abnormalities of the cardiac rhythm leading to an anti-arrhythmic therapy in some cases, even when the cardiac origin of the loss of consciousness (LC) could not be confirmed. Echocardiograms could not lead to the diagnosis and less than one fourth of them disclosed abnormalities. In a developing study (14.8 +/- 8.7 months) that was carried out, 3 out of 4 patients did not present with any more LC; 3 died (6%) and 9 (18%) had LC again. On the other hand, in 5 patients (10%) a diagnosis could be evoked at the end of this follow-up. This study confirms the difficulties of diagnosis of this group of syncope of unknown etiology, as evidenced by the low results of intense and costly explorations and the little information obtained, even after a follow-up of more than 1 year.

[Prognosis of treated temporal arteritis. Retrospective study of 87 cases]. / Pronostic de l'artérite temporale traitée. Etude rétrospective de 87 observations.

Eighty-seven patients (mean age 73 years) with histologically proven Horton's disease were followed up in 5 different specialized hospital units from 1970 to 1984. Except for one patient treated exclusively with antimalarials, all were under corticosteroids. The mean initial dose of prednisone or equivalent was 0.7 mg/kg/day and the mean maintenance dose, 10 mg/day. Steroids could be discontinued in 21 cases after 36 months on average; the other patients could not be weaned, even though 4 of them had been on steroids for more than 10 years. Side-effects were noted in 43 cases. Twenty-four patients died, mostly of cardiovascular diseases. Survival rates were 89 +/- 6.35% at 1 year, 60.2 +/- 8.7% at 5 years and 48 +/- 11.3% at 10 years. In the long run, mortality in our series proved to be exactly the same as in the general population. Nineteen patients had ocular manifestations of giant cell arteritis always from the onset, except for a fall in visual acuity; 26 relapses were observed in 18 patients, either during reduction of steroid dosage (21 cases) or after withdrawal (5 cases). In 2 cases histology showed typical lesions of giant cell arteritis after 41 and 50 months respectively under corticosteroid therapy.

[Hematoma of the psoas. Comparative diagnostic contributions of ultrasonography and x-ray computed tomography]. / Hématomes du psoas. Apports diagnostiques comparés à l'ultra-sonographie et de la scannographie.

A 11 cases study of hematoma of the iliacus muscle underlines better results obtained by C.T. Scanner compared to those of ultrasonography examination in term of definite diagnoses. Comparison of density values and repeated examination were useful to assert diagnosis and to appreciate the course of the illness. Only C.T. Scanner was able to show which portion of the muscle was concerned. Authors correlated the C.T. Scanner results to the nature of the entrapment neuropathy clinically found: an isolated femoral nerve palsy or association with an obturator nerve dysfunction.

[Contribution of echocardiography and Holter monitoring to the diagnosis of occult sources of cerebral embolism]. / Apport de l'échocardiographie et du Holter au diagnostic des sources occultes d'embolie cérébrale.

112 echocardiographies and 91 long-term Holter recordings were performed looking for an emboligenic cardiac lesion in patients in sinus rhythm and free of any major carotid atherosclerosis. The results were evaluated in relation to the emboligenic potential of the lesions observed. 5 positive results were obtained (4.46%) on echocardiography (3 aneurysms of the interatrial septum, 1 myxoma and 1 endocarditis) and 10 positive results (10.99%) were demonstrated on the Holter monitor. Among the 45 (40.18%) echocardiographic anomalies capable of constituting a cardiac site of origin of emboli, there were 18 cases of dilatation or hypertrophy of the left chambers of the heart, 13 cases of calcification of the aortic valve, 8 cases of prolapse of the mitral valve and 8 cases of calcification of the mitral ring. Finally, 55.35 per cent of the echocardiographic examinations and 52.74 per cent of the Holter examinations were found to be normal. Although the yield of these examinations is low, the anomalies discovered were definitely responsible for the cerebral emboli and could only have been demonstrated by such investigations.

[Protein profile and immunoelectrophoresis of cerebrospinal fluid in neurology. Results and etiologies apropos of 430 tests]. / Profil protéique et immuno-électrophorèse du liquide céphalo-rachidien en neurologie. Résultats et étiologies à propos de quatre cent trente examens.

The study of 430 cerebrospinal fluids resulting from a neurological department showed 67 pathological medical cases according to following tests: intrathecal IgG synthesis and/or restricted heterogeneity with immuno-electrophoresis. We established a biological classification to approach the different etiologies. This classification was used for multiple sclerosis for which various strictly clinical classifications are not always able to diagnose the illness, as we show it for one of them.

[The blink reflex and the diagnosis of multiple sclerosis. Clinical correlations in 66 patients]. / Réflexe de clignement et diagnostic de la sclérose en plaques. Correlations cliniques chez 66 patients.

The blink reflex obtained from 66 patients with multiple sclerosis (MS) shows 73% pathologic responses with MS considered as definite, 50% with MS considered as probable and only 18% with possible MS. These findings are of great diagnostical help, particularly in the absence of clinical evidence of involvement of the brain-stem. Among 8 electrological syndromes of alteration of the blink reflex, those due to large lesions of the brain-stem are often associated with definite MS, but small alterations of the blink reflex are more valuable for multifocal characterisation of the illness.

[Spinal cord metastasis of a glioblastoma]. / Métastase médullaire d'un glioblastome.

Two years after surgery followed by chemotherapy and radiotherapy of a temporal glioblastoma, a 51 year-old woman presented pluriradicular symptoms ascribed to compression of the left part of the cauda equina. The second operation confirmed the metastatic nature of the compression, and histological investigation proved the similarity of the neoplastic tissues taken from the medullary and cerebral regions. The authors stress the rarity of the clinical forms of medullary metastases of glioblastomas. The factors conducive to this fluid effusion are trauma and ventricular effraction by the original tumour. Neither screening nor prophylactic irradiation seem necessary in view of the low frequency of these metastases.