FLAIR Vascular Hyperintensities as a Surrogate of Collaterals in Acute Stroke: DWI Matters.

BACKGROUND AND PURPOSE: FLAIR vascular hyperintensities are thought to represent leptomeningeal collaterals in acute ischemic stroke. However, whether all-FLAIR vascular hyperintensities or FLAIR vascular hyperintensities-DWI mismatch, ie, FLAIR vascular hyperintensities beyond the DWI lesion, best reflects collaterals remains debated. We aimed to compare the value of FLAIR vascular hyperintensities-DWI mismatch versus all-FLAIR vascular hyperintensities for collateral assessment using PWI-derived collateral flow maps as a reference. MATERIALS AND METHODS: We retrospectively reviewed the registries of 6 large stroke centers and included all patients with acute stroke with anterior circulation large-vessel occlusion who underwent MR imaging with PWI before thrombectomy. Collateral status was graded from 1 to 4 on PWI-derived collateral flow maps and dichotomized into good (grades 3-4) and poor (grades 1-2). The extent of all-FLAIR vascular hyperintensities and FLAIR vascular hyperintensities-DWI mismatch was assessed on the 7 cortical ASPECTS regions, ranging from 0 (absence) to 7 (extensive), and associations with good collaterals were compared using receiver operating characteristic curves. RESULTS: Of the 209 included patients, 133 (64%) and 76 (36%) had good and poor collaterals, respectively. All-FLAIR vascular hyperintensity extent was similar between collateral groups (P = .76). Conversely, FLAIR vascular hyperintensities-DWI mismatch extent was significantly higher in patients with good compared with poor collaterals (P < .001). The area under the curve was 0.80 (95% CI, 0.74-0.87) for FLAIR vascular hyperintensities-DWI mismatch and 0.52 (95% CI, 0.44-0.60) for all-FLAIR vascular hyperintensities (P < .001 for the comparison), to predict good collaterals. Variables independently associated with good collaterals were smaller DWI lesion volume (P < .001) and larger FLAIR vascular hyperintensities-DWI mismatch (P = .02). CONCLUSIONS: In acute ischemic stroke with large-vessel occlusion, the extent of FLAIR vascular hyperintensities does not reliably reflect collateral status unless one accounts for DWI.

[Respiratory distress syndrome, early postnatal corticoid therapy and periventricular leukomalacia]. / Détresse respiratoire, corticothérapie postnatale précoce et leucomalacie périventriculaire.

UNLABELLED: The aetiology of cavitating periventricular leukomalacia (cPVL) involves pre and perinatal factors. Early postnatal dexamethasone has been associated with an increase in cerebral palsy but its role in the development of PVL remains uncertain. OBJECTIVES: (1) Reevaluate major factors associated with cPVL, (2) Evaluate the potential effect of early postnatal dexamethasone. METHOD: This retrospective case-control study (matched for gestational age, birth weight, twin pregnancy and date of birth) compared 50 premature infants with cPVL diagnosed between D7 and D45 from 1995 to 2000 and 50 matched control newborns with normal serial neurosonograms. A data base with 97 selected perinatal variables was used to perform logistic regression analysis in controlling confounding variables, the results are expressed as adjusted Odds Ratio (OR) with 95% confidence interval. RESULTS: The two populations were comparable for gestational age (median: 29.3 weeks, range: 24.4-34.7) and birth-weight (1297 g, 645-2130 g). The annual incidence of cPVL in preterm infants with a gestational age < 33 weeks varied from 1995 to 2000: 1.3%, 4.5%, 13.4%, 2.1%, 3%, 2.9%. Early postnatal dexamethasone was used in 23 of the newborns who developed cPVL (between november 1996 and march 1998). The only antenatal factor associated with cPVL was cardiac decelerations (28% vs 14%, OR = 3.4, 1.1-11.3). The postnatal risk factors were respiratory distress syndrome requiring the use of rescue surfactant (78% vs 38%, OR = 4.2, 1.4-11.9) and early postnatal dexamethasone at the time it was used (78% vs 17%, OR = 17.1, 3.9-73). CONCLUSION: The use of rescue surfactant and of early postnatal dexamethasone in preterm infants with respiratory distress syndrome were independently associated with the subsequent occurrence of cPVL. Cardiac deceleration was the only antenatal factor associated with cPVL.

[Technic of continuous axillary plexus block]. / Technique du bloc plexique prolongé par voie axillaire.

A technique of continuous axillary brachial plexus block, using an epidural Tuohy needle and an epidural catheter, is described. Studies were carried out in ten patients using this technique with bupivacaine as a local anesthetic drug. The catheter remained indwelling during a mean period of five days. Good analgesia was obtained in nine out of the ten patients. Thus this technique allows pain-free postoperative period in hand surgery.

[Deep morphea-type lesions, first manifestations of lymphocytic lymphoma]. / Lésions à type de morphées profondes, premières manifestations d'un lymphome lymphocytique.

INTRODUCTION: The association between scleroderma and lymphoma is uncommon and can sometimes query an fortuitous association. More particular are observations where chronological and histological features show an evident link between a tumorous process and sclerosis. OBSERVATION: This case concerns a man 69 years old who was treated for one year for partial subcutaneous sclerosis present on his legs, thighs, fore-arms, and on the upper part of the trunk. No signs were present of visceral involvement evoking a systemic scleroderma and histology showed an intrication of a deep sclerosis, fasciitis and a tumoral lymphoma process. Diagnosis of lymphocytic lymphoma was confirmed. Initiating a chemotherapy (CHOP) allowed for a reduction of the sclerosis which didn't respond to the only corticotherapy. DISCUSSION: This observation can be linked to the association of fasciitis and lymphoma identified by Naschitz et al, but is different by: 1) the clinical aspect which correspond more to deep morphea lesions; 2) the histological link between sclerosis and lymphoma. This last point suggest that it is the tumoral population which have induced the sclerosis process linked to the secretion of pro-inflammatory factors. In adverse cases with longer delay between lymphoma and scleroderma this association may be fortuitous.

[Oral and dental health status in a population of schoolchildren aged 5 to 15 years in Wallis]. / Etat bucco-dentaire de la population scolarisée de Wallis âgée de 5 à 15 ans.

This study was performed in 1992 with three aims: to assess precisely the prevalence of dental carries in the child population of Wallis Island; to evaluate the need for dental care; and create a database allowing the oro-dental status to be followed and the effectiveness of preventive programmes to be assessed. The total population of the Wallis Islands according to the 1990 (the most recent) census was 8,973 living in twenty villages. The population was classified into four ethnic groups: Wallisian (94.4%), Futunian (1.2%), European (3.9%) and miscellaneous (0.5%). The lifestyle of the population is traditional and there is virtually no manufacturing, overseas trade or tourism. The population of Wallis Island is young, with 56.6% of the population under 20 years old. Almost all the children attended school from the age of 6 to the age of 19 [3]. Half the Island's children (n = 1407) between the ages of 5 and 15 years old were classified into 11 age groups and were examined. Children from all schools were included in the study group which was representative of the child population of Wallis Island (94.4% were Wallisian) (table 1). The study was performed according to the 1988 WHO guidelines [4] and Cahen [5]. At age 5, a mean of 3.26 teeth had erupted. The permanent dental set (other than the 3rd molars) were present by age 12 years in virtually all cases. The percentage that had carrie-free permanent teeth were 89.9% at age 5, 59.9% at age 6, 22% at age 12 and only 13.4% at age 15.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inefficacy of theophylline in preventing hypoxemia in abdominal surgery]. / Inefficacité de la théophylline dans la prévention de l'hypoxémie en chirurgie abdominale.

It would be very useful to prevent post surgery ventilatory and gazometric insufficiencies that represent a significant risk factor. Ten patients have received proper doses of theophyllin in order to maintain accurate plasmatic concentration immediately after surgery. During the next 24 hours, their respiratory frequency, tidal volume, ventilation per minute, PaO2 and PaCO2 have been recorded. Those data have been compared with a test group (N = 10) having received injections of placebo. No relevant discrepancy exists in the ventilation parameters nor any increase of PaO2. The significant factor is a substantial decrease of PaCO2. It appears that theophyllin has no significatory efficiency for controlling the post surgery hypoventilation and hypoxemia.

Impaired decision-making and brain shrinkage in alcoholism.

Alcohol-dependent individuals usually favor instant gratification of alcohol use and ignore its long-term negative consequences, reflecting impaired decision-making. According to the somatic marker hypothesis, decision-making abilities are subtended by an extended brain network. As chronic alcohol consumption is known to be associated with brain shrinkage in this network, the present study investigated relationships between brain shrinkage and decision-making impairments in alcohol-dependent individuals early in abstinence using voxel-based morphometry. Thirty patients performed the Iowa Gambling Task and underwent a magnetic resonance imaging investigation (1.5T). Decision-making performances and brain data were compared with those of age-matched healthy controls. In the alcoholic group, a multiple regression analysis was conducted with two predictors (gray matter [GM] volume and decision-making measure) and two covariates (number of withdrawals and duration of alcoholism). Compared with controls, alcoholics had impaired decision-making and widespread reduced gray matter volume, especially in regions involved in decision-making. The regression analysis revealed links between high GM volume in the ventromedial prefrontal cortex, dorsal anterior cingulate cortex and right hippocampal formation, and high decision-making scores (P<0.001, uncorrected). Decision-making deficits in alcoholism may result from impairment of both emotional and cognitive networks.

Macrostructural abnormalities in Korsakoff syndrome compared with uncomplicated alcoholism.

OBJECTIVE: To distinguish, in patients with Korsakoff syndrome (KS), the structural brain abnormalities shared with alcoholic patients without KS (AL), from those specific to KS. METHODS: MRI data were collected in 11 alcoholic patients with KS, 34 alcoholic patients without KS, and 25 healthy control subjects (CS). Gray and white matter volumes were compared in the 3 groups using a voxel-based approach. RESULTS: A conjunction analysis indicated a large pattern of shared gray and white matter volume deficits in AL and KS. There were graded effects of volume deficits (KS < AL < CS) in the medial portion of the thalami, hypothalamus (mammillary bodies), left insula, and genu of the corpus callosum. Abnormalities in the left thalamic radiation were observed only in KS. CONCLUSIONS: Our results indicate considerable similarities in the pattern of gray and white matter damage in AL and KS. This finding confirms the widespread neurotoxic effect of chronic alcohol consumption. Only a few cerebral regions, including the medial thalami, mammillary bodies, and corpus callosum, were more severely damaged in KS than in AL. The continuum of macrostructural damage from AL to KS is therefore restricted to key brain structures. Longitudinal investigations are required to determine whether alcoholic patients with medial thalamic volumes that are comparable to those of patients with KS are at increased risk of developing KS.

Topology inversion of CYP2D6 in the endoplasmic reticulum is not required for plasma membrane transport.

The presence of CYP2D6 at the surface of isolated rat and human hepatocytes and its recognition by autoantibodies were reported recently. We wondered whether the unexpected outside orientation at the plasma membrane could be related to topological inversion (luminal-oriented form) of cytochrome P450 in the endoplasmic reticulum. To examine the potential role of cDNA polymorphism, a CYP2D6 variant carrying three positive charges at the amino terminus (2D6ext) was constructed and expressed in yeast. Immunoblotting, flow cytometry, and electron microscopy showed that wild-type CYP2D6 expressed in yeast was present on the outer face of the cell plasma membrane in addition to the regular microsomal location. This location reproduces the hepatocyte situation. 2D6ext expressed in yeast and COS7 cells seemed to be partially N-glycosylated and was located at the plasma membrane surface. Nevertheless, the glycosylated form was not enriched in the plasma membranes compared with microsomes. The relationship between CYP2D6 and 2D6ext topologies and catalytic competence was tested. Cumene hydroperoxide-dependent dextromethorphan demethylation was performed on microsomal vesicles after combined proteolysis and immunoinhibition experiments. CYP2D6 activity was completely abolished, whereas the glycosylated and luminal-oriented fraction of 2D6ext remained active. This suggests that a luminal-oriented glycosylated form is not involved in cytochrome P450 transport to the plasma membrane. Yeast thus reproduces the unusual CYP2D6 plasma membrane location and orientation, which do not require sequence alteration, glycosylation, or even an inverted endoluminal orientation.

[Idiopathic eruptive macular pigmentation]. / Pigmentation maculeuse éruptive idiopathique.

BACKGROUND: Hyperpigmentation can be due to different cause or have no apparent cause. CASE REPORT: A 4 year-old boy was examined because pigmentation had appeared 5 months earlier. The cutaneous lesions were blue-grey, macular (diameter: 2-3 cm), with a predilection for the trunk, the lower part of the neck and the proximal part of the legs. There was no pruritus and the lesions did not urticate when rubbed. Histologically, there was epidermal acanthosis, moderate hyperkeratosis and dermal infiltration with numerous melanophages. The clinical lesions remained stable 6 months later. CONCLUSION: The cutaneous manifestations and their course are similar to those of idiopathic macular pigmentation usually reported in adolescents. Ultramicroscopic findings have led some authors to classify it as lichen planus.

[Discriminant factors of risk of infection in routine digestive surgery. Trial apropos of 308 cases]. / Facteurs discriminants du risque infectieux en chirurgie digestive réglée. Essai à propos de 308 cas.

Postoperative infection in routine digestive surgery is a common complication, its prevalence being variously assessed between 10 and 30%. Study of criteria of infectious risk, whether inherent to the subject or his environment, has not been the subject of overall evaluation. The present study involved 308 subjects in two departments of surgery with different geographical and architectural features. A comparison was first made between the two departments in terms of the surgical population and the reaction rate. The presence was then sought of a relationship between infection, whether general or local (urinary tract, pulmonary, septicaemia) and factors concerning the bacteriological environment and factors indicative of the resistance of the subject. The statistical technique of discriminant analysis was used to determine the preponderance of certain factors which might be indicative of at risk subjects.

[Adsorption of insulin directly added to infusion bottles]. / Adsorption de l'insuline introduite directement dans les flacons de perfusion.

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

Calmodulin is essential for assembling links necessary for exocytotic membrane fusion in Paramecium.

Calmodulin has long been suspected to be involved in calcium-regulated exocytosis but its precise site(s) of action has not yet been identified. In Paramecium, a genetic approach to the problem is possible as in vivo-selected mutations in the calmodulin gene that prevent the activation of some channels have been characterized. Three of these calmodulin mutants were examined for exocytotic capacity and the mutant cam1 was found to be defective for exocytosis at 35 degrees C. The loss of exocytotic capacity in cam1 cells can be restored by transformation with the wild-type calmodulin gene, demonstrating that its exocytotic lesion is indeed due to the mutation in the calmodulin gene. The cam1 mutant displays abnormal exocytotic sites at the non-permissive temperature: it lacks the links ('rosettes' of intramembranous particles in the plasma membrane and the fibrous 'connecting material') which normally connect plasma and trichocyst membranes. Upon shift of cam1 cells from the permissive to a non-permissive temperature, performed sites remain functional. These results demonstrate that calmodulin is necessary for the assembly of these links at the exocytotic site. These results do not, however, exclude the possibility of calmodulin also being involved in Ca(2+)-dependent steps of the stimulus-exocytosis coupling.

[Adsorption of insulin introduced directly into perfusion bottles]. / Adsorption de l'insuline introduite directement dans les flacons de perfusion.

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

Some characteristics of the Coagulation Factor Xa purified from human serum.

1. Coagulation Factor X was purified from human serum to apparent homogeneity in disc gel electrophoresis, sodium dodecyl sulphate-polacrylamide-gel electrophoresis, immunoelectrophoresis and analytical ultracentrifugation. The method used was a modification of that described by Gladhaug & Prydz (1970). 2. The method permits the isolation of an activated form of Factor X (Xa) which has a molecular weight of about 25000. 3. Factor Xa is a glycoprotein containing about 14% carbohydrate. A preliminary report of the amino acid composition is given.

Dental injuries among schoolchildren aged from 6 to 15, in Rennes (France).

A representative sample of 2020 schoolchildren, aged 6 to 15 years, was randomly selected from 85 state and private schools in Rennes and distributed in 10 groups, according to their age. Type and prevalence of dental injuries were determined in each group, using Ellis & Davey's classification, giving rise to a subset of 345 subjects. Simple enamel fracture was the predominant injury (59.4%), occurring most often on maxillary central incisors. Most time (77.1%), the trauma affected only one tooth. Mean prevalence of dental injuries was 13.6% from 2020 subjects. Boys showed a higher prevalence than girls (respectively 17% and 10.2%), but this difference was only significant for age-groups 12 and 13 (p < 0.001) and for the whole group of 6-15 (p < 0.001).