Pathogenicity of Antibodies against NMDA Receptor: Molecular Insights into Autoimmune Psychosis.

Recent years have seen a flourishing literature on detection of circulating autoantibodies against neurotransmitter receptors in patients with neuropsychiatric disorders. These studies have generated hope for a better understanding of the underlying molecular dysfunctions and for appropriate therapeutic strategies. However, the detection of these autoantibodies in healthy subjects, and the lack of mechanistic insights have fostered debate about the pathogenic role of such autoantibodies. Here, we specifically discuss the biological evidence linking autoantibodies directed against the glutamatergic N-methyl-d-aspartate (NMDA) receptor (NMDAR-Abs) and psychosis, emphasising recent single-molecule imaging investigations that unveiled the impaired surface trafficking of NMDAR in the presence of NMDAR-Abs from psychotic patients. Although still in its infancy, the hypothesis that NMDAR-Abs from patients with psychosis play a pathogenic role is thus gaining support, opening avenues of fundamental and translational investigations.

[Parathyroid adenoma: surgical strategy]. / Adénome parathyroïdien: stratégie chirurgicale.

OBJECTIVES: The purpose of this study is to reach a better understanding in the handling of parathyroid adenomas, and to emphasize the importance of pre-operatory explorations in order to establish the best surgical approach and its cost. MATERIAL AND METHODS: We are using a retrospective study of 51 patients that underwent surgery in our department between the years 1997 and 2002, for the treatment of primary hyperparathyroidism. Every patient received to a pre-operatory exploration in order to localize the parathyroid tumors, including cervical echography in 51 of the cases, and a sestamibi scintigraphy in 49 of the cases. Two surgical procedures were performed: unilateral approach, and bi-lateral approach. RESULTS: The implementation of a systematic pre-surgical checkup allowed for unilateral surgery in 76% of the patients (39 out of 51), from which 31% (12 out of 39) under local anesthesia. CONCLUSIONS: The accuracy of the pre-operatory explorations in order to localize the parathyroidian tumors in regard to HPTP, allows for precise surgery via unilateral approach under local anesthesia. The benefits are significant with shorter procedure time, shorter patient hospitalization, and lower risks for complications. The pre-operatory explorations also decrease the total cost of the procedure and are a critical tool for the surgeon.

[Presymptomatic injury of the recurrent laryngeal nerve in benign thyroid disease: contribution of electromyography]. / Atteinte récurrentielle présymptomatique au cours d'affections bénignes de la thyroïde: apport de l'électromyographie.

Diagnosis of recurrent laryngeal nerve palsy is usually possible through a clinical, laryngoscopical and electromyographical approach, but at a critical stage of the nerve injury. We observed four cases of benign thyroïd tumoral processes with a preoperative electromyographic examination showing neurogenic abnormalities in the thyroarytenoid muscle without any clinical symptoms. We presume that only laryngeal electromyography permits the diagnosis of mild, even asymptomatic laryngeal recurrent nerve injury. A recurrent laryngeal nerve palsy occurs in thyroid tumors, most often in malignant conditions, rarely in benign ones. Nevertheless early forms of nerve injury with benign thyroïd pathology could be underrated. Since the functional prognosis of symptomatic laryngeal nerve palsy is doubtful, laryngeal electromyography, through its ability to diagnose early nerve injury, provides helpful indications in thyroïd benign tumoral diseases for the therapeutic decision.

[Carotid sinus hypersensitivity associated with a treated otorhinolaryngologic cancer. Study of 103 patients]. / Hypersensibilité sino-carotidienne associée à un cancer oto-rhino-laryngologique traité. Etude chez 103 malades.

The incidence and characteristics of carotid sinus hypersensitivity were investigated in a homogeneous population of patients undergoing radiotherapy and surgery for ear, nose and throat (E.N.T.) cancers. Among the 103 patients who were thus treated but had none of the risk factors usually correlated with the disease investigated, 30 percent showed evidence of mainly vasodepressive (87 percent) carotid hypersensitivity when subjected to carotid sinus massage accompanied by electrocardiography and intra-arterial blood pressure measurement. The large number of positive responses, as well as the good reproductibility of this provocation test and its concordance with the site of local treatment suggest that surgery contributes to the genesis of the abnormality. Owing to the considerable variations in the type of response obtained, carotid sinus hypersensitivity should systematically and repeatedly be searched for in cases of syncope in patients treated for E.N.T. cancer.

[Ghost curves and early auditory evoked potentials. Role of temporary deafness]. / Courbes fantômes et potentiels évoqués précoces auditifs. Rôle de l'assourdissement.

Phantom ear responses, contralateral to the transducer (head-phone), can be observed during recording of early evoked auditory potentials, as in conventional audiometry, and can ease the problem of temporary deafness. Their appearance obeys laws common to audiometric tests, stimulus transfer to the opposite ear being through bone of cranium with attenuation inversely proportional to bony surface at level of transducer. However, the analogy between conventional and objective audiometry stops there. Normally, the electrophysiologic V wave response is not present or absent alone, as would be a voluntary response of the patient, but varies by its latency and amplitude as a function of intensity and nature of stimulus. These supplementary criteria should make identification simple, allow an abnormal response to be recognized and indications for treatment of the temporary deafness to be better defined. This is illustrated by the present study of 50 cases of unilateral kophosis, using a TDM 39 transducer employed most commonly in both objective and conventional audiometry.

[Phantom responses and early auditory evoked potentials. Comparison of the TDH39 hearing aid and an intra-canal hearing device]. / Réponses fantômes et potentiels évoqués précoces auditifs. Comparaison entre l'écouteur TDH39 et un écouteur intra-canalaire.

Using conventional tonal audiometry, Joseph Zwislocki demonstrated in 1953 that the intensity of sound transfer to the opposite ear depends on the transductor (earphone). Interauricular attenuation is inversely proportional to the bone surface facing the earphone when all air transmission has been eliminated. In earlier work in 1982, we first concluded that this rule is applicable to auditory evoked potentials such as those used for conventional audiometry for unilateral cophosis. A TDH39 device transfers the sound to the contralateral ear with an attenuation of approximately 60 decibels, using the V wave latency as reference for calculating intensity. We verified the reality of Joseph Zwislocki's rule with newly available insert earphones. Surface contact with bone being smaller than with the TDH39, sound transfer to the opposite ear would logically be much more attenuated when air transmission is eliminated. The aim of this work was to determine sound transfer in 27 patients with unilateral cophosis undergoing conventional audiometry and to draw practical conclusions.

[Abnormalities of the intrapetrous internal carotid artery]. / Anomalies de la carotide interne intra-pétreuse.

The abnormalities of the internal carotid artery along its intrapetrosal course are infrequent, but they are interesting because of the etiological hypotheses that must be put forward and because they sometimes have extremely serious consequences if middle ear surgery is performed without a preliminary study of the anatomy and vasculature of this region. No statistics likely to produce accurate guidelines are available at present, as the literature has reported too few cases. After attempting to explain these aberrant variations on the basis of anatomical and embryological considerations, we describe one case encountered in the ENT department of Brest University Hospital, then discuss it according to the data provided by the literature.

[Fistula of the 4th endobranchial pouch: a case report]. / Fistule de la 4ème fente branchiale: à propos d'un cas.

Fourth branchial arch fistula are rare. Their diagnosis is difficult and anknow. It is confirmed by fistulography and endoscopy. It's an surgical treatment.

[Acute valproic acid intoxication: interest of a treatment by extracoporeal elimination combined with L-carnitine]. / Cas d'une intoxication sévère à l'acide valproïque: intérêt d'un traitement par épuration extrarénale combiné à la L-carnitine.

We present the case of a 24-year-old-female patient, who made an attempt to autolysis with valproic acid, benzodiazepines and neuroleptic. The valproic acid plasma level was very high (1437 µg/mL), confirming it was a severe intoxication. She presents an acute encephalopathy with prolonged status epilepticus, a lactic metabolic acidosis and hematologic disorders such as bicytopenia. Treatment including L-carnintine and continuous veno-venous haemodialysis (CVVHD) was rapidly introduced to prevent the occurrence of cerebral oedema. The evolution was favourable despite the occurrence of a nosocomial ventilation acute lung injury. The patient had motor sequelae of cranial nerves following status epilepticus extended, which disappeared spontaneously after several days.