Clinical ictal patterns in epileptic patients with occipital electroencephalographic foci.

Seizure patterns and other clinical features were analyzed in 55 epileptic patients with electrographic evidence of exclusive or predominant occipital involvement. Few statistically significant differences in clinical or ictal patterns were found between subjects with purely focal occipital involvement and those with temporal and temporo-parietal spread or minor additional independent foci. On the other hand, cases with bilateral synchronous occipital spike activity appeared to reflect a different type of epileptic disorder. Clinical pleomorphism was more apparent than is commonly conceived; thus, although the incidence of visual auras was relatively high (47 percent), epigastric, psychic, somatic, and other sensory phenomena were not infrequently encountered. Ictal motor patterns were most commonly (53 percent) nonfocal or absent, but partial or focal motor attacks and psychomotor seizures were amply represented. Ictal features with their localizing and lateralizing reliability were also analyzed and discussed in relation to those found in a comparison study of seizures of fronto-centro-parietal origin.

Depth and direct cortical recording in seizure disorders of extratemporal origin.

This study is based on 28 patients with intractable seizures in whom exclusively extratemporal or a combination of temporal and extratemporal electrodes were chronically implanted for the localization of the epileptogenic process and possible surgical treatment. Clinical and electrographic data are briefly summarized, the indications for the use of implanted electrodes are outlined, and the number and position of the electrodes and the findings in each individual case are given. Four illustrative examples are described in greater detail. Mainly on the basis of data derived from this particular technique of investigation, surgical treatment was eventually carried out in 14 patients. It is concluded that the use of implanted electrodes in seizure disorders of probable extratemporal origin can be of real diagnostic benefit in certain specific situations. In most instances, however, this technique simply serves to demonstrate the complexity of an apparently simple case or, of greater clinical consequence, might tend to oversimplify cases that are actually very complex. Indeed, many data in this study raise some doubts about the validity of the classic concepts of "focal" epilepsy.

Electroencephalographic findings in Gaucher disease.

The electroencephalographs (EEGs) of 26 patients with Gaucher disease were reviewed. Eleven cases with abnormal EEGs or neurologic complications are reported, and the findings of the abnormal recordings are discussed.

Radionuclide cerebral perfusion scintigraphy in determination of brain death in children.

We evaluated a radionuclide scintigraphic technique for imaging relative cerebral perfusion in 18 children who had no evidence of cortical and brainstem function. Patients without scintigraphic evidence of cerebral perfusion all later met criteria for diagnosis of brain death. Patients who failed to satisfy brain-death criteria had persistent scintigraphic evidence of cerebral perfusion. Seven patients with normal scintigraphic studies were being treated with barbiturates and hypothermia at levels that attenuated or completely suppressed EEG activity. Four patients without scintigraphic evidence of cerebral perfusion had mean arterial pressures (MAP) higher than (54.8 +/- 7.6 torr) intracranial pressures (ICP) at the time of scintigraphic study, suggesting that ICP in excess of MAP is not the sole explanation for the absence of cerebral perfusion. Radionuclide cerebral perfusion scintigraphy (RCPS) is a rapid, portable, accurate test that appears to be useful in the diagnosis of brain death in the pediatric population.

Fluorometric monitoring of NADH levels in cerebral cortex: preliminary observations in human epilepsy.

In 14 patients operated upon for focal cerebral seizures under local anesthesia, cortical electrical activity was compared with the levels of nicotinamide adenine dinucleotide (NADH) observed fluorometrically. NADH levels fell 3 to 15% in response to 5-second intervals of cortical stimulation in 42 of 70 observations. Although a rough correlation was seen between the quantity of current delivered (milliamperes X seconds) and the NADH decrease, this varied from case to case. The presence of cortical afterdischarge often, but not invariably, corresponded to a greater percentage of change in the NADH levels. Averaging the NADH response to sporadic interictal epileptiform discharges failed to demonstrate concomitant NADH reductions. A similar lack of change was seen in four patients in whom low frequency spike foci were induced by topically applied penicillin in cortex destined for excision. Preliminary studies of the topography of spread of NADH change after cortical stimulation indicate that this is usually asymmetrical in human epileptogenic cortex. Under experimental conditions in cats, it seemed possible to differentiate primary from projected epileptiform activity, in that the projected activity had little or no concomitant fall in the NADH level after the electrographic spike. Pathological examination of the excised sites of NADH recording showed, with one exception, fibrous astrocytic transformation of the central cortex layers.

Clinical significance of periodic lateralized epileptiform discharges: relationship with status epilepticus.

A retrospective study was carried out in 147 patients who had been found to have periodic lateralized epileptiform discharges (PLEDs). Clinical, laboratory, radiological, and pathological correlation was performed for all patients. As in previously published works, we found a high correlation with cerebrovascular accidents in our population. A large number of patients, however, had no evidence of focal central nervous system pathology. An attempt was made to find a temporal relationship between the onset of seizure activity (or neurological dysfunction in those patients without seizure activity) and the recording of an EEG with PLEDs. We found that most of the EEGs with PLEDs were obtained within the first 4 days of seizure activity or status epilepticus condition. We postulate that the EEG phenomenon of PLEDs could be considered a part of the status epilepticus condition. Suggestive of this was the fact that the first EEG record obtained in one-third of our patients showed electrographic partial status epilepticus. In a small percentage of our patients, a transitional record showed first status epilepticus and then PLEDs. We found that PLEDs usually disappeared from the EEG tracing within 9 days post-ictus flash status. They were most frequently replaced by focal slowing or random spike activity.

Temporal-lobe seizures with additional foci treated by resection.

The authors describe the use of temporal lobectomy following careful and repeated electroencephalogram (EEG) evaluation (with implanted electrodes in otherwise unresolvable cases) in the epileptic group characterized by automatisms (psychomotor seizures) with temporal epileptiform activity complicated by EEG foci in the opposite temporal lobe or by extratemporal activity. They found that this can render a significant number of patients (between 25% and 50%) either seizure-free or with significant and useful reduction in their seizure frequency. The cure and improvement rates of cases followed up after temporal resection with or without prior study with implanted electrodes were approximately equal. However, the implanted electrodes permitted surgical treatment of certain cases which would have been rejected on the basis of evidence derived from the scalp recordings alone. Of 28 of these 34 patients with persisting EEG epileptiform activity in the postoperative period, only one had such activity in a different location in a follow-up period of 6 years. No evidence of spreading epileptic activity or appearance of "mirror foci" was seen during a follow-up period averaging 8.2 years. Seizure remission up to 15 years with eventual recurrence of the original seizure type may occur following surgical therapy. Follow-up studies of surgical epileptic treatment of less than 3 to 5 years are of doubtful value.

Preoperative electroencephalographic localization of large epileptogenic zones in the frontal and temporal lobes.

The concept of epileptogenic zone is defined as a large area of cortical neurons arranged in concentric circles of variable degrees of epileptogenicity. This is particularly so in frontal lobe epilepsy since the interictal and ictal epileptic abnormalities are poorly localized, often absent and at times misleading in terms of localization. In temporal lobe epilepsy, the epileptogenic zones may be more restricted.

Temporal lobectomy for seizures associated with unilateral schizencephaly.

Schizencephaly is characterized by unilateral or bilateral cerebral clefts associated with neurologic deficits and epilepsy. Most commonly schizencephaly is attributed to abnormal neuronal migration, and these malformations are well visualized by current neuroimaging techniques. This report describes a patient with unilateral schizencephaly and poorly controlled complex partial seizures who was found to have a temporal lobe seizure focus; anterior temporal lobectomy produced nearly complete control of the seizures. Despite the extensive malformation, relatively restricted resection was of significant benefit. The principles of seizure focus localization and resection are applicable to the management of patients with schizencephaly.

CD-ROM transnational training program in cervical cytology (CYTOTRAIN).

The Transnational Training Programme in Cervical Cytology (CYTOTRAIN) is a 3-yr project funded by the European Commission to harmonize training and quality standards in cervical screening across the European Union. The aim of the program is to develop new approaches in initial and continuing vocational training, particularly in the area of life-long learning with the aim of meeting national, regional, and local needs. We present a new approach to training in cervical cytology, using an interactive program of cytological images. The method used to prepare the program and the problems encountered are described. The authors have the feeling that giving details of the organizational and management structure adopted for the project implementation might help other pathologists realize more or less similar CD-ROM training programs in their own field of activity.

Peritoneal endometriosis. Report of a case with cytologic, cytochemical and histopathologic study.

The cytologic and histochemical data in a case of extensive peritoneal endometriosis are presented. The presence of macrophages heavily laden with blue and dark pigment (as demonstrated by May-Grünwald-Giemsa, Perls and Fontana stains) and scattered non-neoplastic endometrial cells in hemorrhagic ascitic fluid indicated a diagnosis of peritoneal endometriosis. Metabolized hemoglobin material was related to both recent and older hemorrhages.

Automatic cytopathologic diagnosis of bronchial carcinoma. I. Cytocentrifugation of bronchial brushings for image analysis.

A cytocentrifugation technique for the preparation of monodispersed preparations of bronchial cells collected by brushing is described. First developed with the aim of obtaining slides suitable for automated analysis, it was found to be useful for routine morphologic examinations. This technique requires careful preparation as well as "education" of the pathologist/screener in the appearance of the cellular elements in its samples. However, it is reliable and reproducible and, above all, eliminates a certain number of artifacts found in conventional preparations.

[Intestinal involvement and exudative enteropathy in Waldenström's macroglobulinemia]. / Atteinte intestinale et entéropathie exsudative au cours de la macro-globulinémie de Waldenström.

The case of a 60 year old man in whom diarrhea, steatorrhea and protein losing enteropathy developed one year after the diagnosis of Waldenström's macroglobulinemia is reported. Histological study of multilevel peroral biopsies of the small bowel mucosa showed the following features: a) lymphangiectasia, b) intralymphatic and interstitial deposits composed of lipids and immunoglobulin M of the kappa type (as demonstrated by specific histoimmunofluorescence), c) a mild lymphoplasmocytoid infiltrate, corresponding to the location of Waldenström's macroglobulinemia. The patient died six months later, in spite of improvement of his digestive tract functional abnormalities by a low-fat diet. Sixteen cases of small intestinal involvement have been reported during the course of Waldenström's macroglobulinemia, of which only one showed features similar to those found in our case. Lymphangiectasia appear to be due to mesenteric lymph node involvement by the tumoral process, and/or to increased blood viscosity; in turn the lymphangiectasia seem to be responsible for steatorrhea and plasma protein losses, since in our case both lipids and the immunoglobulin M-kappa were shown to cross the villous epithelium by immunohistochemistry.

Quality control in cytopathology applied to screening for cervical carcinoma.

When screening for cervical carcinoma became one of the priorities of the European Community (1992), the "European Guidelines for Quality Assurance in Cervical Cancer Screening" proposed an organisation of the screening program. In the following years, Quality Assurance/Quality Control (QC) was organized in many countries. The whole staff of the laboratory has to participate in the organization of Internal QC programs: errors must be detected in all categories of smears and the same terminology has to be adopted. External QC is well accepted when organized by the pathologists themselves. The French program is presented. In the near future, pathologists should take into account the evolution of QC, and the role of modern methods such as telecytopathology and computer-assisted screening devices.

Quality control in cytodiagnosis of carcinoma of the cervix.

In many European countries the morbidity and mortality due to cancer of the cervix are too high. Even in countries, where smears have been taken at regular intervals for many years, the percentage of new cases does not decrease as much as it was expected. There are several reasons that may explain this situation. At least two of them can be solved by pathologists: quality control (QC) system and organization of a school of gynaecological cytopathology for pathologists and cytotechnicians. Here we focus on the main aspects of External and Internal QC and new approaches to QC, including new methods and stricter control of the professional level of all persons involved in the screening and diagnosis of cervical cancer.

[Small-cell bronchial cancers. Apropos of their subtyping]. / Cancers bronchiques à petites cellules. A propos du sous-typage.

Histopathological diagnosis of small cell carcinoma may be rather uneasy, due to merely technical reasons. We believe that a careful preparation of the sections' thickness and smearing would reduce the percentage of non routinely classifiable tumors.

[Statistical approach to cervical and vaginal cytology during contraception]. / Approche statistique de la cytologie cervico-vaginale au cours de la contraception.

PIP: We analyzed 1432 smears in order to check if the usual methods of contraception influence the development of cervical lesions. Several observations have to be made. 1) Given the rarity of certain lesions, a much larger number of samples (x 50) should have been analyzed in order to obtain realistic statistical projections especially for dysplasias and cervical cancers. 2) Significant results could only be obtained when several morphological screening criteria were put together (ectropions, repairs or inflammation) provided that at least 10 cases/sample were observed in order to perform statistical analysis. Therefore, the rate of ectropions observed in a population without contreceptive treatment is 6% higher than in a population taking the pill (correlations coefficient 0.95) and more than 5% repairs are observed in a population using the IUD as compared to oral contraceptives. The rate of clean smears (class 1) and inflammatory smears (class 2 according to Papanicolaou) was found to be the same for all 3 populations studied. Comparing statistical data, it seems to be difficult to provide a correct answer about the influence of contraceptive methods on the development of cervical cancer. Indeed, our work and all other studies present the same difficulty in gathering sufficient samples which are qualitatively equivalent. Volume and present methodology of most of the anatomy and pathological cytology laboratories do not meet the requirements of statistical calculus. However, we think that smears should be routinely done on women taking the pill or wearing an IUD. That is not to say that contraception, regardless of method used, increases the risk of cancer or dysplasia, but that the smears represent a chance for screening and are thus considered preventive medicine. This would also enhance the physician's knowledge about precancerous lesions of the cervix and would, in the near future, boost the number of samples to allow for statistical analysis. (author's)^ieng

[Application of cytocentrifugation to routine cytological diagnosis of solid pathologic tissues (author's transl)]. / La cytocentrifugation appliquée à létude cellulaire des tissus cohérents.

Cytocentrifugation (Watson, 1966) was first proposed as a better cell concentrating technique; more recently, it appeared that the samples, thanks to the "monodispersion" of the cells, are quite suitable for A.L.A. *Automated Image Analysis); this property may be applied to routine microscopic cytodiagnosis of several lesions. This paper is an attempt to discuss the different technical problems to obtain suitable cells from solid pathologic tissues: first, a sufficient quantity of cells must be obtained and a correct medium must be adopted; a special care must be taken for the collecting of the samples; the mediums must be chosen as the most convenient to fix cells, to solve mucous, to permit monolayer spreading to stick unto the slides; a method of cytocentrifugation is described. The characters of the smears are reported about cell concentration, evaluation of cell loss, control of monolayer dispersion, signification of clumps and agregates. The techniques of fixation and staining of such samples are precise for the two chosen mediums: after using PBS-albumin, the slides have to be air-dried and stained according to Papanicolaou or May-Grunwald Giemsa technique; after BABS solution, the slides may be fixed with spray and have to be stained according to Papanicolaou. Technical results applied to 97 cases of bronchial, breast and liver samples are discussed. The advantages of the method are: rapid examination, easy storage of slides, satisfactory preservation of cells, even for the most delicate ones (ciliated bronchial cells, for instance), absence of mucous background, minimal cells loss, possibility of enzymologic studies. Moreover the method happens to be inexpensive.

[Contribution of immunocytochemical marking of benign cells to the diagnosis of serous effusions]. / Apport du marquage immunocytochimique des cellules bénignes au diagnostic des épanchements des séreuses.

In pleural and peritoneal effusions, the distinction between mesothelial cells and histiocytic cells is fairly often difficult. This distinction is specially important in malignant effusions, where such reactive cells can be confused with tumoral ones. In order to increase the accuracy of cytological diagnosis, the immunocytochemical reactivity with 13 antibodies was studied. Four antibodies (vimentin, lysozyme, monoclonal keratin, OKM1) realise a panel specially useful for the characterization of mesothelial and histiocytic cells in most cases of benign or malignant effusions.

[Lymphadenopathy of dermatosis in the course of drug hypersensitivity. Cytologic, immunohisto- and immunocytologic, ultrastructural aspects. Report of a case]. / Lymphadénopathie des dermatoses au cours d'une hypersensibilité médicamenteuse. Aspect cytologique, immunohisto et immunocytologique, ultrastructural. A propos d'une observation.

In addition to the morphological details obtained from the imprints, a simple immunocytological study allowed us to diagnose one case of a dermopathic lymphadenopathy simulating a T cell lymphoma, following a drug-induced erythrodermia. We were able to identify the increase of CD1a+ and Prot. S100+ cells on acetone fixed imprints. The histological, immunohistological and ultrastructural investigations confirmed the value of the cytological study and that the dendritic cells were Langerhans cells (Birbeck granules+). Most of them were considered as migrating from the dermal lesions.