[Human neurotoxicity of ethylene-bis-dithiocarbamates (EBDC)]. / La neurotoxicité des éthylène-bis-dithiocarbamates (EBDC) chez l'homme.

Ethylene-bis-dithiocarbamates (EBDC) (maneb, mancozeb,...) are fungicides which rarely cause acute toxicity reactions, but may have a severe long-term toxic effect. Twelve cases reported to the Bordeaux Anti-Poison Center over a 10-year period generally exhibited short-term neurological symptoms of variable severity. Cases of acute intoxication reported in the literature have involved various neurological signs including headache, dizziness and confusion, and a few cases of seizures, all of which were rapidly reversible. Long-term exposure has been associated with parkinsonism and epidemiological studies have found an increased risk of neurocognitive impairment associated with long-term exposure to pesticides in general and to EBDC specifically. Experimentally, EBDC increases the neurotoxicity of MPTP and paraquat. Their metabolite, ethylene thiourea (ETU), is neurotoxic in utero. There are indications that EBDC and/or ETU may increase sensitivity to genetic and environmental risk factors for cell death and apoptosis. Occupational or accidental exposure to EBDC and its possible long-term consequences require adequate studies concerning their mechanism, surveillance and prevention.

[Intra medulla oblongata and cervical ependymoma (surgery, apnea for two months and improvement) (author's transl)]. / Ependymome intra-bulbo-cervical: ablation, apnée de 2 mois, guérison.

A 17 years old female was first seen in a neurology department in December 75. She was running a low grade fever; her general status was not good. At the physical examination she presented:--an amyotrophy of both arms, mainly proximal,--a thermo analgesic dissociation which was complete from C1 to C5 and incomplete from C5 to D4, and--a spastic quadriparesis (with a posterior spinal syndrome). The first physical disabilities appeared 15 months before. The myelography revealed an enlarged spinal cord in the upper part of the cervical region and the contrast media could not go through the foramen magnum. At surgery, a solid mass, localized on the right side, inside the medulla oblongata and the spinal cordal, with a cyst at each extremity, reaching C4 in the lower part and the recessus lateralis in the upper part. During surgery the patient was breathing spontaneously. After the removal of the mass, she presented an apnea. The quadriplegia following surgery was very short. She recovered rapidly a normal motor activity in both legs and in the right arm. Respiratory paralysis remained complete for 2 months. The right diaphragm recovered completely in 4 months, the left one only in part. 4 months after surgery, she went back home. One year later for security reason she still has a tracheotomy. The distal paralysis of the left superior arm is still present.

[Sudden deafness: a randomized comparative study of 2 administration modalities of hyperbaric oxygenotherapy combined with naftidrofuryl]. / Surdités brusques: étude comparative randomisée de deux modes d'administration de l'oxygénothérapie hyperbare associée au Naftidrofuryl.

Hyperbaric oxygen therapy is one of the numerous therapies which have been proposed in the management of sudden deafness. It is presumptuous to claim the efficiency of any treatment in a pathology where both the origin and the actual rate of spontaneous recovery are unknown. The grounds of therapies are therefore empirical but the need of urgent therapy is dictated by ethics. This study compares the effects of hyperbaric oxygen therapy in two groups of patients; according ot their order in randomization the subjects were treated either at a rate of 1 session or 2 sessions per day. Hyperbaric oxygen therapy was associated with infusion of Naftidrofuryl to counteract the vasoconstrictive effect of increased oxygen pressure in blood. Steroids were also administered simultaneously to avoid, for the same reasons, cerebral oedema. Normovolemic hemodilution (Dauman et al. 1983) was systemically performed in all the patients preliminarily to hyperbaric oxygen therapy, in order to reduce the haematocrit and thus facilitate blood supply. The efficiency and the side effects were similar in the two groups, provided that some principles in the selection and the monitoring of the patients were respected. The rate of 2 sessions of hyperbaric oxygen therapy per day has obvious advantages in view of health policy, but it requires the hospitalization of the patient and should be restricted to the younger subjects.

(Treatment of sudden deafness: first results of a comparative study). / Traitements des surdités brusques: premiers résultats d'une étude comparative.

A comparative study is undertaken in 36 cases of sudden deafness in order to appreciate the efficiency of three therapies: vaso-active drug and steroid administered through continuous perfusions, normovolemic hemodilution, and hyperbaric oxygen therapy. Groups are homogeneous with respect to age, time elapsed between onset of deafness and treatment, occurrence of vertigo, degree of hearing loss, and audiometric pattern. Results are expressed in terms of pure tone threshold improvement (dB), audiometric ratio recovery taking into account initial hearing loss, and effects upon tinnitus. These data are complemented with electrophysiological measures (click-evoked electrocochleography and auditory brainstem responses). Analysis of variance does not show significant differences among the three procedures. Mechanisms and possible usefulness are discussed, keeping in mind the difficulty of ascertaining the real efficiency of therapies with respect to spontaneous recovery.

Anthrax meningitis. Report of two cases with autopsies.

The authors report two cases of occupation-related anthrax meningitis; one was direct contamination from a diseased animal; the second was due to handling of bone powder imported from India. The pathological pattern of involvement of the meninges and brain is described and discussed.

[Severe drug complications: current prevalence amongst patients admitted to adult intensive care units (author's transl)]. / Accidents médicamenteux graves chez l'adulte: incidence actuelle dans le recrutement des unités de réanimation.

A retrospective study involving nine teaching hospital mixed intensive units provided information concerning severe drug complications amongst patients admitted to these departments over the past ten years. Amongst a total of 63717 patients admitted, there were 1132 drug complications (1.8%) without any predominance in terms of sex. Mortality was high (252 patients, i.e. 22.2%), being all the greater in older patients. Details concerning the various drug complications are given, the most common being anaphylactic shock and haemorrhage due to anticoagulants. These statistics are compared withthose already published by hospital departments of internal medicine.