Hypothalamic deep brain stimulation augments walking after spinal cord injury.

A spinal cord injury (SCI) disrupts the neuronal projections from the brain to the region of the spinal cord that produces walking, leading to various degrees of paralysis. Here, we aimed to identify brain regions that steer the recovery of walking after incomplete SCI and that could be targeted to augment this recovery. To uncover these regions, we constructed a space-time brain-wide atlas of transcriptionally active and spinal cord-projecting neurons underlying the recovery of walking after incomplete SCI.

[Extra-coronary atherosclerosis in documented coronary patients].

The prevalence and severity of extracoronary atherosclerosis in 728 patients (572 men and 156 women; average age 59 years) referred for coronary angiography and who had a history of coronary disease for at least 2 years, were assessed by ultrasonography. This population was divided into 3 groups: Group I, 115 patients without lesions at coronary angiography: Group II, 76 patients with mild coronary stenosis ang Group III, 537 patients with at least one severe coronary artery stenosis, a group which included 294 cases of single vessel disease. The authors observed a strong correlation between the presence, severity and diffusion of the coronary artery disease and ultra sonographic signs of peripheral arterial disease: the frequency increased regularly from 45% in Group I to 88% in patients with triple vessel disease in Group III.

[Detection of asymptomatic abdominal aorta in coronary disease patients having undergone coronarography].

Detection of asymptomatic abdominal aortic aneurysm (AAAA) was studied in 780 patients whose coronary disease had been evolving for less than 2 years, who had undergone coronagraphy within the framework of the French ALAC Survey (Autres Localisations de l'Athérosclérose chez le Coronarien--other locations of atherosclerosis in coronary disease) and had an interpretable abdominal aortic echography. Clinical and echographic research detected 19 AAAA cases in 15 men and 4 women aged 53 to 77 years having at coronagraphy at least one stenosis > or = 70% on one of the 3 coronary trunks or > or = 50% on the commun trunk. Among the 577 coronary disease patients with at least one significant stenosis, the prevalence of AAAA was 3.

[Venous thromboembolic disease in a geriatric environment. Importance of its detection and treatment].

The elderly population is particularly exposed to risk of venous thromboembolism because the risk of thrombosis increases with age but also because of the side effects of anticoagulant therapy. Clinical signs are neither sensitive nor specific and systematic screen for deep vein thrombosis in elderly patients could be justified using noninvasive techniques such as echo-Doppler or assay of D-Dimers. The aim of this study was to determine the prevalence of venous thrombosis diagnosed by echo-Doppler screening in a population of institutionalized elderly subjects.

[Primary axillary subclavian venous thrombosis].

The thoracic outlet syndrome includes primary axillary-subclavian vein thrombosis. The subclavian vein is compressed in a narrowed costo-clavicular space during certain movements of the arm. The intermittent compression of the vein results in position-dependent symptoms often misinterpreted.

Modulation of fibroblast motility by a cytosolic extract of Cyanobacteria.

Proliferation and migratory behavior of L929 murine fibroblasts were shown to be modified in the presence of a cytosolic extract of Phormidium sp. (Cyanobacteria). The addition of Phormidium extract to the growth medium (Dulbecco's modified Eagle's medium) supplemented with 0.

[Procedures in critical ischemia of the legs in non-emergency situations].

Our experience with 91 operated cases in 84 patients (47 men, 37 women) relates essentially to arterial diseases resulting from overloading and diabetic arteriopathy. Diagnosis of critical ischemia is easy in clinical conditions, but it is advisable to rely on universally recognized hemodynamic standards to define this condition. Ankle pressure should be less than 400 mmHg and the Doppler trace flat or barely perceptible.

[Stress phlebitis of the upper extremity. Medico-legal aspect].

Stress phlebitis of the upper extremity is in fact due to compression of the subclavian vein in the costo-clavicular space during certain movements, the effort being only a fortuitous component. Clinically, it evolves in two stages: at the stage of intermittent compression, the functional symptoms are related to certain positions of the upper extremity; the compression is identified clinically and with additional tests. Treatment includes physical therapy; however, persistence of the symptoms may result in having to consider the resection of the first rib.

[Erythermalgia].

Erythromelalgia is a vascular acrosyndrome affecting mainly the feet and triggered by elevation of room temperature. It may be primary, or secondary, in particular to a polycythemia, when an increased platelet count plays an essential role, explaining the beneficial effect of aspirin or NSAI agents that inhibit platelet prostaglandin cyclo-oxygenase. The favorable action of beta-blockers could result from the possible existence of an anomaly of cutaneous adrenergic nerves.

Nifedipine and Raynaud's phenomenon associated with connective tissue diseases.

We have evaluated the therapeutic effect of the calcium-channel blocking agent nifedipine in Raynaud's phenomenon associated with connective tissue diseases and in idiopathic digital vasospasm. Thirty patients were included in this study: Raynaud's phenomenon was associated with progressive systemic sclerosis (PSS) in ten patients, systemic lupus erythematosus (SLE) in five and rheumatoid arthritis (RA) in three; it was idiopathic (I) in twelve patients. Each patient received, in a double-blind manner and random order, on two consecutive weeks, nifedipine (20 mg three times daily) and placebo.

Calcium entry blocking agents in digital vasospasm (Raynaud's phenomenon).

We have evaluated the therapeutic effect of the calcium entry blocking agent nifedipine in Raynaud's phenomenon associated with connective tissue diseases and in idiopathic digital vasospasm. In a preliminary study 16 patients with a digital vasospasm that could be induced by hand-immersion in cold water (4 degrees C) were challenged a second time with cold water 1 and 6h after 20 mg oral nifedipine. Nifedipine provided an effective protection against this cold-induced vasospasm in 14 of the 16 patients.

[What should be done in the case of an accidental injection of a sclerosant into an artery? Apropos of a case].

The authors report a case of severe ischaemia following an injection of sclerosant for varicose veins in the legs and discuss the pathophysiology of this accident. It seems that such an accident requires the immediate injection of a massive dose of cortisone; an intravenous infusion containing 400 mg of hydrocortisone hemisuccinate, 400 mg of heparin, 400 mg of Praxilene and 4 ampoules of injectable Tranxene 50; admission to a competent unit, i.e.

[Persistence of an embryonic hypoglossal artery. Apropos of a case].

Persistence of an embryonic hypoglossal artery, discovered during exploration of an atheromatous carotid artery stenosis, is a rarely observed anomaly that results from an embryologic slip during closure of basilo-carotid communications. Encephalic protection must be ensured during treatment of such lesions, and the establishment of a shunt during operation has to be considered.

[Etiology of acute ischemia of the lower limbs].

The most frequent cause of acute ischaemia of the lower limbs is arterial: thrombotic, embolic and spastic. In cases of arterial embolism, the site of origin is the left side of the heart in 9 cases out of 10: ischaemic heart disease in 2/3 of cases, with atrial fibrillation (A.F.

[Long-term antithrombotic treatment in coronary disease].

The respective roles of thrombosis and spasm in the pathogenesis of coronary disease is a subject of current discussion. Critical study of trials of long-term secondary prevention of myocardial infarction carried out between 1967 and 1982 have failed to yield any definitive conclusion as to the value of oral anticoagulants, aspirin, sulfinpyrazone or dipyridamole. However oral anticoagulants should be prescribed in the long-term, in the absence of any contra-indication, in cases of myocardial infarction complicated by ventricular ectasia, arrhythmias or cardiac failure with cardiomegaly.

[Controlled study of nifedipine in the treatment of Raynaud's phenomenon].

In each of the 16 patients included in our first study [6 idiopathic Raynaud's phenomenon (I), 4 associated with systemic lupus erythematosus (SLE) and 6 with progressive systemic sclerosis (PSS)] digital vasospasm could be reproduced by immersion of both hands in cold water (4 degree C). Each patient received in a double-blind manner and random order on two consecutive days, the calcium-channel blocking agent nifedipine (20 mg) and placebo. Nifedipine protection against vasospasm provoked by cold water (4 degrees C) was considered good or excellent in 14 of the 16 patients (p less than 0.

[Arteriomegaly. Apropos of 6 cases].

Six cases of megalodolichoartery (M. D. A.

[Angioscintigraphy in venous pathology. Comparison of isotope angioscintigraphy and radiologic examination].

Results of vascular radiology and isotope examinations were compared in 48 patients with suspected ileocaval lesions (37 cases) or affections of the veins of the upper limb or superior vena cava (11 cases). Isotopic examination, which can be performed in ambulatory patients, respects normal hemodynamic conditions, is painless, and can be repeated, was found to give valid results, positive correlations with radiological investigation findings being present in 43 cases. Lack of correlation in the remaining 5 patients could have resulted from the period of time elapsed between the two examinations or the techniques employed during each investigation.

[Treatment of stage II arteriopathy of the lower limbs with coronary involvement (author's transl)].

The author discusses the choice between medical or surgical treatment of a stage II arteriopathy of the lower limbs. 1. Medical treatment: recommended walking, prescription of calcium antagonists (Nifedipine and Diltiazem), maintenance of the cardiac blood flow and anticoagulant treatment.