Occult cancer in patients with venous thromboembolism: which patients, which cancers.

We have previously demonstrated that patients with idiopathic venous thromboembolism (VTE) have a higher frequency of underlying cancer. Now we present a retrospective analysis of our 5-year experience with a series of 674 consecutive otherwise healthy patients, and a more restricted battery of diagnostic tests. Occult cancer was found in 15 patients during admission.

Decreased cholecystokinin levels in cerebrospinal fluid of patients with adult chronic hydrocephalus syndrome.

Cholecystokinin (CCK) levels were measured in cerebrospinal fluid (CSF) of patients with adult chronic hydrocephalus syndrome (ACHS) (n = 16) and compared with levels from a control group (n = 11). The CSF concentration of CCK in the ACHS group (0.79 +/- 0.

Reactive arthritis with a severe lesion of the cervical spine.

Reactive arthritis, or Reiter's disease, characteristically affects the joints of the lower limbs in an asymmetrical pattern. Usually it does not affect the cervical spine, and atlantoaxial subluxations are the exception. This paper describes the case of an HLA-B27-positive female patient with a sexually acquired reactive arthritis where a non-reducible atlantoaxial subluxation was present.

Arterio-jugular differences of oxygen (AVDO2) for bedside assessment of CO2-reactivity and autoregulation in the acute phase of severe head injury.

Autoregulation and CO2-reactivity can be impaired independently of each other in many brain insults, the so-called 'dissociated vasoparalysis'. The theoretical combination of preserved CO2-reactivity and impaired or abolished autoregulation can have many clinical implications in the daily management of brain injured patients. To optimize their treatment, a bedside assessment of autoregulation and CO2-reactivity is desirable.

[Monitoring neurotoxic effects among laboratory personnel working with organic solvents].

The relationship between organic solvent exposure and central nervous disorders make early detection of neurophysiologic et neuropsychologic alterations in organic solvent exposed workers a priority. Moreover, the variability in the frequency of exposure and the numerous organic solvents encountered in scientific laboratories render the environmental and biological measurements used in medical surveys almost impossible. The present study was undertaken to appreciate the potential neurotoxic effects of organic solvents handling in laboratory employees.

Inter-individual variation of selenium in maternal plasma, cord plasma and placenta.

Selenium (Se) in high doses has been known to cause injury to the fetus and newborn. The major difficulty in assessing the effects of selenium on human reproduction stems from the need for a suitable means of estimating maternal and fetal exposure. The present investigation, therefore, examines the respective reliability of maternal plasma, cord plasma and placenta as epidemiological indicators as well as inter-individual variation of this trace element.

Posterior fossa reconstruction: a surgical technique for the treatment of Chiari I malformation and Chiari I/syringomyelia complex--preliminary results and magnetic resonance imaging quantitative assessment of hindbrain migration.

Experimental models have shown that Chiari I malformation is a primary paraaxial mesodermal insufficiency occurring after the closure of the neural folds takes place. According to these hypotheses, a small posterior fossa caused by an underdeveloped occipital bone would be the primary factor in the formation of the hindbrain hernia. The main objective in the surgical treatment of Chiari I malformation and related syringomyelia is directed to restore normal cerebrospinal fluid dynamics at the craniovertebral junction.

Early ischaemia after severe head injury. Preliminary results in patients with diffuse brain injuries.

Ischaemic brain lesions still have a high prevalence in fatally head injured patients and are the single most important cause of secondary brain damage. The present study was undertaken to explore the acute phase of severely head injured patients in order to detect early ischaemia using Robertson's approach of estimating cerebral blood flow (CBF) from calculated arterio-jugular differences of oxygen (AVDO2), lactates (AVDL), and the lactate-oxygen index (LOI). Twenty-eight cases with severe head injury were included (Glasgow Coma Scale Score below or equal to 8).

Somatostatin cerebrospinal fluid levels in dementia.

Somatostatin levels were measured in cerebrospinal fluid of patients with Alzheimer's disease, multi-infarct dementia and normal pressure hydrocephalus and compared with levels from a normal control group. All pathological groups showed a statistically significant decrease of somatostatin with respect to the control group, but no significant differences were found amongst them. A negative correlation was found between the Mini Mental State Test and the somatostatin levels in Alzheimer's disease patients but not in the other groups.

[Cerebral contusions. Study of 182 cases].

Clinical cases were selected in which cerebral contusions were the only visible lesions in CT scan on admission over the period from January 1983 and December 1985. The following characteristics were evaluated: Age, sex, conscience level (Glasgow) at admission, early post-traumatic epilepsy, focal signs, lesion mechanism, cranial fracture, as well as CT scan in which specific signs of bad prognosis were analyzed. According to the evolution of conscience level 3 groups of patients were established: Group 1 "no coma", group 2 "coma with lucid interval", group 3 "coma without lucid interval" and were correlated with the previously mentioned characteristics.

[Symptomatic chronic subdural hematoma. Analysis of 68 cases treated surgically with small craniotomy and placement of a closed drainage system].

Sixty eight cases of chronic subdural hematoma (CSDH) surgically treated (December 1984-December 1988) with twist drill craniostomy (3-4 mm) and application of a closed drainage system (CDS) are reviewed. The patients were distributed in four groups depending on the density of the hematoma: hypodense (36 cases), isodense (6 cases), of mixed density (22 cases) and hyperdense (4 cases). In about one third of patients (25 cases) the duration of symptoms was shorter than one week, in 21 cases it was between one week and one month, and in 22 patients it was longer than one month.

Intraspinal baclofen in the treatment of severe spasticity and spasms.

Ten patients with severe spasticity were evaluated according to a standardized protocol in order to be treated by intraspinal baclofen. Entry criteria in the protocol were the following: 1) Stable central nervous system lesion, 2) Severe spasticity and/or flexo-extensor spasms not controllable by oral treatment, 3) Normal CSF circulation and 4) Informed consent. All patients received a test dose of twenty-five micrograms of baclofen injected intrathecally.

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called "normal pressure hydrocephalus" syndrome.

Fifty-four shunt-responsive patients were selected from a prospective protocol directed to study patients with suspected normal pressure hydrocephalus (NPH). Patients with gait disturbances, dementia, non-responsive L-Dopa Parkinsonism, urinary or faecal incontinence and an Evans ratio greater or equal to 0.30 on the CT scan were included in the study.

[Treatment of cerebrospinal fluid shunt infections using the Perrin and McLaurin technique. Analysis of 11 cases].

Eleven patients with shunt infection (SI) of the cerebrospinal fluid in whom the SI was withdrawn and replaced by a new SI system with reservoir and intraventricular and parenteral antibiotic treatment were reported. The diagnosis was made by culture of the components of the SI and, or, the cerebrospinal fluid. In 9 cases the agent was a staphylococcus.

Aryl hydrocarbon hydroxylase activity in human placenta of passive smokers.

The levels of smoke components and metabolites in maternal blood and urine are useful in assessing direct exposure but they do not appear to be sufficiently sensitive as a long-term indicator of passive smoke exposure. Induction of aryl hydrocarbon hydroxylase (AHH) activity in the placenta as a result of maternal smoking has been well documented. This enzyme oxidizes various polycyclic aromatic hydrocarbons abundantly present in cigarette smoke.

[Evaluation of post-traumatic coma using evoked potentials].

In 130 cases of post-traumatic coma a study of multimodality evoked potentials (MEP) was carried out shortly after the traumatism (within 72 h). According to the morphology of the records they were classified in grades (I-IV) in agreement with Greenberg et al. The worst grade of EP in the different types was related to the outcome at 6 months, distinguishing between focal lesions and diffuse lesions.

Diffuse axonal injury after severe head trauma. A clinico-pathological study.

Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude.

Blood pressure and erythrocyte Na+ transport systems in a French urban male population.

This paper reports an investigation of blood pressure (taken as a continuous variable) as a function of: erythrocyte Na+ content; Na+,K+ pump; Na+,K+ cotransport and Na+,Li+ countertransport fluxes, and passive cation permeabilities in fresh erythrocytes from 129 French males who were living in an urban area and were not under treatment for any medical condition (after allowing for the effects of age, body mass index, alcohol and tobacco consumption). In contrast with previous findings in a North American population, we were unable to confirm that blood pressure was correlated with erythrocyte Na+ content and Na+,K+-AT-Pase activity. Conversely, the only transport parameter correlated (negatively) with blood pressure was outward Na+,K+ cotransport [r = -0.