Hémorragie intracrânienne et phéochromocytome

INTRODUCTION

Pheochromocytoma is rarely disclosed by intracranial hemorrhage. We report two cases.

OBSERVATION

The first 26-year-old patient developed subarachnoid hemorrhage due to a ruptured aneurysm of the middle cerebral artery. The second patient, aged 44 years, had a temporal hematoma. Diagnosis was suggested in both patients by hypertension and elevated urinary catecholamines and confirmed by imaging and MIBG scintigraphy. Adrenal gland tumors, on both glands in the first patient and on the right gland in the second were successfully removed; cranial hypertension totally regressed. Von Hippel Lindau disease was diagnosed by molecular genetics in the first patient. Paroxysmal hypertension could explain the brain hemorrhage in the first patient and may have favored aneurysmal rupture in the second.

CONCLUSION

The relationships between pheochromocytoma and cerebral aneurysm are discussed.

Paralysie faciale et infection du système nerveux par le virus VZV après une varicelle de l’adulte

INTRODUCTION

VZV virus-related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood.

CASE REPORT

A 54-year-old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment. CSF analysis revealed lymphocytic meningitis and the virus was identified by PCR.

CONCLUSIONS

Although previous chickenpox was not found in the patient's past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.

Neuropathie sensitive ataxiante et maladie de Lyme

INTRODUCTION

The clinical spectrum of peripheral neuropathies in Lyme disease is very wide. We report a case which was revealed by an ataxic sensory neuropathy.

OBSERVATION

A 77-year-old patient presented with a subacute ataxic sensory neuropathy which occurred 2 weeks after a skin lesion involving the right lower limb. He fully recovered after specific antibiotic treatment. EMG was suggestive of a predominantly axonal neuropathy. Diagnosis of Lyme disease was assessed by progressive elevation of serum antibodies, demonstration of a lymphocytic meningitis and intrathecal synthesis of antibodies.

CONCLUSION

Lyme disease may be added to the list of diseases which may induce subacute sensory neuropathies.

[Usefulness of tomographic computer colonography for colorectal polyp detection]

BACKGROUND AND OBJECTIVE

Colonoscopy is the procedure of choice for the diagnosis of colorectal neoplasms. CT colonography (CTC), a recently developed minimal invasive radiological technique, permits the identification of colorectal tumors. The aim of the present study was to evaluate the efficacy of CTC in the detection of colorectal polyps, and to establish the factors determining a diagnostic accuracy.

PATIENTS AND METHOD

Patients with colorectal polyps admitted for endoscopic polypectomy were included. CTC was performed prior to colonoscopy in all patients. Demographic and clinical data were registered, as well as the polyp characteristics. Efficacy of CTC was analyzed with respect to each individual polyp and each patient.

RESULTS

Colonoscopy identified 87 colorectal polyps in 30 patients. CTC had a sensitivity of 70% for the detection of polyps of any size, being 92%, 73% and 55% for polyps > or = 10 mm, 5-9 mm and < or = 4 mm, respectively. On the other hand, the sensitivity of CTC for the detection of pedunculated, semipedunculated and sessile polyps was 85%, 92% and 56%, respectively. Accuracy of CTC was associated with polyp size (p = 0.007) and shape (p = 0.007). Sensitivity and specificity of CTC for the identification of patients with polyps > or = 10 mm were 88% and 100%, respectively.

CONCLUSIONS

CTC is a highly accurate technique for the identification of colorectal polyps. Its diagnostic accuracy depends on lesion's size and shape.

[Usefulness of tomographic computer colonography for colorectal polyp detection]

BACKGROUND AND OBJECTIVE

Colonoscopy is the procedure of choice for the diagnosis of colorectal neoplasms. CT colonography (CTC), a recently developed minimal invasive radiological technique, permits the identification of colorectal tumors. The aim of the present study was to evaluate the efficacy of CTC in the detection of colorectal polyps, and to establish the factors determining a diagnostic accuracy.

PATIENTS AND METHOD

Patients with colorectal polyps admitted for endoscopic polypectomy were included. CTC was performed prior to colonoscopy in all patients. Demographic and clinical data were registered, as well as the polyp characteristics. Efficacy of CTC was analyzed with respect to each individual polyp and each patient.

RESULTS

Colonoscopy identified 87 colorectal polyps in 30 patients. CTC had a sensitivity of 70% for the detection of polyps of any size, being 92%, 73% and 55% for polyps > or = 10 mm, 5-9 mm and < or = 4 mm, respectively. On the other hand, the sensitivity of CTC for the detection of pedunculated, semipedunculated and sessile polyps was 85%, 92% and 56%, respectively. Accuracy of CTC was associated with polyp size (p = 0.007) and shape (p = 0.007). Sensitivity and specificity of CTC for the identification of patients with polyps > or = 10 mm were 88% and 100%, respectively.

CONCLUSIONS

CTC is a highly accurate technique for the identification of colorectal polyps. Its diagnostic accuracy depends on lesion's size and shape.

[Hypokalaemic paralysis as a presentation of adrenal tumor]

A 24-year-old patient presented with flaccid quadriplegia due to severe hypokaliemia, initially presumed to have been induced by glycyrrhizin. Persistence of low potassium levels and hypertension led to the diagnosis of primary hyperaldosteronism related to an adrenal cortical tumor. After surgery, the patient recovered from hypertension and hypokaliemia.

[Pituitary tumour as a presenting symptom of a systemic lymphoma]

Pituitary non Hodgkin malignant lymphomas are rare. We report a case of large cell systemic lymphoma with pituitary and meningeal localizations in a 40-year-old patient. The clinical picture was panhypopituitarism with MRI appearance of pituitary adenoma and VII and VIII cranial nerves involvement. Diagnosis was made by identification of lymphomatous cells in CSF. The patient deceased in less than one year despite chemotherapy.

[Hypertensive encephalopathy as revealing symptom of Takayasu's arteritis]

A 29-year-old patient presented with Takayasu's arteritis which was revealed by heart failure, epilepsy, right hemiparesis and fever. Transient abnormalities of MRI and CSF (raised protein and cell content) were initially observed. The hypothesis of a hypertensive encephalopathy is suggested.

[Recurrent acute polyneuropathy and cutaneous vasculitis]

A patient with relapsing cutaneous vasculitis presented 3 times in 10 years with an acute extensive neuropathy and respiratory failure which fully recovered. The relationships between Guillain-Barré syndrome and vasculitis are discussed.

[Continuous nodal reciprocal rhythm and Steinert's disease: treatment by double chamber stimulation. A case report]

We report a case of continuous supraventricular tachycardia in a patient affected by Steinert's myotonic dystrophy. The investigation of this tachycardia showed that there was a "slow-fast" common nodal re-entry, rendered continuous by the existence of significant conduction defects in the fast pathway and the slow anterograde pathway. Implantation of a double chamber cardiac stimulator, necessary for conduction defects present in the basal state in this patient allowed, with the evolution of the conduction defects, the complete eradication of reciprocal rhythm entry, without resorting to ablation.

[Cerebral hemorrhage due to a ruptured mycotic aneurysm. Two cases]

INTRODUCTION

Cerebral hemorrhages due to rupture of mycotic aneurysms are rare but severe complications of infective endocarditis. We report two cases with a good outcome.

EXEGESIS

The first patient presented with a parieto-occipital hematoma which occurred in the course of a relapsing infective endocarditis due to Streptococcus mitis. She fully recovered after neurosurgical treatment. In the second case, a right frontal hematoma revealed two mycotic aneurysms and an infective endocarditis due to Streptococcus gordonii. Motor weakness partially recovered after antibiotic therapy and angiography demonstrated complete resolution of aneurysms.

CONCLUSION

Ruptured mycotic aneurysms are poor prognosis factors in infective endocarditis. Adapted antibiotic therapy is the first-intent treatment. Neurosurgery is indicated when hematomas are poorly tolerated and in cases requiring anticoagulant therapy.

Distinctive features of plant protein kinase CK2

In plants, protein kinase CK2 is involved in different processes that control many aspects of metabolism and development. In mammals and yeast the enzyme is a heterotetramer composed of two types of subunits. During years the subunit composition of the maize protein kinase CK2 enzyme has been a source of controversy. We have recently characterized the maize holoenzyme subunits. Our results show that multiple catalytic and regulatory subunits are expressed in maize and are able to specifically interact with other alpha and beta subunits suggesting a high level of heterogeneity in the typical heterotetrameric structure. Here, we summarize data available on plant CK2 enzymes, in order to clarify the distinctive features and functions of plant protein kinase CK2.

Effect of large targeted deletions on the mitotic stability of an extra chromosome mediating drug resistance in Leishmania

A mitotically stable linear extra chromosome obtained in a Leishmania donovani strain rendered mycophenolic acid-resistant has been physically mapped. This 290-kb chromosome has an inverted duplicated structure around a central inversion region, and is derived from a conservative amplification event of a approximately 140-kb subtelomeric end of chromosome 19. Large-sized targeted deletions of the central region were performed through homologous recombination using three specific transfection vectors. The size of the extra chromosome was thus successfully reduced from 290 to 260, 200 and 120 kb respectively. The mitotic stability of these chromosomes was then analysed in drug-free cultures over >140 days. Results differed according to the deletion created. By contrast with the smallest deletion the two largest deletions altered mitotic stability, leading to progressive loss of the size-reduced chromosomes with similar kinetics in both mutants. The 30-kb region common to both deletions may therefore be considered as involved in mitotic stability. A 44-kb contig covering this region could be assembled and sequenced. The analysis of this sequence did not reveal any sequence elements typical of centromeric DNA. By contrast, its enrichment in homopolymer tracts suggests that this region might contain an origin of replication.

Identification of differentially expressed genes by the cDNA-AFLP technique during dehydration of almond (Prunus amygdalus)

We analyzed several genes that were strongly expressed in response to dehydration of almond (Prunus amygdalus (L.) Batsch) as a means of identifying and determining the genetic basis of mechanisms involved in drought tolerance. The advantages of using almond as a model system for studying dehydration tolerance in woody species include its small diploid genome and its adaptation to drought. We used the differential expression technique cDNA-AFLP (amplified restriction fragment polymorphism derived technique for RNA fingerprinting) to identify transcripts that accumulated in mature embryos and in in-vitro-cultured plantlets subjected to desiccation or abscisic acid (ABA) treatment. The reverse northern approach was used to differentiate between true differential bands and false positives. Some of the predicted polypeptides exhibited similarity to published protein sequences, including a transporter of nitrogenous compounds, a 1-acyl-sn-glycerol-3-phosphate acyl transferase, a low molecular weight heat shock protein, a cysteine proteinase and a constitutively expressed proline-rich protein. We also compared the levels of expression of the identified genes in leaves of young trees of eight almond cultivars differing in drought tolerance.

[Acute onset syringomyelia: two cases]

Two cases of acute presentation of cervical syringomyelia associated with Chiari malformation are reported. In the first case, dysphagia was the main symptom; the second patient had symptoms suggesting acute brain stem ischemia. The mechanism of this acute onset of the illness is discussed.

Role of AP2/EREBP transcription factors in gene regulation during abiotic stress

Crop plants are exposed to many types of abiotic stress during their life cycle. Water deficit derived from drought, low temperature or high salt concentration in the soil, is one of the most common environmental stresses that affects growth and development of plants through alterations in metabolism and gene expression. Adaptation to these conditions may involve passive tolerance or active homeostatic mechanisms for maintaining water balance. Active responses occur at different levels in the plant and may represent a concomitant protection against other types of stress such as pathogen attack. Many morphological and physiological adaptations to water stress are under the control of the plant hormone abscisic acid and involve specific activation of target genes that in one way or another protect cells against water deficit or participate in the regulation of the drought response. Here, we discuss recent advances in our understanding of drought adaptation mediated by specific changes in gene expression and the role of AP2/EREBP nuclear factors in these processes.

Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma

Radiofrequency (RF) ablation is an alternative to percutaneous ethanol injection (PEI) for single nonsurgical hepatocellular carcinoma (HCC) and is currently used as adjuvant therapy before liver transplantation. This phase II study assesses the treatment-related complications and response rate of RF for the treatment of single HCC < or = 5 cm. Percutaneous RF was performed under conscious sedation and ultrasound (US) guidance with an electrical generator connected to a single cooled-tip electrode. Neoplastic cells in peripheral blood (reverse transcription-polymerase chain reaction for alpha fetoprotein [AFP] messenger RNA) were analyzed before and after RF. Treatment response was assessed by spiral computed tomography (CT) at 1 month and every 3 months by US or spiral CT thereafter. Thirty-two patients (20 men; age 67 +/- 4 years; 78% hepatitis C virus; 24 Child-Pugh A) with a mean tumor size of 2.8 cm (25 patients < or = 3 cm) were treated by RF (1.25 sessions; mean time, 22.1 +/- 2 minutes). Adjuvant PEI was performed in 9 cases. Complete response was achieved in 21 patients (65%), being significantly higher for HCC < or = 3 cm (76% vs. 29%, P = .03). After a median follow-up of 10 months, 8 patients showed treatment-related morbidity. Four of them (12.5%) showed biopsy-proven needle-track seeding detected between 4 to 18 months. Neoplastic seeding was related to subcapsular location (P = .009), poor differentiation degree (P = .02), and baseline AFP levels (P = .02). Thus, RF ablation with cooled-tip needle for HCC is associated with a high risk of neoplastic seeding. Iatrogenic dissemination was related to subcapsular location or an invasive tumoral pattern, and has to be considered when selecting curative treatments for HCC or adjuvant therapies before liver transplantation.

[Arterial thrombolysis and angioplasty in atheromatous basilar artery occlusion]

Basilar occlusions treated with conventional therapy (anticoagulants or antiplatelets) have a poor outcome (80p. cent mortality). This unfavorable outcome may require a treatment within 6 hours by intra-arterial thrombolysis, sometimes followed by percutaneous transluminal angioplasty (PTA) in case of atherothrombotic occlusion due to a tight atherosclerotic stenosis. A 48 year-old patient, presented with left hemiparesis, left multimodal hypoesthesia, paralytic dysarthria. CT-scan showed a spontaneous hyperdensity of the basilar artery and arterial occclusion was confirmed by angiography, which showed an atherothrombotic occlusion involving the proximal part of the vessel. Intra-arterial thrombolysis began five hours after the onset with 0,25mg/kg of Rt-Pa (Actilyse((R))), given by bolus followed by 4 others bolus of 10mg. After a total dose of 60mg, arterial recanalization was obtained showing a tight atherosclerotic stenosis involving the proximal part of the basilar artery. PTA was performed 18 hours later with a ballon inflation at 6 atmospheres during 20 seconds. It allowed to decrease the stenosis from 80p. cent to 60p. cent. The patient recovered and MRI at D20 showed a small right lateral infarct involving the pons. Our study confirms the usefulness of intra-arterial thrombolysis in basilar artery occlusion. Consecutive PTA may be proposed in case of associated atherosclerotic stenosis, and the interest of PTA is further discussed.

[Benign acute ataxia in an adult with VZV infection]

In adults, neurological complications of VZV virus usually occur after herpes zoster infection in patients with AIDS. We report a case of acute and benign cerebellar ataxia after chickenpox in a patient without immunodeficiency.