[The image of intravertebral somatic gaseous dissection. Report of 9 cases one of which has a triple localization and review of the literature]

We report a series of 9 cases of vertebral somatic gaseous dissection studied between 1978 and 1989. We find most of the characteristics established from the literature data: advanced age, possible medullar compression contrary to the vertebral compression by common osteoporosis, predilection for the dorso-lumbar junction, frequency of the osteoporosis, possibility of metabolic disorders, of occurrence after radiotherapy. The context of the occurrence and the paraclinical examinations of the whole have enabled us to eliminate, in this series, a malignant pathology. However, when there exists a doubt on a malignant origin, it is preferable to carry out a vertebral biopsy with a trocar. In fact, the image may not be pathognomonic of a benign vertebral osteoporosis. Finally, we give the first description of a triple localization of vertebral gaseous dissection.

Intradiscal injection of triamcinolone hexacetonide for acute, subacute, and chronic sciatica. Results at 3 months an open-prospectus study of 30 cases and review of the literature

The authors report an open study of 30 cases of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica. The patients were monitored at months 1 and 3. The results were judged to be good in 36.6% of the cases, moderate in 36.6% and poor in 26.7% of the cases. Two adverse effects were reported: 1 case of reversible urinary retention and 1 case of deficiency of the dorsiflexor muscles of the foot. The good results reported in previous series were only found in this study when the indications were restricted to certain favourable prognostic factors: duration of sciatica less than 6 months and CAT-scan appearance of discal hernia. This technique has the advantage of being simple, economical and nonallergic. On the basis of the encouraging results of the initial series, this technique should be considered as an interesting therapeutic alternative in sciatica. Larger series and double-blind studies, however, are necessary to confirm the initial results.

Ehlers-Danlos syndrome, clotting disorders and muscular dystrophy

Ehlers-Danlos syndrome includes 11 distinct entities. The diversity of this collagen dysplasia and its combination with other abnormalities make it difficult to understand physiopathologically. A case of Ehlers-Danlos syndrome is reported, which is novel owing to its combination with clotting abnormalities and especially with muscular dystrophy. To our knowledge this has not previously been reported. The patient was a young man aged 16 years who presented with Ehlers-Danlos syndrome satisfying Perelman's diagnostic criteria. His father and two brothers had comparable clinical symptoms, but his mother and sister were healthy. The four male subjects had an increased cephalin-kaolin time, reduced levels of factor VIII and Willebrand's factor (but without haemophilia A or Willebrand's disease), and, especially, an abnormal platelet ATP secretion. The proband alone had muscular disease with bilateral quadriceps fatigability and amyotrophy. The muscle enzyme levels were greatly increased, the electromyographic trace was myogenic, and the biopsy showed severe muscular dystrophy. This new observation poses the problem of the relation between clotting abnormalities and collagen abnormalities in the Ehlers-Danlos syndrome. It is difficult to classify this case within any of the 11 known types because of its muscular manifestations. It may perhaps be a fortuitous combination or an extension of the nosological framework of this syndrome.

A locus involved in kanamycin, chloramphenicol and L-serine resistance is located in the bglY-galU region of the Escherichia coli K12 chromosome

Spontaneous mutants of Escherichia coli K12 displaying an increased level of the kanamycin resistance conferred by plasmid pGR71 were selected. Several mutants obtained in this way apparently carry large chromosomal deletions extending into galU and/or bglY (27 min). This positive selection of deletions allowed detection of a new locus located between galU and bglY. Deletions of this locus are responsible for increased resistance to kanamycin (Irk), decreased resistance to L-serine in minimal medium (Drs) and decreased resistance to chloramphenicol (Drc) when a cat gene is present in the bacteria.

[Oxyurid granuloma of the mesentery]

A 44-year-old woman presented with an acute abdominal syndrome associated with fever. Laparotomy revealed a mesenteric mass; pathology demonstrated a granuloma containing an adult threadworm (Enterobius vermicularis) and its eggs. Ectopic oxyuriasis is rare, and only three cases of peritoneal granuloma distant from the pelvis or the appendix have been reported previously. Our observation is the first case to which a clinical symptomatology could be ascribed. The pathogenesis and the treatment of this particular localization of oxyuriasis are discussed.

[Pseudohyponatremia and anion gap changes in multiple myeloma]

Pseudo-hyponatremia is a rare condition characterized by a decrease in plasma sodium concentration associated with a normal or increased effective plasma osmolarity. We present the case of a 62 year old woman with multiple myeloma (IgG) who had a plasma sodium of 84.5 mEq/l (as measured with flame photometry) and an anion gap of -8.8 mEq/l. However, when determined with an ion-selective electrode, plasma sodium was 135 mEq/l. The patient was treated with chemotherapy and did not receive sodium. One week later, plasma sodium--again measured by flame photometry--was 134 mEq/l and the anion gap 4.0 mEq/l. The pathophysiological and clinical aspects of pseudo-hyponatremia and the anion gap are discussed.

Cholelithiasis and ileal pathology in childhood

Primary cholelithiasis is rare in childhood. A particular etiology has appeared over the last few years in connection with unusual physiological situations. Three cases of cholelithiasis after ileal atresia or resection are presented in children of 1, 1, and 7 yr. Another case is presented after abdominal irradiation for Wilms' tumor and ileal resection in a child of 7. The pathogenesis is discussed, raising the question of the interruption of the enterohepatic circulation of bile salts.