Compensatory image of the stability of people with multiple sclerosis and atrial vertigo based on posturography examination

Pathophysiology of balance disorders due to multiple sclerosis (MS) and atrial vertigo (AV) is different. We evaluated posture stability when maintaining balance in people with MS presenting symptoms of ataxia and those with AV. We included 45 women (15 with MS; 15 with AV; 15 controls). A posturography platform was used to measure balance parameters. To characterize the image of stability and the compensation of balance disorders, the surface area of the stabilogram (SAS), vision control index (VCI) and the vision-motion control index (VMCI) were used. The stability image of people with MS and AV with eyes open (p = 0.002), with eyes closed (p = 0.080) and with visual biofeedback (p = 0.0008) differed significantly. SAS depended on visual biofeedback regardless of the occurrence of balance disorders and was the basis for determining the compensatory share of vision-motor coordination. Differences in VCI between groups were insignificant. VMCI was significantly higher in people with balance disorders than in those without, but similar in the MS and AV groups. The image of stability is different in people with MS and AV. Thanks to visual biofeedback, it becomes possible to launch effective vision-motor coordination when compensating balance disorders. VCI may become the measure of compensation for balance disorders.

Epidermolysis bullosa simplex with PLEC mutations: new phenotypes and new mutations

BACKGROUND

Genetic mutations in the plectin gene (PLEC) cause autosomal recessive forms of epidermolysis bullosa simplex (EBS) associated with either muscular dystrophy (EBS-MD) or pyloric atresia (EBS-PA). Phenotype-genotype analysis has suggested that EBS-MD is due mostly to genetic mutations affecting the central rod domain of plectin, and EBS-PA to mutations outside this domain.

OBJECTIVES

This study aimed to describe new phenotypes of patients with EBS-MD and EBS-PA, to identify novel PLEC mutations and to establish genotype-phenotype correlations.

METHODS

Seven patients with a suspicion of EBS linked to PLEC mutations were included. A standardized clinical questionnaire was sent to the physicians in charge of each patient. Immunofluorescence studies of skin biopsies followed by molecular analysis of PLEC were performed in all patients.

RESULTS

We report the first case of nonlethal EBS-PA improving with age, the first multisystemic involvement in a patient with lethal EBS-PA, and the first patients with EBS-MD with involvement of either the bladder or oesophagus. Eleven novel PLEC mutations are also reported.

CONCLUSIONS

Our results confirm that EBS-PA is linked to mutations in the distal exons 1-30 and 32 of PLEC. Long-term survival is possible, with skin improvement, but a delayed onset of MD is probable. While EBS-MD is linked to PLEC mutations in all exons, in most cases one of the mutations affects exon 31. The precocity of MD seems to be linked to the type and localization of the PLEC mutation(s), but no correlation with mucosal involvement has been found.

Syndrome babouin associé à une polysensibilisation aux corticoïdes

BACKGROUND

The Baboon syndrome is a form of systemic contact dermatitis. We report the case of a patient who presented a Baboon syndrom following oral medication with betamethasone.

CASE REPORT

A 58 year-old man had consulted for eczema involving the groin, the buttocks and the axillae. It was clinically a baboon syndrome related to oral betamethasone (Celestene) treatment, ingested 48 hours earlier. The exploration with a patch-test confirmed the sensitization to betamethasone. This exploration also showed a sensitization to all four classes of corticosteroids. Prolonged withdrawal of all corticosteroids led to the clear improvement of his eczema.

DISCUSSION

The baboon syndrome of this patient was the symptom of a systemic eczema due to betamethasone. The patient was sensitized by the percutaneous route. The application of many topical corticosteroids had provoked this polysensitization. It was impossible to consider a safe corticosteroid for this patient.

Colonisation bactérienne chronique de l’intestin grêle révélée par un érythème pellagroïde et une panniculite

INTRODUCTION

Pellagra is an exceptional disorder in France. The classical description of pellagra associates a photoinduced rash with neurological impairment and intestinal dysfunction. Without adapted treatment, the progression is fatal.

CASE REPORT

A 62 year-old women developed a photoinduced rash, composed of circular and erythematous elements with pustular edges. She also had panniculitis, peripheral neuropathy, depressive mood and diarrhea. Her medical past was marked by epilepsy treated with sodium valproate and hydantoin. Biological exams revealed lowered plasma levels of vitamins PP, B1, B6 and zinc, secondary to intestinal impairment induced by bacteria proliferating in the small intestine. The rash resolved with vitamin PP and zinc supplementation. The bacterial colonisation was improved by long-term, sequential antibiotics.

DISCUSSION

We report a rare clinical form of pellagroid rash. The rash was induced by chronic malabsorption resulting from excessive bacterial proliferation in the diverticules of the small intestine. The antiepileptic treatment could have facilitated vitamin PP et zinc deficiency. Panniculitis was related to the bacterial proliferation. We discuss in this paper the relationship between some vitamin deficiencies, their clinical manifestations and the direct role of intestinal bacterial proliferation in the cutaneous manifestations.

Energy and nutrients intake of elderly people living in the Warsaw region, Poland

The dietary intake of energy, macronutrients, minerals and vitamins was studied in a group of elderly living in urban, suburban, and rural areas of Warsaw region, Poland. The study was conducted in spring 1999 and 298 persons, born between 1919-1924, randomly selected with criteria of age and place of living, were included. Dietary data were based on the 3-day food records. The energy and nutrients intake was calculated on the basis of tables of nutritive value of food products and compared to the Polish RDA's. Daily food rations of the subjects (except for men living in Warsaw) had an incorrect structure as well as insufficient energy content. The highest (i.e. almost 60% or higher) prevalence of intake lower than 2/3 of Polish RDA's was observed for calcium, magnesium, copper, vitamin B2 and vitamin C as well as for iron and vitamin B1 among women. The average intake of fat, cholesterol, and phosphorus was above recommended level. The differences related to area of living were less pronounced for men than for women. Women from suburban area were the most vulnerable group in respect to nutritional inadequacy.

Consumption of food products by the elderly living in different environments of the Warsaw region, Poland

The aim of the study was to compare qualitatively the intake of food groups by the elderly living in urban and rural areas, with regard to the place of living and sex. Fifty-sex subjects in Warsaw and 142 in villages (born in 1919-24) participated in the study. A 3-day record method was used to collect nutritional data. The subjects living in Warsaw consumed more often milk, meat, fish, fruit and their products, as well as fats and oils. Less than 50% of the elderly living in either rural or urban areas ate eggs and fish. Consumption of fruit and its products was also low in the villages (47%). Meat and meat products were consumed more often by elderly men, whereas milk, fruit and their products were eaten more often by women (a rural area only). Consumption of specific food items also differed between the two analyzed living areas; milk, yoghurt and cheese were eaten more often by the residents of Warsaw, however, the intake of cream was significantly higher in the villages. The intake of red meat and meat products was similar, but poultry was included into the diet of 24% of the elderly in the rural area, significantly less than in Warsaw (34%). It also appeared that butter and mixed fats were more common among the elderly in Warsaw,whereas lard, pork fat and margarine were more popular in the villages. Food choice in the rural area was of poorer quality.

[Serum cytokines in patients with ovarian cancer and benign ovarian cysts]

The aim of our study was to evaluate serum interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) as tumor markers--study based on the data about tumor cytokines production and tumor-host interactions.

METHODS

We investigated 48 women: 17 with ovarian cancer untreated before, 16 with benign ovarian cysts and 15 healthy controls. Venous blood for cytokines determinations were obtained before operations and during routine screening tests. Titers of cytokines were measured by means of ELISA technique.

RESULTS

In the control group the upper limit of normal IL-6 titers (95th percentile) was 5.5 pg/ml; the mean IL-8 concentration was 9.6 +/- 15.1 pg/ml and the upper limit of normal was 37 pg/ml; serum TNF-alpha and IFN-gamma were not detectable. In patients with benign ovarian cysts the levels of all investigated cytokines didn't differ significantly from healthy controls. Women with ovarian cancer had significantly higher serum IL-8 levels (mean: 290.5 +/- 351 pg/ml) than healthy controls or women with benign ovarian cysts; 88% of them had IL-8 titers above the normal. The IL-6 titers in ovarian cancer were also higher but didn't reach statistical significance, 53% of them had IL-8 titers above the normal. TNF-alpha and IFN-gamma levels in ovarian cancer were similar to patients with benign ovarian cysts.

CONCLUSION

Serum IL-8 levels in patients with ovarian cancer were significantly higher when compared to healthy controls and benign ovarian cysts and in almost 90% of ovarian cancers the titers of IL-8 were increased. Additionally, 53% of women with ovarian cancer had elevated serum IL-6 levels.

[Maternal serum cytokines in labor, pregnancy and chorioamnionitis]

The purpose of our study was to compare maternal serum levels of interleukin-6, interleukin-8, tumor necrosis factor-alpha and interferon-gamma in gravidities, during spontaneous term and preterm labor and their relation to histologic chorioamnionitis.

METHODS

We investigated 61 women: 10 in preterm labor, 36 in term labor and 15 healthy pregnant nonlabouring controls. Venous bloods for cytokines determinations were obtained during the first stage of labor and during routine screening tests. Titers of cytokines were measured by means of ELISA technique. All births after preterm deliveries were examined to establish histologic chorioamnionitis.

RESULTS

Serum levels of IL-6 and IL-8 were significantly elevated both in term (mean: IL-6: 17.5 +/- 58 pg/ml; IL-8: 148 +/- 215 pg/ml) and preterm labor (IL-6: 23 +/- 44 pg/ml; IL-8: 332 +/- 389 pg/ml) when compared to nonlabouring gravidities (IL-6: 5 +/- 7 pg/ml; IL-8: 14 +/- 11 pg/ml). IL-6 and IL-8 titers were statistically similar in term and preterm labors and in patients with and without histologic chorioamnionitis. TNF-alpha and IFN-gamma were not statistically analyzed because only a few patients had detectable serum levels of these cytokines.

CONCLUSION

Serum levels of IL-6 and IL-8 in both: term and preterm labor are elevated in comparison to nonlabouring gravidities. The elevated levels of these cytokines are not connected with coexisting chorioamnionitis.

[The use of maternal serum cytokines in the predicting of the efficacy of tocolytic therapy in case of the threat of preterm labor]

OBJECTIVES

The purpose of our study was to evaluate the use of maternal serum IL-8, IL-6, IFN-gamma levels in the predicting of the efficacy of tocolytic therapy in preterm labor.

MATERIALS AND METHODS

We investigated prospectively the group of 47 women in singleton pregnancies with threatened preterm labor in less than 36 weeks gestation and administered tocolytic therapy.

RESULTS

In 19 of them tocolysis failed (group II and they delivered premature newborns (the group I--successful tocolysis consisted of remaining 28 women). The incidence of clinical chorioamnionitis, histologic chorioamnionitis and inherited infection of newborns was significantly higher among women refractory to tocolytic therapy (10.2%, 36.8%, 26.3% versus 0%, 3.6%, 0%, respectively, p < 0.05). Maternal serum IL-8, IL-6, IFN-gamma (by means of ELISA technique) and CRP, WBC, ESR levels were measured at the admission to the study. The mean WBC, ESR and the median (range) IFN-gamma (0 (0-7.1) and 0.9 (0-10.4) pg/ml, respectively) didn't differ in both groups. The concentrations of serum IL-8, IL-6, CRP were significantly higher in the group of failed tocolysis (median (range): IL-8: 22.7 (6.3-83.2) vs 3.0 (0-26.0) pg/ml; IL-6: 7.4 (0-21.0) vs 0 (0-11.3) pg/ml; CRP: 1.8 (0.6-7.0) vs 0.6 (0.6-3.9) mg/dl; p < 0.05). Serum IL-8 determinations (definition of abnormal test: > 8 pg/ml) were found the most reliable in the prediction of tocolysis failure with a sensitivity 87.5%, specificity 81.8%, positive predictive value 77.8%, negative predictive value 90% and accuracy 84.2%. Also reliable were IL-6 determinations (IL-6 > 6 pg/ml had a sensitivity 75%, specificity 90.9%, positive predictive value 85.7%, negative predictive value 83.3% and accuracy 84.2%) and CRP determinations (CRP > 1.2 mg/dl had a sensitivity 75%, specificity 81.8%, positive predictive value 75%, negative predictive value 81.8% and accuracy 78.9%). The efficacy of IFN-gamma, WBC and ESR was significantly lower.

CONCLUSIONS

Our data revealed that the maternal serum IL-8, IL-6 and CRP determinations are very useful in the predicting of the efficacy of tocolytic therapy in women with threatened preterm labor. The use of IFN-gamma, WBC, ESR was significantly lower.

[Maternal serum cytokines concentrations during normal pregnancy and labor]

OBJECTIVES

The purpose of our study was to determine maternal serum concentrations of IL-8, IL-6, IFN-gamma during normal pregnancy and labor.

MATERIALS AND METHODS

Maternal serum IL-8, IL-6 and IFN-gamma levels were measured by means of ELISA technique in 41 healthy pregnant women in 22-42 week gestation and 15 healthy women in labor at term. All newborns and afterbirths had no signs of infection.

RESULTS

IL-8 values for pregnant women ranged from 1.98 to 35.2 pg/ml with the median value 10.24 pg/ml, and the 95th percentile 24.5 pg/ml. IL-8 values for women in labor at term ranged from 3.96 to 54.8 pg/ml with the median 10.4 pg/ml. No statistically significant changes in serum IL-8 concentration were observed during pregnancy or in labor. Serum IL-6 concentrations in pregnant women ranged from 0 to 21.7 pg/ml with the median value 0 pg/ml, and the 95th percentile 15.5 pg/ml. Serum IL-6 concentrations in women in labor at term were significantly higher (p < 0.05): ranged from 0 to 39.2 pg/ml with the median 10.1 pg/ml and 95-th percentile 33.5 pg/ml. Maternal serum IFN-gamma concentrations in pregnant women ranged from 0 to 9.8 pg/ml with the median value 3.9 pg/ml, the 95th percentile 9.2 pg/ml and didn't differ during labor at term: range from 0 to 14.5 pg/ml, median 1.9 pg/ml.

CONCLUSIONS

Our data revealed that maternal serum IL-8 concentrations didn't changed during the course of pregnancy and in labor. Women in labor had significantly elevated serum IL-6 concentrations compared to those in pregnancy. We didn't observed such changes in serum IFN-gamma levels.

[Erythropoietin in the pathogenesis of anemia in patients with multiple myeloma]

Anemia is a common symptom in multiple myeloma (MM) patients but the pathogenesis of it is still unknown. The aim of the study was to explain the causes of anemia in MM patients. Peripheral blood count, bone marrow aspirate, iron and ferritin level, serum erythropoietin (EPO) level, T cell subsets and in vitro CFU-E count were analyzed in the group od 31 MM patients. Erythropoietin and iron deficiency in the study group were not observed. EPO serum level was not significantly different in patients with multiple myeloma and in comparison to patients with sideroblastic anemia with solid tumors. Absolute CD8 T lymphocyte count was not significantly increased in the study group. CFU-E colonies count in vitro was not decreased in these patients.

CONCLUSIONS

In the study group of the MM patients anemia probably does not depend on EPO production. Diminished proliferative response of erythropoietic cells on normal serum level of EPO and abnormal iron utilisation probably occur in these patients. Replacement of normal erythropoiesis by tumor plasma cells is probably not decisive.

[Methods of nutrient intake and nutritional status of the elderly in Poland on the basis of the literature from the years 1980-1996]

According to papers published in the years 1980-1996 there were many faults in nutritional habits of the elderly in Poland, which can affect nutritional and health status. Low consumption of calcium, vitamins C, A, and B group was identified most often while the intake of fats was too high in comparison to Polish recommended daily intake. Moreover iron and protein intake among women were also too low. The analysis of food products intake indicated that above mentioned inadequacy in nutrient intake was the result of low consumption of milk and milk products, fruits and vegetables containing vitamin C and beta- carotene as well as grain products and potatoes and high consumption of products from the group other fats. The observed differences between intake and nutritional recommendation were confirmed by the indices of nutritional status. BMI indicating overweight or obesity was observed for many subjects under study, more frequently among women than among man. Biochemical analysis showed risk of deficiency of some vitamins.

[Infection with parvovirus B19 in pregnant women]

The viral infection caused by Parvovirus B19 which occurs at pregnant women may be reason of many different kinds of complications during pregnancy. Until this time it is not known the frequency of the Parvovirus infections at pregnant women in Poland. We have based our studies on a group of 78 pregnant women with symptoms of a abortion, a premature imminent labour, premature labor and intrauterine death of foetus. In 10 cases (12.8%) we have confirmed a presence of antibodies IgM class antiparvovirus B19 at patients serum. It seems that the Parvovirus infection is one of most often reasons of unsuccessful pregnant.