Widenings of the myelin lamellae in a typical Guillain-Barré syndrome

The so-called "widening of the myelin lamellae" are thought to be specific ultrastructural features of peripheral nerve myelin in patients with peripheral neuropathy associated with a monoclonal dysglobulinemia of IgM type and antiglycolipid activity. We report here a case of Guillain-Barré syndrome with no evidence of serum monoclonal dysglobulinemia, presenting the typical widenings of the myelin lamellae in small-diameter myelinated fibers from a sural nerve biopsy. In view of the positive reaction with anti-C3d complement on direct immunofluorescence, an immunological mechanism may be involved in the widenings of the myelin lamellae.

Lack of association between peripheral neuropathy and HTLV-I infection in west Africa. Epidemiological, serological and nerve biopsy study

Patients (n = 1166) with various neurological disorders hospitalized in Dakar, Abidjan, Lomé and Ouagadougou were examined prospectively over a 42-month period. Seropositivity for HTLV-I alone was found to be 1.8%, which is comparable to that estimated for the general population in Africa. Eighteen of the patients with TSP and only 5 with PN were HTLV-I positive, but co-infections were found in 30-40% of cases. Discrete and unspecific lesions were observed on light and electron microscopic examination of peripheral nerve biopsies from 11 patients. Since spastic paraparesis emerges as the disorder containing the largest number of HTLV-I-positive individuals, it may be premature to conclude that HTLV-I is a causal agent in PN. Nevertheless, their rarity and the frequency of retroviral co-infections distinguish these cases of African HTLV-I-associated myelopathy from comparable cases observed in other parts of the world.

[Peripheral neuropathies and hemopathies]

In our experience, the incidence of an association between peripheral neuropathy and hemopathy is around 7%. The corresponding nerve involvement may reveal or complicate a known hemopathy. The exact cause-effect relationship is not always easy to identify. We discuss here the peripheral nerve complications of acute leukemia, myeloproliferative disorders, monoclonal dysglobulinemia, non-Hodgkin's malignant lymphoma and Hodgkin's disease. The peripheral neuropathy arising in cases of monoclonal dysglobulinemia, non-Hodgkin's malignant lymphoma have most benefited from ultrastructural examination and advances in immunological and immunocytochemical techniques. Accurate determination of the lesional mechanism should help devise appropriate therapeutic strategies.

[Primary congestive cardiomyopathies of the adult in a tropical environment: nosologic, diagnostic and developmental data]

The authors describe the cases of 86 black african patients (75 males and 11 females), affected by a congestive primitive cardiomyopathy (CMP), confirmed by echocardiography. Echocardiographic investigation revealed, in all cases, stigmas of a developed CMP: cavitary dilatation, hypokinesia and thinness of walls, offsetting and miniaturization of the valvula mitralis. Pericardial effusion was associated in 20 cases, and thrombosis of left cavities was recognized through bi-dimensional investigation. Angiography and hemodynamics performed in 15 patients pointed out in all cases a significant falling off of the pumping function and the muscular function. Angiography, in 8 cases, displayed a left ventricular cavity distended and hypokinetic, with a moderate mitral incompetency. Evolution was characterized by the following complications: heart failure: 68 cases--systemic thromboembolism: 5 cases--pulmonary embolism: 2 cases--auricular rhythmic irregularity: 20 cases--ventricular rhythmic irregularity: 42 cases--second or third degree atrioventricular blocks: 5 cases. Death rate was 25% (22 patients). Taking into account these 86 cases, the position of the congestive CMP defined among the tropical CMP and its classification studied as well as its echocardiographic and evolutive peculiarities.