Progressive necrosis of the conus medullaris: magnetic resonance imaging and surgical findings

A 67-year-old man with non-insulin-dependent diabetes mellitus progressively developed, over a 2-year period, lower extremity sensory and motor defects associated with impaired bladder function and perineal and perianal sensation related to a disease of the conus medullaris extending from T12 to S5. The magnetic resonance imaging scan suggested myelomalacia and the diagnosis of progressive necrotic myelopathy was confirmed by surgical intervention.     

Dexfenfluramine in the treatment of severe obesity: a placebo-controlled investigation of the effects on weight loss, cardiovascular risk factors, food intake and eating behaviour.

Dexenfluramine, an effective and safe serotoninergic drug with anorectic and possible food-selection-tuning properties, was investigated in a placebo-controlled study of 1 year's duration in severe and refractory obesity. The aim of the study was to assess weight loss, and changes in cardiovascular risk factors, food intake and eating behaviour. Dexfenfluramine- and placebo-treated patients achieved a similar weight loss (greater than 10% of initial weight, by 39.5 and 30.0%, greater than 20% of initial overweight by 42.1% and 32.5% and greater than 10 kg by 41.4 and 33.3%, respectively, of the initial cohorts). Furthermore, the decreases in weight (10.7 vs. 8.0 kg), in body mass index (3.9 vs. 2.9 kg m2) and in waist/hip ratio (0.04 vs. 0.02) were not significantly different. After discontinuation of the drug, the increase in weight (2.8 vs. 1.0 kg) was significantly higher in the dexfenfluramine-treated group. Except for a borderline better effect on glucose of dexfenfluramine, both groups showed similar beneficial changes in food intake and cardiovascular risk factors. Eating behaviour in response to emotional and external stimuli was comparable in the two groups, but placebo-treated patients had to restrain their eating more in order to achieve the same weight loss. Notwithstanding the fact that weight losses and an associated amelioration of health-risk factors were of similar magnitude in dexfenfluramine- and placebo-treated patients, dexfenfluramine might have a useful role in promoting a less stressed adherence to prolonged restriction of energy intake in the severe and refractory obese subject.     

Hydrocephalus and cavernoma of the cauda equina

The association of a tumor of the cauda equina and hydrocephalus is unusual. We report a case of hydrocephalus with normal pressure associated with an equally rare affliction, a cavernous angioma of the cauda equina, which regressed after surgical ablation. The physiological mechanism involved is discussed.     

Extragonadal germ cell tumor invading the prostate

To our knowledge, only 3 patients with an extragonadal germ cell tumor of the prostate have been described in the literature until now. We here present a patient with a germ cell tumor arising in the retroperitoneum, invading the prostate, which was successfully treated by a combination of chemotherapy and nonmutilating surgery.     

Blood pressure studies among Amazonian native populations: a review from an epidemiological perspective

Nine publications are reviewed concerning blood pressure (BP) levels among Amerindian tribes of the Amazon Basin. The lifestyle of these lowland peoples includes most known protective factors against hypertension, and relative isolation from Western society. The latter, however, is rapidly changing. Sampling, data, and analysis problems make current blood pressure data difficult to interpret, and provide a questionable baseline from which to document pressure change during rapid culture change for these groups. Ethnographic and epidemiological perspectives are offered for future blood pressure and health studies among native Amazonians.