Auditory brainstem evoked responses and attention. Contribution to a controversial subject

The clinical usefulness of the brainstem evoked response (BAER) derives from the high inter- and intra-subject reproducibility of V-wave latency. Attentiveness represents one possible cause of variation. To evaluate the effect of auditory or visual attention tasks and their repetition, we recorded BAERs during six repetitions of each of these two tasks. Each BAER was evoked by 2 000, 40 dB Hearing Level clicks. The results show that, at the 0.05 level, the difference in V-wave latency for auditory and for visual tasks is not significant. Moreover, repetition of the attention tasks fails to bring about any significant (p less than 0.05) change in this difference. In agreement with some researchers, but not with others, we show that attentiveness has little effect on BAER V-wave latency.     

Laser treatment of rectosigmoid villous tumors. Study of a series of 313 patients

Endoscopic laser treatment is reported in 313 patients with benign rectosigmoid villous adenomas. Total tumor destruction was achieved in 92% of them, without any major complications. The circumferential extension of the tumor base was the only factor affecting this result. During the average 37-month follow-up period of the patients with total tumor destruction, 14% had a tumor recurrence. The recurrence rate after initial treatment was higher a) in patients treated for a recurrence after a previous non laser treatment, b) when the initial histology was low-grade dysplasia and c) when the tumor was located in the lower or middle rectum. Because treatment is long and difficult with a high cancer rate, laser treatment for patients with a circumferential villous adenoma should be limited to nonsurgical candidates. In the other cases, laser is well adapted to old and fragile patients, when transanal resection seems difficult or in case of recurrence after a previous non-laser treatment.     

Single photon emission computerized tomography (SPECT) for monitoring regeneration of the human liver after partial hepatectomy for secondary tumours

In 18 patients, the liver volume during regeneration after partial hepatectomy for secondary tumours was estimated by single photon emission computerized tomography (SPECT). Hepatic weight index (HWI) was subsequently calculated to follow evolution of the regeneration as a function of postoperative complications over a 30-day period. In patients with postoperative complications the HWI curves initially rose progressively and either reached a plateau or declined thereafter. The same pattern of HWI evolution was observed in patients with tumour recurrence, which was diagnosed later. On the other hand, in patients without postoperative complications the HWI curves rose continuously. These findings showed that a regenerative response was not the same in patients with or without postoperative complications; whereas in patients with tumour recurrence it could additionally provide prognostic information.     

Chlamydial antibodies and tubal infertility

Prevalence of Chlamydia trachomatis antibodies was studied in infertile women with and without tubal obstruction, and in a control group of pregnant women in a Central-African country with a high infertility rate. In comparison with the control group, tubal infertility patients were significantly more likely to have serum antibodies of 1:64 or greater with an age-adjusted odds ratio of 7.8 (95% confidence interval (CI) 3.2-19.1). Infertile women without tubal obstruction had antibody titres similar to the control group with an odds ratio of 1.1 (95% CI: 0.6-1.9). In the tubal infertility group there was a kind of dose-response relationship between chlamydial antibodies and the severity of tubal damage and pelvic adhesions on laparoscopy, with odds ratios of 3.2 (95% CI: 0.7-14.8), 6.2 (95% CI: 1.9-21.6) and 18.1 (95% CI: 6.0-68.5) in the group with mild, moderate and severe pelvic adhesions respectively. This survey adds more evidence to the hypothesis that C. trachomatis is a major agent responsible for tubal infertility in Central Africa.     

Predictive factors and correlates for pain in postpoliomyelitis syndrome patients

OBJECTIVE: To identify predictive and associated factors for muscle and joint pain in postpoliomyelitis syndrome (PPS). DESIGN: Cross-sectional study design. SETTING: Postpolio clinics. PARTICIPANTS: Baseline data on 126 PPS patients entered into a multicentered clinical trial. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Adjusted odds ratios were computed by using logistic regression modeling. Patients with or without muscle or joint pain were compared with regard to predictors and associated factors. RESULTS: In multivariate analyses for muscle pain, significant predictive and associated factors were female gender (P=.0006), longer duration of general fatigue (P=.019), and a lower score on the general health scale (P=.009) of the Medical Outcomes Study 36-Item Short-From Health Survey (SF-36). In multivariate analyses for joint pain, significant predictive and associated factors were female gender (P<.003), longer latency (duration of stability after polio; P=.008), younger age at interview (P<.002), greater weakness at acute polio (P<.07), weaker lower-extremity muscle strength (P<.04), and a lower SF-36 general health scale score (P<.02). CONCLUSIONS: Women are more likely to report muscle and joint pain in PPS. Greater initial motor unit involvement and lower-extremity weakness may be additional important factors for determining joint pain. Both muscle and joint pain are associated with reductions in quality of life.     

Frequency of -163 C>A and 63 C>G single nucleotide polymorphism of cytochrome P450 1A2 in two African populations.

Cytochrome P450 1A2 (CYP1A2) is an important member of the cytochrome P450 superfamily of enzymes because of its involvement in the metabolism of some carcinogens and therapeutically important drugs. As a result, factors affecting the activity of the enzyme are the focus of considerable research effort as they may have important pharmacological or toxicological implications. CYP1A2 has been shown to exhibit a genetic polymorphism with most of the data, however, coming from studies in Caucasian and Oriental populations. In this study therefore, we investigated the frequencies of two point mutations, -163C>A and 63C>G, in two Bantu African populations. A total of 214 healthy subjects were recruited from Zimbabwe (n=143) and Tanzania (n=71). The two single nucleotide polymorphisms were detected using polymerase chain reaction-restriction fragment length polymorphism analysis. The frequency of -163A was 57% (95% confidence interval (CI), 54%, 60%) and 49% (95% CI, 45%, 53%) among Zimbabweans and Tanzanians, respectively, but the difference between the two populations was not statistically significant (p=0.123). The base change 63 C>G was not found in any of the subjects from the two populations. We report here a high frequency of -163 C>A base change and an absence of the 63 C>G change in the two African populations.     

Hématome rétroplacentaire

Retroplacental haematoma (RPH) is a complication affecting 0.25 to 0.4% of all pregnancies and 4% of severe PEs. It is of acute onset, usually unpredictable and its symptoms are not specific: Isolated metrorrhagia, foetal distress, uterine hypertonicity. Clinical, biological and sonographic features suggesting a RPH can be early or late. Haemoconcentration and the forming of notches on Doppler examination of the uterus can appear weeks before the event, whereas raised D-Dimers and foetal tachycardia are identified within days of the event. Although Caesarian section reduces the perinatal death rate by 20 to 50% in a setting of RPH with a live foetus, vaginal delivery is indicated in cases of RPH with fetal demise, following the control of haemorrhagic shock, clotting disorders and uterine hypotonicity.