CSF flow measurement in syringomyelia

BACKGROUND AND PURPOSE: CSF circulation has been reported to represent a major factor in the pathophysiology of syringomyelia. Our purpose was to determine the CSF flow patterns in spinal cord cysts and in the subararachnoid space in patients with syringomyelia associated with Chiari I malformation and to evaluate the modifications of the flow resulting from surgery. METHODS: Eighteen patients with syringomyelia were examined with a 3D Fourier encoding velocity imaging technique. A prospectively gated 2D axial sequence with velocity encoding in the craniocaudal direction in the cervical region was set at a velocity of +/- 10 cm/s. Velocity measurements were performed in the larger portion of the cysts and, at the same cervical level, in the pericystic subarachnoid spaces. All patients underwent a surgical procedure involving dural opening followed by duroplasty. Pre- and postoperative velocity measurements of all patients were taken, with a mean follow-up of 10.2 months. We compared the velocity measurements with the morphology of the cysts and with the clinical data. Spinal subarachnoid spaces of 19 healthy subjects were also studied using the same technique. RESULTS: A pulsatile flow was observed in syrinx cavities and in the pericystic subarachnoid spaces (PCSS). Preoperative maximum systolic cyst velocities were higher than were diastolic velocities. A systolic velocity peak was well defined in all cases, first in the cyst and then in the PCSS. Higher systolic and diastolic cyst velocities are observed in large cysts and in patients with a poor clinical status. After surgery, a decrease in cyst volume (evaluated on the basis of the extension of the cyst and the compression of the PCSS) was observed in 13 patients. In the postoperative course, we noticed a decrease of systolic and diastolic cyst velocities and a parallel increase of systolic PCSS velocities. Diastolic cyst velocities correlated with the preoperative clinical status of the patients and, after surgery, in patients with a satisfactory foraminal enlargement evaluated on the basis of the visibility of the cisterna magna. CONCLUSION: CSF flow measurement constitutes a direct evaluation for the follow-up of patients with syringomyelic cysts. Diastolic and systolic cyst velocities can assist in the evaluation of the efficacy of surgery.     

Neurokinin-1 receptor immunoreactivity in hypotension sensitive sympathetic preganglionic neurons

Substance P activation of neurokinin-1 (NK1) receptors on spinal sympathetic preganglionic neurons (SPN) influences blood pressure. We identified SPN likely to subserve the baroreceptor reflex and established if these neurons showed NK1 receptor-immunoreactivity. Nitroprusside (NP) infusion or inferior vena cava (IVC) constriction activated similar numbers of SPN. Of these, about 40% were NK1 receptor-immunoreactive after NP infusion, but only about 20% were NK1 receptor-immunoreactive after IVC constriction. The distribution of Fos/NK1 receptor SPN suggested that substance P may preferentially target sympathoadrenal SPN.     

Management of sinonasal hemangiopericytomas

The purpose of the present study is to report four cases of sinonasal hemangiopericytoma (HP) diagnosed and treated in our department between 1987 and 1998. The pretreatment findings and the treatment are described and discussed in the light of the literature. HP are unusual vascular tumors, featuring pericytes distributed around normal vascular channels. Two of these four cases were located in the nasal cavity and the other two were located in the maxillary sinus. Inside the nasal cavity, HP presented as a protruding reddish-gray mass with marked bleeding on contact. Electron microscopy and immunohistochemical techniques are essential for diagnosis and to distinguish HP from other sarcomatous tumors. Preoperative assessment included routine CT, MRI, arteriography and selective embolization. These tumors must be treated surgically with complete excision. An endonasal approach was performed in two cases of intranasal HP, while a combined external-endonasal approach was required for the other two cases of HP.     

MMPI profiles of acute and chronic PTSD in a civilian sample

In a treatment setting, a group of 165 subjects presenting with either acute or chronic posttraumatic stress disorder (PTSD) were compared to 72 subjects presenting with panic disorder only in order to determine whether the MMPI PTSD assessment strategy developed with Vietnam veterans could be validly used with civilians. Results indicated that the MMPI profile, codetype, diagnostic decision rule, and PK scale developed with samples of Vietnam veterans did not apply well to civilians, especially those presenting with acute PTSD. It is thus recommended that specific assessment strategies be developed for these populations.     

Evaluation of Clinical Severity in Sickle Cell Disease

For a severity classification of sickle cell disease to be accepted, it is necessary that clinicians agree upon relative disease severity between patients. This condition was shown to be satisfied for a randomly selected group of patients evaluated by four persons. All rank correlation coefficients between observer pairs were highly significant. Representative severity indices based on history and recent hospital events also correlated significantly with evaluator ranking. The results show that, in principle, a classification of sickle cell disease patients by severity is possible. Such a classification would be most useful to evaluate the prognostic significance of particular signs or symptoms, or the success of various treatments in affecting severity of disease.     

Multiple sclerosis: Oligoclonal IgG, ξ-λ light chain distribution and measles antibodies in brain extracts

The presence of measles antibodies in white and grey brain material and in 8 demyelination plaques from 6 patients affected with multiple sclerosis was investigated with the hemagglutination inhibition (HI) and complement fixation (CF) techniques.White and grey matter of 5 controls were run in parallel. No measles antibodies could be detected, except for one plaque, where the answer could be considered as doubtful. The immunoglobulin G (IgG) content and the ξ/λ light chain ratios of all the samples were evaluated. No unique monoclonal immunoglobulin population could be detected, but ξ or λ predominant oligoclonal populations appeared in controls as well as in MS IgG.     

A correlation between Paco2 and body temperature in febrile patients

Chapot, G., Muller, Michèle, Barrault, Nicole, Dargnat, Nicole, and Languillat, J-M. (1974).Thorax, 29, 104-105. A correlation between Paco₂and body temperature in febrile patients. Paco₂ has been measured in 49 patients with normal and raised body temperature. Within the temperature range 35·5°C-41·4°C, there was an inversely proportional relationship between Paco₂ and body temperature with a highly significant correlation coefficient.