Troubles psychotiques révélateurs de maladie de Creutzfeldt-Jakob sporadique

The onset of the sporadic Creutzfeldt-Jakob disease is usually characterized by dementia or neurological symptoms. We are reporting the case of a 31 year-old man with a sporadic Creutzfeldt-Jakob disease characterized by a schizophrenia-like onset. The schizophrenic symptoms developed for sixteen months before the neurological symptoms appeared. The psychiatric onset of the present case was linked with the early age of onset and the long duration of the disease and could have been influenced by polymorphism of the codon 129 of the prion protein gene (PRNP) and a type of pathological prion protein (PrPres).     

Magnetic resonance imaging in full-term infants with repetitive focal seizures.

We report two full-term infants who developed repetitive focal seizures within the first 48 hours of life. Neither infant had predisposing factors and there were no abnormalities on a computed tomography (CT) scan performed on day 2 of life. Magnetic resonance imaging (MRI) performed during the second week of life showed a focal hemorrhagic infarction in both patients. We conclude that either an MRI or a contrast-enhanced CT scan should be obtained within 1 week in patients in whom the initial imaging technique failed to reveal a focal lesion, at which time a cerebral infarction can be diagnosed with greater sensitivity.     

Genome-wide linkage survey for genetic loci that affect the risk of suicide attempts in families with recurrent, early-onset, major depression.

We previously described the results of a genome-wide linkage survey for genetic loci that influenced the development of unipolar mood disorders in 81 families identified by individuals with Recurrent, Early-Onset, Major Depressive Disorder (RE-MDD) [Zubenko et al. 2003b; Am J Med Genet (Neuropsychiatr Genet) 123B:1-18]. In the current study, we extended this linkage analysis by including the history of a suicide attempt as a covariate to identify chromosomal regions that harbor genes that influence the risk of this behavior in the context of mood disorders. This approach identified six linkage peaks with maximum multipoint DeltaLOD scores that reached genome-wide adjusted levels of significance (2p, 5q, 6q, 8p, 11q, and Xq). Four of these (2p, 6q, 8p, and Xq) exceeded the criterion for "highly-significant linkage" (genome-wide adjusted P < 0.001) recommended by Lander and Kruglyak [1995; Nat Genet 11:241-246]. The strongest evidence for linkage was observed in analyses employing affected relative pairs (ARPs) with the most severe and disabling Mood Disorders: Depression Spectrum Disorder and RE-MDD. The highest DeltaLOD score that emerged from this linkage analysis, 5.08, occurred for ARPs with Depression Spectrum Disorder at D8S1145 (37.0 cM, 18.2 Mbps, P < 0.0001) at cytogenetic location 8p22-p21. Significant linkage results on Xq arose from analyses of ARPs with RE-MDD at DXS1047 (143 cM, 127.8 Mbps, DeltaLOD = 3.87, P < 0.0001), a finding that may contribute to the higher rate of suicide attempts among women than men. These findings provide evidence for suicide risk loci that are independent of susceptibility loci for Mood Disorders, and suggest that the capacity for suicide risk loci to affect the development of suicidal behavior depends on the psychiatric disorder or subtype with which they interact.     

Ultrastructural Changes Associated with Peripheral Neuropathy in HIV/AIDS

Light and electron microscopic studies were performed on neuromuscular biopsy specimens from 12 neurologically affected seropositive patients, 7 with the acquired immune deficiency syndrome (AIDS), 2 with AIDS-related complex, and 3 with no symptoms except for neuropathy. All patients had an axonal injury associated or unassociated with demyelination and peripheral neurogenic atrophy. Capillary lesions were consistently present, which seems to be a new finding. Moreover, tubuloreticular inclusions (TRIs) were found in endomysial (9 of 12 cases) and endoneurial (7 of 12 cases) vessels. Statistical analysis showed that TRIs in more than 20% of endomysial vessels correlated with a survival time shorter than 12 months (P = 0.028). Thus the quantification of TRIs seems to be one of the vital prognostic elements in this patient population.     

Comparison of the 5-hydroxytryptamine3 (serotonin) antagonist ondansetron (GR 38032F) with high-dose metoclopramide in the control of cisplatin-induced emesis

To compare ondansetron (GR 38032F), a 5-hydroxytryptamine3-receptor antagonist, with metoclopramide in the prophylaxis of acute cisplatin-induced emesis, we conducted a double-blind crossover study in 97 patients scheduled to receive cisplatin (80 to 100 mg per square meter of body-surface area) for treatment of cancer. None had received chemotherapy before this trial. Among the 76 patients who satisfactorily completed both parts of the study, complete or nearly complete control of emesis (i.e., no episodes of emesis occurred, or only one or two) was achieved in 57 of 76 treatments (75 percent) with ondansetron and in 32 of 76 treatments (42 percent) with metoclopramide (P less than 0.001). Ondansetron was also more effective in controlling acute nausea, as assessed with a visual-analogue scale (P = 0.019) or a graded scale (P = 0.024). There was a significant preference among patients for ondansetron (55 vs. 26 percent; P = 0.006). Dystonic reactions were observed during three treatments with metoclopramide; both agents were otherwise well tolerated. We conclude that ondansetron is more effective than metoclopramide in the control of cisplatin-induced nausea and vomiting, and that this suggests that serotonin is an important mediator of this side effect.     

Comparison of 2 systems of blood culture: Signal and Bactec

Two Bactec bottles (aerobic and anaerobic) and one single bottle Signal were used for detecting bacteremia in 405 patients (47 children and 358 adults). The two blood culture Signal and Bactec aerobic were continuous shaking for up to 24 hours. 10.3 p. cent of patients had positive cultures (62.3 p. cent Gram +, aero-anaerobic bacteria). Nine bacteremia were detected by only one system (4 for signal, 4 for Bactec) 77.1 p. cent of 83 strains were positive on the two systems together, but 7.2 p. cent only in the Bactec and 15.6 p. cent only in the Signal. The delay of growth give an advantage to the Bactec (67 p. cent in 24 hours). The advantages and the disadvantages of the two systems were analysed.     

Alzheimer's disease and Meynert's nucleus basalis. An anatomo- clinical point of view

The existence of a lesion in the nucleus basalis (NbM), in Alzheimer's disease, which has been brought up again by Whitehouse et al. (1981), is not doubted anymore. The lesion is correlated with the disease's cholinergic deficit. The histology of the lesion isn't much described, and its importance not very clear. This study compares ten cases of Alzheimer's disease, and six cases of "senile dementia". A cellular count and a histologic observation of the NbM are done on slides imbedded in paraffin. The cortex is studied in the classical way. There are neuro-fibrillary tangles "en boules" in the NbM of the two types of dementia, but more frequently in Alzheimer's disease. No senile plaques are observed. The neuronal loss appears much more important in the group of Alzheimer's disease than in the senile dementias. But a typical clinical and histological case of Alzheimer's disease did not show neuronal loss in the NbM. The final results invite to further discussions concerning the present knowledge of Alzheimer's disease and senile dementia.     

Differentiation of proton-pumping activity in cultured renal inner medullary collecting duct cells

Cultured inner medullary collecting duct (IMCD) cells have been shown to secrete protons (H⁺) by two mechanisms: anN-ethylmaleimide-and dicyclohexyl-carbodiimide-sensitive electrogenic H⁺-ATPase or H⁺ pump, and an amiloride-sensitive, secondary active Na⁺/H⁺ exchanger. These cells also express Cl^–/HCO₃ ^– exchange and carbonic anhydrase activity in common with other renal epithelial cells involved in acid-base transport. Video fluorescence microscopy of individual cells using 2, 7-biscarboxyethyl-5(6)-carboxyfluorescein has demonstrated that adjacent-cultured IMCD cells show substantial functional intercellular heterogeneity. The development of H⁺-pumping activity is associated with high-baseline intracellular pH and peanut agglutinin (PNA) affinity, and loss of mitotic activity and of Na⁺/H⁺ exchange. The H⁺-pumping activity may be further enhanced by removal of fetal calf serum for 6–54 h or by selecting cells with high PNA affinity. IMCD cells in their most differentiated state form domes, which consistently showed the highest rates of H⁺-pumping activity, as well as high affinity for peanut lectin. When IMCD were plated at low density, domes developed relatively late (2–4 weeks), at which time cells located in the center of nests of contiguously growing cells were quiescent and showed H⁺-pumping activity but no Na⁺/H⁺ exchange. On the other hand, dense plating was associated with early development of domes (end of 1st week), at which time adjacent cells showed a high mitotic activity and Na⁺/H⁺ exchange, but no H⁺-pumping activity. We speculate that differentiation of IMCD cells results in the development of cell polarity. This could include either loss of the apical Na⁺/H⁺-exchange activity, or localization of this exchanger only to the basolateral membrane, while the H⁺ pump differentiates at the apical membrane.