Aluminium encephalopathy: a potential risk of aluminium gels in children with chronic renal failure.
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Biomedical subjects
Publications and source records attributed to M Poisson.
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Various questions are asked to the neuropathologist when the diagnosis of malignant glial tumor is suspected: is there a tumor on the sample? is it a glial tumor? What is the degree of malignancy and the prognosis? Answers to be given are easier if the biopsy has been performed before any treatment than in case of suspicion of tumor recurrence. The limits of the neuropathological methods, as well classical as more up to date ones such as electron microscopy, immunohistochemistry, image analysis or tissue culture and those of other research methods such as biochemistry, are emphasized.
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Intracranial hypertension is a rare phenomenon in the development of intra-spinal neoplasm. In the present case, it occurred without ventricular dilatation raising the problem of the underlying mechanism. Perturbations in the CSF reabsorption would appear less likely than an increase in brain volume, where cerebral edema may play an important role.
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Periarteritis nodosa was observed in three of 266 persistent hepatitis B antigen (HBsAg) carriers undergoing long-term hemodialysis; no cases of necrotizing vasculitis occurred among 384 other patients undergoing dialysis having either no or transient antigenemia. Circulating e antigen, but no e antibody, was found in two of these three patients. The serum level of the third component of complement (C3) was normal in two patients and low in the third. Circulating immune complexes were demonstrated in all three patients, using polyethylene-glycol (PEG) precipitation, PEG-C4, and solid phase C1q tests. HBsAg and anti-hepatitis B antibody (HBsAb) were identified in the PEG precipitates using radioimmunoassay and electron microscopy technics. Direct immunofluorescence performed on a muscle biopsy specimen from one patient was positive for HBsAg, but not for immunoglobulin G (IgG), immunoglobulin M (IgM), C3 or C1q. These data support the hypothesis that circulating immune complexes involving HBsAg may be involved in the pathogenesis of periarteritis nodosa.
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The authors have searched for oestrogene (RE) and progesterone (RP) receptors in 22 cases of meningiomas. Hormone receptors were determined on the cytosol and nuclear fractions of tumor tissues, using synthetic oestrogen R 2858 and progestin R 5020 in conditions where exchange was nearly achieved. The receptors were considered as present for values equal or higher than 100 femtomoles per gram of tumour tissue (fmol/gT). For the 22 studied cases the RE were present in 13 cases (59 p. 100) with values between 100 and 500 fmol/gT in 9 cases and higher than 500 fmol/gT in 4 cases. The RP were present in all cases (100 p. 100), with values between 100 and 500 fmol/gT in one case, between 500 et 5 000 fmol/gT in 13 cases and higher than 5 000 fmol/gT in 8 cases. The results were compared with neuropathologic data obtained by light microscopy. The clinical and biological significance of results are discussed.
The cases presented with psychic troubles and repeated somnolence episodes accompanied by dysarthria in 5 cases, myoclonic jerks in 4 cases and epileptic seizures in 1 case. In all cases the EEG was disturbed. It showed symetrical, paroxystic, bilateral, monomorph slow activity with more or less frequent paroxysms. The average serum aluminium level was at 407 microgram/l in the acute phase, at 161 microgram/l in the remission phase and at 123 microgram/l three months later. After interruption of oral and dialytic aluminium intake the remission is maintained. However in 2 cases the transitory readministration of aluminium gel was followed by reversible recurrency. The role of both aluminium gel and dialysate aluminium as the origin of encephalopathy is discussed.
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Report a typical case of dialytic dementia in a patient treated with aluminium gels. The course was fatal in fifteen months duration. Before interruption of aluminium gel intake, the aluminium blood level measured by atomic absorption spectrography was at 1300 microgram/l (normal less than 40 microgram/l). Cerebral aluminium was studied by the method of Le Gendre and Alfrey. On the three studied specimens of gray matter including, the parieto rolandic cortex, the thalamus, the cerebellar cortex, the mean aluminium concentration was seven times higher than the witness. The optic and electronic microscopy study showed important accumulation of lipofuscin. No neurofibrillary degeneration was observed. In contrast to the intensity of the clinical signs and the fatal course the cerebral lesions were slight.
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Forty-six patients with gliomas were introduced after surgery into a therapeutic programme of six cycles of combination chemotherapy with VM26 and CCNU, followed by delayed irradiation six months after surgery with an average dose of 5,800 rads. After irradiation the same preradiation chemotherapy was readministered for an average of four cycles. The results were compared to those from another group of 28 patients treated only by the same chemotherapy (CRC and C groups sucessively). Twelve patients (26%) died before irradiation in the CRC group, six patients (13%) had recurrences at the time of irradiation, and 28 patients (61%) had no clinical or radiological signs of recurrence at the time of irradiation. For the total of treated patients the median survival after surgery was 17 months, and 46% of the patients were surviving at 18 months. The percentage of survivors at 18 months was significantly more elevated in the group treated by combination chemotherapy and delayed irradiation than in a control group treated by the same combination chemotherapy alone. This result suggests that in approximately 50% of cases combination chemotherapy after surgery, and delayed irradiation six months after surgery, cumulated their effects on survival time.
34 patients operated on for malignant gliomas were successively treated by combination chemotherapy with VM26 and CCNU and conventional radiation therapy with an average dosage of 5,800 Rads, six months after surgery. The general and haematological tolerance of delayed irradiation after chemotherapy was satisfactory. Twelve patients developed neurological complications during or after irradiation. The complications were early in 10 cases, and delayed in 2. They were probably due to tumour growth in five cases, and secondary to irradiation in seven. In four of the seven cases the preradiation chemotherapy seemed to potentiate the radiation effect on the central nervous system.
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A case of encephalopathy with elevation of plasma aluminium level in a patient treated by maintenance hemodialysis is reported. Clinical symptoms were made of moderate impairment of intellectual functions and of intermittent drowsiness. EEG after 3 minutes of hyperpnea evidenced bisynchronous anteriorly dominant intermittent delta waves. Plasma aluminium level, determined by atomic absorption spectrophotometry, was initially at 300 microgram/l (normal range greater than 40 microgram/l). After interruption of aluminium gels, clinical and EEG symptoms slowly subsided in 9 months, plasma aluminium level came down to 145 microgram/l. This picture of encephalopathy could preceede irreversible dialysis dementia in chronic dialysis patients.
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