Respiratory muscle dysfunction in facioscapulohumeral muscular dystrophy

Sleep and Breathing -     

Demonstration of a second rapidly conducting cortico-diaphragmatic pathway in humans

Functional imaging studies in normal humans have shown that the supplementary motor area (SMA) and the primary motor cortex (PMC) are coactivated during various breathing tasks. It is not known whether a direct pathway from the SMA to the diaphragm exists, and if so what properties it has. Using transcranial magnetic stimulation (TMS) a site at the vertex, representing the diaphragm primary motor cortex, has been identified. TMS mapping revealed a second area 3 cm anterior to the vertex overlying the SMA, which had a rapidly conducting pathway to the diaphragm (mean latency 16.7 ± 2.4 ms). In comparison to the vertex, the anterior position was characterized by a higher diaphragm motor threshold, a greater proportional increase in motor-evoked potential (MEP) amplitude with voluntary facilitation and a shorter silent period. Stimulus–response curves did not differ significantly between the vertex and anterior positions. Using paired TMS, we also compared intracortical inhibition/facilitation (ICI/ICF) curves. In comparison to the vertex, the MEP elicited from the anterior position was not inhibited at short interstimulus intervals (1–5 ms) and was more facilitated at long interstimulus intervals (9–20 ms). The patterns of response were identical for the costal and crural diaphragms. We conclude that the two coil positions represent discrete areas that are likely to be the PMC and SMA, with the latter wielding a more excitatory effect on the diaphragm.     

Reflections and perspectives on institutional therapy in neurotic depressions

We have found that an institutional psychothérapy for neurosis could benefit by using elements of the work of Winnicott as well as of the bioenergetic and existential movements. This corresponds to a more and more explicit request from depressed patients who are expecting more from their stay in the hospital than simply to recharge their energy. We thought that our department, because of its size, type of patients, staff and its own orientation would be well adapted to an experience of this kind. In our hospital we try to facilitate in the patient: --regressive experiences; --the perception of "being"; --the symbolic and emotional feeling of the reality of time and place and particularity of the body; --the capacity to repair himself; --playing in the sense of Winnicott: playing with the in and the out (of onesself), the positions of the body, verbal play, play of alternation. --Centering on desire on the interior space, with the capacity to be "alone in the presence on another"; --the discovery of "responsability" and "compassion", also in the sense of Winnicott. We must take into consideration that in order to benefit from this type of therapy, there must be a good enough integration and a pain that is authentically experienced, that is, not acted out, not sutured, and without too many defenses. The results can be appreciated only very subjectively, since improvement is of a qualitative order, in the area of development of being serious existentially. We can perhaps envisage another future for the depressed patient than the interminable repetition of relapses or of beign treated indefinitely. This consists of discovering another way of being, more global, more serious, more authentic (real-self), considering the difficulties involved in the engagement of the realself in an already structured existence.     

Septic arthritis due to a nontoxigenic diphtheria bacillus]

Septic arthritis of the hip in a 2 year old child is described. A nontoxigenic diphtheria bacillus was isolated in large numbers from the articular fluid. The same organism was isolated from excoriated skin lesions of the toes. The bacteriology, epidemiology and pathology of the infection are discussed.     

Global mean diffusivity: A radiomarker discriminating good outcome long term after traumatic brain injury

BackgroundTraumatic brain injury (TBI) is a chronic pathology responsible for cognitive disorders impacting outcome. Global clinical outcome several years after TBI may be associated with anatomical sequelae. Anatomical lesions are not well described because characterizing diffuse axonal injury and brain atrophy require using specific MRI sequences with quantitative measures. The best radiologic parameter to describe the lesions long term after TBI is not known.ObjectiveWe aimed to first, assess the global volumetric and diffusion parameters related to long-term outcome after TBI and second, define the most discriminating parameter.MethodsIn this observational study, we included 96 patients with severe TBI and 22 healthy volunteers. The mean delay after TBI was 63.2 months [range 31–119]. The Glasgow Outcome Scale Extended (GOS-E) was used to assess the global long-term clinical outcome. All patients underwent multimodal MRI with measures of brain volume, ventricle volume, global fractional anisotropy (FA) and global mean diffusivity (MD).ResultsAll 96 participants had significant impairment in global FA, global MD, brain volume and ventricle volume as compared with the 22 controls (P < 0.01). Only global MD significantly differed between the “good recovery” group (GOS-E score 7-8) and the other two groups: GOS-E scores 3-4 and 5-6. Brain volume significantly differed between the GOS-E 7-8 and 3-4 groups. Global MD was the most discriminating radiological parameter for the “good recovery” group versus other patients, long term after TBI. FA appeared less relevant at this time. Global atrophy was higher in patients than controls but lacked reliability to discriminate groups of patients.ConclusionGlobal mean diffusivity seems a more promising radiomarker than global FA for discriminating good outcome long term after TBI. Further work is needed to understand the evolution of these long-term radiological parameters after TBI.