Search

Each time a patient is examined somewhere, one looks for Babinskis sign. It is recorded in medical files all over the world, but because the history of medicine is only minimally taught, Babinski remains virtually unknown. At times he is thought to be Russian, some write his name with a Y; the reflex he discovered is sometimes abbreviated as Bab or, less frequently, as BBK. The essence of Babinskis success was in creating an original approach to the evaluation of the patient, based on a meticulous clinical exam, looking for those abnormal reflexes or signs which he described, often in the face of considerable criticism.

We report a case of seizures with acute encephalopathy in a female patient under sulfasalazine treatment for polyarthritis. Neurotoxicity secondary to sulfasalazine was suspected. This side effect has seldom been reported in the literature.

Peripheral neuropathies were the presenting feature of an IgA lambda myeloma in a 61-year-old man and a mixed cryoglobulinaemia in a 46-year-old woman. A spectacular improvement in these symptoms followed treatment including large volume plasma exchanges with appropriate chemotherapy. This efficacy of repeated plasmapheresis leads to a discussion of the possible mechanisms of these neuropathies.

Temporal arteritis is still often overlooked in 1982 as shown by the diagnostic delay reported in a retrospective review of 33 patients and in the series previously published in the medical literature. Clinical features to be especially kept in mind are the occasional nature of temporal signs, the pathognomonic value of jaw claudication and the existence of signs which may constitute a premonitory syndrome of blindness. The frequent rise in alkaline phosphatase levels is often misleading. In patients over 65 with an unexplained inflammatory syndrome, biopsy of both temporal arteries should be promptly performed, prior to the unpleasant and costly investigations designed to detect an occult carcinoma. Corticosteroids are still the best treatment of giant cell arteritis but the optimal initial dosage remains unknown as no data from randomized trials are available. Symptomatic relapses have been reported up to 10 years (5 years for ocular symptoms) after onset of the disease. Because of this protracted course, which makes adequate follow-up difficult to ensure, recovery rates from different series are at variance. The main side-effects of maintenance corticosteroid therapy in these elderly patients are osteoporosis, which warrants systematic countermeasures, and probably an increased rate of atheromatosis.

The drugs and drug combinations responsible for cutaneo-mucosal reactions are very numerous, which explains why this undesireable side effect is the most frequent of all. Multiple pathogenic mechanisms are described: immunoallergic with its different types of reactions, overdosage, idiosyncrasy, drug interactions, etc. The reactions of produced vary from the maculo-papular rash to definitive staining of the skin. A few specific cases have been analyzed: the allergic reactions with penicillins, the photo-toxicity of certain tetracyclines, licheniform eruptions with gold salts or lupus erythematosus with penicillamine. Centralization of pharmacological information is desireable in order to better understand these reactions.

Acute myoclonic encephalopathy related to the ingestion of bismuth salts has been known for 3 years and would appear to be reversible. Of a total of 41 cases, 32 were observed for an average of more than a year. Alongside the commoner benign forms, there coexist severe forms, sometimes fatal, prolonged forms and complicated forms. Permanent deterioration, affecting memory above all, tremor, marked insomnia, headache and disturbed gait are amongst the most durable complications, sometimes definitive, whilst in four cases osteo-arthropathy of the shoulders was associated with permanent invalidism.

The rheumatoid rosette test was performed in 33 patients with febrile valvular cardiopathy. In 19 cases bacterial endocarditis was proved by blood culture or by histological examination. The test was positive in 3 cases out of 5 during the first ten days of the fever (group A1), in 6 cases out of 6 after the tenth day (group A2), and in 4 out of the 8 already treated patients (group A3). In 3 positive cases, successive measurements, before and during treatment, showed a rapid fall in rosette levels. In controls patients, the test was positive 8 out of 9 cases with febrile valvular cardiopathy without endocarditis (group B) and in 5 out of 5 cases in which bacterial endocarditis was probable but not proved (group C). The increase in rheumatoid rosette levels seems therefore to be non specific of bacterial endocarditis. Nevertheless it could be a good test for biological activity of the disease in treated patients. The origin and signification of the rheumatoid rosette forming cells are discussed.

Four cases of histologically proven temporal arteritis presenting with atypical clinical, anatomical or evolutive features and raising nosological problems concerning the type of vasculitis involved are presented. In patients with temporal arteritis, some elements are suggestive of periarteritis nodosa. They include peripheral neurological lesions, renal or pleuro-pulmonary lesions and the histological appearance of the temporal artery. Diagnosing periarteritis nodosa in a case of temporal arteritis leads to a special therapeutic strategy.

The diagnosis of temporal arteritis is made after a mean delay of four months. This delay is explained by the absence, in 50% of cases, of any clinical sign in the temporal area, the possible presence of alterations in liver function tests, and the frequency of anemia and loss of weight. These signs often suggest a mistaken diagnosis of hepatobiliary disease or cancer. The authors evaluate the cost of this delay in a personal series of 33 cases confirmed histologically. They recommend biopsy of the temporal artery in each patient aged more than 70 with a marked rise in erythrocyte sedimentation rate unexplained by an infectious disease or dysglobulinemia.