Guillain-Barré syndrome: rehabilitation outcome and recent developments.

Guillain-Barré syndrome is the most common polyneuropathy causing major disability and respiratory failure. Respiratory complications are the main cause of death. Improved respiratory care and new treatment strategies such as plasmaphoresis and immunoglobulin have been shown to improve outcome. We studied the course and outcome of 37 patients with Guillain-Barré syndrome who were admitted to a rehabilitation and respiratory care facility over a 10-year period. There were 21 males and 16 females with a mean age of 62+/-3 years. Fourteen patients developed respiratory failure requiring endotracheal intubation and mechanical ventilation. The mean duration of mechanical ventilation was 38+/-10 days. All patients were successfully liberated from the ventilator. However, 83 percent of the patients were moderately to severely disabled at the time of discharge. Thirteen out of 37 (35 percent) developed long-term disability. None of the patients died over the period of follow-up. These results indicate that early recognition and treatment of respiratory complications in Guillain-Barré syndrome could reduce the morbidity and mortality of this condition.     

Guillain-Barré syndrome and Campylobacter jejuni: a serological study.

The association between Campylobacter jejuni infection and Guillain-Barré syndrome was investigated serologically in a retrospective study of 56 patients admitted to this hospital over four years. Evidence of preceding C jejuni infection was found in 21 (38%) of these patients, indicating that C jejuni was the most common single identifiable pathogen precipitating the disease. Among those patients who had presented with preceding diarrhoea the serum antibody response was similar to that in uncomplicated C jejuni enteritis. Patients with serological evidence of preceding C jejuni infection manifested a significantly more severe form of the disease. In cerebrospinal fluid the predominant specific antibody class was IgG, and this was closely related to the serum titres of specific IgG. IgA and IgM specific antibodies were found only in the cerebrospinal fluid of patients with recent C jejuni infection. These findings support the possibility that humoral immune factors are responsible for the neural damage and demyelination seen in Guillain-Barré syndrome.     

L’évolution chez les Phyllocerataceae,la variabilité des paramètres dimensionnels et relatifs. Variabilité de la complexité de la ligne cloisonnaire: Variabilité et paedomorphose

Evolution of the Phyllocerataceae, the variability of the dimensional and relative parameters. Variability of the complexity of the suture line. Variability and paedomorphosis. A recent study has shown the importance of heterochronies in the development of Phyllocerataceae. It was attractive to estimate with precision the variability of some morphological characters of the shell and of the suture line in order to study how this variability changed in the course of time (from Jurassic to terminal Cretaceous). This note gives the averages of the calculations of variability in dimensional and relative variables in the shell of Phylloceratidae and variability in the complexity C of their suture lines. Coefficient of variation V is the statistical parameter used here, because it allows the comparison between the dispersions of different populations. This study shows that the variability of the complexity in the suture line and h₁ + h₂ is more fluctuating among the taxa (usually subfamilies, genera and species) in which heterochrony is evident. On the other hand, the variability of other parameters (V₁, V₂, D) first grows and then slowly decreases till the branch or the lineage is extinct. This schema is mostly acceptable down to the Lower Cretaceous-Upper Cretaceous in the Tethys and in the marine shelf of Gondwana. In the family of Neophylloceratidae, very clearly in the Tethys, less clearly in marine shelf of Gondwana (it is less obvious in the genus Phyllopachyceras), the variability grows as far as the terminal Cretaceous. The extinction of this family may result from a catastrophic event and not from internal causes. In short, the decrease of variability comes before the extinction of the taxa and consequently it agrees with a Darwinian classic schema. On the other hand, the extinction of Neophylloceratidae that occurs when the variability is maximal probably takes place in another perspective, an external « catastrophic » event. To cite this article, B. Joly, C.R. Palevol 2 (2003).     

Reproductibilité interobservateur d'un tympanomètre portatif,le MicroTymp.

OBJECTIVE: To determine the interobserver reliability of tympanograms obtained with the MicroTymp, a portable tympanometer. SETTING: Family medicine teaching unit in a tertiary care hospital. PATIENTS: Thirty-three patients who presented to the ear, nose and throat clinic in August 1990 for an ear problem. INTERVENTION: Three residents in family medicine independently attempted to record with the MicroTymp one tympanogram for the 66 ears. We excluded the results for seven ears for which tympanograms could not be obtained. MAIN OUTCOME MEASURE: Using objective criteria, two family physicians and two residents in family medicine independently classified the 177 tympanograms into five categories (normal, possible effusion, possible perforation, possible tympano-ossicular dysfunction and unclassifiable). Reliability was estimated by means of the kappa (kappa) coefficient on 161 tympanograms from 59 ears for which the interpretation of the three tympanograms agreed. MAIN RESULTS: The interpretation of the three tympanograms agreed for 34 of the 59 ears (0.58) (kappa = 0.52, 95% confidence limits 0.45 and 0.59). There was no significant difference in interobserver reliability between pairs of observers or between symptomatic and asymptomatic ears. CONCLUSIONS: The interobserver reliability of the MicroTymp is moderate. The tympanograms obtained with the instrument should be interpreted in the context of the clinical findings.