1 Statins inhibit synthesis of mevalonate, a precursor of ubiquinone that is a central compound of the mitochondrial respiratory chain. The main adverse effect of statins is a toxic myopathy possibly related to mitochondrial dysfunction. 2 This study was designed to evaluate the effect of lipid-lowering drugs on ubiquinone (coenzyme Q10 ) serum level and on mitochondrial function assessed by blood lactate/pyruvate ratio. 3 Eighty hypercholesterolaemic patients (40 treated by statins, 20 treated by fibrates, and 20 untreated patients, all 80 having total cholesterol levels >6.0 mmol l−1) and 20 healthy controls were included. Ubiquinone serum level and blood lactate/pyruvate ratio used as a test for mitochondrial dysfunction were evaluated in all subjects. 4 Lactate/pyruvate ratios were significantly higher in patients treated by statins than in untreated hypercholesterolaemic patients or in healthy controls (P<0.05 and P<0.001). The difference was not significant between fibratetreated patients and untreated patients. 5 Ubiquinone serum levels were lower in statin-treated patients (0.75 mg l−1±0.04) than in untreated hypercholesterolaemic patients ( 0.95 mg l−1±0.09; P<0.05). 6 We conclude that statin therapy can be associated with high blood lactate/ pyruvate ratio suggestive of mitochondrial dysfunction. It is uncertain to what extent low serum levels of ubiquinone could explain the mitochondrial dysfunction.

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NPH can be reversible after cerebrospinal fluid (CSF) diversion. In the past no reliable criteria could be defined to predict the successful outcome of CSF shunting. Several authors demonstrated an increased cerebral blood flow after lumbar puncture in patients with NPH, indicating an underlying impairment of cerebral circulation autoregulation. 123I-AMP brain tomoscintigraphy was applied to 23 individuals with NPH before and after CSF drainage. Of these 23 patients, 10 underwent surgical shunting. The frontal and parietal hypoactive cortical pattern was present in NPH but not pathognomonic. Under stimulation of CSF pressure lowering, seven patients with improved outcome after shunting demonstrated an increase of cerebral perfusion in these areas, whereas a decrease of activity was found in three patients whose clinical status was unchanged after CSF diversion. This tomoscintigraphic test may be an interesting additional criterion for surgical admission.

SUMMARY The clinical and pathological findings of a 31-year-old woman, in whom the diagnosis of Leigh's disease was made, are reported. CT scan examination with contrast enhancement showed symmetrical areas of low density, in both thalami, anterior limbs of internal capsules and corpus callosum. Longstanding chronic lesions involved the optic chiasma and the cerebral peduncles and consisted of myelin loss, status spongiosus, astrocytic gliosis and marked capillary proliferation. The neurons were spared. In the basal ganglia, internal capsules and corpus callosum, these lesions were more recent and consisted of focal necrosis, perivascular oedema and few lymphocytic perivascular cuffings.Subacute necrotising encephalomyelopathy (Leigh's disease) rarely occurs in adults: to our knowledge only 16 pathologically studied cases have been reported'-9 and only one of these had computed tomography.' This paper reports the clinical and pathological findings of an adult case in which the diagnosis of Leigh's disease was made. Case reportA 31-year-old Chilean woman was admitted to hospital because of visual impairment and increasing stupor. The family history was difficult to obtain because the patient lived alone, did not speak French well and was stuporous. She only could say that her mother was epileptic. The patient was not alcoholic. At the age of 21 years, she had suffered from an episode of confusion which lasted one week and resolved spontaneously. Two months before death, she developed intellectual slowing, behavioural abnormalities and impairment of recent memory. One month later, she experienced transient fever, headache and nausea and over the following weeks, her mental state worsened; she had visual hallucinations, became stuporous and was admitted to the hospital. The patient could answer when questioned; she frequently yawned and made chewing movements. Neurological examination revealed ptosis

Thirty‐eight different strains of extended‐spectrum β‐lactamase (ESBL)‐producing Klebsiella pneumoniae (ESBL Kp), isolated from urine and pus samples of 38 patients hospitalized in a medium‐ and long‐stay neurology department between 1 January 1992 and 31 December 1996, were analysed by antibiotic resistance phenotyping, DNA macrorestriction by pulsed‐field electrophoresis and isoelectric focusing of β‐lactamases. An epidemiological survey was conducted to identify risk factors for infection by ESBL Kp in this setting. The 38 isolates were distributed into 13 antibiotypes, three of which predominated (13, six and six isolates). The DNA macrorestriction pattern identified 15 genotypes, four of which predominated (11, six, four and four isolates). A combination of the two typing methods revealed several epidemic clones that emerged consecutively. Two main types of ESBL (SHV‐2 and CTX‐1) were identified by isoelectric focusing, the former predominating. The case‐control study showed that the length of hospital stay, degree of malnutrition and dependency, and urinary sphincter status were the main factors significantly associated with ESBL Kp isolation.