Gastrointestinal involvement occurs early in the course of Parkinson Disease (PD), as shown both by clinical 1-3 and pathological 4,5 studies. These findings have led to speculations about the role of gastrointestinal dysfunction in the early pathophysiology of the disease 6,7 . It has been conjectured that an ingested neurotoxin could permeate the gastrointestinal mucosa, reach the enteric nervous system, locally induce the aggregation of native α-synuclein, trigger cell death, and subsequently reach the dorsal motor of the vagus nerve via retrograde axonal transport, and thus be the primary pathological event in the development of PD. On the other hand, it has been well established that the frequency and severity of gastrointestinal symptoms tend to increase with disease progression 8 , thus suggesting that the involvement of the gastrointestinal tract may be a dynamic process over the course of the disease.Given the high prevalence of gastrointestinal complaints among PD patients (reported by as high as 88% in some existing reviews 8 ) we decided to systematically evaluate 15 consecutive early-to-moderate PD patients seen at our Clinic, both from a neurological and a gastrointestinal perspective. Among the multiple tests of gastrointestinal function, we decided to focus on mucosal permeability. Derangement in gastrointestinal permeability may be significantly involved in the pathogenesis of PD 6 , and, although its presence cannot be inferred from any ABSTRACT: Gastrointestinal involvement is a frequent and early event in the course of Parkinson Disease (PD), and may have a prominent role in the early pathophysiology of the disease. On the other hand, derangement in intestinal permeability could also result from the involvement of the gastrointestinal tract over the course of the disease. Patients and methods: The intestinal permeability of 12 non-selected PD patients was studied using a validated, non-invasive test; these results were compared to predefined age-adjusted reference values. Results: 4/12 PD patients had abnormal gastrointestinal permeability; two had both an abnormal lactulose/mannitol ratio and an abnormal sucrose concentration, and two an isolated abnormal result. An increased lactulose/mannitol ratio is consistent with defect of either the enterocytes or the tight junctions between them. Conclusion: Intestinal permeability is increased in a significant proportion of unselected PD patients with minimal gastrointestinal symptoms. The significance of this finding needs to be further evaluated.RÉSUMÉ: Augmentation de la perméabilité intestinale chez les patients atteints de la maladie de Parkinson : la poule ou l'oeuf ? L'atteinte gastro-intestinale est fréquente et précoce dans l'évolution de la maladie de Parkinson (MP) et pourrait jouer un rôle important tôt dans la physiopathologie de la maladie. D'autre part, l'altération de la perméabilité intestinale pourrait également être due à une atteinte du tractus gastrointestinal au cours de l'évolution de la maladie. Méthode : Nous avons étudié la...

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Bilateral uveal metastases from papillary thyroid carcinoma are extremely rare. A 36-year-old woman with a 12-month history of papillary thyroid carcinoma presented with sudden loss of visual acuity and fields in the left eye. An examination and B-scan revealed a large, solid choroidal lesion in the left eye causing exudative retinal detachment. A small solid mass was also observed in the right eye fundus. Following left eye enucleation, immunohistopathology confirmed metastatic papillary thyroid carcinoma. The authors report the third known case of bilateral choroidal metastases.

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