Long term surgical results of 154 petroclival meningiomas: A retrospective multicenter study.

BACKGROUND: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS: There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS: Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.

Infections Revealing Complement Deficiency in Adults: A French Nationwide Study Enrolling 41 Patients.

Complement system is a part of innate immunity, its main function is to protect human from bacterial infection. As genetic disorders, complement deficiencies are often diagnosed in pediatric population. However, complement deficiencies can also be revealed in adults but have been poorly investigated. Herein, we describe a case series of infections revealing complement deficiency in adults to study clinical spectrum and management of complement deficiencies.A nationwide retrospective study was conducted in French university and general hospitals in departments of internal medicine, infectious diseases enrolling patients older than 15 years old who had presented at least one infection leading to a complement deficiency diagnosis.Forty-one patients included between 2002 and 2015 in 19 different departments were enrolled in this study. The male-to-female ratio was 1.3 and the mean age at diagnosis was 28 ±â€Š14 (15-67) years. The main clinical feature was Neisseria meningitidis meningitis 75% (n = 31/41) often involving rare serotype: Y (n = 9) and W 135 (n = 7). The main complement deficiency observed was the common final pathway deficiency 83% (n = 34/41). Half of the cohort displayed severe sepsis or septic shock at diagnosis (n = 22/41) but no patient died. No patient had family history of complement deficiency. The mean follow-up was 1.15 ±â€Š1.95 (0.1-10) years. Half of the patients had already suffered from at least one infection before diagnosis of complement deficiency: meningitis (n = 13), pneumonia (n = 4), fulminans purpura (n = 1), or recurrent otitis (n = 1). Near one-third (n = 10/39) had received prophylactic antibiotics (cotrimoxazole or penicillin) after diagnosis of complement deficiency. The vaccination coverage rate, at the end of the follow-up, for N meningitidis, Streptococcus pneumonia, and Haemophilius influenzae were, respectively, 90% (n = 33/37), 47% (n = 17/36), and 35% (n = 14/34).This large study emphasizes that complement deficiencies can be revealed in adults by infectious episodes. Most of them were meningococcal infections revealing common final pathway deficiency. To avoid undiagnosis or late diagnosis, adult displaying first episode of N meningitidis infection should be tested for complement deficiency.

Oral sildenafil increases skin hyperaemia induced by iontophoresis of sodium nitroprusside in healthy volunteers.

BACKGROUND AND PURPOSE: Sildenafil, a specific inhibitor of phosphodiesterase 5A (PDE5A), is currently tested as a treatment for severe Raynaud's phenomenon. Here, we tested whether sildenafil, alone or combined with local sodium nitroprusside (SNP) delivered through skin iontophoresis, increased forearm cutaneous blood conductance in healthy volunteers, and to assess how well this combination was tolerated. EXPERIMENTAL APPROACH: Ten healthy volunteers were enrolled. Variations in cutaneous vascular conductance (CVC) following oral administration of 50 or 100 mg of sildenafil with or without SNP iontophoresis were expressed as a percentage of maximal CVC, and were monitored using laser Doppler imaging. SNP iontophoresis was performed on the ventral surface of the forearm, 1 h after application of lidocaine/prilocaine cream. KEY RESULTS: Sildenafil at 100 mg, but not 50 mg, increased overall responses (area under the curve) (44%) and peak responses (29%) to SNP iontophoresis. Sildenafil at 100 mg, but not 50 mg, increased baseline CVC (75%). Incidence of headache was not changed when SNP iontophoresis was combined with sildenafil. One episode of symptomatic arterial hypotension occurred in a volunteer given 50 mg sildenafil, 30 min after the beginning of SNP iontophoresis. CONCLUSIONS AND IMPLICATIONS: Oral sildenafil at 100 mg potentiated local skin hyperaemia induced by SNP iontophoresis, with no increased incidence of headaches. The combination of oral specific PDE5A inhibitor and nitrates administered through skin iontophoresis deserves further investigation in diseases such as severe Raynaud's phenomenon, with particular attention to the incidence of arterial hypotension.

Reproducibility of a local cooling test to assess microvascular function in human skin.

OBJECTIVE: In the present study we aimed to assess the reproducibility of skin microvascular reactivity while fast cooling locally with a custom-designed laser-Doppler flowmetry (LDF) probe. METHODS: Twenty-two healthy volunteers underwent local 15 degrees C cooling on the forearm during 5 (protocol 1, n=12) or 30 min (protocol 2, n=10). Skin blood flow was concomitantly assessed using LDF. Measurements were repeated after 30 min (protocol 1) or 7 days (protocols 1 and 2). Data were expressed as cutaneous vascular conductance (CVC) and percentage of baseline (%BL). Within subject coefficients of variation (CV) and intra-class correlation coefficients (ICC) were calculated. RESULTS: Immediate reproducibility of the 5-min cooling was very good, either expressed as CVC or %BL (CV were 8% and 18%; ICC were 0.85 and 0.78, respectively). However, the 30-min cooling was the most reproducible at 1 week, either as CVC or %BL (CV were 26% and 23%; ICC were 0.86 and 0.75, respectively). Local cooling was well tolerated by all volunteers. CONCLUSIONS: We propose in the present work a reproducible 30-min LDF cooling test. Such a tool could be of great interest to assess microvascular reactivity to local cooling in diseases such as Raynaud's syndrome, and to further evaluate drugs for such diseases.

Mechanical role of the leaf sheath in rattans.

Leaf sheaths of rattans are long, tubular and persistent and unlike many self-supporting palms, extend far from the apex of the plant. The mechanical role of the leaf sheath was investigated in eight rattan species of the subfamily Calamoideae. The main objective was to analyse its influence on the mechanical architecture and contribution to the climbing habit. Bending mechanical properties were measured along climbing axes before and after removal of leaf sheaths. Results were related to stem and leaf sheath geometry and mechanical properties. Contribution of the leaf sheath to axial flexural rigidity was high (c. 90%) in the early stages of growth and towards the apex of older climbing axes for all climbing palms tested. Senescence and loss of the leaf sheath strongly influenced axial stiffness. A nonclimbing species, Calamus erectus, showed a different mechanical architecture. Although lacking secondary growth, palms have been able to develop successful climbers with a mechanical architecture broadly analogous to, although developmentally different from, dicotyledonous lianas. The role of the leaf sheath in modulating mechanical properties during ontogeny ought not to be neglected in studies on monocotyledons, as it possibly contributed significantly to the ways in which different growth forms have evolved in the group.

Mechanical architecture and development in Clematis: implications for canalised evolution of growth forms.

• Mechanical architectures of two Clematis species, the herbaceous perennial Clematis recta and the woody liana, Clematis vitalba, were investigated and compared with the woody rhizomatous sand dune plant Clematis flammula var. maritima. • Bending mechanical properties of stems from various developmental stages were compared and related to stem geometry and relative proportions of tissues during development. • Clematis vitalba and C. flammula var. maritima showed mechanical architectures with reductions in structural Young's modulus of the stem during ontogeny. Irreversible loss of stem rigidity was mediated by disruption, separation and eventual loss of primary phloem fibres via secondary growth of the periderm and cambial activity. Each species showed variations of non-self-supporting mechanical architecture relating to specific habitat preferences. In aerial stems of C. recta the structural Young's modulus remained approximately constant during ontogeny, a mechanical signal characteristic for semi-self-supporting architectures. • Woody aerial plant stems are extremely rare in the Ranunculaceae and seldom, if ever, show self-supporting characteristics. Growth form evolution in the group may have been canalised by evolution of rhizomatous geophytic growth forms with secondary growth confined to underground stems specialized for water conduction, storage and perennation. Variation of this ground plan includes climbing, straggling or rhizomatous architectures but not self-supporting shrubs or trees with secondary growth generating requisite self-supporting mechanical properties. Certain body plan organisations appear to have inbuilt mechanical constraints which may have profound effects on the subsequent evolution of growth forms.

[Progestogen tests after the menopause]. / Tests aux progestatifs après la ménopause.

There is virtually no screening for endometrial cancer after the menopause. The methods so-far available (cervico-vaginal smear or endouterine specimens) are either unreliable or else difficult to perform. The progestogen tests are, in contrast, easy for any doctor to carry out, acceptable to patients, fairly reliable and low cost, which should make their widespread use possible. The administration of a progestogen to a post-menopausal woman should not produce bleeding unless the endometrium is hyperplasic or proliferative. 1 366 tests of this type were carried out and resulted, amongst other discoveries, in the detection of 5 cases of asymptomatic cancers of the endometrium and 2 cases of ovarian cancer.