Striking forest revival at the end of the Roman Period in north-western Europe.

The Holocene period (last 11,700 years BP) has been marked by significant climate variability over decadal to millennial timescales. The underlying mechanisms are still being debated, despite ocean-atmosphere-land connections put forward in many paleo-studies. Among the main drivers, involving a cluster of spectral signatures and shaping the climate of north-western Europe, are solar activity, the North Atlantic Oscillation (NAO) varying atmospheric regimes and North Atlantic oceanic gyre dynamics. Over the last 2500 years BP, paleo-environmental signals have been strongly affected by anthropogenic activities through deforestation and land use for crops, grazing, habitations, or access to resources. Palynological proxies (especially pollen grains and marine or freshwater microalgae) help to highlight such anthropogenic imprints over natural variability. Palynological analyses conducted in a macro-estuarine sedimentary environment of north-western France over the last 2500 years BP reveal a huge and atypical 300 year-long arboreal increase between 1700 and 1400 years BP (around 250 and 550 years AD) that we refer to as the '1.7-1.4 ka Arboreal Pollen rise event' or '1.7-1.4 ka AP event'. Interestingly, the climatic 1700-1200 years BP interval coincides with evidence for the withdrawal of coastal societies in Brittany (NW France), in an unfavourable socio-economic context. We suggest that subpolar North Atlantic gyre strengthening and related increasing recurrence of storminess extremes may have affected long-term coastal anthropogenic trajectories resulting in a local collapse of coastal agrarian societies, partly forced by climatic degradation at the end of the Roman Period.

[Donor site morbidity after free gracilis muscle flap. Report of 32 cases]. / Évaluation des séquelles du site donneur du lambeau libre de muscle gracilis. À propos de 32 cas.

BACKGROUND: Coverage of tissue defects of the lower limbs is a complex problem. Free gracilis muscle flap is a reliable surgical technique and the morbidity of its donor site is considered as minimal. Our retrospective study involved all patients who underwent a free gracilis muscle flap in a reconstructive surgery of the lower limb. To the best of our knowledge, this is the first study to assess comprehensively the aesthetic and functional morbidity of the free gracilis flap donor site. PATIENTS AND METHODS: Thirty-two patients underwent a gracilis muscle free flap in our plastic surgery department, between January 2009 and April 2012, as part of a reconstructive surgery of the lower limb. All medical datas were carried out using computerized records. Aesthetic and functional assessments of the donor site were done by the patient using questionnaires and by a plastic surgeon and a physiotherapist using a clinical evaluation, 6 months after surgery. A comparative study between both limbs including the thigh perimeter analysis, an isokinetic study of the knee, a study of the range of motion of hip and knee, and an assessment of the strength of adduction of the hip were conducted. RESULTS: Concerning the aesthetic outcomes, the clinical and subjective scores were satisfactory with a Vancouver score under 1. Five patients had a decrease in the volume of the thigh after surgery. Concerning the functional outcomes, no motor or sensory defects were reported. No statistically significant difference was demonstrated for the range of motion of the hip and knee between both limbs. The strength of hip adduction was not altered by the removal of the gracilis muscle. CONCLUSION: This study confirms the low aesthetic and functional donor site morbidity of the free gracilis muscle flap. The aftermath of the donor area of the flap are very well accepted by patients, which is a sign of good acceptance of the whole reconstruction. Because of these findings and the suitability of the flap at the recipient site, the gracilis muscle free flap should be part of the armamentarium of any reconstructive surgeon.

[Cement burns: a 10-year retrospective study in our burn unit. About 55 cases]. / Brûlures par ciment : étude rétrospective sur dix ans dans le centre des brûlés du CHRU de Tours. À propos de 55 cas.

SUBJECT: Although cement burns represents only a small percentage of admissions to burn centers, their diagnosis and treatment are specific. Our retrospective study concerns all patients treated for cement burns in our unit between 1999 and 2009. This is the largest series described. PATIENTS AND METHOD: Fifty-five patients, aged from 23 to 63, were treated in our burn unit from 1999 to 2009. A review of medical and socioeconomic data was made from computer data files. RESULTS: This population is predominantly male, young and active. These burns occurred mainly in a domestic accident situation (78.2%). Burns were limited but deep and concerned especially lower limbs. The average duration of treatment was 39days. Forty-four patients were treated medically. The mean duration of sick live for these patients was 63 days. It was only of 21 days for those treated surgically. Aesthetic and functional sequelae were present in 88% of medically treated patients and in 18% of patients treated surgically. CONCLUSION: This study demonstrates that early surgical diagnosis and the coverage (care) of these burns allows to limit the socioeconomic echo and to reduce the risk of after-effects for this population of patients mainly young and active. The necessity of strengthening the precautionary measures with these users who are informed enough about the risks incurred during the misuse of the cement is also a reality.

[The free gracilis muscle flap in the foot and ankle reconstructive surgery]. / Le lambeau libre de muscle gracilis en chirurgie reconstructrice du pied, de la cheville et du tiers distal de la jambe.

SUBJECT: The distal third of the leg, ankle and foot is an anatomical region where reconstructive surgery is difficult and many flaps are described. The authors describe their own experience in the reconstruction of this anatomical region using the gracilis muscle free flap. METHODS: From January 2009 to April 2012, the authors operated 32 patients for reconstructive surgery of the distal third of the leg, ankle or foot using a free gracilis muscle flap. A retrospective analysis of the etiology and the size of the loss of tissue substance were performed. The operative data, complications, as well as aesthetic and functional results were analyzed. RESULTS: Thirty-two free gracilis muscle flap were performed. The authors reported five necrosis requiring surgical use of a locoregional flap. The mean duration of follow-up was 15.2 months (6-34 months). The average size of the defect was 53.4 cm(2) (35.7 to 78.1cm(2)) and the etiology was traumatic in 81.3% of cases. The Vancouver score of the area reconstructed was excellent. Functional assessment of the ankle was satisfactory and usual footwear was possible in 96% of patients. Concerning the isokinetic study of the ankle, maximum and average forces were similar to the healthy ankle in a tumor etiology, but less when traumatic. CONCLUSION: In our experience, the free gracilis muscle flap is an excellent technique for the reconstruction of tissue defects of the distal third of the leg, ankle or foot. Its donor site morbidity is very low. The free gracilis flap is suitable for small or long lost of substance and its adaptation at the receptor site is excellent. For these reasons, the gracilis muscle free flap should have its place in reconstructive surgery of the foot and ankle.

[Evaluation of the psychological benefits of breast augmentation for aesthetic purposes. Results of a multicenter prospective study of a series of 181 patients]. / Évaluation des bénéfices psychologiques de la chirurgie d'augmentation mammaire à visée esthétique. Résultats d'une étude prospective et multicentrique à partir d'une série de 181 patientes.

BACKGROUND: Cosmetic breast augmentation is becoming increasingly popular and acceptable to women in France. This prospective and multicenter study aims to investigate whether breast augmentation surgery for aesthetic purposes leads to improved body image, self-esteem, depression problems and sexuality. We also sought to analyze the sociodemographic profile of woman who underwent this surgery. PATIENTS AND METHODS: This study was conducted in France, from March 2009 to March 2011. One hundred and eighty-one patients were included in the survey. We used questionnaires to analyze body image, self-esteem, sexuality, depression, motivations and the sociodemographic profile of the patients before surgery and 6 months after. Questionnaires that were answered were returned in an anonymous way to the investigators to guarantee a blinded survey. RESULTS: The findings showed that women who underwent breast augmentation were mostly employed, married and aged between 20 and 30 years. Analyses revealed a significant improvement in body image, self-esteem and depressive symptoms, 6 months after surgery. Correlations between body image and self-esteem and between depression and self-esteem were also demonstrated. Only sexuality was almost unchanged after the procedure. Finally, a change of body image induced by breast augmentation surgery would improve self-esteem and thus reduce the signs for a depression. CONCLUSION: As with any request for aesthetic surgery, the desire for morphological breast surgery must be analyzed accurately and requires very thorough questioning by the plastic surgeon. The expected result is not only morphological but also psychological, as outlined in our study. The goal of breast augmentation surgery is to create a physical result that matches the expected body image in order to improve the patient's body image and self-esteem and so, bring the patient to recognize herself. Under these conditions, cosmetic breast augmentation surgery will assume a therapeutic function.

[Posterior interosseous nerve palsy. A series of 18 cases and literature review]. / Les paralysies du nerf interosseux postérieur. À propos de 18 cas et revue de la littérature.

OBJECTIVES: Posterior interosseous nerve palsy is a rare syndrome frequently unrecognized, while the clinical presentation is characteristic: finger extension paresis associated with wrist extension in radially deviated position. Here, we assessed our results of surgical treatment. METHODS: A 20-year retrospective study was carried out in our unit. Analysis of causes and an assessment of postoperative functional outcome were performed. Our study was compared with literature data. RESULTS: Eighteen cases were treated with a predominance in men manual workers. The etiology of the posterior interosseous nerve palsy was tumor in four cases, traumatic in two cases, iatrogenic in two cases and idiopathic in ten cases. In seven of these ten cases, compression under the arch of the extensor carpi radialis brevis was found. The postoperative results were satisfactory with full recovery in nine out of fifteen cases treated by neurolysis, depending on the duration of the paralysis. In the literature, we found 264 cases over 50 years through a variety of clinical cases and five case series. A predominance of tumor etiology was found. CONCLUSION: Ignorance of the clinical presentation of a posterior interosseous nerve palsy frequently leads to misdiagnosis. Early complete neurolysis enables a satisfactory functional recovery.

[Indication of sclerotherapy in the treatment of ischiatic pressure sore: about 13 cases]. / Indication de la sclérothérapie dans le traitement de l'escarre ischiatique. À propos de 13 cas.

INTRODUCTION: Ischiatic pressure sore is a common pathology of the paraplegic patient. Usually treated after medical therapy, with fasciocutaneous or musculocutaneous local flaps, despite this treatment the recurrence rate is high. Sclerotherapy, injection of pure ethanol in the cavity of the pressure sore could be an interesting solution in the armentarium of the plastic surgeon in some indications. PATIENTS AND METHODS: Sclerotherapy was used for 13 patients in the plastic surgery department to treat ischiatic pressure sores with a cavity, beneath the defect. RESULTS: The mean length of stay was 24 days. The ischiatic pressure sore was completely healed with no skin defect or cavity for nine patients (65%). For two patients, there was a delay of healing of the skin defect but no cavity beneath. There were two early recurrences of the pressure sore. They were treated by sclerotherapy with a complete recovery in 2 months with simple hydrocolloid dressings. The mean post op follow-up was 14,6 months (4 to 24). Only one recurrence was observed after 12 months. CONCLUSION: The injection of pure ethanol in the cavity of specifics ischiatics pressure sores is a simple, fast and effective technique with a good and stable long term wound healing. The mean length of stay is shorter and the recurrence rate is equivalent to other techniques.

Evaluation of the E test for antifungal susceptibility testing of Candida glabrata.

The E test was compared to the reference NCCLS broth macrodilution method for susceptibility testing of Candida (Torulopsis) glabrata. The MICs of amphotericin B, flucytosine, fluconazole and itraconazole were determined using the appropriate culture media (RPMI 1640 agar with 2% glucose, Casitone agar or Antibiotic Medium 3 agar) according to the drug tested. Agreement between the two methods was within plus/minus two dilutions for 77-100% of test results, according to the drug/medium combination. The study revealed problems in determining the MICs of azoles using the E test, and confirmed the suitability of Casitone agar for susceptibility testing of fluconazole even if results were read within 24 h.

In-vitro susceptibility pattern of Candida lusitaniae and evaluation of the Etest method.

The antifungal susceptibility of 35 Candida lusitaniae isolates was determined in vitro by the National Committee for Clinical Laboratory Standards (NCCLS) M27-P macrodilution methodology. All the isolates were susceptible to ketoconazole, itraconazole and fluconazole. Of the 35 isolates, eight (23%) were resistant to flucytosine. For amphotericin B, M27-P yielded a narrow range of MICs (0.06-0.5 mg/L). We therefore investigated the activity of this drug by reading MICs at 72 h and by using alternative media, namely casitone complex medium (CCM) and antibiotic medium 3 (M-3). Reading at 72 h did not generate reproducible results. CCM and M-3 provided better discrimination between the isolates but did not change the rank order of the MICs. We thus concluded that all the isolates were susceptible to amphotericin B. We also conducted an evaluation with the Etest method according to the manufacturer's instructions with RPMI 1640 agar, CCM and the alternative semi-synthetic medium (SSM). For RPMI 1640, agreements +/-2 dilutions were 58% for amphotericin B, 92% for flucytosine, 57% for ketoconazole, 92% for fluconazole and 74% for itraconazole. CCM did not improve the agreement rates between the two methods but it led to better growth of all the isolates. The suitability of SSM was pointed out with itraconazole. The poor agreement rates for amphotericin B and ketoconazole call for further evaluation of the Etest method to assess several drug-organism combinations.

[Anuria caused by renal pelvis candidiasis in an infant]. / Anurie par candidose pyélique chez un nourrisson.

Report of a case of rare anuria in a newborn, secondary to bilateral ureteropelvic fungus balls obstruction. Urinary decompression by bilateral nephrostomy associated to Ketoconazole therapy allowed recovery.

[Bacterio-parasitic interactions. Enterobacteria and schistosomes (Salmonella - schistosome association)]. / Interactions bactério-parasitaires. Enterobactéries et schistosomidés (salmonello-schistosomo-synusies).

The description of a case imported from Chad of an association of Salmonella typhi - Schistosoma haematobium and, in this connection, a new revised general account. The association Salmonella-Schistomas is wide-spread. It corresponds to a salmonello - schistosomo - micro - association by the fixation of precise bacteria in the case of a bacteriemia on the cutaneous surface of male schistosomes in clearly defined places. These Salmonella constitute a permanent antigenic solicitation and they are capable of mobilization and rejection (bacteriuria after passage through the blood-stream) whereas bacteriosis remains asymptomatic. In fact, on the practical level, a clear and absolute distinction must be made between:--the bacteriemia with the concomitant bacteriuria, which are largely physiological in nature, very frequent and originating from various germs, connected with the emunctory function of the kidneys and which can be observed in any subject.--the schistosomal bacteriuria which are specific entities and evidence of a veritable micro-association of a symbiotic nature between the Salmonella and the schistosome, a micro-association which the bacteriuria reveals unexpectedly whereas the clinical symptoms are absent, not clearly discernible or totally misleading.

[Current means of controlling pediculosis outbreaks in the South of France]. / Moyens actuels de lutte contre la recrudescence de la pédiculose dans le Midi méditerranéen.

The authors sum up the principal morphological, biological and ecological characteristics of the human lice. Moreover they recall the therapeutic and prophylactic measures which could be used against them, and they bring to mind their "in vitro and in vivo" research technics on comparative effectiveness of certain insecticides against head lice.

Results of a controlled trial of the acaricide paragerm on Dermatophagoides spp. in dwelling houses.

The effect of Paragerm spray from either a hand pressurized can or from a general room mist device (MCR device) on mattress mite populations was compared with the effect of a control spray. After 1 month a reduction in mite population due to the cleaning procedures was evident in the control treated mattresses; Paragerm treated mattresses had significantly fewer mites, notably those treated with the aerosol can spray, nine out of fifteen of which were mite free. Dissection of the mattresses showed that some mites survive and they could form the nucleus from which reinfestation could occur.

Methods of destroying house dust pyroglyphid mites.

Attempts to reduce the growth of house dust pyroglyphid mites by vacuum cleaning, and modifications of temperature and humidity are useful but not sufficient. Their absence in dust from hospital beds which are disinfected led the authors to test PARAGERM AK, a non toxic bactericidal and fungicidal spray. This proved highly effective as an acaricide, killing off cultures of Dermatophagoides spp. and other mites with acceptable and easily produced concentrations, thus providing a new way of combating the house dust allergy mite.