Truly unentangled photon pairs without spectral filtering.

We demonstrate that an integrated silicon microring resonator is capable of efficiently producing photon pairs that are completely unentangled; such pairs are a key component of heralded single-photon sources. A dual-channel interferometric coupling scheme can be used to independently tune the quality factors associated with the pump and signal and idler modes, yielding a biphoton wavefunction with a Schmidt number arbitrarily close to unity. This will permit the generation of heralded single-photon states with unit purity.

Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair.

BACKGROUND: Transversus abdominis plane (TAP) block has been reported to provide effective analgesia after lower abdominal surgery, but there are few data comparing ilioinguinal/iliohypogastric nerve (IHN) block with ultrasound-guided TAP block in patients undergoing inguinal hernia repair. METHODS: Two hundred and seventy-three patients undergoing day-case open inguinal hernia repair with a mesh were randomly allocated to receive either ultrasound-guided TAP block or blind IHN block with levobupivacaine 0.5%, before surgery. Patients were monitored for visual analogue scale (VAS) scores at rest (in the post-anaesthesia care unit, and at 4 and 12 h) and at rest and during movement (at 24, 48 h, 3 and 6 months). Pain at 6 months was also assessed using the DN4 questionnaire for neuropathic pain. RESULTS: Median VAS pain scores at rest were lower in the ultrasound-guided TAP group at 4 h (11 vs 15, P=0.04), at 12 h (20 vs 30, P=0.0014), and at 24 h (29 vs 33, P=0.013). Pain after the first 24 h, at 3 and 6 months after surgery, and DN4 scores were similar in both groups (P=NS). The proportion of patients with VAS >40 mm on movement at 6 months was comparable {18.2% [95% CI (12.2-26.1%)] vs 22.4% (15.8-30.6%) in the TAP and IHN groups, respectively, P=0.8}. Postoperative morphine requirements were lower during the first 24 h in the TAP block group (P=0.03). CONCLUSIONS: Ultrasound-guided TAP block provided better pain control than 'blind' IHN block after inguinal hernia repair but did not prevent the occurrence of chronic pain.

[Mandibular advancement device: a 5-year long experience in obstructive sleep apnea/hypopnea syndrome]. / Orthèse d'avancée mandibulaire: cinq ans de traitement du syndrome d'apnées-hypopnées obstructives du sommeil.

INTRODUCTION: We assessed the effectiveness of mandibular advancement device (MAD) on 113 patients having consulted in our specialized unit for obstructive sleep apnea syndrome (OSAS), from January 2005 to January 2010. METHODS: We included all adult patients referred by pulmonologists for OSAS. The data collected were gender, age, BMI, dental occlusion, presentation of retromandibulism, apnea hypopnea index (AHI) at diagnosis, and MAD effectiveness (AHI, compliance, satisfaction, tolerance). RESULTS: One hundred and thirteen patients were included, 83 men and 30 women, with an average age of 53.6 years, and average BMI of 26.9. Fifty-eight patients (55.8%) used the MAD regularly, 17 (16.4%) irregularly, and 29 (27.9%) stopped using it. Fifty-seven patients (54.8%) were very satisfied, 20 (19.2%) somewhat satisfied, and 27 (26%) not at all. The average AHI with MAD was 13.3 (±10.3) and the average improvement of AHI was 19 (±14.1). Twenty-seven patients (28.7%) were cured, 46 (48.9%) presented with an AHI decrease greater than 50%, and for 21 (22.3%) the treatment failed. DISCUSSION: The sample of patients in this study has the same characteristics as the general apneic population. Adherence and satisfaction were satisfactory. AHI results were also good but seemed low compared to other studies. This was due to more stringent criteria for cure, more in line with the overall management. No criterion for inclusion was predictive of good tolerance and no score predictive of success could be established. However, the improvement in AHI was significantly correlated to the patient's BMI and its diagnostic AHI.

[Cranial osteopathy as a complementary treatment of postural plagiocephaly]. / Place de l'ostéopathie dans la correction des déformations crâniennes du nouveau-né et du jeune enfant.

For the majority of neonates and young infants, appropriate postures and standard physiotherapy succeed in preventing or correcting acquired cranial deformations (fetal due to restricted mobility in utero or postnatal secondary to exclusive dorsal decubitus). However in some cases, when postural management is not efficient, pediatricians will be asked by the parents about the potential benefits of osteopathy. What is osteopathic treatment? At first, diagnostic palpation will identify which suture is normally mobile with the respiratory cycle, and which has limited or absent mobility secondary to abnormal postures. Later on, the goal of the therapeutic phase is to mobilise impaired sutures, by various gentle maneuvers depending on the topography of the impairment. The treatment is not restricted to the skull but extended to the spine, pelvis and lower extremities which contribute to the deformative sequence. Osteopathic treatment belongs to complementary medicine, therefore demonstration of its scientific value and favorable results have to be provided. Based on randomized studies, the answer is yes, it significantly decreases the degree of asymmetry. Do postural deformations matter to the development of an healthy infant? It seems that the prejudice is not only esthetic but also functional, however more research is necessary. In conclusion, pediatricians should be more aware of the method and expectations: major deformative sequence since birth and increasing deformations despite preventive postures and standard physiotherapy are reasonable indications for such complementary treatment. "Preventive" osteopathy in maternity is not justified. Moreover osteopathy has no place in the treatment of craniosynostosis ; the latter belong to malformations, completely distinct from postural deformations.

[Severe hypercalcemia due to vitamin D intoxication]. / Hypercalcémie majeure secondaire à une intoxication par la vitamine D.

UNLABELLED: We report on a case of severe hypercalcemia due to vitamin D intoxication in a 4-month-old infant, CASE REPORT: A 4-month-old boy was admitted for anorexia, weakness, hypotonia, constipation and lethargy. Initial physical examination evidenced a severe axial hypotonia, signs of moderate intracellular dehydration, polyuria and leucocyturia. Hemodynamic parameters were normal. The infant's origin was Turkish. Basic blood chemistry showed a high serum calcium concentration of 4.28 and 4.55 mmol/l on a second control. The EKG showed a short QTc interval calculated at 0.34 s. Due to worsening neurological condition, the infant was referred to the pediatric intensive care unit. Because of the association of neurological impairment, EKG abnormality and high serum calcium level, haemodialysis was performed. Treatment included hyperhydration, high doses of intravenous of loop diuretics and sodium pamidronate infusion. Hormonal, radiological, abdominal and cardiac investigations combined with a new parental interview led to the diagnosis of vitamin D intoxication due to excessive daily administration. We were unable to determine the exact total amount because of the language barrier. Clinical outcome was marked by nephrocalcinosis without renal function impairment, iliac venous thrombosis secondary to the dialysis catheter and a full neurological recovery without sequelae after 3 months. DISCUSSION: Fear of rickets, especially in Turkish families residing in France, can lead some parents to administer massive daily quantities of vitamin D. This practice is facilitated by the possibility of purchasing high dosage forms of vitamin D via the Internet. When faced with an infant presenting with digestive disorders such as vomiting and constipation, associated with neurological troubles (lethargy, hypotonia) and hypercalcemia, vitamin D intoxication should be considered after tumoral, hormonal or malformative (Williams-Beuren syndrome) causes have been eliminated. Combined with hyperhydration and loop diuretics, biphosphonate infusion often allows to control hypercalcemia. Nephrocalcinosis seems correlated to chronic administration while cardiovascular disorders are more likely associated with massive acute vitamin D administration, severe dysrhythmia being rare in children in this context.

Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system.

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.

Adaptive changes in the developing brain during intrauterine stress.

Maturation of neurological performance in moderately to severely growth-retarded newborn infants (SGA) can be accelerated by 3 to 4 weeks or more when compared to the development of appropriately grown infants (AGA) of the same gestation. This is particularly the case in multiple pregnancies or pregnancies characterized by maternal hypertension. This clinical finding has been confirmed by neurophysiological studies on the maturation of brainstem auditory evoked responses (BAERs). The possible mechanisms which underly this phenomenon are not yet elucidated. Glucocorticoids, other steroid hormones and catecholamines are elevated in pregnancies with placental dysfunction, and it is known that these substances have multiple actions on neuronal maturation, particularly on mechanisms of release of neurotransmitters. These observations suggest that the acceleration of brain maturation, and lung maturation, in SGA infants reflects an adaptation of the fetus to early extrauterine life. However, if the placental dysfunction progresses, these mechanisms of adaptation will be overwhelmed by severe malnutrition and anoxia which result in cerebral lesions and risk of death. The clinical goal at the present time for obstetric management of these risk pregnancies is to distinguish between these two periods.

Relation of early neuromotor and cranial signs with neuropsychological outcome at 4 years.

The persistence and predictive value at 3-5 years of age of three signs detected within the first 18 months of life were investigated: phasic stretch reflex in one or both gastrocnemius muscles, imbalance in passive axial tone with an excess of dorsal extension, and a ridge on the squamous sutures. Phasic stretch reflex and at least one of the other signs were found in 14 children during repeated assessments within the first 18 months. The progress of these children was compared with that of 14 matched controls who had repeatedly normal neurological assessments during the first 18 months in the same clinic in Paris. At the age 3-5 years all the children were then assessed blindly by the second author from a pediatric neurological viewpoint and by two psychologists and two psychomotor therapists as well. The parents of the affected children reported significantly more problems in motor/praxis skills, language development and attention. Abnormal neurological signs were also significantly more frequent than in the controls. Suboptimal cognition did not reach significance. The neurological inclusion criteria were still present at 3-5 years old in 86% (vs. respectively 100% and 93% during the first 18 months of life) of this small group of children, while the cranial suture sign was still present in only 28% (vs. 64%). Findings of these three signs during the first 18 months of life may help in predicting long-term neurobehavioral or long-term neuropsychological problems.

Neurological and physical maturation in normal growth singletons from 37 to 41 weeks' gestation.

An evaluator blinded to gestational age (GA) assessed a cohort of 397 singletons born at between 37 and 41 week's gestation, by looking at 11 criteria exploring neurological maturity and 12 criteria exploring physical maturity. The analysis of correlation coefficients shows various degrees of association between GA and each of the criteria examined. A highly significant correlation (p < 0.001) was found for 4 neurological criteria defining passive tone in limbs and sucking reflex. The activity of flexor muscles of the neck and crossed extension reflex were also associated with maturity but weakly (p < 0.01). A highly significant correlation (p < 0.001) was found for 8 of the physical criteria, skin colour and texture, lanugo, ear firmness, genitalia, breast size, nipple formation and plantar skin creases. Oedema, skull firmness and ear form were also associated but weakly. With multivariate analysis combining the neurological and physical criteria, predictive values ranked in the following order: 1) plantar skin, 2) breast size, 3) sucking reflex, 4) scarf sign, 5) skin colour, 6) genitalia, 7) popliteal angle, 8) return to flexion of forearms, 9) dorsiflexion angle. In conclusion, a score based on physical and neurological criteria is associated with duration of pregnancy (r2 = 0.32) between 37 and 41 weeks' gestation. Such an instrument allows us to study fetal maturity as a variable independent of GA, and therefore makes it possible to identify various influences that may modify maturational rate during the last weeks of pregnancy.

Neck extensor hypertonia: a clinical sign of insult to the central nervous system of the newborn.

Abnormal hypertonia of the neck extensor muscles in newborns may be appreciated by observing spontaneous posture, evaluating resistance to repeated passive flexion of the head, and eliciting the head straightening reflexes. This sign correlates well with other signs of insult to the central nervous system. Of 1743 newborns over 37 wk gestational age, 17 appeared to have signs of cerebral insult according to the classical criteria of abnormal state of consciousness, tone, and reflexes. Of these 17, 12 (70%) had neck extensor hypertonia. 38 newborns appeared to have mild signs of cerebral insult with abnormalities of tone and excitability. Of these 38, 14 (37%) had neck extensor hypertonia. Only 12 (0.7%) of 1655 newborns with otherwise normal neurological examination had neck extensor hypertonia. Further studies are necessary to evaluate the prognostic value of neck extensor hypertonia in the neonatal period.

Neurodevelopmental status at 1 year predicts neuropsychiatric outcome at 14-15 years of age in very preterm infants.

BACKGROUND: Neurodevelopmental and behavioural problems have been repeatedly reported in very preterm survivors, often showing themselves later in childhood as poor school performance. Early identification of problems would mean that appropriate remedial therapy can be implemented. We have previously shown that neurodevelopmental status at 1 year was predictive of outcome at 8 years in a cohort of preterm infants. The aim of this paper was to see if neurodevelopmental outcome in adolescence could be predicted by assessment by 1 year in the same cohort of preterm infants. STUDY DESIGN: Prospective cohort study. SUBJECTS: 150 adolescents, born before 33 weeks gestation. OUTCOME MEASURES: Neurological examination, developmental quotient, vision and hearing by 1 year. At 14-15 years, neurological examination, school performance questionnaire, Schonnell test of reading age, a premorbid adjustment score, Rutter behavioural score and for those born from 1981, cognitive tests (WISC-R). RESULTS: A highly significant relationship existed between neurological status by 1 year and the need for extra educational provision, overall neurodevelopmental status, cognitive function in those that had their IQs measured and premorbid adjustment score of prepsychotic symptoms in adolescence. However, status at 1 year was not predictive of adolescent reading age or behavioural score. CONCLUSIONS: Neurodevelopmental assessment at 1 year is predictive of school performance and outcome in the adolescent period.

Cerebral handicap in full-term newborns related to late pregnancy and/or labor.

The improving results of modern obstetrics, anesthesiology and immediate pediatric care have to be assessed. Clinical methods are available, providing guidelines for a simple neuro-sensorial assessment of the full-term newborn. When abnormalities are detected at the first assessment, the newborn will be assessed daily or every other day, as the symptomatology often rapidly changes. Based on these repeated evaluations, a gradation of 3 levels of severity is established, by the end of the first week: mild (1) includes tone abnormalities and hyperexcitability but no seizures and no CNS depression; moderate (2) includes CNS depression +/- isolated seizures; severe (3) includes coma and repeated seizures. Though this gradation represents an empirical cut-off in a continuum of signs and symptoms indicating brain dysfunction at birth, correlations with late outcome are reasonably good. Individual prognosis is out of our reach, specially in grade 2 infants. However, as a group estimation of late outcome, this gradation is satisfactory. Neurobehavioral competence in the full-term newborn is such that one assessment performed within normal limits in the first 3 days allows a reasonable prediction of a normal outcome, no matter how dreadful the pregnancy and/or delivery has been. Therefore neurological assessment of the full-term newborn in the first week of life can be considered as a good marker for the quality of perinatal care, and good feed-back information for the obstetrical staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of idiopathic respiratory distress syndrome during the last ten years.

In the Port Royal Maternity Hospital, with about 2000 deliveries per year, the incidence of idiopathic respiratory distress syndrome (IRDS) has been studied during the last ten years. Because of the potential hazards of drugs, the attitude of restricting the use of steroids to a few particular cases was adopted. In period I (1968-1969), the incidence of IRDS was 1 per 100 live births. In period II (1972-73), the incidence dropped to 0.54% of the live births. In period III (1975-77), the incidence remained at 0.47% of the live births. The difference in frequency between period I and period II and III is statistically significant (P less than 0.01). This diminution appears to be the result of an overall improvement in the pre- and postnatal care of premature infants. The newborns who could have benefited from prenatal glucocorticoid treatment are studied in period III. From 28 to 34 wk of gestational age, 148 infants were born. Seventy-eight (not equal to 50%) did not have any respiratory problems, 54 had mild and transitory distress and 16 (not equal to 10%) had IRDS. In only 7 cases was the time interval between the first signs of premature labor and delivery longer than 24 h. In conclusion, at least 148 neonates would have had prenatal glucocorticoid treatment, in order possibly to avoid 7 cases of IRDS, which would mean hazard for 20 and benefit for 1. A hazardous effect on brain development seems to be the main concern and has to be more fully documented.

Does neurological assessment still have a place in the NICU?

Comments at discharge from the neonatal intensive care unit tend to concern porencephalic cysts or ventricular dilatation rather than clinical neurological findings. This neglect in collecting clinical information can be understood during the acute stage of neonatal adaptation due to the non-specificity and lability of many neurological signs. However, it does not seem justified when the infant has recovered, can breathe on his/her own and can tolerate handling. To define optimal Central Nervous System function at 40 weeks (just born or corrected), a simple basic assessment composed of nine variables is proposed, with descriptions and illustrations. Rationale for the timing and selection of variables is discussed. The benefit of this clinical approach is to subdivide children with normal ultrasound imaging into two subgroups according to non-optimal or optimal responses. Prospective follow-up of children with non-optimal responses will reduce the number of late diagnoses of developmental disabilities. Rational optimism for the others will diminish parents' anxiety and neurologic clinics' overload.

[Bilateral compartment syndrome after colorectal surgery in the lithotomy position]. / Syndrome bilatéral des loges de jambe après chirurgie colorectale en position à double équipe.

Lower limb compartment syndrome is an unusual but severe complication of prolonged surgery more than four hours in lithotomy position. It is usually a consequence of hypoperfusion of the lower extremities and muscle necrosis may occur. Several risk factors are pointed out: trendelenburg, the hardness of operating table, hypothermia, control hypotension, occlusion of arterial blood flow of the lower extremity, arteritis (and smoking), diabetes, obesity, arterial hypertension, myopathy and an important muscle mass. The symptoms are postoperative pain with neurological signs. A rapid diagnosis and aggressive management (i.e. resuscitation and aponevrotomy) is recommended. Neurological sequelae are sometimes invalidating. Reporting a case of bilateral syndrome, we reviewed the literature and describe the present diagnosis and therapeutic management as well as prevention modalities of this iatrogenic complication.

[Video-laparoscopic diagnosis and follow-up of a peritoneal tuberculosis]. / Diagnostic et suivi vidéolaparoscopique d'une tuberculose péritonéale.

A 21-year-old woman suffering from abdominal pain and a fever of 39 degrees C was hospitalized. Ultrasonography and computed tomographic scan showed a large amount of ascites and one hepatic node. The serum CA 125 level was elevated. Protein Chain Reaction (PCR) searching tuberculosis antigen in ascitic fluid was normal. A diagnosis of peritoneal tuberculosis was supposed and an exploratory laparoscopic procedure performed. Peroperative observation of the ascites, with multiple sites of adhesion, and pathological examination of the hepatic nodule and peritoneum confirmed initial diagnosis. Antituberculous treatment was given for one year. A second laparoscopic procedure was performed and found no disease remaining.

[Some aspects of prevention in perinatology (author's transl)]. / Quelques accidents périnatals évitables.

The main lines in prevention are analyzed in two fields. Prevention of brain damage during birth process is studied according to the data of a prospective study, showing the obstetrical situations where the fetus is at risk. Prevention of fetal infection is shown on a few clinical examples.

[The lecithin-sphynogomyelin ratio in the amniotic fluid in insulin dependent diabetic pregnancies]. / Le rapport lécithine-sphingomyéline du liquide amniotique dans les grossesses diabétiques insulino-dépendantes

A delay in the pulmonary maturation of the foetus of diabetic mothers assessed by the lecithin-sphingomyelin (L/S) ratio has been reported (2, 3, 5). A suggestion has been raised that the results of the L/S ratio should be viewed with caution in predicting lung maturity in pregnancies complicated by maternal diabetes (8). We report our findings on 52 insulin-dependent diabetic pregnancies which involved 90 estimations of the L/S ratio on the amniotic fluid. In all cases, the L/S ratio accurately reflected lung maturity, as no hyaline membrane disease (HMD) was observed with a L/S ratio greater than 2. There was no significant difference in the proportion of mature fetal lung between insulin-dependent diabetics and controls for each week of pregnancy between 32 and 38 weeks. There is no statistical difference in the mature L/S ratio between classes B + C and D + F diabetics.

[Follow-up network for newborns with a handicap risk: experience of the Pays-de-la-Loire network]. / Réseau de suivi des nouveau-nés à risque de développer un handicap: l'exemple du réseau Grandir ensemble en Pays-de-la-Loire

Newborns are given attentive perinatal care but the organization of further follow-up can be haphazard. The main consequences are the difficulties parents have in finding appropriate medical assistance for caring for high-risk infants and the absence of appropriate surveillance or efficient care. An inpatient-outpatient healthcare network enables early care of these infants and can reduce the consequences of neurosensorial sequelae. The overall impact of the regional perinatal care can also be evaluated. Such a network has been implemented in the Pays de Loire region in France since early 2003. In six months, among 1000 initially included infants, 500 were followed by pediatricians working in an outpatient (40%) or inpatient (60%) setting. This organization enables correction of over-centralization of neonatal care and the absence of coordination for follow up.