[Intramedullary Elastic Transphyseal Tibial Osteosynthesis and Its Effect on Segmental Growth].

BACKGROUND: Intramedullary transphyseal elastic osteosynthesis is used in children for the diseases accompanied by the reduced strength properties of bone tissue, and primarily for osteogenesis imperfecta. OBJECTIVE: The purpose of the experimental study was to investigate tibial growth under the conditions of transphyseal counter-directed insertion of elastic rods without bone integrity breaking, under transverse fracture modeling, as well as under combining transphyseal reinforcement and subperiosteal positioning the titanium mesh with the elastic rods intervolved in it. METHODS: Non-randomized controlled trial was performed. Three series of experiments performed in 18 puppies. Counter-directed transphyseal reinforcement of tibia performed in Series I, transphyseal reinforcement combined with transverse osteotomy of leg bones--in Series II, transphyseal elastic osteosynthesis and subperiosteal positioning the titanium nickelide mesh with intervolved in it elastic rods during transverse leg bone osteotomy performed in Series III. RESULTS: Transphyseal reinforcement resulted in growth retardation of the operated tibia. The loss of residual growth was 3.8 mm (p=0.078) in series I; 7.8 mm (p=0.032)--in series II; 7.7 mm (p=0.042)--in series III. Eccentric insertion of transphyseal rods formed an angular deformity (mean value 7°; p=0.023) of the distal tibial epiphysis in the process of residual growth. Periosteal and endosteal reactions contributed to enlargement of diaphyseal diameter of 3.9 mm (series II; p=0.037) and 3.8 mm (series III; p=0.041). Any difference of diameter between operated and intact tibia was not observed in series I. CONCLUSION: Intramedullary transphyseal reinforcement retards longitudinal bone growth. The positioning of the telescopic systems should be as close as possible to the center of growth plates in order to prevent angular deformities. Subperiosteal reinforcement doesn't retard consolidation of fragments, and it can be combined with intramedullary transnhyseal osteosynthesis.

[OVERUSE INJURIES IN THE YOUNG ATHLETE]. / Lésions osseuses de sollicitation excessive chez l'enfant sportif.

Sport injuries are common in children and teenaggers, especially overuse injuries. Typical musculoskelotal disorders include apophyseal pains or avulsion, stess fractures, and also epiphyseal ostoochondritis. Some lesions are specific according the practice, such spine or wrist lesions. Prevention of sport injury should be the main priority as well for the parents than the coaches and children themselves. Proper education and preparation, specific training and streching are essential for all sports activities.

Strain-hardening in nano-structured single phase steels: mechanisms and control.

The detrimental effect of grain size refinement on the strain hardening is highlighted in single phase steels. A physical based approach for understanding the underlying mechanisms is presented. In order to overcome this limitation a promising metallurgical route exploiting the thermal stability of mechanically induced twins in austenitic steels has been successfully applied to a stainless grade confirming the opportunity to get nano-structured alloys exhibiting high yield stress with high strain-hardening.

Ion-exchanged Er3+/Yb3+ co-doped waveguide amplifiers longitudinally pumped by broad area lasers.

A multimode pumping scheme for Er(3+)/Yb(3+) co-doped waveguide amplifiers based on broad area lasers at around 980 nm is presented. The proposed amplifier is fabricated by ion-exchange (IE) technique on silicate and phosphate glasses. The highly efficient energy transfer from Yb(3+) to Er(3+) ions, combined with the use of low cost and high power broad area laser, allows the realization of high performance and cost-effective integrated amplifiers. The structure has been designed and numerically studied using a 3D finite element modelling tool, and over 3 dB/cm small signal gain has been predicted for an optimized amplifier. Preliminary characterization of an amplifier structure provides a first experimental evidence of the novel multimode longitudinal pumping.

EBSD for analysing the twinning microstructure in fine-grained TWIP steels and its influence on work hardening.

A 22 Mn-0.6 C twinning induced plasticity steel with an average grain size of 2.6 mum was deformed in tension at room temperature. The electron backscattered diffraction technique was used to characterize the twinning structure in relation with the local texture evolution. For nanoscale analysis, additional transmission electron microscopy analysis was performed. Nanotwins were activated in the largest grains from the beginning of the deformation. They interacted with a well-developed dislocation structure that induced detectable intragranular orientation variations. With increasing deformation, dense bundles of nanotwins preferentially developed in grains oriented close to the <111>//tensile direction fibre (promoted by the deformation) as well as medium to high angle sub-boundaries. These key features of the twinned microstructure were finally related to the remarkably high strain hardening, which evolved according to different stages.

Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction.

PURPOSE: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. METHODS: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31. RESULTS: Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously. CONCLUSION: This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner. LEVEL OF EVIDENCE: IV, prospective case series.

Single-mode and high power waveguide lasers fabricated by ion-exchange.

We report on a single-end diode-pumped waveguide laser providing output power in excess of 20 mW with 17% slope efficiency in robust single longitudinal and transverse mode operation at 1533.5 nm. The active medium was an Er:Yb-doped waveguide only 9-mm long fabricated by Ag-Na ion-exchange in a phosphate glass. The overall cavity length including butt-coupled fiber-Bragg-grating mirrors was <60 mm. We also report on high power waveguide lasers providing more than 160 mW output power and 46% slope efficiency in multimode operation. Feasibility of high power single mode waveguide lasers based on ion-exchange technology in phosphate glasses is also experimentally investigated by using a 50-mm long active waveguide specially designed for efficient single-end pumping.

[Schistosomiasis in school children in the Bandafassi region of East Senegal]. / Bilharzioses au Sénégal oriental prévalence chez les enfants de la région de Bandafassi.

This epidemiological study was conducted to evaluate the incidence of intestinal and urinary schistosomiasis in children from 6 to 14 years old in the district of Bandafassi of east Senegal. The stools of 505 children from 10 villages were examined. In addition water holes that might serve as biotopes for the intermediate host snails, i.e., Biomphalaria sp. and Bulinus sp., were located and tested. Findings demonstrated the existence of permanent foci of S. mansoni deep within the bush of the Bandafassi district. Sporadic distribution of praziquantel has been effective but not sufficient to eradicate permanent S. mansoni foci in test sites.

[Can we overcome schistosomiasis? A Senegalese example]. / Peut-on vaincre les bilharzioses ? Un exemple sénégalais.

The authors report the results of controlling schistosomiasis in 53 villages from Ninefecha area-(Kedougou District, East Senegal) within Schistosomiasis National Control Program partnership. The four aims were: i) praziquantel treatment of 3324 children 6-14 years old, ii) installation of a laboratory for children prevalence annual monitoring (random draw one in three), iii) health education of the concerned people ("sensitization"), iiii) construction of latrines. 900 latrines are required and 649 have been built. The initial prevalence (2006) of 44% for S. mansoni and 4% for S. haematobium are now respectively 1.9% and 1.4% (2013). The program must be continuous as shown in the Assoni village: a prevalence study in children 0-5 years old, for which praziquantel is not recommended, reveals an infestation rate for S. mansoni of 78% in 2008 and of 47% in 2012. This age group is an important parasite reservoir and health education of parents is absolutely necessary. A permanent and effective center like Ninefescha hospital for distribution of praziquantel, sensitization meetings and latrines control is essential for the success of the program.

Quantitative structure-activity relationship of human neutrophil collagenase (MMP-8) inhibitors using comparative molecular field analysis and X-ray structure analysis.

A set of 90 novel 2-(arylsulfonyl)-1,2,3, 4-tetrahydroisoquinoline-3-carboxylates and -hydroxamates as inhibitors of the matrix metalloproteinase human neutrophil collagenase (MMP-8) was designed, synthesized, and investigated by 3D-QSAR techniques (CoMFA, CoMSIA) and X-ray structure analysis. Docking studies of a reference compound are based on crystal structures of MMP-8 complexed with peptidic inhibitors to propose a model of its bioactive conformation. This model was validated by a 1. 7 A X-ray structure of the catalytic domain of MMP-8. The 3D-QSAR models based on a superposition rule derived from these docking studies were validated using conventional and cross-validated r2 values using the leave-one-out method, repeated analyses using two randomly chosen cross-validation groups plus randomization of biological activities. This led to consistent and highly predictive 3D-QSAR models with good correlation coefficients for both CoMFA and CoMSIA, which were found to correspond to experimentally determined MMP-8 catalytic site topology in terms of steric, electrostatic, and hydrophobic complementarity. Subsets selected as smaller training sets using 2D fingerprints and maximum dissimilarity methods resulted in 3D-QSAR models with remarkable correlation coefficients and a high predictive power. This allowed to compensate the weaker zinc binding properties of carboxylates by introducing optimal fitting P1' residues. The final QSAR information agrees with all experimental data for the binding topology and thus provides clear guidelines and accurate activity predictions for novel MMP-8 inhibitors.

Left lung asthma.

The chest radiograph of a woman with acute asthma showed signs of obstructive emphysema of the left lung. Fiberoptic bronchoscopy excluded obstruction of a large bronchus. The signs disappeared after antiasthmatic treatment, suggesting that they were caused by airway closure. In usual asthma, airway closure affects both lungs; the reason for the unilateral predominance we observed is unknown.

Seroepidemiological survey of toxoplasmosis in La Guadeloupe, French West Indies.

A random survey of 1% of the total population of La Guadeloupe, French West Indies, for toxoplasmosis was carried out. Blood specimens from 3,238 individuals were collected on filter paper strips and tested for Toxoplasma antibodies by the fluorescent antibody technique. Sixty percent were positive. A gradual increase in positivity with increasing age, and high prevalence in children (50% in the 6- to 10-year age group) were observed. No differences were found among the different ethnic groups, nor among persons in different occupations. Economic status showed a highly negative correlation with antibody prevalence rates. The infection rate was not higher in individuals who consumed raw or undercooked meat, and no differences in antibody prevalence related to the sources of meat were observed. The seropositivity rates varied over a wide range (40-76%) according to the locality; higher Toxoplasma antibody rates were found in areas with higher rainfall, and toxoplasmosis prevalence rates correlated positively with mean annual rainfall but not with altitude or with rural or urban residence. A significant difference was observed between seropositivity rates when people living in houses with or without cats were compared. A higher prevalence of hookworm and Strongyloides infections--considered as evidence of closer contact with moist soil--were found in children with Toxoplasma antibodies than in age-adjusted control children without such antibodies. These results provide evidence that meat plays a negligible role in the transmission of Toxoplasma to man, and support the hypothesis that oocysts shed in cat feces are the almost exclusive mode of human infection in Guadeloupe.

Leishmania braziliensis guyanensis dermal leishmaniasis: cell-mediated immunity related to clinical features.

The non-specific and specific cellular immune responses in vitro were investigated in 26 patients infected with Leishmania braziliensis guyanensis and compared with those of 12 healthy donors. An absence of marked suppression of lymphocyte proliferation in vitro to Con A, PHA and PWM mitogens, and a high variability in the cellular responsiveness to Leishmania antigens were detected in the infected patient group. The occurrence of relapses seemed to be associated with a lower lymphocyte transformation assay and a high number of lesions. The influence of delayed type hypersensitivity responses on the pattern of infection is considered.

Anterior cervical fusion and Caspar plate stabilization for cervical trauma.

A technique for anterior cervical iliac graft fusion with standardized, commercially available screw and plate fixation (Caspar plating) has been developed. The step-by-step procedure, as well as the instruments designed to facilitate the procedure, are described in this report. Sixty cases of cervical trauma (fractures, subluxations, ligamentous instability, or a combination of these problems) were treated with Caspar plating. All patients obtained fusion, and stability was achieved immediately after surgery without external stabilization. No unusual surgical complications occurred, and the most dreaded complication of dural penetration by drilling or screw placement was not observed. This report details the neurological presentation, anatomical lesions, surgical therapy, and outcome of these patients. Caspar plating combines the advantage of an anterior surgical approach with immediate postoperative stabilization without external stabilization. This advantage persists even in the presence of posterior ligamentous instability. The technique is an important addition to the surgical treatment of cervical trauma.

The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure.

The outcome in 119 patients who were operated on with a conventional standard lumbar discectomy procedure was retrospectively compared with that in 299 patients who were operated on with a microsurgical discectomy technique developed in Homburg/Saar, Federal Republic of Germany by the senior author (W.C.). All patients in this consecutive series had "virgin" lumbar radiculopathy evaluated and operated upon by two experienced surgeons at one institution. Determination of the final outcome was made objectively by an impartial third party using identical criteria for both groups, and with a patient self-evaluation form. The study looked at various pertinent aspects of the treatment course and at final outcome. The results in the microsurgical group were significantly favorable: fewer levels were explored: there was less operative blood loss and a decreased incidence of deep venous thrombosis, urinary tract infections, pulmonary emboli, and bladder catheterization; the time to full ambulation, discharge, and return to work was faster: and there was a decrease in change of occupation and a greater percentage of satisfactory final outcomes, as measured both objectively and subjectively. A description of the microsurgical technique used in this study, which differs significantly from existing microdisectomy techniques, is presented. The authors conclude that the microsurgical disectomy technique presented in this study is a safe and effective approach to the treatment of lumbar radiculopathy.

Gas permeability of porous silicon nanostructures.

The gas (air and hydrogen) flow through porous silicon ( PS ) nanostructures is studied. Being well described by Darcy's law, the gas flow measurements allow us to deduce PS permeability values, which are measured to be 10(-16) - 10(-15) m(2), corresponding to the 50-70% porosity range. A strong porosity dependence of the PS intrinsic permeability is found to be in good agreement with Kozeny's model. The influence of nanoscale morphology on the porous layer permeability is shown and discussed, taking into account the fractal-like specific surface of the PS nanostructures. In particular, the liquid permeability of the PS nanostructure is estimated to be 6.4x 10(-18) m(2) from the observed Klinkenberg effect for gas flow.

[Methodologic treatment of anxiety. Apropos of benzodiazepine utilization in schizophrenic anxiety states]. / Approche méthodologique du traitement de l'anxiété. A propos de l'utilisation des benzodiazépines dans les états anxieux schizophréniques.

Certain psychiatrists systematically use benzodiazepines to treat psychosis. Are these substances efficient in this indication? In order to answer this question, the authors propose the following protocol which appreciates the efficiency of benzodiazepines in anxious schizophrenic states.

[In vitro changes induced by phenylmercury nitrate on fungi causing keratitis. Scanning electron microscopy study]. / Modifications induites in vitro par le nitrate de phénylmercure sur des champignons responsables de kératites. Examen en microscopie électronique à balayage.

Antifungal activity of phenylmercury nitrate was studied on fungi from keratitis. Important deterioration and bursting were observed with 2 mg/100 ml phenylmercury nitrate concentration on Aspergillus flavus, Scedosporium and Candida albicans spores.

[Ovarian hyperstimulation syndrome during in vitro fertilization stimulations. Comparison between the experience of the Center for Medically Assisted Procreation of the Saint Antoine maternity department and a review of the literature]. / Syndrome d'hyperstimulation ovarienne au cours des stimulations pour fécondation in vitro. Confrontation de l'expérience du Centre de Procréation médicalement assistée de la maternité Saint-Antoine et de la revue de la littérature.

The authors present their experience with the severe ovarian hyperstimulation syndrome when they were using stimulation for IVF and ET and they compare it with the literature. Over a period of 23 months. 154 stimulations were carried out using a long protocol associated with a CnRH agonist and hMG. 142 vaginal aspirations were carried out. The clinical pregnancy rate was 19% per aspiration and 21.9% per transfer. Of the 142 patients who were aspirated five had severe ovarian hyperstimulation with a favourable outcome. The authors suggest a physiopathological comparison for ovarian hyperstimulation and the management to be carried out when this complication occurs. They emphasise how potentially serious this complication is and that there has been no physiopathological explanation for its recrudescence since GnRH agonist have started to be used.

[Depression in the elderly. Clinical aspects]. / La dépression du sujet âgé. Aspects cliniques.

DIFFICULT DIAGNOSIS: Depression in the elderly can take on many often misleading aspects. Sadness may be considered legitimate or "normal" for an elderly person. Depression may masquerade as an organic disorder where somatic complaints, pain and anxiety predominate. All these different clinical forms may mislead the clinician. THE MASK OF HYPOCHONDRIA: A tendency to hypochondria, found in more than one-half of all depressed elderly subjects, may be reinforced by bouts of complementary examinations. The patient is convinced of having an unrecognized organic disease. The mask of hypochondria must be considered with special care because it is a major risk factor for attempted and successful suicide. THE MASK OF DELUSIONS: Elderly patients often develop a state of melancolia-like depression with delusions. Delusions may be congruent with the predominant depressed mood, for example a guilt feeling for an act never committed, or inversely, non-congruent with the thymic state (persecution, negation delusin), for example Cotard syndrome where the patient is persuaded that his/her organs are malfunctioning or have disappeared. Despite these impressive mood disorders that often incite prescription of a neuroleptic, these elderly patients respond favorably to antidepressor treatment.