Ammoniated phyllosilicates with a likely outer Solar System origin on (1) Ceres.

Studies of the dwarf planet (1) Ceres using ground-based and orbiting telescopes have concluded that its closest meteoritic analogues are the volatile-rich CI and CM carbonaceous chondrites. Water in clay minerals, ammoniated phyllosilicates, or a mixture of Mg(OH)2 (brucite), Mg2CO3 and iron-rich serpentine have all been proposed to exist on the surface. In particular, brucite has been suggested from analysis of the mid-infrared spectrum of Ceres. But the lack of spectral data across telluric absorption bands in the wavelength region 2.5 to 2.9 micrometres--where the OH stretching vibration and the H2O bending overtone are found--has precluded definitive identifications. In addition, water vapour around Ceres has recently been reported, possibly originating from localized sources. Here we report spectra of Ceres from 0.4 to 5 micrometres acquired at distances from ~82,000 to 4,300 kilometres from the surface. Our measurements indicate widespread ammoniated phyllosilicates across the surface, but no detectable water ice. Ammonia, accreted either as organic matter or as ice, may have reacted with phyllosilicates on Ceres during differentiation. This suggests that material from the outer Solar System was incorporated into Ceres, either during its formation at great heliocentric distance or by incorporation of material transported into the main asteroid belt.

Dark material on Vesta from the infall of carbonaceous volatile-rich material.

Localized dark and bright materials, often with extremely different albedos, were recently found on Vesta's surface. The range of albedos is among the largest observed on Solar System rocky bodies. These dark materials, often associated with craters, appear in ejecta and crater walls, and their pyroxene absorption strengths are correlated with material brightness. It was tentatively suggested that the dark material on Vesta could be either exogenic, from carbon-rich, low-velocity impactors, or endogenic, from freshly exposed mafic material or impact melt, created or exposed by impacts. Here we report Vesta spectra and images and use them to derive and interpret the properties of the 'pure' dark and bright materials. We argue that the dark material is mainly from infall of hydrated carbonaceous material (like that found in a major class of meteorites and some comet surfaces), whereas the bright material is the uncontaminated indigenous Vesta basaltic soil. Dark material from low-albedo impactors is diffused over time through the Vestan regolith by impact mixing, creating broader, diffuse darker regions and finally Vesta's background surface material. This is consistent with howardite-eucrite-diogenite meteorites coming from Vesta.

Impact of continuous glucose monitoring on everyday life of young children with type 1 diabetes and their parents: An evaluation of 114 families.

INTRODUCTION: The prevalence of type 1 diabetes is increasing worldwide. The advent of new monitoring devices has enabled tighter glycemic control. AIM: To study the impact of glucose monitoring devices on the everyday life of young children with type 1 diabetes (T1D) and their parents. METHODS: A questionnaire was addressed to parents of children with T1D under the age of 6 years with an insulin pump treated in one of the hospitals of the ADIM network in France between January and July 2020. RESULTS: Among the 114 families included in the study, 53% of parents (26/49) woke up every night to monitor blood glucose levels when their child had flash glucose monitoring (FGM), compared with 23% (13/56) of those whose child had continuous glucose monitoring (CGM). Overall, 81% of parents (86/108) found that glucose monitoring improved their own sleep and parents whose child had CGM were significantly more likely to report improved sleep (86% vs 73%, p = 0.006). Forty-nine percent of parents (55/113) declared that they (in 87% of cases, the mother only) had reduced their working hours or stopped working following their child's T1D diagnosis. Maternal unemployment was significantly associated with the presence of siblings (p = 0.001) but not with glycemic control (p = 0,87). Ninety-eight percent of parents (105/107) think that glucose monitoring improves school integration. CONCLUSION: In these families of children with T1D, new diabetes technologies reduced the burden of care but sleep disruption remained common. Social needs evaluation, particularly of mothers, is important at initial diagnosis of T1D in children.

[Gastric cancer: epidemiologic profile 2001-2007 in Lima, Peru]. / Cancer gastrico: perfil epidemiológico 2001-2007 en Lima, Peru.

OBJECTIVE: To describe and compare the demographic and social characteristics as well as lifestyles of patients with gastric cancer against patients with other important gastric disorders, who attended at main reference health services in Lima, Peru. METHODS: Case control study, matched by sex and age + 2 years, applying a questionnaire to 96 cases with gastric cancer, and to 96 controls from September 2001 to November 2007. RESULTS: There were no significant differences about ethnicity; marital status; exposure to minerals, wood, and metal dusts; tobacco and alcohol; red meat consumption; salt addition; food temperature. 87, 5% of the control group had lesions in the gastric antrum, and 73% of cases group had a tubular adenocarcinoma (56%) in the gastric antrum. There was no family history of cancer in 85% patients of cases group and 59% of controls, (with significant difference). There were significant differences in low scholarship level of cases, as well as for their mothers and fathers (OR 3.75, 3.9, and 3.49 respectively), fruit or vegetables intake, milk or cheese consumption (minus of once a day) (OR 2, 3, 2, 57 and 2, 9 respectively), type of fuel for cooking (firewood, charcoal, and kerosene OR 5, 25), lack of use of refrigerator (OR 8, 4). CONCLUSIONS: The profile of a gastric cancer patient was to proceed from the Andean zone (high altitude +3000 meters over sea level) and jungle, low education level (low socioeconomic level), low consumption of fruits, vegetables and milk, use of firewood, charcoal, or kerosene to cook, and no use of refrigerator. The most frequent histological diagnosis in the case group was tubular adenocarcinoma.

Distribution of phyllosilicates on the surface of Ceres.

The dwarf planet Ceres is known to host phyllosilicate minerals at its surface, but their distribution and origin have not previously been determined. We used the spectrometer onboard the Dawn spacecraft to map their spatial distribution on the basis of diagnostic absorption features in the visible and near-infrared spectral range (0.25 to 5.0 micrometers). We found that magnesium- and ammonium-bearing minerals are ubiquitous across the surface. Variations in the strength of the absorption features are spatially correlated and indicate considerable variability in the relative abundance of the phyllosilicates, although their composition is fairly uniform. These data, along with the distinctive spectral properties of Ceres relative to other asteroids and carbonaceous meteorites, indicate that the phyllosilicates were formed endogenously by a globally widespread and extensive alteration process.

Dawn arrives at Ceres: Exploration of a small, volatile-rich world.

On 6 March 2015, Dawn arrived at Ceres to find a dark, desiccated surface punctuated by small, bright areas. Parts of Ceres' surface are heavily cratered, but the largest expected craters are absent. Ceres appears gravitationally relaxed at only the longest wavelengths, implying a mechanically strong lithosphere with a weaker deep interior. Ceres' dry exterior displays hydroxylated silicates, including ammoniated clays of endogenous origin. The possibility of abundant volatiles at depth is supported by geomorphologic features such as flat crater floors with pits, lobate flows of materials, and a singular mountain that appears to be an extrusive cryovolcanic dome. On one occasion, Ceres temporarily interacted with the solar wind, producing a bow shock accelerating electrons to energies of tens of kilovolts.

[Health care in non-insulin dependent diabetics in lower Normandy]. / Etude de la prise en charge de diabétiques non insulinodépendants en Basse-Normandie.

To contribute to better quality health care for patients with type 2 diabetes mellitus living in the French Department Basse-Normandie, the Regional Union of General Practitioners (URML) and the Regional Union of the Nation Health Insurance (URCAM) studied ambulatory practices in this population in 1999. Eight hundred diabetics whose health care reimbursements suggested they were not followed by a specialized center were studied: 400 received a mailed questionnaire and for the 400 others, another questionnaire was filed out by the primary care physician. The physicians' responses demonstrated that they do not feel certain recommended complementary investigations are always necessary for following diabetic patients (microalbuminuria, glycated hemoglobin, search for neuropathy, ophthalmology consultation). Interaction with diabetologists, nutritionists and chiropodists was found to be insufficient. Globally, the responses of the diabetics was coherent with the physicians' statements, providing further precision concerning health care delivery and propositions for improvement. These results can be used to better target education programs for associations, specialists and general practitioners.

A study of thirty right hepatic arteries.

Thirty right hepatic arteries discovered among 137 celiomesenteric angiographies show the high frequency (22%) of this variation. Radiologic anatomy of the right hepatic artery was discussed; with the exception of one atheromatous stenosis, the pathologic findings of the right hepatic artery and its terminal branches illustrate the development of a regional disease (12 cases or 40%). This assumed pathology is divided half in pancreatic causes (neoplasm, pancreatitis, pseudocysts) and half in hepatobiliary causes (metastatic cancer of the liver, cancer of the hilus, cirrhosis, hydatid cyst, alveolar echinococcosis or angioma). Five times the surgical technic was modified because of the right hepatic artery. Since these observations were made, we are studying the consequences of this hepatic artery over surgical technics and the approach to the various segments of this artery.

Hematoma of the iliacus muscle with femoral palsy.

A case of two simultaneous complications of anticoagulant therapy is presented: a hematoma strictly of the iliacus muscle causing femoral nerve paralysis and a retroperitoneal hematoma. The femoral nerve was trapped by the inguinal ligament to such an extent that its section was necessary to assure rapid and total nerve decompression. Evacuation and drainage of the hematoma was necessary. The favorable postoperative course encourages surgical management of this hematoma with nerve paralysis.

[Foreign bodies in the body following vascular surgery (11 cases)]. / Les corps étrangers de l'organisme après chirurgie vasculaire (11 observations).

Eleven cases of foreign body (F.B.) (3 autochthonous and 8 of other sources) demonstrate the rarity but also the persistent reality of these accidents. Incidence between 1970 and 1985 was close to one F.B. per 3,000 vascular procedures. In 4 cases the F.B. followed surgical non-reconstructive surgery and in the other 7 cases revascularization procedure, material involved being most often textile, sponges in 7 cases and towel in one case. Circumstances leading to let F.B., without disculpating the surgeon, included long and difficult operations conducted as emergencies or requiring one or more recovery operations. Clinical findings of the F.B. were of post-operative sepsis (10 cases) of varied clinical expression. General (4 cases of septicemia) and local (3 thrombosis, 1 anastomotic hemorrhage) consequences were serious. Prognosis in patients with F.B. closely follows that of vascular sepsis, with maximum seriousness after bifurcated prosthetic shunt. An essential prognostic factor is early diagnosis of F.B.: it is dependent on a series of clinical and paraclinical etiologic arguments, particularly results of radiography of the operated zone, fistulography and echography. Surgical intervention is a function of initial operation and is that proposed for all cases of vascular sepsis, with the common denominator of the total revision of the operated zone and removal of foreign bodies. Prophylaxis of F.B. in vascular surgery follows the rules for general surgery; these have been enounced for the last 50 years but have failed to prevent the postoperative F.B. This rare but always possible accident justifies its knowledge by even the most serious, experienced vascular surgeon.

[Aneurysms of the infrarenal aorta and visceral cancer. Therapeutic problems]. / Anévrysmes de l'aorte sous-rénale et cancers viscéraux. Problèmes thérapeutiques.

The association of an abdominal aortic aneurysm (AAA) and a long-standing or progressing cancer is a frequent finding: 14 cases among the 112 infrarenal aortic aneurysms treated by one of us (J.C.) are discussed in this report. The marked predominance in bronchial and ORL epithelioma (50%) is explained by the common pathogenic factors of these neoplasms and atheroma. Surgical treatment is difficult because of the potentially lethal character of the two lesions: it must allow for size and possible progressive nature of aneurysm and prognosis of the neoplasm as defined by the TNM classification. Detection of an AAA in a patient with a history of neoplasm means that the opportunity for aortic surgery is dependent of therapeutic control (or otherwise) of the neoplastic disease and therefore frequently the length of follow up period after therapy. When detection of the AAA and neoplasm is simultaneous, the aneurysm progressing or ruptured, surgical complications leave little choice with regard to operative strategy. In 3 cases, simultaneous treatment of an AAA and a neoplasm was possible, particularly in the case of Grawitz tumors of cortical development without pyelocaliceal invasion. In most patients, separate operative stages are necessary in order to ensure asepsis of AAA surgery. Aneurysmal occlusion with an extrafocal shunt can allow one-stage surgery when aneurysm and neoplasm are equally menacing.

[Chylothorax and chylous ascites following surgery of an inflammatory aortic aneurysm. Case report with review of the literature]. / Chylothorax et chyloperitoine après chirurgie d'un anévrysme aortique inflammatoire. Un cas avec revue de la littérature.

Chylous ascites complicating surgery on the abdominal aorta is infrequent: we report one case associated with right chylothorax, secondary to the surgical cure of an inflammatory aortic aneurysm. Surgery for aneurysms causes 81% of all chylous ascites caused by injuries to the intestinal lymphatics or to their recipients, the left latero-aortic lymph nodes or the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the cisterna chyli. Upper or extensive dissections of the retroperitoneal space and difficult dissection of ruptured or inflammatory aneurysms are the major etiological factors. Stasis and fibrosis, then the rupture of the lymphatics into the aneurysmal wall were described during inflammatory aneurysm: this lymphatic etiology might explain the inflammatory character of these aneurysms and entail a risk of lymphoperitoneal fistula when laying the aneurysmal wall flat. An early diagnosis must be established with paracentesis before any compressive, metabolic, immunological or septic complications occur. Continuous parenteral feeding and selective paracenteses dry out 80% of the postoperative chylous ascites. If the ascites persists after 4 to 6 week's conservative treatment, a peritoneojugular derivation or a direct lymphostasis may be contemplated, according to the patient's condition.

[Carotid-jugular fistula after an attempt at placement of a vena cava filter]. / Fistule carotido-jugulaire après tentative de placement d'un filtre cave.

A carotid-jugular fistula complicated the placement of a Green-field filter via the right internal jugular percutaneous passage: the local signs of an arterio-venous fistula were associated with right parietal infarction neurological symptoms. A crossography showed a carotid-jugular fistula and a limited dissection of the original carotid artery. An elective echo-guided compression failed. The surgical treatment eliminated the fistula, fixed the carotid dissection and placed a vena cava filter with an excellent result 34 months later. Percutaneous placement of vena cava filters can lead to rare vascular complications such as carotid-jugular fistulas which can, in certain cases, be treated with an elective external compression or endovascular procedures. Surgery offers a reliable technical solution that is complete and stable in time, particularly with recent fistulas and associated neurological symptoms.

[Amyloidosis of a coral reef infrarenal aorta]. / Amylose d'une aorte sous-rénale en pierre de corail.

This case concerns a 37-year-old woman with a cruro-gluteal claudication, from which she had been suffering since the age of 33, and which prevented her from walking more than 50 metres. The arteriographic examination revealed preocclusive coralliform proliferations of the infrarenal aorta, with a 30% stenosis of the right internal carotid artery. After 18 months, a straight aorto-aortic tube yielded excellent results. The results of the pathological examination led to the conclusion that this was a secondary aortic amyloidosis with no specific lesions of the aortic wall. This coral reef aorta is distinguished by its infrarenal location (fourth case worldwide), as well as by the major amylotic infiltrations of the endoaortic proliferations and of the aortic wall. In the absence of generalized amyloidosis, we suspect massive localized amyloidosis subsequent to an old inflammatory aortic process compatible with a juvenile atheroma opened in the aortic lumen or more probably a sequel of Takayasu's disease.

[Low incidence of pseudomembranous colitis associated with antibiotics at a general hospital in Lima]. / Baja incidencia de colitis pseudomembranosa asociada a antibióticos en un hospital general de Lima.

Clostridium difficile is associated to episodes of diarrhea related to the use of antibiotics in general hospitals. The aim of this study has been to determine the incidence of this complication among the patients admitted in a 400 bed general hospital in Lima, Perú; we registered every day, in all the wards of the hospital, the presence of diarrhea in patients under antibiotic treatment. In every patient with diarrhea we investigated the presence of cytotoxin and cultivated for C. difficile in the feces. Only 25 patients presented diarrhea and none of them showed inflammatory changes in the endoscopic exploration. Only one patient presented positive cytotoxin with negative culture. In the control group of 41 new-born, asymptomatic infants, already on breast-feeding there were 27 (65.8%) culture and/or cytotoxin positive. We conclude that in our adult population colitis due to C. difficile, associated to antibiotic therapy is an infrequent disease.

[Carotid surgery under loco-regional anesthesia. Early results of 100 recent cases]. / Chirurgie carotidienne sous anesthésie loco-régionale. Résultats précoces de 100 cas récents.

A prospective single-centre study was performed to evaluate the safety and efficacy of carotid revascularisation under local anesthesia. Between November 1, 1996 and March 30, 1998, 92 patients underwent surgery for 100 carotid artery stenoses under local cervical block anesthesia. Fifty-eight stenoses were asymptomatic and 42 were symptomatic. Duplex ultrasound scanning showed a tight (n = 17) or very tight carotid artery stenosis (n = 83); angiography showed 19 contralateral carotid artery stenosis and 30 hemodynamically significant stenosis of vertebral and/or subclavian arteries. Cerebral Magnetic Resonance Imaging (MRI) (N = 87) with circle of Willis Magnetic Resonance Angiogram (MRA) (n = 83) detected 29 ischemic defects (33%). Fifteen ischemic defects were found in 58 asymptomatic patients (26%). Circle of Willis was incomplete in 41%. Anesthesia was performed using superficial cervical block (n = 100). Endarterectomy was the most commonly used revascularisation technique in 86 cases with 5 eversion endarterectomies; carotid vein or prosthetic graft was used in 14%. In this study, there was no mortality, and no cardiac or neurologic complications, during the first postoperative month. Twelve patients experienced neurologic intolerance to carotid clamping. This clamping-related ischemia required 4 shunts. All patients with clamping intolerance had a good clinical outcome after revascularisation with no objective or MRI sequelae. Incomplete circle of Willis on MRA was a significant predictive test of clamping intolerance (p < 0.0001). Carotid artery surgery under local anesthesia reduces the cumulative mortality and morbidity rate (TCMM) to a very low level: 0% in this study. These recent results are the modern reference for current carotid artery surgery evaluation.

[Acute postoperative arterial ischemia (author's transl)]. / Les ischémies aiguës postopératoires.

The authors analyse 16 cases of acute ischemia observed over a period of one month after an operation of general surgery. The classical cardiac origin, e.g. infarct, arrythmia, was found in only three patients. The septic etiology was predominant, septic arterial emboli but not infective or acute thrombosis during septic or post-operative shock. The clinical aspect showed no special characteristics. Surgery remains the principal form of treatment. The results are good, except in acute arterial thrombosis justifying plastic surgery which may give better results than simple thrombectomy.

[Indications for the Greenfield filter at the distal side of renal veins. 15 cases]. / Les indications du filtre de Greenfield en aval des veines rénales. 15 observations.

Analysis of results of short- and medium-term use of 15 Greenfield's filters (GF) introduced distal to renal veins confirmed the good nephrologic tolerance and efficacy of partial interruption of suprarenal inferior vena cava. The surgical technic necessarily involves use of internal jugular vein (with the exclusion of femoral vein) and it is recommended to insert the GF in the retro-hepatic vena cava at a distance from renal veins. Review of 53 cases reported in the world literature indicates cases suitable for this procedure as being patients with severe thromboembolic accidents unable to be treated by direct surgery, fibrinolysis or by effective anticoagulation. Indications for use of a suprarenal GF include suprarenal extension of a caval thrombus or lack of efficacy of an anterior caval block proximal to renal veins. In these cases, that are rare and should remain so, the suprarenal Greenfield filter is the most satisfactory solution at the present time for ensuring the very poor vital prognosis of this very particular group of patients.

[Arterio-venous fistula of the left renal pedicle after nephrectomy. Possibilities and interest of early diagnosis (author's transl)]. / Fistule artério-veineuse du pédicule rénal gauche après néphrectomie. Possibilités et intérêt du diagnostic précoce.

The authors study a new case of arterio-venous fistula of the left renal pedicle after nephrectomy for trauma. The interest of this case resides in the existence of a right para-umbilical pulsating mass which corresponds to systolic expansion of the inferior vena cava. This sign, which disappeared after corrective operation has the advantage of orienting towards an abdominal vascular condition. In fact, the diagnosis of iatrogenic arterio-venous fistula was made very early : 6 weeks after nephrectomy. The lesion was treated by the purely abdominal route, in the absence of marked peri-aneurysmal fibrosis. Complete removal of the fistula and of the afferent and efferent vessels corrects recent hypertension and prevents later heart failure.

[Haemoperitoneum due to ruptured hepatoma in a cirrhotic patient with porphyria cutanea tarda. Three years' survival (author's transl)]. / Hémopéritoine par rupture d'un hépatome chez un cirrhotique atteint de porphyrie cutanée tardive. Survie de 3 ans après hépatectomie.

A case of ruptured hepatocarcinoma of the left lobe in a cirrhotic patient with a 7 years' history of porphyria cutanea tarda (PCT) is reported. Emergency left lobectomy resulted in 3 years' survival with no sign of recurrence at present. Comments are made concerning the clinical association PCT-hepatoma: (1) either PCT is associated with a hypersecretory hepatoma and behaves as a neoplastic syndrome following the same course as the tumour; (2) or PCT is associated with a cirrhosis (usually alcoholic) which facilitates the development of a hepatoma. In such cases, PCT precedes the tumour and follows a separate course.