[Indications of the expansion in pediatric surgery. Experience of 30years and literature review]. / Indications de l'expansion chez l'enfant. Expérience de 30ans d'activité et revue de la littérature.

The expansion of soft tissue, especially skin, is an old and physiological process to increase the skin reserve allowing excision while coveraging of the resulting loss of substance. Easy in principle, this process is subjected to constraints in children requiring precise planning and rigorous technical procedure. Between 1990 and 2016, we performed 293 expansion protocols with 411 implants in 244 children. The scalp was the most interested area (158 cases), followed by the trunk (29). The congenital nevi represented the most frequent indication (119 cases), followed by sequelae of burns and scars (64 cases) and hamartoma sebaceous of Jadassohn (27 cases). Three categories of indication can be established. Ideal indications of the expansion are on the scalp, skin preparation prior to the excision of a large nevus, nevus sebaceous of Jadhasson and severe breast hypoplasia. Common but delicate indications are scars, especially after burns, treatment of vertex aplasia cutis congenita and expansions of the limbs, abdomen, head and neck. Rare indications include separation of Siamese twins, or protection of the bowel before radiotherapy. Contra-indications are infected lesions, malignant tumors and lesions requiring immediate coverage. If the principle of expansion is relatively simple, its positioning on the scale of reconstruction methods is harder because of the risk of significant complications.

[Oral health of elderly occupants in residential homes]. / Salute orale degli anziani ospiti delle Residenze Sanitarie Assistenziali.

Institutionalised elderly often report oral and dental problems which reduce nutrition ability and compromise significantly quality of life. The main objective of this study was to assess the prevalence of oral diseases in a group of residential homes elderly and to evaluate the association between degree of edentulism and some individual characteristics. From November 2004 to April 2005 448 subjects living in 10 residential homes of the city of Rome were enrolled in a special dental health programme in Lazio (Central Italy). The median age was 83.2 yrs, 47.3% of the subjects were edentulous, while 24.8% had 1 to 9 teeth, 63.1% of whom didn't have denture. 57.1% of subjects reported one or more oral disorders. Multivariate analysis showed a significant association between edentulism and the following factors: age > or = 75 yrs (Odds Ratio [OR] = 3.16 CI 95% 2.11-4.74) permanence of stay in the residential home > or = 3 yrs (OR = 1.96 CI 95% 1.13-3.40), lack of routine dental visits (OR = 1.71 CI 95% 1.14-2.58). The study findings confirmed that institutionalised elderly subjects, together with several chronic diseases, also show a poor oral health. Consequently greater attention should be paid to improve actively oral health services in this care setting.

Resting CBF sequential study during recovery from aphasia due to ischemic stroke.

Cerebral blood flow (133Xenon inhalation method) has been studied in 30 aphasic stroke patients at 15, 30, 60 and 90 days after onset. In total aphasia the CBF values are low and the regional hypoperfused areas are extensive. In Broca's, Wernicke's and nominal aphasias, resting CBF measurements do not provide the clinician with useful additional information and clinical improvement can by no means be attributed to a resting CBF rise during the observation period.

Giardia intestinalis antigens expressed in Escherichia coli.

cDNA and genomic DNA of Giardia intestinalis have been cloned in pUC vectors and used to express Giardia antigens in Escherichia coli. Several expression libraries have been produced and positive clones identified by immuno-colony assays with antisera raised against whole parasites and partially purified antigen(s). Those clones which express G. intestinalis antigens have been used to raise antisera in mice and the antisera used in immunofluorescence assays. The proteins expressed by the clones have been shown to represent a 32 kDa protein of the flagellae and axonemes, a protein associated with the spiral part of the ventral disc, proteins covering the surface of the trophozoite or associated with the coat, and other proteins associated with axonemes of posterolateral flagellae, kinetosomes and funis, and the anterolateral axonemes. mRNA was purified from G. intestinalis and translated in a cell free lysate. A rabbit antiserum raised against trophozoites immunoprecipitated several translation products while an antiserum raised against a purified 32 kDa protein only immunoprecipitated this protein. G. intestinalis rRNA subunits also were examined in the course of mRNA purification. Two rRNA species were evident, the small rRNA and the post-transcriptionally processed large rRNA.

A rapid method for evaluation of regional cerebral blood flow after intra-arterial injection of 133Xe.

A technique based on the stochastic method is described for the computation of regional blood flow (RBF) after intra-arterial infection of 133Xe. Results are presented on scintigrams, defined by 600-800 channels in a 64 times 64 matrix. The content of each channel is equal to the computed RBF value. The standard deviation is also computed for each channel. The total computation cycle is achieved within 10 min. The method has been used to investigate the influence of anesthesia or drugs on regional blood flow. For this purpose, a differential printout program was written in which variations of RBF values between the two measurements are expressed in units of a fixed percentage; provision is made for calculation of RBF variations in units of differential standard deviations. Data are in good accordance with other clinical findings. This method is suitable for clinical use when blood flow values in gray and white substances are not requested.

Use of 99mTc-labeled albumin microspheres in cerebral vascular disease.

The intracarotid injection of radioalbumin microspheres (15 and 30 mum) is followed by scanning procedures that permit the description of the cerebral bloodflow distribution. The method is reproducible. Injection can be made into the internal and common carotid arteries, as well as into the aortic arch or the left ventricle. This last procedure makes it easy to examine patients with severe extracranial vascular stenosis or thrombosis and permits comparison of the two hemispheres. Most patients (88%) injected on the affected side showed one or more local vascular deficits. The method therefore is more efficient than pertechnetate scanning or arteriography.

Similarities of Giardia antigens derived from human and animal sources.

A total of 37 Giardia stocks isolated from humans and 14 stocks derived from animal sources have been analysed for antigenic differences. Separation of the proteins of the stocks by polyacrylamide gel electrophoresis showed no major differences among the stocks. Immunoblotting of these antigens demonstrated some minor differences which were not correlated with geographic location, allozyme type, virulence or any other distinguishing characteristic of the stocks. Immunofluorescence tests using monoclonal antibodies revealed some differences between stocks but the monoclonal antibodies did not significantly inhibit growth in inhibition assays.

Acute effects of low levels of ambient ozone on peak expiratory flow rate in a cohort of Australian children.

BACKGROUND: We enrolled a cohort of primary schoolchildren with a history of wheeze (n = 148) in an 11-month longitudinal study to examine the relationship between ambient ozone concentrations and peak expiratory flow rate. METHODS: Enrolled children recorded peak expiratory flow rates (PEFR) twice daily. We obtained air pollution, meteorological and pollen data. In all, 125 children remained in the final analysis. RESULTS: We found a significant negative association between daily mean deviation in PEFR and same-day mean daytime ozone concentration (beta-coefficient = 0.88; P = 0.04) after adjusting for co-pollutants, time trend, meteorological variables, pollen count and ALTERNARIA: count. The association was stronger in a subgroup of children with bronchial hyperreactivity and a doctor diagnosis of asthma (beta-coefficient = -2.61; P = 0.001). There was no significant association between PEFR and same-day daily daytime maximum ozone concentration. We also demonstrated a dose-response relationship with mean daytime ozone concentration. CONCLUSIONS: Moderate levels of ambient ozone have an adverse health effect on children with a history of wheezing, and this effect is larger in children with bronchial hyperreactivity and a doctor diagnosis of asthma.

The epidemiology of tuberculosis in New South Wales 1975-1995: the effects of immigration in a low prevalence population.

SETTING: New South Wales (NSW) is Australia's most populous state and is home to one third of the country's rapidly growing immigrant population. OBJECTIVE: To examine the effects of immigration upon the epidemiology of tuberculosis (TB) in a low prevalence population. DESIGN: A retrospective review of state TB surveillance data in NSW from 1975-1995. RESULTS: The crude notification rate for all active TB declined from 12.2 per 100000 population in 1975 to 5.2/100000 in 1986, after which the notification rate increased steadily to 7.6/100000 in 1995. Between 1975 and 1995, the proportion of all TB notifications occurring in overseas-born residents increased from 30% (178/601) to 79% (345/435). During this period, the proportion of new extra-pulmonary TB notifications increased from 13% (72/549) to 42% (171/405). Notifications amongst women increased from 31% (188/601) to 47% (218/462) of the total, while the median age at notification fell from 55 to 41 years. The pattern of TB disease has not changed for Australian-born cases, who are mostly elderly men with pulmonary disease. Multidrug-resistant TB remains uncommon (<1%), and co-infection with the human immunodeficiency virus (HIV) and TB has not emerged as a major problem (2% of notifications), but is poorly documented. CONCLUSION: TB has re-emerged in NSW predominantly because of increased immigration from high prevalence countries. The epidemiology of TB has become dominated by overseas-born notifications, and now younger adults are primarily affected. Enhancing the effectiveness of the TB screening procedures for immigrants is a priority. Information should be provided to all immigrants and to long-term visitors from countries of high TB prevalence regarding TB infection and the TB services available in Australia.

Brain activation during a linguistic task in conduction aphasia.

In order to investigate functional cortical reorganization during recovery from conduction aphasia, regional cerebral blood flows (rCBF) were measured by the two-dimensional 133 Xenon inhalation method in ten stroke patients. rCBF measurements were performed at rest and during the performance of a linguistic task, one month and three months after onset. The analysis of flow changes from rest to test condition indicates an increasing contribution of the right hemisphere as time goes on. The absence of flow increase in Broca's region suggests that this region is definitively disconnected from posterior language "centers" by the arcuate fasciculus lesion.

Assessment of hemispheric dominance for language in crossed aphasia by two atraumatic methods.

In a right handed patient with crossed aphasia, two atraumatic techniques (regional cerebral blood flow measurements during the performance of a linguistic task and dichotic listening test) were used to assess language lateralization. The prominence of rCBF activation patterns in the right hemisphere and the presence of a clear-cut right ear extinction on the dichotic listening test provide evidence that, is this case, the right hemisphere was dominant for language.

Occupational and environmental exposures and lung cancer in an industrialised area in Italy.

AIMS: To investigate the effects of occupational exposures and residence near to industrial sites on lung cancer mortality in an area in Italy. METHODS: 234 cases of lung cancer and 729 controls matched by sex, age, and date of death were enrolled. Environmental exposure was evaluated using historical residence data. A geographical information system was used to compute distances from residence to pollution source (cement factory, power plants, harbour) and an average distance was computed for each subject. Odds ratios (OR) and 95% confidence intervals (CI) in a logistic regression model were used to estimate the relative risk of lung cancer associated with the risk factors (smoking habits and occupational exposure) collected by questionnaire; ORs for distances from pollution sources and from city centre were computed, adjusting for smoking habits, education, and occupation. RESULTS: Smoking habits (< or =10 cigarettes/day, OR = 2.28; 11-20, OR = 4.64; >20, OR = 6.61) and occupational exposure to asbestos (OR = 3.50) were significantly associated with lung cancer risk. Reported traffic level of area of residence and residence near the four sources were not associated with increased risk of lung cancer. There was a significantly increased risk for those residing outside the city centre, in the southern outskirts (OR = 1.51). CONCLUSIONS: The increased lung cancer risk observed in the area can partly be explained by occupational exposures. The increased risk in the outskirts of the city is consistent with the results of dispersion models that indicate high levels of pollutant deposition in the same area.

Environmental investigation of a legionellosis outbreak in western Sydney: the role of molecular profiling.

This investigation used DNA profiling in an attempt to identify the environmental source of a community outbreak of 11 cases of Legionnaires' disease. Nine of these cases were culture positive and a single strain (DNA profile) of Legionella pneumophila serogroup 1 was isolated from eight cases. Spot water samples were collected from 51 cooling towers implicated by case exposure histories; this same strain was isolated from four towers at three separate locations up to 6 km apart. None of these locations had been frequently implicated by case histories. Because we did not perform an analytic epidemiological investigation, we were unable to identify a single environmental source for the outbreak. It is also possible that this outbreak was multifocal. The use of molecular profiling should not overshadow the importance of epidemiological methods in these environmental investigations. More data is needed regarding the prevalence, distribution, and clinical significance (virulence) of environmental L. pneumophila strains. This would aid interpretation of molecular profiling used in investigations of community legionellosis outbreaks.

Changes in regional cerebral blood flows produced by dexamethasone in patients with brain metastases.

Four patients suffering from brain metastases were studied by brain scintigraphy carotid angiography and rCBF measurement, before and after one week of treatment with dexamethasone. It was noted that the neurological signs and the blood perfusion around the tumor were improved but that the volume of the lesion, as judged from the angiogram was unmodified. It is suggested that the corticosteroids reduce tissue pressure before actually diminishing the volume of the brain oedema.

Study of two cases of aphasia by infarction of the left thalamus, without cortical lesion.

Two patients suffering from a left thalamus infarct were studied over a long period. The precise location of the lesion has been demonstrated by the C.T. scan. In spite of the absence of any cortical lesion, both presented with aphasia and other neuropsychological disorders (left-right confusion, dyscalculia and possible finger agnosia). Their speech disorders although different, had several features in common. The observations were compared with the other cases reported in the literature.

Conditional reasoning and the Tower of Hanoi: the role of spatial and verbal working memory.

This paper reports a study that investigated the relationships between verbal and spatial measures of working memory capacity and performance on the Tower of Hanoi and a conditional reasoning task. Four working memory measures were included, a simple word span, a simple spatial span, a complex verbal span and a complex spatial span. The participants were 70 undergraduate students. Solution time on the Tower of Hanoi task correlated highly with both measures of spatial memory capacity, but not with the verbal working memory spans. In contrast, logical performance on the conditional reasoning task correlated highly with the complex verbal working memory span, but not with the spatial spans. A confirmatory factor analysis of the data elicited a best-fit model comprising a correlated spatial and verbal factor. The results are interpreted in the context of recent work that suggests a dissociation between spatial and verbal resources at the level of the central executive.

[Cerebral crossed diaschisis caused by cerebellar lesion: role of the cerebellum in mental functions]. / Diaschisis cérébral croisé par lésion cérébelleuse: rôle du cervelet dans les fonctions mentales.

In 3 patients with a stroke limited to the posterior fossa, regional cerebral blood Flows were measured by the 133 Xe inhalation method (the first two cases) or by the SPECT with HMPAO method (the third case). The first patient had a median and paramedian hematoma of the left cerebellar hemisphere and the left dorsolateral portion of the pons. Remote cerebral hypoperfusion, measured 3 months later, was observed in both frontal premotor regions (but more marked in the right hemisphere) and in a circumscribed area of the right temporal region. The second patient had a right-sided ischaemic lesion of the anterior cerebellar lobe and the mesencephalic tectum. Contralateral parietal and rolandic hypoperfusion, measured 7 weeks after the stroke, was observed. The third patient had on old infarct of the right cerebellar hemisphere. The SPECT, measured 17 years later, showed a left fronto-parieto-temporal hypoperfusion and the absence of perfusion in the right cerebellar hemisphere. Preliminary data of neuropsychological assessment in our patients disclosed impairment in visuo-spatial and constructive organization, memory and learning compatible with the published findings in some patients and animals with predominantly cerebellar damage. These interesting findings should be confirmed in a large number of patients with age, sex, and sociocultural matched controls. In the absence of supratentorial insult, and during the hemodynamical stable phase, crossed cerebello-cerebral diaschisis is suggested in our 3 patients. Although it is too early to draw definite conclusions, our findings may: (1) confirm the functional interconnections between the cerebellum and the cerebrum in man and (2) provide functional basis for the behavioral function impairment reported in patients with cerebellar insult. Further rCBF, metabolism, and pathologic studies on this subject are required to elucidate this issue.

Cerebral blood flow under enflurane anesthesia.

Cerebral blood flow was measured, under controlled conditions of stable ventilation and PaCO2, in 11 patients suffering from cerebro-vascular lesions. Comparing the results under N2O-enflurane 1% anesthesia with those under N2O-fentanyl anesthesia shows an average 8.4% decrease of blood flow. In 5 cases, a third measurement was performed under N2O-enflurane 2% anesthesia. This caused an average 8.5% complementary decrease. Whereas most inhalational anesthetic agents produce an increase of cerebral blood flow, this is not observed with enflurane, the tendency rather being towards a decrease.

[Techniques for the diagnosis of cerebral ischemia (author's transl)]. / Moyens instrumentaux de diagnostic dans l'insuffisance circulatoire céébrale.

The various techniques for the diagnosis of cerebral ischemia are reviewed. The methods for investigating the large cervical arteries are considered (angiography, ultrasonic Döppler technique, carotid compression test) as well as those concerned with intracranial circulation. The latter are divided in "functional" methods (Rheoencephalography cerebral blood flow measurements with Xenon or with microspheres) and "morphological" methods (Brain scintigraphy and CAT scan). The respective values of the various methods are estimated in a personal series of patients.

Electrocortical activation induced by abrupt increases in blood pressure in "pontine" cats.

Acute "pontine" cats were submitted to abrupt increases in blood pressure induced by a transient obstruction of the lower thoracic aorta. This stimulation regularly provoked a complex electrocortical response. The first part of it, which occured 12 sec after the beginning of the pressure rise, consisted of an activation reaction accompanied by dilatation of the pupils and tonic contraction of the lower back muscle and preceded by arrest of respiration. The activation reaction and pupillary dilatation were absent in the cats with a brain stem section at the junction between the pons and the mesencephalon. The effects on the cerebrum are attributed to a passive increase in blood flow which is effective on ECoG and pupils only when the midbrain is connected to the brain. The second and third parts of the response, a burst of slow waves followed by a flattening of the record, were dependent of the hypotension which followed the end of the blood pressure rise. They were preserved in the cats with a lesion of the junction between the pons and the mesencephalon. They are attributed to a relative ischemia of the brain.