Assessment of organ dose and image quality in head and chest CT examinations: a phantom study.

The purpose of this study is to assess dose for radiosensitive organs and image quality in head and chest computed tomography (CT) examinations. Our focus was in the brain, eye lens and lung organs using two protocols; one protocol with fixed mAs and filtered back projection (FBP) and another with tube current modulation (TCM) and sinogram affirmed iterative reconstruction (SAFIRE). Measurements were performed on a 128-slice CT scanner by placing thermoluminescent dosimeters (TLDs) in an anthropomorphic adult phantom. Results were compared to a CT-Expo software. Objective image quality was assessed in terms of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). SPSS software was used for data analyses. Results showed that, using TCM, doses were reduced by 22.84%-25.06% for brain, by 21.82%-23.48% for eye lens and by 54%-53.22% for lung with TLD and CT-Expo respectively. The increased SNR and CNR values achieved for scans performed with TCM combined with iterative reconstruction techniques were 38.68%-58.81% and 38.91%-43.60% respectively. We conclude that, using TCM, a significant mean organ dose reduction is achieved for brain, eye lens and lung organs. Then, combined with iterative reconstruction, image quality was well maintained in terms of SNR and CNR. Thus it is highly recommended in clinical practice optimization in head and chest CT examinations.

Assessment of acrosome and nuclear abnormalities in human spermatozoa with large vacuoles.

BACKGROUND: Spermatozoa with large vacuoles (SLV) may have a negative impact on embryo development. The origin of these vacuoles is unknown. We evaluated acrosome and nucleus alterations in isolated SLV, versus unselected spermatozoa. METHODS: We studied 20 patients with teratozoospermia. Spermatozoa from the native semen sample and spermatozoa presenting a vacuole occupying >13.0% total head area, isolated under high magnification (×6600), were assessed. Confocal and transmission electron microscope evaluations were performed on SLV and native sperm, respectively. Acrosome morphology and DNA fragmentation were analysed using proacrosin immunolabelling (monoclonal antibody 4D4) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling assay. Chromatin condensation was evaluated with aniline blue staining. Sperm aneuploidy was assessed using fluorescence in situ hybridization. RESULTS: SLV represented 38.0 ± 5.10% of motile spermatozoa obtained after gradient density centrifugation. Vacuoles were mainly in the anterior and median sperm head (45.7 ± 2.90 and 46.1 ± 3.00%, respectively). Abnormal acrosomes were increased in SLV compared with unselected spermatozoa (77.8 ± 2.49 versus 70.6 ± 2.62%; P = 0.014). Microscopic observations showed an exclusively nuclear localization of large vacuoles. Complete DNA fragmentation was higher in native spermatozoa (P < 0.0001) than SLV, while chromatin condensation was altered in SLV (P < 0.0001). Aneuploidy and diploidy rates were increased in SLV (P < 0.0001). CONCLUSIONS: Sperm vacuoles were exclusively nuclear. In our selected teratozoospermic population, aneuploidy and chromatin condensation defects were the main alterations observed in SLV. Based on results from this small sample of spermatozoa, we propose a global impairment of the spermatogenesis process as a common origin of the morphological alterations.

Total knee arthroplasty with the Medial-Pivot knee system: Clinical and radiological outcomes at 9.5 years' mean follow-up.

INTRODUCTION: The "ball-in-socket" design of the Medial-Pivot knee system (MicroPort Orthopedics, Arlington, Tennessee, USA) aims to reproduce normal knee kinematics by medializing its rotational axis. The goal of this study was to measure knee range of motion (ROM) with this implant after a mean follow-up of 10 years and to report the survivorship and long-term clinical and radiological outcomes. We hypothesized the prosthetic knee would have at least 120° flexion at 10 years. MATERIAL AND METHODS: This was retrospective, single-centre study of 74 Medial-Pivot knees implanted in 71 patients (average age of 69 years) between May 2005 and November 2007. All patients who received a Medial-Pivot knee were included consecutively. The mean follow-up was 10 years. Clinical and radiological assessments were performed using the Knee Society Score (KSS) and Ewald's score. Kaplan-Meir survival analysis was used to calculate survivorship. RESULTS: Seven percent of cases were lost to follow-up. The knee ROM was 110° at 10 years. The survivorship was 93% for all revision causes and 95.9% when revisions due to trauma or infection were excluded. The mean KSS score was 195. Stable radiolucent lines were found in 14% of cases. No aseptic loosening was observed. CONCLUSION: Our hypothesis was not confirmed. Knee flexion at the final follow-up was comparable to other semi-constrained implant designs but was not as large as expected. The survival of the Medial-Pivot knee at 10 years is good. Its radiological and clinical outcomes are satisfactory. LEVEL OF EVIDENCE: IV (retrospective cohort study).

Results of 115 Rubis II reverse thumb carpometacarpal joint prostheses with a mean follow-up of 10 years.

The aim of this study was to assess the clinical and radiological results of the Rubis II thumb carpometacarpal joint reverse prosthesis, at a mean follow-up of 10 years. Between 1997 and 2008, 253 prostheses were implanted in 199 patients; 115 were reviewed. The survival after a mean of 10 years was 89%. At the last follow-up, 70% of prostheses were painless; the others reported moderate or intermittent pain. The satisfaction rate was 98%. The mean opposition was 9 on the Kapandji scale; the mean QuickDASH score was 30. Wrist, key and tip pinch strengths were comparable with the non-operated side. Of the 115 implants, one was radiologically loose (1%) and 15 had suffered dislocations (13%), 12 of which were caused by an injury. Eleven thumbs had revision surgery. This study confirms that the good clinical results of the Rubis II prosthesis are maintained in the medium and long term, and represents a useful alternative to trapeziectomy for selected patients. LEVEL OF EVIDENCE: IV.

Total hip arthroplasty revision by dual-mobility acetabular cup cemented in a metal reinforcement: A 62 case series at a minimum 5 years' follow-up.

INTRODUCTION: Total hip arthroplasty (THA) requires bone reconstruction in case of severe acetabular injury, with risk of dislocation, especially postoperatively. Dual-mobility cups have proved effective in preventing dislocation in THA revision for instability, but their behavior when cemented in a metal reinforcement has been little studied. OBJECTIVES: The present study assessed results for a dual-mobility cup cemented in a metal reinforcement, in terms of aseptic loosening and postoperative instability. MATERIAL AND METHODS: A single-center continuous series of 62 patients receiving such an assembly in THA revision was assessed retrospectively at a minimum 5 years' follow-up. Failure due to aseptic loosening or instability and implant survival at last follow-up were analyzed. RESULTS: Radiological and clinical analysis was performed at a mean 77 months' follow-up. Mean Merle-d'Aubigné-Postel score was 14, Harris score 73 and Oxford-12 score 23.9 at last follow-up. Complications comprised 5 cases of loosening and 2 of dislocation. Loosening risk was significantly greater in case of<2mm cement thickness between cup and reinforcement. Eight-year infection-free survival was 91.9%. DISCUSSION: The present clinical results were comparable to those in series using the same kind of assembly; the dislocation rate was low, but the rate of aseptic loosening was higher than reported elsewhere. Cement thickness between cup and reinforcement was a determining factor for stability. Cup design may also be relevant to loosening. This technique seemed to be a good option in THA revision with severe bone loss. LEVEL OF EVIDENCE: IV, retrospective study.

Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients.

In this prospective study, we assessed the incidence of central venous catheter (CVC)-related thrombosis in haematopoietic stem cell transplant (HSCT) recipients. We determined the contribution of inherited prothrombotic abnormalities in blood coagulation to CVC-related thrombosis in these patients. The study was conducted between May 2002 and September 2004. CVCs were externalized, nontunneled, polyurethane double lumen catheters. Before catheter insertion, laboratory prothrombotic markers included factor V Leiden, the prothrombin gene Gly20210A mutation, plasma antithrombin levels, and protein C and S activity. All patients were systematically examined by ultrasonography just before, or <24 h after, catheter removal, and in case of clinical signs of thrombosis. A total of 171 patients were included during the 28-month study period. Five (2.9%) and three (1.7%) patients had evidence of protein C and protein S deficiency, respectively. Only one patient had an antithrombin deficiency (0.6%). In total, 10 patients (5.8%) were heterozygous for the factor V Leiden mutation, and one patient had heterozygous prothrombin G20210A mutation (0.6%). We observed a CVC-related thrombosis in 13 patients (7.6%). Thrombosis was diagnosed in four out of 20 patients (20%) with a inherited prothrombotic abnormality compared to nine of 151 patients (6%) who did not have a thrombophilic marker (relative risk 3.3 CI 95% 1.1-9.9). Our results suggest that inherited prothrombotic abnormalities contribute substantially to CVC-related thrombosis in HSCT recipients. In view of physicians' reluctance to prescribe prophylactic anticoagulant treatment in these patients, a priori determination of inherited prothrombotic abnormalities may form a basis to guide these treatment decisions.

Palmitoyl derivatives of GpMBP epitopes: T-cell response and peptidases susceptibility.

We report for the first time the immunoadjuvant effects of lipoconjugation of peptide antigens in an in vitro system by using CD4+ T-cells. The lipopeptides obtained by conjugating a palmitoyl moiety at the N(alpha)-terminal of Gln(74) or at the epsilon-NH(2) of Lys(75) of GpMBP(74-85) induced increased T-cell responsiveness compared to the native nonlipidated peptide. On the other hand, lipoderivatives of GpMBP(82-98) did not increase the T-cell response, demonstrating that the superagonist inducing effect of lipoconjugation is epitope-specific. Digestion of the two native peptides with cathepsin D and L, both implicated in antigen processing, and with a complete lysosomal fraction of a EBV-transformed B cell line shows that GpMBP(74-85) is resistant to cellular proteases, while GpMBP(82-98) is easily digested by these enzymes. These results suggest that the first prerequisite for increasing the T-cell response by lipoconjugation is the stability of the native peptide to peptidases, providing an important insight into the understanding of the immunoadjuvant effect of lipoderivative antigens.

Reaction of some antiinflammatory 17 beta-(2-aminooxazol-4-yl) steroids with hydrogen peroxide. Synthesis of steroid-17-spiro-5'-oxazolidine-2',4'-diones.

The heterocyclic moiety of 17 beta-(2-aminooxazol-4-yl) steroids is sensitive to the oxidizing action of hydrogen peroxide and yields products mainly from the opening of the amino-oxazole ring. Unlike simple 2-aminooxazoles, it does not rearrange to 2-imidazolone and the expected steroidal hydroperoxyimidazolidinones were not detected. Among the substances we isolated, N-(aminocarbonyl)-17 alpha-hydroxy-17-carboxamides (2a) and (3a) undergo spontaneous cyclization, in the reaction conditions, giving steroid-17-spirooxazolidinediones (2d) and (3d). Spirane (2d) was synthesized in high yields from (2a) in strongly alkaline medium.

Highly efficient synthesis of steroid-17-spiro-5'-oxazolidine-2',4'-diones from 17-keto steroids.

Spiro[androst-4-en-17 alpha,5'-oxazolidine]-2',3,4'-trione 8a and spiro[androst-4-en-17 alpha,5'-oxazolidine]-2',3,4',11-tetraone 8b, two potentially bioactive spiranes, were prepared from the parent 17-ketones in four steps (64% and 49.5% yield, respectively). The key intermediates were the hydroxyimidates 5a and 5b, which easily underwent cyclization to the corresponding spirooxazolinone 4'-enol ethers when treated with alkylchlorocarbonates. The respective N-amyl derivatives of the spiranes 8a and 8b were obtained with n-pentyl bromide in the presence of KF. A new method for the synthesis of steroid 17 alpha-hydroxy-17-carboxyesters and 17 alpha-hydroxy-17-carboxamides is described. Attempts to synthesize the title compounds from these products were unsuccessful.

X-ray structure analysis of 3,11,17-trioxoandrostane-5 alpha-carbonitrile and of 17 alpha-ethoxycarbonyloxy-3-oxoandrost-4-ene-17-carbonitrile.

The crystal and molecular structures of the title compounds were determined by x-ray diffractometric analysis. Torsion angles and puckering parameters are reported for both compounds. In 1 the 5 alpha-cyano group influences the A-ring conformation. The carbonate ester 3 crystallizes in the monoclinic P2(1) space group with two molecules (I and II) in the asymmetric unit. The D-ring conformation is to some extent different between I and II.

[Heart valve prosthesis and pregnancy]. / Prothèses valvulaires cardiaques et grossesse.

Sixteen pregnancies were followed up in 13 patients with prosthetic heart valves: 8 pregnancies went to term under oral anticoagulation, 4 under heparin and 4 without anticoagulation. 9 healthy normal children were delivered; there were 2 still births and 5 abortions. On the maternal side 3 haemorrhages and thromboembolic episodes which involved 2 patients on heparin, one of whom died, were observed. The following points are apparent from our observations and a review of the existing medical literature: --the risk of thromboembolism is not increased. The marked clotting tendency of maternal blood post-partum contraindicates the withdrawal of anticoagulants during this critical period; --haemorrhagic complications are common with anticoagulants; --foetal loss is greatly increased; --the teratogenecity of vitamin-K antagonists is certain, but the risk is small. The problems of anticoagulation are discussed; theoretically heparin should be given during the 1st trimestre and from the 38th week to the second post-partum week. The patients should be closely supervised by both obstetrician and cardiologist and hospitalisation is advised for the last month of pregnancy. Normal vaginal delivery is usually possible.

[Diabetic fibrous mastopathy]. / La mastopathie fibreuse diabétique.

Diabetic fibrous mastopathy was first described in 1984. This mastopathy usually occurs in patients with autoimmune disorders and often occurs in patients with insulin-dependent diabetes. Little is known about this benign condition. Clinically and radiologically, this entity may simulate malignancy. The presence of an underlying auto-immune disorder or diabetes may suggest the correct diagnosis. The authors report two cases of fibrous mastopathy and suggest that core biopsy could replace surgical biopsy for diagnosis.

[Pelvic ganglioneuroma. Case report]. / Ganglioneurome pelvien. A propos d'un cas.

Ganglioneuroma is a neurogenic tumor originating from autonomic ganglia. It most commonly occurs in patients younger than 20 years with a slight predominance of females. The pelvic localization is rare. Imaging can lead to diagnosis but it is not specific. The diagnosis can only be confirmed by the pathologic study. The authors report one case of pelvic ganglioneuroma diagnosed in an 11-year-old child who also had hypertension and renal failure.

[Term pregnancy in a rudimentary uterine horn with a live infant. An unusual case report]. / Grossesse à terme dans une corne utérine rudimentaire avec enfant vivant. Une observation exceptionnelle.

We present a rare case history of a pregnancy that went to term and was followed by the birth of a live baby in a ruptured rudimentary horn of the uterus. The diagnosis was made when caesarean section was carried out past term in a primiparous woman who had been followed in the antenatal clinic. The child who is now 5 months of age was born live. A review of the literature has produced two similar cases by O'Leary and Bourgeois. After reviewing briefly the embryological, anatomical and physiological factors we have discussed how difficult it is to make a diagnosis before operation.

[Severe epistaxis during pregnancy. A case history (author's transl)]. / Les épistaxis graves au cours de la grossesse.

We report on a case of severe epistaxis in pregnancy with maternal collapse and fetal death. A few similar cases have been published in the literature. These epistaxis happen towards the end of the pregnancy and occur with hyperaemia of the nasal mucosa, which is very probably hormone dependent. Delivery or death of the fetus brings about immediate cessation in the bleeding. The mother's life and that of the fetus can be jeopardised because of the severity of the bleeding or its recurrence, which makes it a very severe condition. When local treatment is useless in such a case two radical treatment have to be considered: the one is surgical, and is ligature of the sphenopalatine artery, and the other is obstetrical, and is termination of the pregnancy (which brings to an end the aetiological factor).

[Von Recklinghausen's neurofibromatosis and pregnancy. Apropos of a case]. / Neurofibromatose de von Recklinghausen et grossesse. A propos d'un cas.

Having seen a personal case and having reviewed the literature, we clarify the details when neurofibromatosis and pregnancy occur together. Few cases of this combination of conditions have been reported. The complications can be serious and have led some authors to suggest that the pregnancy should be terminated in every case and that the patient should be sterilised. Sometimes the only risk is hypertension of pregnancy, which is what occurred in our case. Its progress was benign and according to the literature this seems to be the most usual outcome. All the same, because it is possible that complications can occur in any case of neurofibromatosis in pregnancy, pregnant women with neurofibromatosis should be placed in a high-risk group which has to be watched very carefully.

[Pelvic echinococcus in Tunisian women. 12 cases histories (author's transl)]. / L'échinococcose pelvienne chez la femme en Tunisie. A propos de 12 cas.

We have seen 12 cases of pelvic echinococcus in the Gynaecological and Obstetric Department of the Charles Nicolle Hospital in the last 10 years. These case histories have been worked up into a thesis. The frequency of this infection in a country like ours where it is endemic, and the rarity of its localisation in the pelvis among other sites has persuaded us to report the conclusions of this study. It recalls the difficulties of the diagnosis and of the treatment of pelvic hydatid disease.

[Maternal mortality at the Charles Nicolle Hospital Maternity Department in Tunis between 1972 and 1975. With the exclusion of abortions (author's transl)]. / La mortalité maternelle à la maternité de l'hôpital Charles Nicolle à Tunis de 1972 à 1975. Avortements exceptés.

The change in maternal mortality during the time of pregnancy, labour and the puerperium is similar in our department to that reported in many countries. The overall figure for maternal mortality between 1972 and 1975 is 0.54 per 1000 (54 per 100,000 deliveries. This is a halving of numbers as compared with our previous statistics. This improvement can be ascribed to several factors, which are increased in number and quality of medical and para-medical personnel, and the better environmental factors of the inhabitants of the region. On the other hand if mortality is looked at in relationship to aetiology, there has been no change in the order of the causes, which are principally haemorrhage and eclampsia. The former is avoidable in most cases by better prevention and blood replacement, which has to be fought for. The second, in spite of the drop of 50%, remains very worrying. Improvement in the prognosis for the mother depends on measures that are taken such as better equipment of maternity departments and informing and educating pregnant women.

[Gastro-duodenal ulcers with pregnancy. Condition of shock in labour due to intestinal haemorrhage from an ulcer (author's transl)]. / Ulcère gastro-duodénal et grossesse. Etat de choc en cours de travail, par hémorragie digestive d'origine ulcéreuse.

We present the case of a multiparous woman of 32 years of age who, at term after a more or less normal pregnancy, went into severe shock in labour. The patient in this case was very difficult to diagnose. Her life was only saved after massive blood transfusions and after delivering a fresh stillborn infant. It was not a case of uterine rupture nor of retro-placental haemorrhage. The site of origin of the hypovolaemic shock was intestinal. The patient had an ulcer of the pylorus which was diagnosed after fibroscopy. Some authors state that it appears that the few ulcers that have been diagnosed before pregnancy go into remission during pregnancy. All the same it would appear that sometimes very serious complicated ulcers which have to be treated with great respect do occur, especially in toxaemic patients at the end of pregnancy, and these carry with them a significant mortality both for the mother and the fetus. Although medical treatment (resuscitation) is essential, surgery should be resorted to if necessary because it may save the mother and sometimes the infant and so improve the prognosis of complicated ulcers occurring in pregnancy.

[3 cases of uterine inversion. Description of a new technic for the management of this complication]. / A propos de trois cas d'inversion utérine. Description d'une technique originale pour la cure de cette complication.

We report three cases of complete inversion of the uterus following delivery. One became chronic and this gave rise to the need for surgical cure, which consisted in carrying out a midline hysterotomy longitudinal and sagital, without reaching down to the cervix. The two halves of the body of the uterus which resulted were reduced easily one after the other. The hysterotomy was then sewn up correctly.