Pattern forming systems coupling linear bulk diffusion to dynamically active membranes or cells.

Some analytical and numerical results are presented for pattern formation properties associated with novel types of reaction-diffusion (RD) systems that involve the coupling of bulk diffusion in the interior of a multi-dimensional spatial domain to nonlinear processes that occur either on the domain boundary or within localized compartments that are confined within the domain. The class of bulk-membrane system considered herein is derived from an asymptotic analysis in the limit of small thickness of a thin domain that surrounds the bulk medium. When the bulk domain is a two-dimensional disk, a weakly nonlinear analysis is used to characterize Turing and Hopf bifurcations that can arise from the linearization around a radially symmetric, but spatially non-uniform, steady-state of the bulk-membrane system. In a singularly perturbed limit, the existence and linear stability of localized membrane-bound spike patterns is analysed for a Gierer-Meinhardt activator-inhibitor model that includes bulk coupling. Finally, the emergence of collective intracellular oscillations is studied for a class of PDE-ODE bulk-cell model in a bounded two-dimensional domain that contains spatially localized, but dynamically active, circular cells that are coupled through a linear bulk diffusion field. Applications of such coupled bulk-membrane or bulk-cell systems to some biological systems are outlined, and some open problems in this area are discussed. This article is part of the theme issue 'Recent progress and open frontiers in Turing's theory of morphogenesis'.

Operative versus conservative treatment for giant omphalocele: Study of French and Ivorian management.

INTRODUCTION: The giant omphalocele is currently a surgical challenge. The morbidity and mortality associated with its care is non-negligible. Nowadays, different studies have revived the debate between conservative and surgical management for giant omphalocele. The purpose of this study is to compare the conservative and surgical management of the giant omphalocele in terms of morbidity and mortality. METHODS: Retrospective study including all giant omphaloceles comparing surgical management (French University hospital centers) and tanning (Ivory Coast University hospital center). Epidemiology was studied as well as medical and surgical managements both intra and post operative. RESULTS: One hundred and forty-seven patients included (98 patients in the "tanning" group and 49 in the "surgery" group). Hospital length of stay is significantly shorter in the "tanning" group as they do not spend time in intensive care unit. Morbidity is higher in "surgery" group. The average duration for oral empowerment was acquired at 179 days in the "surgery" group, whereas in the "tanning" group 90% was immediately and exclusively breastfed. No significant differences in terms of epithelialization time. CONCLUSION: The tanning treatment has its own place in the therapeutic arsenal in the management of the giant omphalocele no matter where it takes place. However, its realization in surgical environments prevents certain complications related to the technique or the pathology.

Combined use of two supervised learning algorithms to model sea turtle behaviours from tri-axial acceleration data.

Accelerometers are becoming ever more important sensors in animal-attached technology, providing data that allow determination of body posture and movement and thereby helping to elucidate behaviour in animals that are difficult to observe. We sought to validate the identification of sea turtle behaviours from accelerometer signals by deploying tags on the carapace of a juvenile loggerhead (Caretta caretta), an adult hawksbill (Eretmochelys imbricata) and an adult green turtle (Chelonia mydas) at Aquarium La Rochelle, France. We recorded tri-axial acceleration at 50 Hz for each species for a full day while two fixed cameras recorded their behaviours. We identified behaviours from the acceleration data using two different supervised learning algorithms, Random Forest and Classification And Regression Tree (CART), treating the data from the adult animals as separate from the juvenile data. We achieved a global accuracy of 81.30% for the adult hawksbill and green turtle CART model and 71.63% for the juvenile loggerhead, identifying 10 and 12 different behaviours, respectively. Equivalent figures were 86.96% for the adult hawksbill and green turtle Random Forest model and 79.49% for the juvenile loggerhead, for the same behaviours. The use of Random Forest combined with CART algorithms allowed us to understand the decision rules implicated in behaviour discrimination, and thus remove or group together some 'confused' or under--represented behaviours in order to get the most accurate models. This study is the first to validate accelerometer data to identify turtle behaviours and the approach can now be tested on other captive sea turtle species.

Norepinephrine infusion improves haemodynamics in the preterm infants during septic shock.

AIM: This study evaluated the clinical and haemodynamic effects of norepinephrine infusion in preterm infants. METHODS: The effects of norepinephrine therapy for refractory hypotension were evaluated in preterm infants between April 2009 and April 2011 at the neonatal intensive care unit of Sainte-Justine Hospital, Montreal, Quebec. Changes in haemodynamics and clinical parameters were analysed eight hours before and eight hours after the start of norepinephrine infusion, and eight hours after its cessation. RESULTS: During the study, 30 preterm infants at a mean gestational age of 26.5 ± 2.6 weeks (median: 25.7, 23.4-34) and birthweight of 903 ± 437 g (median 827, 450-2550) received norepinephrine infusion for neonatal septic shock. After eight hours of treatment, mean blood pressure, urine output and FiO2 significantly improved. Eight hours after cessation of norepinephrine infusion, the number of patients treated with other inotropes decreased significantly, 24 patients (80%) had normal mean blood pressure and 27 patients (90%) had normal urine output. CONCLUSION: Norepinephrine therapy could be considered to improve blood pressure and urine output during neonatal septic shock in preterm infants. Further studies are needed to prove the efficacy and safety of norepinephrine infusion in neonates.

Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial†.

Background: In children younger than 4 yr, it is difficult to distinguish the cause of postoperative distress, such as thirst, pain, and emergence delirium. This may lead to inappropriate treatment, such as administration of opioids. The aim of this study was to evaluate the influence of early postoperative oral fluid intake on the use of opioid analgesics and the incidence of postoperative vomiting (POV) after paediatric day case surgery. Methods: After ethics committee approval and with parental informed consent, planned day surgery patients aged 6 months to 4 yr were randomized to the liberal group (LG), in which apple juice (10 ml kg−1) was offered first if the Face Legs Activity Cry COnsolability (FLACC) score was ≥4 in the PACU, or to the control group (CG), in which children were treated after surgery according to the institutional opioid protocol, and drinking was allowed only upon the return to the ward. Bayesian statistical analysis was used to compare POV incidence and opioid use across groups. Results: Data from 231 patients were analysed. The incidence of POV in the LG and the CG was 11.40 and 23.93%, respectively. An opioid was needed in 14.04% (mean total dose: 0.18 mg kg−1) and 35.89% (mean total dose: 0.20 mg kg−1) of the patients in the LG and the CG. The PACU stay was 53.45 and 65.05 min in the LG and the CG, respectively (all differences were statistically significant). Conclusions: In our paediatric outpatient setting, early postoperative oral fluid intake was associated with a reduction in opioid use and POV incidence. These results deserve confirmation in other settings. Clinical trial registration: NCT02288650.

Hypospadias.

Hypospadias is a hypoplasia of the tissues forming the ventral side of the penis responsible of an ectopic meatus of the urethra. This congenital anomaly results in a fusion defect of the two epithelial surfaces of the urethral groove between the 11th and the 18th weeks of development. The earlier this process arrests, the more the form is proximal and severe. This is the second genital malformation in boys with 1 case per 250 male births. Its origin is often multifactorial (genetic, endocrine, placental and environmental). Three anatomical forms exist: proximal, middle and distal (the most common). Additional exams (endocrine, genetic and morphological) are realized early, before surgery, in case of severe hypospadias, familial, associated with cryptorchidism, bifid scrotum, micropenis and/or skeletal, kidney, and/or heart abnormalities. It clarifies pubertal prognosis. The surgical management is made between 6months and 12months: it limits the functional and aesthetic impact of this malformation. Many surgical techniques are described. They all have in common the three operating time: penile straightening, urethroplasty, reconstruction of the ventral side of penis. They are based on direct sutures, local flaps pedicled, and grafts (skin or mucosa). The rate of postoperative complications is between 6 and 30 %. The two main complications are fistulae and stenoses. The psychological follow-up of these children is necessary to adulthood. Surgery of hypospadias remains a delicate surgery and must be performed by experienced surgeons.

[Breast cancer screening program in France: for optimization of the information]. / Dépistage organisé du cancer du sein en France : pour une optimisation de l'information.

BACKGROUND: Based on international and national recommendations, organized breast cancer screening in France raises questions of medical ethics built around the key concepts of individual autonomy and public health policy. Because of the evolving knowledge, professionals and institutions involved in the program must review the ethical values associated with this medical practice. METHODS: The ethical aspects of organized breast cancer screening were studied. In response to newly acquired knowledge highlighted by a review of texts governing this practice in France, proposals for changes resulting from reflections of a working group coordinated by the National Cancer Institute are presented. RESULTS: Ethical issues raised by screening must find expression in the general principles of the program's organization: acceptability of screening, efficiency, adverse effects, equity of access, free care…, but also at different stages of the procedure: information delivery, first and second invitations, refusal of further diagnostic investigation… CONCLUSION: A better match between breast cancer screening and recently developed knowledge requires optimal information delivery to women targeted by the program as well as a stronger role for the referring healthcare professional.

Is an ellipsoid surface suitable to model the scapulothoracic sliding plane?

Closed loop kinematic chain approaches are commonly used to assess scapular kinematics but with heterogeneous ellipsoid calibration procedures. This study aimed to assess whether an ellipsoid surface can model the scapulothoracic sliding plane and determine the optimal number of static poses to calibrate the ellipsoid parameters. An intracortical pin with a rigid cluster of four reflective markers was inserted into the left scapular spine of two healthy males (P1 and P2). They performed arm elevations, internal rotations, ball throwing, hockey shooting, and eating movements. Ellipsoid radii and center location were functionally calibrated for each participant and each movement, either based on all frames of a movement or based on a reduced number of frames (from 3 to 200 equally position-distributed frames). Across both participants and all movements, ellipsoid radii varied up to 10.2 cm, 3.9 cm, and 18.4 cm in the antero-posterior, medio-lateral, and cranio-caudal directions, respectively. When all frames of a movement were considered for calibration, the median scapula-to-ellipsoid distance was, on average, 0.52 mm and 0.38 mm for P1 and P2, respectively. When only five frames were considered for ellipsoid calibration, the scapula-to-ellipsoid median distance slightly increased with 0.57 mm and 0.47 mm for P1 and P2, respectively. To conclude, this study highlights that an ellipsoid surface may effectively be appropriate to model the scapulothoracic sliding plane, especially when the calibration is functional, participant- and movement-specific. Furthermore, the number of poses required for the ellipsoid calibration can be reduced to five, minimizing the experimental cost.

Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

High incidence but low burden of coronaviruses and preferential associations between respiratory viruses.

Respiratory viruses are the leading cause of acute infections in humans. However, the burden of certain respiratory viruses, such as coronaviruses, and the relevance of viral coinfections remain unclear. In this study, we investigated the distribution and seasonal occurrences of respiratory viruses detected by multiplex molecular assay in 6,014 samples from 2008 to 2011 in a French hospital. We assessed the detection frequencies of 14 respiratory viruses and their clinical impact in immunosuppressed and nonimmunosuppressed patients. Furthermore, we explored the preferential association patterns between respiratory viruses in multiple infections. Our results indicated that human rhinovirus/enterovirus (HRV/EV) and coronavirus (HCoV) were frequently detected in respiratory samples (48.81% and 11.74% of infected samples, respectively), and the detection frequencies of these viruses were further increased in immunosuppressed patients. The most common subtypes of HCoV were HCoV-229E (33.80%) and HCoV-HKU1 (32.39%). A sharp increase in the detection frequencies of HCoV-229E and HCoV-HKU1 over several months suggested that these subtypes were epidemic in our population. In immunosuppressed patients, HCoV contributed to upper respiratory tract infections (52%). Evidence did not support lower respiratory tract infections exclusive to a unique HCoV infection. In multiply infected individuals, determined in 6.3% of samples, HRV/EV and HCoV were detected in 33.29% and 22.90% of samples, respectively. Interestingly, nearly 50% of HCoV infections were detected in association with another virus. Since the distributions of respiratory viruses in multiply infected patients were subject to preferential association patterns between viruses, we propose complex interactions between different respiratory viruses and host factors.

[Chondrodermatitis nodularis chronica helicis: a descriptive study of 99 patients]. / Nodule douloureux de l'oreille : étude descriptive de 99 cas.

BACKGROUND: Painful nodule of the ear was described at the start of the 20th century as a form of chronic chondrodermatitis nodularis helicis (CNH). It comprises a painful erythematous papule or nodule appearing on the ear and adhering to cartilage, and which may or may not have a central scab. The aim of this study was to describe the clinical characteristics of CNH as well as the population currently affected by such lesions, and to identify predisposing factors. The secondary aim was to describe treatments commonly used in private dermatological practice and to examine their efficacy. MATERIALS AND METHODS: Questionnaires were sent out to private dermatologists belonging to the Association d'information post-universitaire en dermato-vénérologie de Strasbourg [Association for post-university information in dermatology-venerology] in Strasbourg. Patients were included in the study if they consulted for CNH, clinically diagnosed as such by the dermatologist. The questionnaire was used to analyze the age, gender and phototype of patients, as well as pain assessed on a numeric scale, duration, site, supposed trigger factors, treatment and outcome after treatment. RESULTS: A total of 99 patients was included by 27 dermatologists between March 2010 and October 2011, mainly men (sex-ratio: 1.6). The mean age was 65 years. Patients had no significant previous history. Pain was moderate in 23 patients, severe in 59 and unbearable in 14; in most patients it was brought on by provocation (78 patients). The right ear was affected in 48 patients and the left ear in 39. CNH had been present for a mean 14 months. The most common site was the upper/horizontal section and the angle of the helix of the ear (62 patients). Exposure to sunlight or to cold were the predisposing factors most frequently mentioned (56 patients). Medical treatment was given for 52 patients, and resulted in cure of almost half of this population. Surgery was performed in 34 patients, with only one case of relapse. DISCUSSION: Our study shows that the current population of subjects with CNH is comparable with that described in the literature. New professional and technological apparatus appearing in recent decades (hearing aids, headphones and in-ear headphones, crash helmets) result in continual trauma to the ear and could favour the onset of CNH. The treatment most commonly given by dermatologists is non surgical, which may be effective in certain patients. Analgesic treatment and removal of factors responsible for trauma are also important in management.

Influence of marker weights optimization on scapular kinematics estimated with a multibody kinematic optimization.

Scapular kinematic estimates are altered by soft tissue artefacts, therefore experimental and numerical methods should be developed to improve their accuracy. This study aimed to assess the influence of weights applied to the scapula markers within a closed-loop multibody kinematic optimization on scapular kinematic estimates. Fifteen healthy volunteers performed static postures mimicking analytical, daily living and sport movements. Scapulo-thoracic angles were computed either from a scapula locator as the reference, or from a closed-loop multibody-kinematic optimization (MKO) including a participant-specific point-on-ellipsoid scapulothoracic joint. Weights applied to scapula markers in the MKO were optimized to minimize the difference in scapular orientation from the reference. Optimizing weighting sets significantly (p < 0.0001) improved scapular orientation from 0.9° to 12.1° in comparison to scapular kinematics estimated with non-optimized weighting sets. The mean optimized weighting set contained no neglectable weight for all markers from the acromion to the medial border of the scapular spine but showed no significant difference (p = 0.547) compared to homogeneous weights. Optimized weighting sets were participant- and movement- specific. To conclude, homogenous weights applied on redundant markers located from acromion to scapular medial border spine are recommended when estimating scapular kinematics in upper limb MKO.

Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study.

BACKGROUND: People with mental disorders face frequent stigmatizing attitudes and behaviors from others. Importantly, they can internalize such negative attitudes and thus self-stigmatize. Self-stigma is involved in diminished coping skills leading to social avoidance and difficulties in adhering to care. Reducing self-stigma and its emotional corollary, shame, is thus crucial to attenuate the negative outcomes associated with mental illness. Compassion-focused therapy (CFT) is a third-wave cognitive behavioral therapy that targets shame reduction and hostile self-to-self relationship and allows for symptom improvement while increasing self-compassion. Although shame is a prominent part of the concept of self-stigma, the efficacy of CFT has never been evaluated in individuals with high levels of self-stigma. The purpose of this study is to evaluate the efficacy and acceptability of a group-based CFT program on self-stigma, compared to a psychoeducation program for self-stigma (Ending Self-Stigma) and to treatment as usual (TAU). We hypothesize that diminished shame and emotional dysregulation and increased self-compassion will mediate the relationship between self-stigma improvements post-therapy in the experimental group. METHODS: This seven-center trial will involve 336 participants diagnosed with a severe mental illness and/or autism spectrum disorder and reporting high levels of self-stigma. Participants will be randomized into one of three treatment arms: 12 week-treatment of compassion-focused therapy (experimental arm), 12 week-treatment of Psychoeducation (active control arm), and TAU (treatment as usual-passive control arm). The primary outcome is the decrease of self-stigma scores on a self-report scale, i.e., ISMI, at 12 weeks. Secondary endpoints include sustainability of self-stigma scores (ISMI) and self-reported scores regarding target psychological dimensions, e.g., shame and emotional regulation, social functioning, and psychiatric symptoms. Assessments are scheduled at pretreatment, post-treatment (at 12 weeks), and at 6-month follow-up. Acceptability will be evaluated via (i) the Credibility and Expectancy Questionnaire at T0, (ii) the Consumer Satisfaction Questionnaire for Psychotherapeutic Services posttreatment and at 6-month follow-up, (iii) attendance, and (iv) dropout rates. DISCUSSION: This study will evaluate the potential efficacy and acceptability of a group-based CFT program on the decrease of self-stigma and thereby contribute to the continuing development of evidence-based therapeutic interventions for the internalized stigma of mental and neurodevelopmental disorders. TRIAL REGISTRATION: ClinicalTrials.gov NCT05698589. Registered on January 26, 2023.

How large the number of redundant copies should be to make a rare event probable.

The redundancy principle provides a framework to study how rare events are made possible with probability 1 in accelerated time, by making many copies of similar random searchers. However, what is a large n? To estimate large n with respect to the geometrical properties of a domain and the dynamics, we present here a criterion based on splitting probabilities between a small fraction of the exploration space associated with an activation process and other absorbing regions where trajectories can be terminated. We obtain explicit computations especially when there is a killing region located inside the domain that we compare with stochastic simulations. We also present examples of extreme trajectories with killing in dimension 2. For a large n, the optimal trajectories avoid penetrating inside the killing region. Finally, we discuss some applications to cell biology.

An evaluation of indices of gross pathology associated with the nematode Anguillicoloides crassus in eels.

This study compares two alternative indices for quantifying the gross pathology of the swimbladder of eels, Anguilla anguilla (L.), infected with the nematode Anguillicoloides crassus. Two observers recorded twice the scores obtained by the two indices on the same set of 71 wild caught eels (from elver to silver eels, French Mediterranean lagoons). The Length Ratio Index (LRI), performed better than the Swimbladder Degenerative Index (SDI), in three of four predefined criteria of decision. First, the LRI better correlated with an estimate of the swimbladder volume reduction, a functional consequence of the infection (representativeness). Also, the LRI was less prone to subjectivity (inter-observer variability) and more precise (intra-observer variability), although less easy to generate (time needed for measurement/assessment). Using a sub-sample of 32 unaffected eels (showing minor if any swimbladder damage and no living worms at autopsy), we ascertained a linear relationship between the swimbladder length and the total body length, a prerequisite of isometric growth, to definitively accept the new ratio index as a valid alternative to the SDI. Also, because the LRI can be recorded on live specimens with radio-imagery (non-invasive method), we recommend its use, and provide a graph of correspondence between the SDI scores, the LRI scores and the estimated proportion of gas loss in the swimbladder.

Risk of septic spread during surgical management of digital flexor tendon sheath phlegmon: Exsanguination by mechanical compression versus simple elevation.

This study aimed to demonstrate that there was no risk of extension of infection in performing mechanical exsanguination before inflating the tourniquet for surgical treatment of digital flexor tendon sheath phlegmon. The series comprised 96 patients, with a mean age of 47 years (range, 18-87 years) and 37 women. Group I included 47 patients in whom exsanguination was performed with a Velpeau band before inflating the pneumatic tourniquet at the root of the limb. In Group II, which included 49 patients, the tourniquet was inflated after simple elevation of the limb. Six patients underwent revision surgery for recurrence or osteoarticular complications: 4 (8.5%) in Group I and 2 (4.1%) in Group II, the difference between two groups being non-significant (p = 0.6378). In conclusion, mechanical exsanguination before inflating the tourniquet did not incur risk of complications in surgical management of digital flexor tendon sheath phlegmon.

Use of cutaneous flap for continent cystostomy (daoud technique).

PURPOSE: We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy. MATERIALS AND METHODS: A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated. RESULTS: Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%. CONCLUSIONS: We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

Huge intramedullar neurenteric cyst with intrathoracic development in a 1 month-old boy: excision though the anterior approach. A case report and review of the literature.

Spinal neurenteric cyst is a rare congenital lesion that may occur either alone or in the context of a complex malformative disorder. Our case is unusual because of its rare intramedullary location, the association with an important intrathoracic development, and the age of the child at presentation (1 month). An anterior approach through a right-sided lateral thoracotomy was performed for a total resection of the intrathoracic part and a subtotal resection for the intramedullar portion. During 2 years of follow-up, the child presented no neurological deficit and post-operative magnetic resonance imaging found a small residue fixed on the anterior spinal cord without progression.

[Acute idiopathic scrotal oedema in young boys: A report of ten cases and a review of the literature]. / Œdème aigu scrotal idiopathique de l'enfant : présentation d'une série de dix cas et revue de la littérature.

BACKGROUND: acute idiopathic scrotal oedema (AISO) is most commonly seen in boys aged between 5 and 10 years. It comprises a benign dermatosis of spontaneously favourable outcome but requiring surgical exploration in some cases in order to rule out testicular torsion. Our retrospective study of a series of 10 children presenting AISO allowed us to set out the specific features of this dermatological disorder well-known to paediatric surgeons, but concerning which only one publication exists in the dermatology literature. PATIENTS AND METHODS: this was a retrospective study of the files of all children seen in the paediatric surgery department of Reims University Hospital between 1996 and 2008 for acute scrotal oedema. Diagnosis of AISO was made on the basis of clinical criteria after ruling out potential differential diagnosis. The demographic, clinical and laboratory data were collated from patient files. Long-term outcome was determined by means of telephone calls. RESULTS: among 185 cases of acute scrotal disease, 10 cases of AISO (5.4%) were identified. The mean age at onset of the initial episode was 6 years (range: 3 to 12 years). Oedema was unilateral in eight cases and bilateral in two cases; there was involvement of the inguinal folds, the perineum and the homolateral buttock in three cases, and of the penis in one case. The skin was erythematous and relatively non-inflamed in all but one case. Non-focal scrotal pain was present on palpation in nine cases. General health status was unimpaired and none of the children presented any associated signs. White cell count was between 7000 and 12000 per millimeter cube, with no neutrophil polynucleosis or inflammatory syndrome; in three cases, hypereosinophilia was between 700 and 2300 per millimeter cube. Two patients underwent surgical exploration to rule out testicular torsion; Doppler ultrasound was performed in the remaining eight cases and no surgery was required in six cases. In all cases, a favourable outcome was attained within 2 to 3 days and there were no sequelae. Five children presented a total of 21 recurrences (between three and eight per child) over a maximum period of 12 years. DISCUSSION: the clinical characteristics of our patients are entirely consistent with the descriptions given in the literature. The chief problem with AISO is differential diagnosis; in this respect, Doppler ultrasound may be useful in obviating surgical investigation for testicular torsion. Treatment involves bed rest and analgesics where necessary; a rapidly favourable outcome is achieved within 2 to 3 days, but relapse occurs in at least 20% of cases, although these were more frequent and more numerous in our series. The aetiopathogenesis has not yet been fully elucidated. CONCLUSION: Identification of AISO, a fairly stereotypical though misunderstood diagnostic entity, is useful in order to avoid unwarranted medical treatment and, above all, unnecessary surgical exploration.

Development of a positron probe for localization and excision of brain tumours during surgery.

The survival outcome of patients suffering from gliomas is directly linked to the complete surgical resection of the tumour. To help the surgeons to delineate precisely the boundaries of the tumour, we developed an intraoperative positron probe with background noise rejection capability. The probe was designed to be directly coupled to the excision tool such that detection and removal of the radiolabelled tumours could be simultaneous. The device consists of two exchangeable detection heads composed of clear and plastic scintillating fibres. Each head is coupled to an optic fibre bundle that exports the scintillating light to a photodetection and processing electronic module placed outside the operative wound. The background rejection method is based on a real-time subtraction technique. The measured probe sensitivity for (18)F was 1.1 cps kBq(-1) ml(-1) for the small head and 3.4 cps kBq(-1) ml(-1) for the large head. The mean spatial resolution was 1.6 mm FWHM on the detector surface. The gamma-ray rejection efficiency measured by realistic brain phantom modelling of the surgical cavity was 99.4%. This phantom also demonstrated the ability of the probe to detect tumour discs as small as 5 mm in diameter (20 mg) for tumour-to-background ratios higher than 3:1 and with an acquisition time around 4 s at each scanning step. These results indicate that our detector could be a useful complement to existing techniques for the accurate excision of brain tumour tissue and more generally to improve the efficiency of radio-guided cancer surgery.