Pulvinar and pubic cartilage measurements to refine universal ultrasound screening for developmental dysplasia of the hip: Data from 1896 infant hips.

PURPOSE: Screening modalities for Developmental Dysplasia of the Hip (DDH) and indications for treatment of mild forms remain controversial. Ultrasound (US) measurement of the pubofemoral distance (PFD > 6 mm, composed of the pubic cartilage and the pulvinar) can avoid late diagnoses of DDH. A thick pubic cartilage may nevertheless lead to false positives. The purpose of this study was to establish standard measurements of pubic cartilage and pulvinar, through universal US screening, to lower false positive results and thus any overtreatment. METHODS: This is a single-center observational prospective study conducted from December 2016 to January 2018, on infants who underwent universal US screening for DDH. The only inclusion criterion was an adjusted age between 4 and 12 weeks when US was realized. PFD measurement was made using the Couture and Tréguier method. In addition, thicknesses of pubic cartilage and pulvinar were measured on the same US section, in millimeters. RESULTS: Nine hundred and forty-eight patients, representing 1896 hips, were included. The average value of pubic cartilage thickness was 1.25 mm ±â€¯0.58 mm, with an upper threshold of 2.39 mm (+1.96σ). The average value of pulvinar thickness was 2.67 mm ±â€¯0.78 mm, with an upper threshold of 4.20 mm (+1.96σ). We found high inter-observer reproducibility in pubic cartilage measurements. CONCLUSION: Systematic measurements of pubic cartilage and pulvinar may refine therapeutic decision by identifying false positives. Patients with increased PFD due to a thick pubic cartilage >2,39 mm, without an associated pulvinar enlargement (<4,20 mm), could be therefore only monitored and not overtreated.

Renal artery embolization in a child with delayed hemodynamic instability from penetrating knife wound.

Penetrating laceration injury in the pediatric population may present as an acute or delayed life-threatening injury. Although emergent intra-arterial embolization is commonly utilized in adults, few cases have been reported for children. Surgical treatment for severe renal laceration injuries may require complete nephrectomy; an unfortunate outcome for a pediatric patient if a renal-preserving alternative is feasible. We present a case of penetrating renal laceration in a 10-year-old boy treated with intra-arterial embolization of the lacerated dominant renal artery and subsequent renal perfusion by an uninjured accessory renal artery allowing for renal preservation.

Influence of human impacts on Albeluvisol analysed by X-ray microfluorescence: relative evolution of the transforming front at the tongue scale.

In this paper we studied the nature and hierarchy of the processes responsible for soil evolution as a function of land use (forest and culture). Albeluvisols were chosen as a pedological model for this study. Iron, manganese, calcium, potassium and trace elements were used as indicators of the soil processes. Their spatial distribution was mapped along tongues of Albeluvisols at a pluri-centimetric scale, using X-ray microfluorescence. In both land use, Fe distribution was shown to be closely related to the soil colour variation along the tongues. Nickel and Cu followed the same distribution. Zinc was almost functioning as Fe with the difference that this element was not lost from the transition zone identified between the bleached tongues and the ochre volumes representative of the illuvial horizon. Under forest, the Fe and Mn redox fronts were closely associated that allows mapping them on the same thin section. Manganese disappeared from the neighbourhood of the iron redox front under agriculture. This was interpreted as a slow down of the iron redox process due to pH increase while Mn redox process was not modified. In addition, under forest, Ca seems totally leached. Liming causes an increase of Ca concentrations in the whole soil profile. This Ca is in an exchangeable form principally located at the interface between white and ochre volumes. We concluded that by liming, Man induced drastic changes in the kinetic of redox process in Albeluvisols over 200 years showing at the same time the extreme rapidity of these processes.

[Prolactin adenoma developed during puberty. Diagnosis and long-term course. 9 cases]. / Adénomes à prolactine développés pendant la puberté. Diagnostic et évolution à long terme. 9 observations.

Nine patients (2 boys, 7 girls) with prolactinomas diagnosed at puberty were followed for 2 to 20 years. The presenting signs were sexual infantilism (n = 2), amenorrhea-galactorrhea (n = 6) and hypogonadism (n = 1). Growth retardation was also present in 3 cases. The pituitary tumor induced endocranial manifestations in only 2 cases, whereas a suprasellar extension was found in 5 cases with visual field defects in 2 cases. Initial prolactin levels ranged between 132 and 2,400 ng/ml and were unresponsive to TRH (n = 6/7). The hormonal work-up showed decreased GH (n = 4/4); LH, FSH (n = 9/9) or ACTH, TSH (n = 1/9) functions. Seven patients underwent trans-sphenoidal adenomectomy associated with dopaminergic agonist treatment. Two patients were treated with bromocriptine. In the long term, clinical signs (n = 6), hyperprolactinemia (n = 7) or prolactinoma (n = 4) persisted or recurred. These data stress the severity of this disease at this period of life, the therapeutic difficulties and the need for long term follow up of these patients.