Fetal facial bone growth: Post-mortem CT analysis.

OBJECTIVE: To describe and model the normal growth of fetal facial bones and angles. MATERIAL AND METHODS: A total of 118 fetal CT scans obtained at 19 to 41 weeks gestation after in utero fetal death or late miscarriage were analyzed. CT scan was followed by autopsy and pathological examination and only fetuses free from brain disease or abnormal craniofacial development were included. The measurements were taken using software for frontal, sagittal and 3D reconstruction from native axial sections. The optimal plane for bone analysis was chosen and the measurements made by multiplanar reconstruction. RESULTS: There was a statistically significant increase (P<0.001) in all measurements regardless of gestational age (GA) except those of the mandibulo-fronto-maxillary angle (P=0.412), the naso-mandibulo-maxillary angle (P=0.828) and mandibular width (P=0.86). There was no significant difference according to fetal sex. Based on these results, the corresponding growth curves were created. The anteroposterior mandibular diameter (APD) was very strongly correlated with GA (R=0.926, P<0.001). The following equation: GA=(8.187×APD)+4.257 can be used to estimate GA with a confidence interval (CI) of±2.42. The same applies to maxillary width (MW) (R=0.922; P<0.001). The equation GA=(11.059×MW)+7.571 can be used to estimate GA with a CI of 2.17. CONCLUSION: The growth of the mandible, maxilla, zygomatic bone and orbits was measured and the corresponding growth curves were established. Several measurements were strongly correlated with gestational age.

Study of the growth and shape of the brain and cranial base during the first two years of life.

Ontogeny of the cranial base and the brain integrates data on growth, maturation and ontogenetic allometry of these two systems in the course of development. The aim of our work was to study the ontogeny of the cranial base and the brain in order to understand their growth dynamic and shape changes using a traditional morphometric approach in individuals with normal (non-pathological) development. MATERIEL AND METHOD: Forty-seven infants having been included in the unexpected infant death french protocol were analyzed. Medical imaging (CT and MRI) exams, followed by an autopsy and pathology examination allowed us to include only infants free from brain disease or pathology affecting growth. RESULTS: Testing of measurement reliability validated 12 distances and 3 angles as well as the positioning of the landmarks that had been used to obtain the distances and the angles. No correlation between sex and the various variables studied was found. However, a correlation was observed between these variables and age, making it possible to propose a growth curve. A medium to strong correlation was found between brain variables and the bone variables of the cranial base, underlining the parallel development of the two systems. CONCLUSION: Our study, carried out in a rigorously selected population of infants, presents a fundamental approach to the study of ontogenesis.

Dermatoses associadas à infecção pelo vírus da imunodeficiência humana (HIV) em pacientes atendidos no conjunto hospitalar de Sorocaba / Skin diseases associated with human immunodeficiency virus (HIV) infection in patients treated at conjunto hospitalar de Sorocaba

As dermatoses são observadas em aproximadamente 90% dos pacientes infectados pelo HIV, podendo ser a primeira e, às vezes, a única manifestação que o paciente apresenta no curso da doença. Também podem servir como um parâmetro para classificar o estágio da Aids.Objetivos: O objetivo deste estudo é fazer uma análise da frequência e classificação etiológica das dermatoses presentes em pacientes portadores do vírus HIV atendidos no Ambulatório de Moléstias Infecciosas do Conjunto Hospitalar de Sorocaba, além de relacioná-las com o nível de linfócitos CD4+.Casuística e método: Estudo prospectivo, realizado no Conjunto Hospitalar de Sorocaba, em pacientes portadores do vírus HIV atendidos no Ambulatório de Moléstias Infecciosas que apresentavam dermatoses relacionadas. Foram avaliados 46 pacientes infectados pelo vírus HIV com dermatoses, com idade superior a 18 anos, no período de 26 de março a 19 de dezembro de 2008, realizados em mutirões mensais de dermatologia e infectologia.Resultados: Foram registradas 59 dermatoses, classificadas em 32 diagnósticos clínicos diferentes, ocorrendo mais de uma dermatose em 13 pacientes. Os cinco diagnósticos mais frequentes foram dermatite seborreica (8,48%), melasma (8,48%), prurigo (6,79%), psoríase (6,79%) e lipodistrofia (6,79%). As dermatoses também foram classificadas, de acordo com a lesão elementar encontrada, em eritêmato-descamativa (33,8%), pápula/placa (27,1%), atrófica/cicatricial (16,9%) mácula (13,5%), vesicobolhosa (3,5%), tumoral (3,5%) e exulceração/ulceração (1,7%).Conclusões: A dermatose mais frequente neste estudo foi a dermatite seborreica, dado que está de acordo com relatos nacionais e internacionais. O uso de antirretrovirais pela maioria dos pacientes estudados pode justificar a menor incidência de dermatoses neste estudo. Pode também justificar o encontro da lipodistrofia, efeito colateral da terapia antirretroviral, como o quinto diagnóstico mais frequente.

[Individual social characteristics, municipal environment and the prevalence of weight problems in early childhood: a multilevel analysis]. / Caractéristiques sociales individuelles, contexte résidentiel et prévalence des problèmes de poids dans la petite enfance: une analyse multiniveau.

BACKGROUND: Few studies have examined the prevalence of weight problems before the age of 5 years although this period is critical in the development of obesity. An inverse association between socio-economic status and weight problems is well documented in adult women but not for young children. Similarly several studies of adults and adolescents or older children show that the prevalence of weight problems is associated with the level of deprivation of the neighbourhood environment and the degree of urbanization, independent of social individual factors, even though this has not been examined for young children. METHODS: We evaluated prevalence rates of weight problems in children aged 3.5-4.5 years in southeastern France and their association with both individual social factors and municipal environment characteristics. Random stratified cluster sampling allowed us to select 112 nursery schools. Physicians from the early childhood protective services conducted a mandatory medical examination and collected data with a new questionnaire (EVALMATER), developed to standardise these examinations. Overweight and obesity were defined by international references after calculation of each child's BMI (kg/m(2)). We constructed a social disadvantage index to assess characteristics of the municipalities where the nursery schools were located and used multilevel analysis to study the associations of municipal characteristics (the disadvantage index and a urban/rural classification of the municipalities) with weight problems independently of individual socio-economic variables. RESULTS: The study included 2495/2959 (84.3%) children, with a mean age of 3.9+/-0.3 years. The prevalence of overweight was 8.2% (CI95%=7.1-9.3) and that of obesity 2.1% (CI95%=1.5-2.7). Prevalence of obesity was significantly higher in girls, only children, those who had not attended day-care before nursery school, whose mother was not employed, or whose father was not a white-collar-worker. Independently of these variables, it was also significantly higher among children who lived in urban areas or deprived municipalities. None of these factors were found associated with overweight alone. CONCLUSION: Actions of prevention in France should target parents of young children.

[Situations regarding the labour market for people suffering from chronic diseases]. / Situations à l'égard du travail des personnes atteintes de maladies chroniques.

BACKGROUND: This paper is aimed at investigating the extents to which illness modifies labour supply and employment conditions of people with chronic diseases (defined as severe diseases giving rise to 100% coverage of health expenditures by the Sickness Fund). METHODS: It is based on the data of 35073 individuals interviewed in the 2002-2003 French Decennial Health Survey, reporting their health, health care consumption and socioeconomic characteristics, and collected by the French National Institute of Statistics and Economic Studies. Models have been estimated with logistic strategies. RESULTS: Participation in labour market appears, all other things being equal, to be less important for people with chronic diseases. Chronic diseases are more deleterious for blue collar than for white collars workers. The probability to have a part-time job is raised by 60% for people with chronic diseases (100% for men, 50% for women). Suffering from chronic diseases raises the probability to have a desired part-time job rather than a full-time job by 80% (170% for men, 60% for women) and the probability to have an undesired part-time job rather than a full-time job by 50% (30% for men, 50% for women). For the elderly (50-65 years), chronic diseases multiply by three the probability to be out-of-work (and not retired), by two the probability to be retired and by 1.5 the probability to be unemployed compared to being employed. CONCLUSION: The consequences of chronic diseases on the workplace are not negligible, creating new social inequalities that the French social protection system does not seem to be able to completely cover.

Twiddler's syndrome with transvenous defibrillators in the pectoral region.

Advances in technology have enabled the implantation of defibrillators in the pectoral region. Complications encountered with pacemakers may also be observed with defibrillators. We describe two cases of twiddler's syndrome in patients with defibrillators implanted subcutaneously in the left pectoral region.

Predictors of fracture in the Accufix Atrial "J" lead.

The Accufix atrial lead has a "J"-shaped retention wire at the distal end that has been reported to fracture. Our findings suggest that the more deformed the J, the higher the incidence of fracture.