Neurological imaging of brain damages after radiotherapy and/or chimiotherapy.

Radiotherapy and chemotherapy may induce neurological toxicities with different appearances on CT and MRI scans. While optimized radiotherapy techniques have reduced some complications, new unwanted effects have occurred on account of therapeutic protocols involving the simultaneous use of radiotherapy and chemotherapy. Advances in radio-surgery, innovative anti-angiogenic therapies, as well as prolonged patient survival have led to the emergence of new deleterious side effects. In this report, we describe the early, semi-delayed, and late encephalic complications, while specifying how to identify the morphological lesions depending on the therapeutic protocol.

Per-subject characterization of bolus width in pulsed arterial spin labeling using bolus turbo sampling.

Quantification of cerebral blood flow using QUIPSSII pulsed arterial spin labeling requires that the QUIPSS saturation delay TI1 is shorter than the natural temporal bolus width. Yet the duration of the bolus of tagged spins entering the region of interest varies during vasoactive stimuli such as gaseous challenges or across subjects due to differences in blood velocity or vessel geometry. A new technique, bolus turbo sampling, to rapidly measure the duration of the inflowing bolus is presented. It allows to optimize the arterial spin labeling acquisition to ensure reliable quantification of perfusion while maximizing the arterial spin labeling signal by avoiding the use of unnecessarily short label durations. The average bolus width measured in the right and left middle cerebral artery territories using the bolus turbo sampling technique has a repeatability coefficient of 75 ms and correlates significantly with the TI1,max determined from a novel multi-TI1 protocol (R=0.65, P<0.05). The possibility to measure the bolus width under hypercapnia is demonstrated.

Impaired cerebral vasoreactivity to CO2 in Alzheimer's disease using BOLD fMRI.

OBJECTIVE: To evaluate the cerebral vasoreactivity using blood oxygenation level dependent functional MRI during carbogen inhalation with 7% CO(2) in Alzheimer's disease and amnestic mild cognitive impairment. PARTICIPANTS AND METHODS: Thirty nine subjects were included to be investigated using blood oxygenation level dependent (BOLD) functional MRI at 1.5T during a block-design carbogen inhalation paradigm, with a high concentration face-mask under physiological monitoring. Basal cerebral perfusion was measured using pulsed arterial spin labeling. Image analyses were conducted using Matlab® and SPM5 with physiological regressors and corrected for partial volume effect. RESULTS: Among selected participants, 12 subjects were excluded because of incomplete protocol, leaving for analysis 27 subjects without significant microangiopathy diagnosed for Alzheimer's disease (n=9), amnestic mild cognitive impairment (n=7), and matched controls (n=11). No adverse reaction related to the CO(2) challenge was reported. Carbogen inhalation induced a whole-brain signal increase, predominant in the gray matter. In patients, signal changes corrected for gray matter partial volume were decreased (0.36±0.13% BOLD/mmHg in Alzheimer's disease, 0.36±0.12 in patients with mild cognitive impairment, 0.62±0.20 in controls). Cerebral vasoreactivity impairments were diffuse but seemed predominant in posterior areas. The basal hypoperfusion in Alzheimer's disease was not significantly different from patients with mild cognitive impairment and controls. Among clinical and biological parameters, no effect of apoE4 genotype was detected. Cerebral vasoreactivity values were correlated with cognitive performances and hippocampal volumes. Among age and hippocampal atrophy, mean CVR was the best predictor of the mini-mental status examination. CONCLUSION: This BOLD functional MRI study on CO(2) challenge shows impaired cerebral vasoreactivity in patients with Alzheimer's disease and amnestic mild cognitive impairment at the individual level. These preliminary findings using a new MRI approach may help to better characterize patients with cognitive disorders in clinical practice and further investigate vaso-protective therapeutics.

Ecografía en Atención Primaria: estado de la cuestión / Ultrasonography in Primary Care: State of the question

Introducción. Cíclicamente nos preguntamos si es útil y conveniente introducir la ecografía en Atención Primaria, al tratarse de un procedimiento diagnóstico inocuo y rápido realizable en nuestra consulta, y con la que se obtienen imágenes de calidad diagnóstica equiparables a técnicas más costosas y menos accesibles. Material y Métodos. Realizamos una revisión bibliográfica en INAHTA, Pubmed y las páginas web de distintas sociedades científicas, entre los años 1996-2006, buscando estudios que confirmasen si la realización de ecografías en Atención Primaria era factible y fiable en el terreno diagnóstico. Resultados. Encontramos un bajo número de artículos sobre la cuestión, con baja calidad y centrados en cuestiones parciales. Este hecho contrasta con una actividad intensa de las sociedades científicas en este tema: grupos de trabajo, cursos acreditados, etc. Conclusiones. La realización de la ecografía en Atención Primaria es factible, quedando por definir y reglamentar sus indicaciones, criterios de formación del médico de familia, y las consideraciones legales que la rodean (AU)

Introduction. Periodically, we question if introducing ultrasonography into Primary Health Care would be useful and suitable because it is a safe and rapid diagnostic procedure that could be used in our consulting room. This method can obtain quality diagnostic images comparable to more expensive and less accessible techniques. Material and methods. We have performed a review of the literature in INAHTA, Pubmed, and the websites of some scientific societies between the years 1996-2006 to find studies that would confirm whether performing ultra-sound in Primary Health Care was feasible and reliable in the field of diagnosis. Results. We only found a small number of articles on the subject that were of low quality and focused on partial issues. This contrasts with the intense activities of the scientific societies on this subject: work groups, accredited courses, etc. Conclusions. Performing ultrasound in Primary Care is feasible. However, its indications, training criteria of the medical practitioner and the legal considerations surrounding it still need to be defined (AU)

pH-dependent kinetics of MgCl2 adsorption under a fatty-acid Langmuir film.

The effect of subphase pH (5.5 and 10.5) on the structure of behenic-acid monolayers was investigated during Mg(2+) adsorption by means of Grazing Incidence X-ray Diffraction (GIXD) and Brewster Angle Microscopy (BAM). The final phase corresponding to an ion superlattice commensurate to the behenic-acid cell is pH-independent. In contrast, the sequence of phases evidenced from the initial L(2)-phase to this final state presents at pH 10.5 an additional stage associated to a film condensation toward the L' (2)-phase. The structures of the intermediate states preceding the superstructure nucleation are slightly different, both with a short-range fatty-acid order. Finally, a laser light effect that could result from visible light absorption by the inorganic complexes is evidenced in the final state as well as in the intermediate phases.

Observation of a two-step mechanism in the formation of a superstructure of cadmium-behenic acid Langmuir monolayer: evidence of an intermediate structure.

By means of grazing incidence x-ray diffraction, the structure of a behenic acid monolayer spread over chloride salt solutions of cadmium is observed to evolve from the tilted L2 phase to the superstructure (corresponding to an organized monolayer of ions in addition to the ordered organic film), through an intermediate phase. The studied salt concentrations are below the so-called "threshold" needed for the formation of this superstructure. This kinetic process involving two first-order phase transitions is confirmed by Brewster angle microscopy experiments and surface pressure-area isotherms measured at different times after monolayer deposition.

Variation of the in-plane structure with depth revealed by grazing incidence x-ray diffraction in a thin Langmuir-Blodgett film.

Grazing incidence x-ray diffraction is used to characterize the molecular arrangement of ultrathin Langmuir-Blodgett (LB) multilayers. Using two angles of incidence of the beam allowing its penetration either throughout the complete depth of the film or only through the external layers, we show that it is possible to discriminate between the molecular packing of the deeper monolayers and that of the external monolayers of the LB film.

[Conjugal violence during pregnancy: a literature review.]. / Violence conjugale pendant la grossesse : recension des écrits.

Conjugal violence is a complicated issue which scope and consequences are increasingly documented. Among the many facets of the phenomenon, its occurrence during pregnancy is particularly worrisome. This article reviews the scientific literature pertaining to this issue. After establishing the prevalence of conjugal violence during pregnancy, the authors examine the major studies analyzing factors associated with this violence as well as its consequences for the mother and the infant. The article concludes that the current informations, although partial, are sufficient to justify early detection of conjugal violence in order to help future mothers efficiently.

[Patellectomy: results of a long-term follow-up]. / Patellectomie: résultats à long terme.

The authors are in disagreement with the literature on the results of patellectomy after comminuted fracture of the patella. They assessed retrospectively 17 patients who underwent unilateral total patellectomy between 1955 and 1980. Subjective and objective (clinical examination, radiologic examination and Cibex II studies) assessment was carried out for each patient using the contralateral healthy knee as a control. The results demonstrated 88% patient satisfaction, no ligamentous instability and no early arthrosis but a decrease in extensor muscle strength to 75% of normal. The authors conclude that total patellectomy is better tolerated and causes less morbidity than suggested in the literature.

The Akin procedure in hallux valgus.

A retrospective study of 28 Akin procedures was undertaken to assess their results. Patient satisfaction, clinical findings and roentgenographic measurements were evaluated after follow-up periods of 12 to 42 months. The outcome was excellent in nearly 60% of the patients, especially those whose discomfort was related to the laterally deviated great toe and to the prominence of the first metatarsal head.