[Multidisciplinary management of children with disabling chronic pain in a French pediatric rehabilitation center: Current management and perspectives]. / Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d'une série et perspectives.

INTRODUCTION: Chronic pain in children and adolescents has a major impact on their life in terms of school, sleep as well as family and social life. Teenagers aged 13-15 and girls are at the highest risk. Zeltzer et al. established a bio-psychosocial model of chronic pain in 1998 to account for all its dimensions and advocated a multidisciplinary management plan. Programs based on their principles target specific symptoms such as anxiety and loss of function, while treating underlying factors and teaching coping skills to patients and their families. They aim for patients to regain autonomy rather than focusing on pain resolution. Such programs, with varied protocols, have existed outside of France for approximately 15 years. The efficacy of these multidisciplinary programs has been shown in studies in Germany, the United Kingdom, the United States, Canada, and Australia. To our knowledge, there are no French studies on this topic; therefore, our aim was to describe a French program. We hypothesized that the program would be effective in reducing chronic pain and its impact. METHODS: The aim of this study was to describe the multidisciplinary management of chronic pain in a French pediatric functional rehabilitation center. It is a public health establishment located in the suburbs of Lille, offering care for children aged 0-18 with various conditions. It has 52 hospital beds, can accommodate up to 22 day-hospital visits per day and has comprehensive technical facilities. This prospective study consisted in a chart review of all consecutive patients who were hospitalized in the functional rehabilitation center for chronic pain with significant disability since 2010. We reviewed the treatment protocol for each patient as well as the treatment results for the composite primary endpoint, comprising pain characteristics and the impact of pain on function and schooling after discharge. RESULTS: Twenty-nine patients, aged 9.4-17.8 years, 62.1% of whom were girls, were hospitalized for chronic pain with a significant impact on their daily life between 2010 and August 2014. The most common diagnosis was complex regional pain syndrome type 1 (CRPS1) (37.9%). Pain had major consequences, with total disability in 69% of cases and 100% of children taking pain medications. In 65.5% of cases, patients were hospitalized in an inpatient setting, and 34.5% attended an outpatient program. Treatment lasted from 1 to 68 weeks (mean, 24.3; standard deviation [SD], 21.6). Patients received a combination of medical care, physical therapy (100%), occupational therapy (37.9%), psychological counseling (100%), pain medications (96.6%), and schooling (96.6%). Pain improved significantly in 89.7% of patients (95% confidence interval [95% CI] [0.73-0.98]) and pain medication consumption decreased significantly in 72.4% of children (95% CI [0.53-0.87]). Patients who had stopped walking could ambulate again in 91.7% of cases (95% CI [0.73-0.99]) and 86.4% of patients who had been missing school were back at school full time (95% CI [0.65-0.97]). There were no significant differences for these results between inpatient and outpatient management programs. Improvements were maintained at 3-6 months after discharge in 83.3% of cases. CONCLUSION: The multidisciplinary pain management program in this French pediatric functional rehabilitation center shows results comparable to the programs described in other countries. Chronic pain should be evaluated with standardized and validated tools, such as the measurement of the pain-related disability with the Functional Disability Index.

Total laparoscopic aortobifemoral bypass.

AIM: To assess the feasibility of aortobifemoral bypass by a laparoscopic approach. MATERIAL AND METHODS: During November 2002 through July 2003 a total of 21 patients with aorto-iliac occlusive disease underwent total laparoscopic aortobifemoral bypass surgery. RESULTS: The median operative time was 240 (range 150-420) min with a median aortic cross-clamp time of 60 (30-120) min. Operating time was reduced with experience. The median blood loss was 500 (100-2500) ml. One conversion to open surgery for acute dilation of the small bowel was necessary. Post-operative complications occurred in five patients (coagulation problems, disseminated intravascular coagulation secondary to thrombosis of the left limb, cerebro-vascular accident, dyspnoea, lymph leak) and there was no peri-operative death. Median hospital stay was 7 (5-30) days. CONCLUSION: Aorto-bifemoral bypass using a total laparoscopic approach can be performed safely. As all new techniques, a learning curve is observed. This new technique should be evaluated in a larger randomised trial to assess its clinical value in comparison to conventional surgery.

Rupture of a thoracic aneurysm in the left bronchus.

Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. Thereafter, he developed an aortic isthmic dilation (36 mm in diameter). The patient suffered from long standing pulmonary insufficiency and emphysema and was admitted several times on an urgent basis for acute dyspnea. During an hospitalization for respiratory distress, he presented haemoptysis and left lung hyperinflation secondary to partial fistulization and extrinsic compression of the main left bronchus. Isthmic aortic resection and prosthetic grafting was performed and the left main bronchus was closed by an autologous pericardial patch. Ten days later, following an air-leak from the bronchial closure, a transposed latissimus dorsi flap was used by the plastic surgeon to repair the defect. Nevertheless, the patient died from multisystemic failure six weeks later.

Thyroid hormone receptors in perennibranchiate amphibians.

Thyroid hormone has long been known to induce metamorphosis in amphibians. The understanding of the molecular steps controlling the completion of metamorphosis has nevertheless been hampered by the complexity of this event. The comparison of organisms in which metamorphosis does or does not occur, may provide clues into the molecular cascade that control it. Up to now the available data suggest that perennibranchiate amphibians retain their larval characters mainly because their tissues do not respond to thyroid hormones. In such a context the recent identification of a thyroid hormone receptor alpha in the perennibranchiate Proteus anguinus is provocative (Ho Huynh et al., Int. J. Dev. Biol. 40:537-543, 1996). In the present paper, we provide evidences that this recently described sequence is in fact a sequence from Xenopus laevis. Indeed, we identified the authentic thyroid hormone receptors of both alpha and beta types in two perennibranchiate species Necturus maculosus and Proteus anguinus. The various controls required to ascertain the authenticity of a developmental gene cloned by PCR or RT-PCR analysis are presented. The results reported in the present paper are relevant with phylogenetical analysis. This induces our team to conclude that the Proteus TR alpha sequence reported by Ho Huynh et al. (1996) reflects a contamination of the RT-PCR by Xenopus laevis material.

Interaction of human papillomavirus type 16 and adeno-associated virus type 2 co-infecting human cervical epithelium.

Recently, we hypothesized that the tumour-suppressive, human helper-virus-dependent, adeno-associated parvoviruses (AAV) may interfere with transforming functions of human papillomaviruses (HPV) in the development of cervical carcinoma. Here, we demonstrate that in cervical epithelium containing papillomavirus DNA, AAV DNA can be detected in a replication-competent form and that AAV proteins are expressed. In cultured cells containing integrated AAV-2 DNA, transfection of HPV-16 DNA induced rescue of infectious AAV-2, revealing helper functions of HPV-16. Similarly, cotransfection of HPV-16 and AAV-2 DNAs into human epithelial cell lines led to replication of AAV-2, and, in keratinocytes, to a cytopathic effect. These data suggest an interaction of the two viruses, possibly influencing the development of HPV-related lesions.

[Toxic hepatitis due to dimethylformamide: case reports and literature review]. / Toxische hepatitis op dimethylformamide: case reports en literatuurgegevens.

We report two patients with toxic hepatitis due to the solvent dimethylformamide (DMF). Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis, could be excluded or were considered to be unlikely. Hepatotoxicity due to professional exposure to solvents e.g. dimethylformamide should be considered in any patient with unexplained hepatitis. The fast improvement of the clinical symptoms and the progressive normalisation of the liver function tests once the exposure to the product has been stopped, supports the diagnosis. Yet, non-drug induced toxic hepatitis remains an exclusion diagnosis. Therapy consists of avoiding every contact with the causative agent. Table 3 (Addendum) gives an overview of some industrial agents able to cause hepatitis.