From commodity to money: The rise of silver coinage around the Ancient Mediterranean (sixth-first centuries bce).

The reasons why the Western Mediterranean, especially Carthage and Rome, resisted monetization relative to the Eastern Mediterranean are still unclear. We address this question by combining lead (Pb) and silver (Ag) isotope abundances in silver coinage from the Aegean, Magna Graecia, Carthage and Roman Republic. The clear relationships observed between 109Ag/107Ag and 208Pb/206Pb reflect the mixing of silver ores or silver objects with Pb metal used for cupellation. The combined analysis of Ag and Pb isotopes reveals important information about the technology of smelting. The Greek world extracted Ag and Pb from associated ores, whereas, on the Iberian Peninsula, Carthaginians and Republican-era Romans applied Phoenician cupellation techniques and added exotic Pb to Pb-poor Ag ores. Massive Ag recupellation is observed in Rome during the Second Punic War. After defeating the Carthaginians and the Macedonians in the late second century bce, the Romans brought together the efficient, millennium-old techniques of silver extraction of the Phoenicians, who considered this metal a simple commodity, with the monetization of the economy introduced by the Greeks.

Definition and epidemiology of mild traumatic brain injury.

BACKGROUND/OBJECTIVES: The definition of mild traumatic brain injury (mTBI), also known as concussion, has been a matter of controversy, which makes comparison between studies difficult. Incidence varies greatly from one country to another. The present article reviews definitions and epidemiology. METHODS: Literature review. RESULTS: According to the Mild TBI Committee of the American Congress of Rehabilitation Medicine, revised by the World Health Organization (WHO), mTBI is defined by a Glasgow Coma Scale score between 13 and 15 at 30minutes post-injury, and one or more of the following symptoms: <30min loss of consciousness; <24hours post-traumatic amnesia (PTA); impaired mental state at time of accident (confusion, disorientation, etc.); and/or transient neurological deficit. If a focal lesion is found on computed tomography (CT) or magnetic resonance imaging (MRI), the term "complicated mild TBI" has been proposed. Incidence of mTBI is 200-300/100,000 persons per year for hospitalized patients and probably twice as high if non-hospitalized patients are included. However, a few recent population-based studies reported a much higher rate (>700/100,000). A changing pattern of epidemiology has been found in high-income countries, related to a decrease in road-accident injuries in young adults, while conversely the proportion of falls has increased with population aging. CONCLUSION: Mild TBI is a major public health concern, the epidemiology of which has greatly changed in the last twenty years.

Management of unfavorable outcome after mild traumatic brain injury: Review of physical and cognitive rehabilitation and of psychological care in post-concussive syndrome.

INTRODUCTION: Mild Traumatic Brain Injury (mTBI) is a public health issue with approximately 42 million people worldwide affected yearly. Most patients have a favorable short-term recovery but 10-20% are likely to develop post-concussive syndrome (association of physical, cognitive, and psychological difficulties after injury). Post-concussive syndrome can be associated with Post-Traumatic Stress Disorder (PTSD). There is to date no recommendation on the interventions that could be done to reduce post-concussive syndrome. The present review aims at summarizing the effect of therapeutic education, physical and cognitive rehabilitation and of psychological care in mTBI patients with post-concussive syndrome. METHODS: In the current international literature, we investigated the effects of therapeutic education, physical and cognitive rehabilitation and of psychological care in this population using the Medline database and we discussed the results of these studies. RESULTS: The application of a therapeutic education intervention within 3 months after mTBI has been found appropriate and effective to prevent post-concussion syndrome in several studies but the timeline of this intervention differs among the existing studies. Concerning physical disabilities, several pharmacological, rehabilitative and non-pharmacological techniques have shown some efficacy in reducing headache and vertigo; rTMS seems also promising in this context. The management of fatigue is also crucial and requires a multidisciplinary approach. We did not find any intervention in mTBI patients with post-concussive syndrome suffering from dysosmia and/or dysgueusia. No pharmacological treatment is currently recommended to reduce the cognitive symptoms of post-concussive syndrome after mTBI. Rehabilitation and brain-stimulation techniques have already proven their efficacy to reduce the cognitive impairment in this population. Even if the use of Virtual Reality software seems well tolerated in this population, its efficacy and additional value needs to be demonstrated in larger studies. Concerning the psychological care after mTBI, Cognitive and Behavioral Therapy interventions are the most frequently reported in this population, followed by psychoeducational interventions. PTSD management seems crucial in overall recovery of patients with post-concussive syndrome. CONCLUSION: Many studies have sought to demonstrate the effectiveness of various rehabilitation techniques, including different cognitive rehabilitation programs, technology-assisted rehabilitation, different types of brain stimulation and some pharmacological treatments. However, most of these studies are of a low level of scientific evidence and it would be necessary to carry out well-conducted prospective randomized trials in order to offer an appropriate and effective multidisciplinary management for patients with post-concussive syndrome after mTBI.

Lack of repercussions of sleep apnea syndrome on recovery and attention disorders at the subacute stage after stroke: a study of 45 patients.

INTRODUCTION: Sleep apnea syndrome (SAS) frequently occurs after a stroke. Its association with a poor prognosis is open to discussion. OBJECTIVE: To study, in a physical and rehabilitation medicine (PRM) unit, the possible repercussions of SAS on neurological and functional recovery as well as attentional abilities following a stroke. PATIENTS AND METHODS: Forty-five patients, all of whom had recently had a stroke without previously documented SAS, were screened using the ApneaLink(®) system. An apnea-hypopnea index (AHI) score ≥10 was considered as indicative of SAS. The NIHSS, Fugl-Meyer (FM) and Functional Independence Measure (FIM) Scales were applied on admission and at two months as means of assessing neurological and functional recovery, which was expressed by the difference between the first and the second scores (delta FM, delta NIHSS, delta FIM). The Battery Attention William Lennox (BAWL) Test was given once in order to evaluate attention disorders. SAS severity was categorized according to the AHI. We compared the groups formed (mild, moderate and severe) using the same method. RESULTS: Twenty-eight patients (62.2%) presented AHI ≥ 10. Stroke characteristics were comparable in the SAS+ and the SAS- groups, with average post-stroke time lapse of 26 days, initial average FIM score of 71.2 points ± 26.3 and initial average NIHSS score of 8.9 ± 4.9. The demographic characteristics of the two groups were likewise comparable with the exception of age, as the SAS+ group was pronouncedly older (65.4 vs. 53.5 years). As for delta FIM, which evaluated functional recovery, it averaged 31.8 ± 20.6. Cases of SAS were found to be mild (37.1%), moderate (28.6%) or severe (34.3%). No significant difference was observed on admission or at 2 months as regards the clinical scales or the BAWL test between the two groups or according to severity, except for the NIHSS score at 2 months in the severe sub-group. DISCUSSION AND CONCLUSION: This study did not demonstrate the supposed repercussions of SAS on the recovery or attentional abilities of post-stroke patients. The tests were maybe given too early; they should take place at a lengthier time interval after the stroke, and also to be more complete.

[The obstetrics and gynaecology departments in the French public hospitals: an updated overview]. / État des lieux des services de gynécologie-obstétrique dans les centres hospitaliers publics français.

Restructuring the surgery and gynecology-obstetrics departments taking place now raise many interrogations. It appears as a mandatory necessity to some people and as a tribute to financial strategies to others to the detriment of quality and accessibility of care. Its effect is to clarify a good amount of socioeconomical and medical indicators. The plans of perinatality for the obstetrical aspect and the thresholds of activity for the surgical aspect constitute the major lines of these restructurings. A survey soliciting all the French public hospitals was used to assess the state of obstetrics and gynecology departments in the light of these recent restructurings. Medical demography, preserving and improving the quality and continuity of care, efficiency of the technical supports are discriminating criteria of the involved challenges. Such restructurings have an impact on the doctor's lives, which looks globally positive and a good omen to complete this remodeling process. The activity was safeguarded by a redistribution and a refocusing of institutions. One should not minimize the social impact of these changes, with a potential deterioration of working conditions (internal professional reclassifications, mobility obligation towards other sites). It thus appears that the deep changes which affect the small size institutions will be able to achieve well only if they are clearly done (information) and truly integrated in their medical project.

Increasing incidence of abnormal glucose tolerance in women with prior abnormal glucose tolerance during pregnancy: DIAGEST 2 study.

AIMS: Mild blood glucose abnormalities during pregnancy may be linked to later glucose tolerance abnormalities or diabetes mellitus. Our aim was to determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) 6.75 years after delivery in women with differential blood glucose status during pregnancy. METHODS: We compared long-term outcomes among control women (n = 221), women with abnormal glucose tolerance during pregnancy (AGT; n = 322) and women with gestational diabetes (GDM; n = 466) who participated in DIAGEST 1. Women were recruited from 15 public maternity units in France. Clinical parameters could be determined in 155 control, 220 AGT and 338 GDM subjects. Rates of DM, IGT, IFG and 'Any Abnormality' were compared between the groups (American Diabetes Association criteria). RESULTS: Adherence to follow-up was 70.7%. Rates of DM, IGT and IFG were respectively 0.9% DM, 2.1% IGT and 3.6% IFG in the control group; rates in the AGT group were 6.3%, 11.3% and 6.3%. In GDM women, the rates of DM, IGT and IFG were, respectively, 18.0%, 13.4% and 8.5%. Predictors for DM were previous GDM, medical history of hypertension, age at delivery > or = 33 years, family history of diabetes, fasting glucose during pregnancy > or = 5.5 mmol/l and the severity of hyperglycaemia during pregnancy defined by the number of abnormal blood glucose values fasting, 1, 2 and 3 h during the glucose tolerance test at diagnosis of GDM. CONCLUSION: This study has identified a high prevalence of glucose tolerance abnormalities after AGT during pregnancy. Compared with GDM women, women with AGT have an intermediate risk of later diabetes.

Is mild gestational hyperglycaemia associated with maternal and neonatal complications? The Diagest Study.

AIMS: To evaluate the maternal and neonatal complications rates of mild gestational hyperglycaemia (MGH) compared to a control group in France. METHODS: A systematic screening by a 50-g glucose challenge test was offered to all women between 24 and 28 weeks of gestation in 15 maternity units. If the 50-g glucose challenge test was > or = 7.2 mmol/l, a 100-g 3-h oral glucose tolerance test (OGTT) was performed. MGH (n = 131) was defined by one abnormal value on the 3-h OGTT (Carpenter and Coustan criteria). The control group (n = 108) was defined by a 50-g glucose challenge test below 7.2 mmol/l. Women with MGH received no treatment or specific advice during the pregnancy. Large for gestational age (LGA) was defined by a birth weight of at least the 90th percentile on French standard growth curves. RESULTS: Women with MGH were older than the controls (28.8 (5.8) vs. 27.0 (5.2); P < 0.05) and had a higher body mass index (24.8 (4.8) vs. 23.0 (3.9); P < 0.01). The rate of pregnancy-induced hypertension and Caesarean section were not different between the MGH and control group. The rate of LGA was significantly higher in the MGH group than the control group (22.1% vs. 11.4%; P < 0.05). After adjustment for confounding factors of macrosomia (pre-pregnancy body mass index > 27, maternal age > 35, multiparity and educational level), there was a persistent relationship between LGA and MGH (odds ratio 2.50; 95% confidence interval (1.16-5.40); P < 0.05). MGH was more frequently associated with adverse maternal and fetal outcome than in the controls (53.4% vs. 28.7%; P < 0.01). CONCLUSIONS: This study suggested that the increased rate of adverse maternal and fetal outcome, especially LGA, was associated with untreated mild gestational hyperglycaemia women compared to a control group. This link to lower degrees of hyperglycaemia during pregnancy is independent of confounding factors.

[Problems caused by the therapeutic interruption of pregnancy. Apropos of 120 cases observed from 1976 to 1983]. / Problèmes posés par les interruptions thérapeutiques de grossesse. A propos de 120 observations relevées de 1976 à 1983.

The authors present statistical data on 120 medical abortions performed at "Pavillon Victor Olivier" between April, 1976 and June, 1983. A precise study was performed on the maternal and fetal indications, the different techniques employed according to gestational age, and their follow-up since 1976. The principal purpose of this article is to arouse reflexion on the consequences of the law of 1975, as well as the appropriateness of the maternal and especially of the fetal indications. A major portion of these could be avoidable with prophylactic measures and adequate contraception.

[Diagnostic and therapeutic problems in anencephaly]. / Problèmes diagnostiques et thérapeutiques posés par l'anencéphalie.

The authors report on 18 cases of anencephalus, studied from April, 1976 to December, 1982. Possible etiologies, morphological characteristics, circumstances leading to its discovery, and diagnostic tools are presented. Emphasis is placed on the usefulness of ultrasonography to diagnose this condition as early as the 13th to 14th week of gestation. Evacuation of the uterus is always difficult as it involves a second trimester abortion, but is one of the best indications for the use of prostaglandins. In a woman with a previous history of an anencephalic child, careful monitoring of subsequent pregnancies is necessary as the recurrence rate is approximately 4 p. 100 (13 p. 100 in the case of a second anencephalic child). Dosing of alpha-fetoprotein and acetylcholinesterase in amniotic fluid and repeated sonograms are indispensable.

[Steinert disease and pregnancy]. / Maladie de Steinert et grossesse.

Steinert's syndrome and pregnancy with delivery are rarely associated. It is a dominant autosome disease. Certain signs in pregnancy may suggest that the fetus is affected. One case made it possible to demonstrate these facts. Hydramnios with infrequent fetal movements and a slow fetal heart rate may lead to a suspicion of fetal involvement. This is always serious. The presence of the disease in the mother should be sought if it is not already known. If there is already a known family history the patient should see a geneticist so long as early amniocentesis has not yet been performed.

[Subacute pre-eclampsia and hydramnios as manifestation of fetal triploidy. In utero diagnosis in the 28th week]. / Pré-éclampsie et hydraminos subaigu révélateurs d'une triploïdie foetale. Diagnostic in utero à la 28 semaine.

The authors report a case of triploidy that was diagnosed in utero by amniocentesis at the 28th week of amenorrhoea which presented with a classical picture of sub-acute hydramnios and pre-eclampsia and a dermoid cyst in the pelvis below the uterus. This case has given us a chance of showing the clinical evolution that led us to carry out amniocentesis and make the diagnosis of triploidy. A review of the literature gives us the chance of showing the incidence of triploidy and its genetic origin and the characteristics that this chromosome abnormality produces. The value of the study is to show the differences that exist between this condition and partial molar triploidy demonstrating the anatomo-pathological, genetic and developmental changes that can be recognized. The conclusion that this article reaches could be that the term "triploid embryonic mole" should be abandoned because it brings under one heading two quite different pictures.

[The fetus without a heart: the diagnosis and observations using ultrasound. A case history]. / Le foetus acardiaque: diagnostic et surveillance échographique. A propos d'un cas.

The condition is extremely rare, since acardia is only found in 1% of monozygotic twin pregnancies. A case was discovered and observed using ultrasound and was then studied anatomically and pathologically. The histopathology and the physiopathology of the malformation is described. The aetiology that has been most usually accepted is that there is an anastomosis between the two umbilical cords of the two "twins" and that this leads to an inversion of the direction of the circulation in the affected fetus. The failure of the myocardium to develop would follow this vascular abnormality because of failure of the allantoid vessels to fuse. The interest in this kind of observation lies in the possibility of making the diagnosis very early in pregnancy using ultrasound, and of following the evolution and the regression of the acardiac fetus throughout the pregnancy, and with the possibility of comparing the views obtained by ultrasound with the anatomo-pathological features that can be diagnosed after birth.

[Postpartum renal cortical necrosis]. / La nécrose corticale rénale du post-partum.

The authors report two cases of post-partum cortical renal necrosis. The diagnosis was made on clinical and biological criteria (severe, prolonged oliguria, the signs of intra-vascular coagulation defects, a rise in L.D.H. and anaemia with micro-angiopathy. It is confirmed by selective renal arteriography and renal punch-biopsy. There is a threefold method of treatment: --of the kidney condition by repeated haemodialysis and diuretics; --antihypertensive treatment; --treatment aimed at the aetiological pathology (heparin, anti-platelet aggregation and fresh plasma). Functional recovery of the kidney was obtained in both cases (after an interval of 1 year and an interval of 1 1/2 year). The authors review the diagnostic, physiopathological, morphological and therapeutic elements in the condition of cortical renal necrosis.

[Dissecting aortic aneurysm in the 8th month of a twin pregnancy. A review of the literature (author's transl)]. / Dissection aortique au 8e mois d'une grossesse gémellaire. Revue de la littérature.

48 % of women under the age of 40 who have an acute dissecting aortic aneurysm are pregnant. Dissection of the ascending aorta (types I and II of De Bakey) are most frequent types to be found, as indeed they are outside pregnancy. There are no histological lesions that are specific for pregnancy. The clinical and angiographic signs are not specially modified in pregnancy. Surgical treatment is made more difficult by the pregnant state. It seems to have been used very little in pregnancy, as there have been only two cases published since 1961. The prognosis for the mother is frightful, with 94 % of cases dying, most of them within the first 48 hours. The fetal prognosis is not much better, with 10 children alive (including our 2 children) out of 78 case histories published to date.

[Extrauterine pregnancies in patients with intrauterine devices (apropos of 9 cases)]. / Grossesses extra-utérines sur dispositifs intra-utérins (à propos de neuf observations).

PIP: The published literature reports an increase of ectopic pregnancies in patients wearing an IUD. Over the total number of pregnancies with IUD in situ, ectopic pregnancies account for about 10-17%. The incidence is lower for the first 6 months after insertion, and higher after that. The mechanism responsible for extrauterine pregnancies can be the appearance of infectious lesions in the genital tract, or the slow and continuous secretion of prostaglandin promoted by the presence of the IUD. Diagnosis of ectopic pregnancy is not always easy, and it usually follows episodes of pelvic pain and metrorrhagia.^ieng