Pregnancy outcome in patients with a medical history of immunoglobulin A vasculitis: a case-control study.

OBJECTIVE: Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy. METHOD: We conducted a French retrospective case-control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls). RESULTS: Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy. CONCLUSION: Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable.

Interface Roughening in Nonequilibrium Phase-Separated Systems.

Interfaces of phase-separated systems roughen in time due to capillary waves. Because of fluxes in the bulk, their dynamics is nonlocal in real space and is not described by the Edwards-Wilkinson or Kardar-Parisi-Zhang (KPZ) equations, nor their conserved counterparts. We show that, in the absence of detailed balance, the phase-separated interface is described by a new universality class that we term |q|KPZ. We compute the associated scaling exponents via one-loop renormalization group and corroborate the results by numerical integration of the |q|KPZ equation. Deriving the effective interface dynamics from a minimal field theory of active phase separation, we finally argue that the |q|KPZ universality class generically describes liquid-vapor interfaces in two- and three-dimensional active systems.

Cervical pedicle agenesis: case report and bibliographic review.

The posterior arch defects of the cervical spine are rare, and they arise out of deviations of the normal intrauterine development of the spine (4-8 weeks of development). The defects range from a cleft to the total agenesis of the posterior arch, with a reported prevalence of 4% and 0.15%, respectively. The pedicle agenesis is most frequently found in C6. A diagnosis is usually made after a traumatic incident in a previously asymptomatic patient. 35% of a patient's current symptoms are associated with instability or translation of the impaired vertebral segments like headaches, chronic pain, and neurological impairment. The clinical and radiological findings of a patient with an unusual and complex cervical spine malformation are reported. These are rare entities and seldom require surgical treatment. It is imperative for spine surgeons to be aware of these anatomical abnormalities to avoid misinterpretation and thus inappropriate treatment, particularly in acute trauma patients.

[Erratum to: Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view]. / Erratum zu: Wirksamkeit und Verträglichkeit der Elektrokonvulsionstherapie : Einfluss des klinischen Ansprechens aus Patientensicht.

BACKGROUND: Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients' view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response. MATERIAL AND METHODS: In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI­II) RESULTS: Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients' rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate. CONCLUSION: Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients' perspective.

[Effectiveness and tolerability of electroconvulsive therapy : Influence of clinical response from the patient's point of view]. / Wirksamkeit und Verträglichkeit der Elektrokonvulsionstherapie : Einfluss des klinischen Ansprechens aus Patientensicht.

Background: Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients' view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response. Material and Methods: In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI-II). Results: Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients' rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate. Conclusion: Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients' perspective.

[Electroconvulsive therapy in nonconsenting patients]. / Elektrokonvulsionstherapie gegen den natürlichen Patientenwillen.

BACKGROUND: Electroconvulsive therapy (ECT) is a potent and successful method for the treatment of severe psychiatric disorders. Severe depressive and psychotic disorders may lead to legal incapacity and inability to consent. In Germany, administration of ECT against the patient's will is feasible under certain constellations and is regulated under the terms of the guardianship law. OBJECTIVE: This article outlines the prevalence, effectiveness and tolerability of ECT when applied in nonconsenting patients. MATERIAL AND METHODS: Case report and literature review. RESULTS: The literature on ECT as a treatment in nonconsenting patients is relatively sparse. In 2008 the prevalence in Germany was less than 0.5 % of all patients receiving ECT. Case reports and case series suggest a good and equal level of effectiveness when compared to consenting patients. In the course of treatment the majority of patients consented to receive further ECT and retrospectively judged ECT as helpful. CONCLUSION: The use of ECT is a highly effective treatment in severe psychiatric disorders even when administered as treatment in nonconsenting patients. It can be lifesaving and lead to a rapid improvement of symptoms and relief from severe suffering also from the patients' perspective. Thus, it seems unethical not to consider ECT as a treatment against the nonautonomous will of legally incompetent patients in individual cases. Nevertheless, physicians should always seek to obtain the patients' consent as soon as possible for both legal and ethical reasons.

Occupation-dependent loading increases bone strength in men.

SUMMARY: Ex vivo analyses of humeri and radii from an anthropological collection and in vivo analyses of the distal radius of retired men indicate that occupation-dependent loading positively influences bone strength by an increase of bone size when young followed by a slowdown of the age-related endocortical and trabecular bone alteration. INTRODUCTION: Skeleton responds to mechanical stimuli, but it is not established whether chronic loading in the context of occupational activities (OA) influences bone properties. We assessed the impact of occupation-dependent loading on upper limb bone strength. METHODS: Individuals were classified according to the intensity of physical loading associated with their OA in two models. Ex vivo, computed tomography scans of the humeri and radii of 219 male skeletons (age of death, 20-93 years) from an anthropological collection of the 20th century (Simon collection) were used to determine estimates of bone strength and cross-sectional geometry. In vivo, distal radius were analysed in 180 men enrolled in the Geneva Retirees Cohort study using high-resolution peripheral quantitative computed tomography and finite element analysis. RESULTS: Heavy-loading OA was associated with higher bone strength in both models. This benefit was associated with higher total area (Tt.Ar), medullary area (Me.Ar) and cortical area (Ct.Ar) in young adult skeletons, but the difference decreased in older age. In older men, the humerus supporting heavy loading had a lower Me.Ar. This effect resulted in greater asymmetries of the Me.Ar and the Ct.Ar/Tt.Ar ratio between the humeri of men with unilateral versus bilateral heavy-loading OA. In vivo, an additional benefit of heavy-loading OA was observed on the distal radius trabecular density and microstructure. CONCLUSION: Repeated occupation-dependent loading positively influences bone strength by an increase of bone size when young followed by a slowdown of the age-related endocortical and trabecular bone alteration. These data supports the necessity to promote bone health in the context of sedentary occupation.

Multivariate assessments of activity-related skeletal changes: Interpreting Bell Beaker specialized male archery and social organization in Central Europe.

OBJECTIVES: The Bell Beaker period witnessed the rise of individual inhumations with "wealthy" burial contexts containing archery-related grave goods, leading archaeologists to label the individuals in these tombs as "archers." This study looks to (1) compare the skeletons from male "archer" burials with those from male "non-archer" burials-those not having archery-related grave goods-in order to assess a possible link between burial context and physical activity, and (2) apply a biomechanics profile to evaluate whether the individuals associated with these "archer" burials practiced specialized archer activity. MATERIALS AND METHODS: The corpus (males only) included 46 "archers" and 40 "non-archers" from Bell Beaker individual inhumations. Osteological data included measurements, scores of entheseal changes, and a diagnosis of certain pathologies. Data analyses involved visual observations, hypothesis tests, dimension reduction, and MANOVA, with approaches aimed at exploring the treatment of data missingness. RESULTS: Measurement data revealed no differences between the two groups. Evaluations of entheseal changes found that "non-archers" had consistently more instances of bone surface modifications than "archers." Individual assessments of specialized archer occupation identified 11 possible specialized archers. DISCUSSION: These findings indicate a possible labor differentiation represented through the presence of a probably prestigious "archer" burial context. This suggests a link between grave good presence and labor, but not between a Bell Beaker archery occupation and an "archer" burial context. Data analyses support the application of biomechanics to osteological analyses in order to assess specialized activity on the skeleton.

[A late onset diagnosis of giant cell arteritis in remission]. / Diagnostic tardif d'une artérite à cellules géantes en rémission.

Giant-cell arteritis (GCA) is a classical cause of chronical inflammation (CI) in the elderly, causing headaches, scalp hypersensitivity and jaw claudication. We describe a patient with a GCA revealed with a year-long biological inflammation and weight loss. Diagnosis was performed on a systematic temporal artery biopsy showing typical histological features. No treatment was intended as the patient had a spontaneous remission, maintained at one year of follow-up. This case highlights the benefit of a systematic temporal artery biopsy to explore CI and reminds us that GCA may undergo spontaneous remission.

Intraoperative neuromonitoring in non-idiopathic pediatric scoliosis operated with minimally fusionless procedure: A series of 290 patients.

BACKGROUND: One of the worst complications of surgery for spinal deformity is postoperative neurological deficit. Multimodal intraoperative neuromonitoring (IONM) can be used to detect impending neurological injuries. This study aimed to analyze IONM in non-idiopathic scoliosis using a minimally invasive fusionless surgical technique. METHODS: This retrospective, single-center study was performed from 2014 to 2018. Patients with non-idiopathic scoliosis who underwent a minimally invasive fusionless procedure and had at least 2 years of follow-up were included. IONM was performed using a neurophysiological monitoring work station with somatosensory evoked potentials (SSEP) and neurogenic mixed evoked potentials (NMEP). RESULTS: A total of 290 patients were enrolled. The mean age at surgery was 12.9±3 years. The main etiology was central nervous system (CNS) disorders (n=139, 48%). Overall, 35 alerts (11%) in the SSEP and 10 (7%) in the NMEP occurred. There were two neurological deficits with total recovery after 6 months. There were no false negatives in either SSEP or NMEP, although there was one false positive in SSEP and two false positives for NMEP in the group without signal recovery. There was no significant relationship between the incidence of SSEP or NMEP loss and age, body mass index (BMI), number of rods used, upper instrumented vertebrae (p=0.36), lower instrumented vertebrae, or type of surgery. A preoperative greater Cobb angle was associated with a significantly higher risk of NMEP loss (p=0.02). In CNS patients, a higher BMI was associated with a statistically significant risk of NMEP loss (p=0.004). The use of a traction table was associated with a higher risk of signal loss (p=0.0005). CONCLUSION: A preoperative higher Cobb angle and degree of correction were associated with a significant risk of NMEP loss. In CNS scoliosis, a higher BMI was associated with a significant risk of NMEP loss. The use of a traction table was associated with a higher risk of signal loss.

[Course of plasma fibronectin in burn patients. Its variations during septic episodes]. / Evolution de la fibronectine plasmatique chez le brûlé. Ses variations lors d'épisodes septiques.

The time course of plasma fibronectin (FNp) was evaluated following burn injury in 62 patients during 30 days. Those patients were divided into three groups: A: 36 non septic survivors, B: 7 septic survivors, C: 19 dead patients. Those groups were statistically different if either age or total body surface area burnt (TBSA), or unit burnt standard (UBS) or the percentage or third degree burnt area were considered. The relationship between FNp, UBS or sepsis was studied. No correlation was found between FNp levels and TBSA or UBS for the first three days. After acute depletion on day 2, the FNp level returned to initial values on day 3. That depletion was probably a consequence of resuscitation since both falls in plasma FNp and haematocrit were parallel from day 1 to day 2. When the patients became septic, there was always a drop in FNp level. The depleted level of FNp remained low in the patients who finally died, whereas in those who survived that level had returned to normal. The observation of FNp level could therefore be useful in determining how serious a sepsis is.

[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation]. / Le poumon des sujets en état de mort cérébrale. Corrélations anatomo-biologiques en vue de la transplantation pulmonaire.

Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.

[Health and violence as perceived by young people, a study of the Parisian region]. / Santé et violences perçues par les jeunes, une étude en région parisienne.

We know better the violences made by the youngs than those they suffer from. The purpose of this study is to assess, as for a city surrounding Paris, the prevalence of the violences they felt and its relation with the psychic uneasiness. Some 344 youngs (from 15 to 25 years old) selected in the city, have filled in an autoquestionnaire. It has shown that 61.6% of them have already suffered from violences, among them 44.5% from adults and what is more from institutional adults. 13.7% of the selected youngs were victims of regular violences in school sphere and 12.8% in urban environment. The expression of a psychic uneasiness is linked to the previous violences they have felt. The feeling of call for help by a psychologist or a psychiatrist is in relation with the past psychic discomfort and not with the past suffered violences.

[Prostate radiation therapy: in vivo measurement of the dose delivered by kV-CBCT]. / Radiothérapie des cancers de la prostate : évaluation in vivo de la dose délivrée par tomographie conique de basse énergie (kV).

PURPOSE: To investigate if the regular use of kV-CBCT notably increases the dose delivered to tumor and surrounding healthy tissues. MATERIAL AND METHODS: Images were obtained using a Varian equipment (OBI version 1.3, 645 to 650 projections in 370 degrees to acquire image), and patients were irradiated at source-tumor distance: 100cm. In vivo measurements were performed using radio-thermoluminescent dosimeters Harshaw-TLD700H (TLD) at skin (anterior-posterior and lateral axis crossing the rotation axis), with a fourth TLD group under the table thanks to a retrolaser. TLD's were calibrated at the kV-CBCT effective energy (64 keV), and the method validated using an anthropomorphic phantom, in which Gafchromic EBT films were also inserted. RESULTS: The phantom study showed that the dose distribution depends on the phantom position relative to the axis and that the doses measured at the phantom surface using TLD and films (good agreement) were maximum at the entrance of the anterior-posterior axis. Their arithmetic mean was equal, or a slightly greater than doses measured at mid-thickness of the phantom and at the level of the rectum (OAR). In vivo measurements performed on the five first patients (125 kV-CBCT) yield a mean skin dose per kV-CBCT varying from 5.8+/-0.1 to 7.3+/-0.2 cGy on the anterior-posterior axis. Lateral skin doses vary from 3.4+/-0.2 to 4.5+/-0.2 cGy. CONCLUSION: Doses delivered by repeated kV-CBCT are not negligible. They should be taken into account, but questions about the RBE to be applied to kilovoltage X-rays are raised.

[Pediatric head injuries. Observations in pediatric surgery. 1,019 cases (author's transl)]. / Traumatismes crâniens de l'enfant. Expérience d'un service de chirurgie infantile. A propos de 1019 cas.

For 5 years, 1,019 children with head injury have been admitted in pediatric surgery. More often the patient is a boy one to five years old. 8.9 p. cent of the children had one or more other body injury. A skull fracture was found in 23 p. cent of the cases without influence on the evolutivity but a repeated clinical examination is necessary. For all head injuries an E.E.G. study is necessary. In 93.5 p. cent of the children the clinical findings allowed to said that head injury was "benign".