The classic: Radiography of the trapeziometacarpal joint. Degenerative changes of this joint. 1936

This classic article is a translation and reprint (Appendix 1. Supplemental material is available with the online version of CORR.) from the French of the original article by M. Robert, entitled La radiographie de l'articulation trapézo-métacarpienne. Les arthroses de cette jointure. The original article was published in Société de Radiologie Méd de France, Bulletins.1936;24:687-689. (Reproduced with kind permission of the SFR.).

Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques

Type 2 diabetes (T2D) remission after bariatric procedures has been highlighted in many retrospective and some recent prospective studies. However, in the most recent prospective study, more than 50 % of patients did not reach T2D remission at 1 year. Our aim was to identify baseline positive predictors for T2D remission at 1 year after bariatric surgery and to build a preoperative predictive score. We analysed the data concerning 161 obese operated on between June 2007 and December 2010. Among them, 46 were diabetic and were included in the study-11 laparoscopic adjustable gastric banding (LAGB), 26 Roux-en-Y gastric bypass (RYGB) and 9 sleeve gastrectomy (SG). We compared anthropometric and metabolic features during 1 year of follow-up. A receiver operating characteristic analysis was performed to predict T2D remission. RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB; 62.8 % of patients presented with T2DM remission at 1 year, with no significant difference according to the surgical procedure. A 1-year body mass index (BMI) <35 kg m(-2) was predictive of T2DM remission whatever the procedure. The preoperative predictive factors of diabetes remission were baseline BMI ≤50 kg m(-2), duration of type 2 diabetes ≤4 years, glycated haemoglobin ≤7.1 %, fasting glucose <1.14 g/l and absence of insulin therapy. A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1 year after surgery. Preoperative metabolic data could be of greater importance than the choice of bariatric procedure.

Anchor placement and subsequent movement in a mesh kit with self-fixating tips: 6-month follow-up of a prospective cohort

OBJECTIVE

To describe the initial placement of Elevate single-incision mesh kit device tips relative to the sacrospinous ligament, and to measure tip movement over a 6-month period from initial placement.

DESIGN

Prospective cohort.

SETTING

Tertiary care urogynaecology centre in Calgary, Canada.

POPULATION

Women electing for surgical management of anterior vaginal wall prolapse.

METHODS

Ten women underwent anterior prolapse repair using the Elevate single-incision mesh kit with a metallic fiducial marker attached to the tips of the surgical device. Women were imaged by magnetic resonance imaging (MRI) within 48 hours of surgery, and again 6 months later to investigate the position of the device tips and change ≥4 mm over the 6-month postoperative period.

MAIN OUTCOME MEASURE(S)

Position of self-fixating tips within 48 hours of surgery, and at six months post-operative.

RESULTS

Anchor insertion was directly into the sacrospinous ligament in 10 of 20 insertion points (50%, 95% CI 27-73%). Movement was most often noted in the cranial-caudal direction: a change in location of ≥4 mm was observed for 8/20 anchors (40%, 95% CI 19-64%). Cranial-caudal movement was observed less frequently among sacrospinous anchors than among anchors inserted into other pelvic structures (1/10 versus 7/10, P = 0.020, difference in proportion -60%, 95% CI -94 to -26%). PFDI-20 scores improved statistically significantly by 6 months (P = 0.008, mean change -62.9%, 95% CI -105.1 to -20.7%), but PFIQ-7 scores did not change statistically significantly over the same time period (P = 0.523, mean change -12.4%, 95% CI -54.5 to 29.8%).

CONCLUSIONS

The novel self-fixating anchoring tips of this single-incision mesh kit do not reliably anchor into the sacrospinous ligament. The tips have been shown to move with time, although not all cases of anchor movement were associated with recurrent prolapse.

Dietary management of urea cycle disorders: European practice

BACKGROUND

There is no published data comparing dietary management of urea cycle disorders (UCD) in different countries.

METHODS

Cross-sectional data from 41 European Inherited Metabolic Disorder (IMD) centres (17 UK, 6 France, 5 Germany, 4 Belgium, 4 Portugal, 2 Netherlands, 1 Denmark, 1 Italy, 1 Sweden) was collected by questionnaire describing management of patients with UCD on prescribed protein restricted diets.

RESULTS

Data for 464 patients: N-acetylglutamate synthase (NAGS) deficiency, n=10; carbamoyl phosphate synthetase (CPS1) deficiency, n=29; ornithine transcarbamoylase (OTC) deficiency, n=214; citrullinaemia, n=108; argininosuccinic aciduria (ASA), n=80; arginase deficiency, n=23 was reported. The majority of patients (70%; n=327) were aged 0-16y and 30% (n=137) >16y. Prescribed median protein intake/kg body weight decreased with age with little variation between disorders. The UK tended to give more total protein than other European countries particularly in infancy. Supplements of essential amino acids (EAA) were prescribed for 38% [n=174] of the patients overall, but were given more commonly in arginase deficiency (74%), CPS (48%) and citrullinaemia (46%). Patients in Germany (64%), Portugal (67%) and Sweden (100%) were the most frequent users of EAA. Only 18% [n=84] of patients were prescribed tube feeds, most commonly for CPS (41%); and 21% [n=97] were prescribed oral energy supplements.

CONCLUSIONS

Dietary treatment for UCD varies significantly between different conditions, and between and within European IMD centres. Further studies examining the outcome of treatment compared with the type of dietary therapy and nutritional support received are required.

Use of sapropterin in the management of phenylketonuria: seven case reports

Sapropterin treatment, with or without dietary treatment, improves blood phenylalanine control, increases phenylalanine tolerance, and may reduce the day-to-day dietary treatment burden in a subset of patients with phenylketonuria (PKU). Balancing the need for maintained control of blood phenylalanine with diet relaxation is complex when administering sapropterin. We present a series of seven patient cases with PKU that illustrate important aspects of using sapropterin with diet in the management of the disorder.

[Smile "forced" smile versus "spontaneous": comparison of 3 techniques of reconstructive surgery of the face. Myoplasty temporal muscle, hypoglossal facial anastomosis and gracilis muscle free flap]

The facial palsy cause serious consequences for patients. Studies have also shown that in these patients, the inability to produce an appropriate and spontaneous smile would be a key factor of depression. When facial palsy is considered complete and the nerve cannot be repaired, the patient can benefit from palliative surgery to regain a better quality of life in the aesthetic, functional, and psychological aspects. The hypoglossal-facial anastomosis (AHF), temporal myoplasty (MAT) and gracilis transposition (TG) are the major surgeries currently used for this purpose. The aim of our study is to assess quantitatively and qualitatively the effects of each of these surgeries on the lip mobility and production of smile. From this perspective, we proposed a protocol of an evaluation of facial motricity, of quality of life, and more particularly on the quality and the analysis of the smile. The results underline that there is no significant difference in the recovery of the facial motricity according to the surgery. Only the slower, deferred deadline of recovery at the patients AHF and TG who have to wait several months, it is for the same levels as that of the patients' MAT. A premature and intensive rehabilitation such as the patients of our protocol benefited from it what is nevertheless essential to a good recovery whatever is the surgery.

Main issues in micronutrient supplementation in phenylketonuria

For almost all patients with PKU, a low phenylalanine diet is the basis of the treatment despite a widely varying natural protein tolerance. A vitamin and mineral supplement is essential and it is commonly added to a phenylalanine-free (phe-free) source of L-amino acids. In PKU, many phe-free L-amino acid supplements have age-specific vitamin and mineral profiles to meet individual requirements. The main micronutrient sources are chemically derived and their delivery dosage is usually advised in three or more doses throughout the day. Within the EU, the composition of VM (vitamin and mineral) phe-free L-amino acid supplements is governed by the Foods for Special Medical Purposes (FSMP) directive (European Commission Directive number 1999/21/EC and amended by Directive 2006/141/EC). However the micronutrient composition of the majority fails to remain within FSMP micronutrient maximum limits per 100 kcal due to their low energy content and so compositional exceptions to the FSMP directive have to be granted for each supplement. All patients with PKU require an annual nutritional follow-up, until it has been proven that they are not at risk of any vitamin and mineral imbalances. When non-dietary treatments are used to either replace or act as an adjunct to diet therapy, the quality of micronutrient intake should still be considered important and monitored systematically. European guidelines are required about which micronutrients should be measured and the conditions (fasting status) for monitoring.

Micronutrient status in phenylketonuria

Patients with phenylketonuria (PKU) encompass an 'at risk' group for micronutrient imbalances. Optimal nutrient status is challenging particularly when a substantial proportion of nutrient intake is from non-natural sources. In PKU patients following dietary treatment, supplementation with micronutrients is a necessity and vitamins and minerals should either be added to supplement phenylalanine-free l-amino acids or given separately. In this literature review of papers published since 1990, the prevalence of vitamin and mineral deficiency is described, with reference to age of treatment commencement, type of treatment, dietary compliance, and dietary practices. Biological micronutrient inadequacies have been mainly reported for zinc, selenium, iron, vitamin B12 and folate. The aetiology of these results and possible clinical and biological implications are discussed. In PKU there is not a simple relationship between the dietary intake and nutritional status, and there are many independent and interrelated complex factors that should be considered other than quantitative nutritional intake.

[Prosodic analysis of speech of patient affected by peripheral facial paralysis]

INTRODUCTION

The aim of study of prosody in facial palsy is to assess the intensity of pathology in suprasegmental viewpoint in order to establish a proper rehabilitation.

METHODS

Patients were recorded during a reading and spontaneous speech test and a prosodic observation of speech spectrogram provided by Praat software.

RESULTS

The Accentual Groups lowering and significant dysprosodics elements (adverse effects and breaking balance) and a larger amount of disfluencies showed that the prosody of patients with facial palsy is altered because they need to swallow their saliva intentionally. Then, the decrease of Mean Length of Utterance (MLU) and the opinion of the jury highlight a decrease in desire to communicate and a loss of speech informativeness.

CONCLUSIONS

In patients with severe facial palsy, there is an impact of swallowing disorder (caused by salivary stasis) on the prosody of speech, with variations in the position of intonations boundaries and the intensity of prosodic marking. This also creates impact on fluency and on the perception of the message by the listener.

[Acoustic analysis of the articulatory disorders of patients affected by peripheral facial paralysis]

INTRODUCTION

The study of joint disorders in facial paralysis is an important element of support to guide rehabilitation.

MATERIAL

The material used for the registration of the database is a digital recorder Zoom H4N (way format, sample rate 44,100 Hz, 16 bit quantization). The microphone used is a Shure Beta 58, super cardioid. All recordings are made in a specific room.

METHODS

The annotation of the corpus is done using Praat software and its plug-in EasyAlign order to achieve alignment phonetics.

RESULTS

High frequency power ratio (HPR) is a good indicator of the setting in motion of the articulators as the number of explosions of bilabial phoneme was significantly related to the motor of the face and lips, and the score at dynamometer. The VOT was significantly shorter in patients with grade IV and V-VI than in control subjects. The results highlight a significant difference between the values of F3for the vowels /i/ and /y/, depending on the severity of the damage. There is even, for the most severe grades, there are a hundred Hertz difference between F3 of /i/ and that of /y/, which means that these two vowels becomes impossible to discriminate.

CONCLUSIONS

If these functional disorders are much discomfort for patients, however, these are not speaking of articulatory disorder in the strict sense, according to the definition of Borel Maisonny. We must therefore focus more specifically to the acoustic analysis of speech in order to check for spectral indices likely to identify these disorders.

[Infant feeding]

Infants are vulnerable: their growth and their development depend largely on their nutritional status. It is important to propose for them an optimal food. The human milk is unquestionably the best choice for the infant. When breastfeeding is not possible, the choice of the milk is made among hundreds of formulas for infants. They are regulated by a European directive. The healthcare professionals have to recommend as often as possible an infant formula: low protein content, predominance of whey proteins, enrichment with long chain fatty acids, lactose, addition of pre- or probiotics. The formulas for specific indications will be recommended in case of particular situations after verification that the complaints (constipation, regurgitations, stomach pains) cannot be corrected by simple dietary measures (increasing of the intakes of meals with a concomitant reduction of the volume of the meals). The food diversification is recommended between 17 and 26 weeks according to the neuromuscular capacities of the infant. These meals must be presented with a spoon to assure a sufficient nutritional intake. In Belgium, the use is to begin with fruits. One should avoid adding biscuits or sugar. The meal of vegetables will be introduced a little later. It should consist of starchy foods, vegetables with some fat to which the meat will be added. Numerous foods (biscuits, croissants and similar products, chips) should never be part of the ordinary menu, but should be reserved for particular occasions. The education of the children should begin from this age on.

Diet in phenylketonuria: a snapshot of special dietary costs and reimbursement systems in 10 international centers

BACKGROUND AND AIMS

To gather exploratory data on the costs and reimbursement of special dietary foods used in the management of phenylketonuria (PKU) from ten international specialist PKU centers.

METHODS

Experts from each center provided data on retail costs of the three most frequently used phenylalanine-free protein substitutes and low-protein foods at their center; reimbursement of protein substitutes and low-protein foods; and state monetary benefits provided to PKU patients.

RESULTS

The mean annual cost of protein substitutes across 4 age groups (2 y, 8 y, 15 y and adults) ranged from €4273 to €21,590 per patient. The cost of low-protein products also differed; the mean cost of low-protein bread varied from €0.04 to €1.60 per 100 kcal. All protein substitutes were either fully reimbursed or covered by health insurance. However, reimbursement for low-protein products varied and state benefits differed between centers.

CONCLUSIONS

The variation in the cost and reimbursement of diet therapy and the level of additional state benefits for PKU patients demonstrates the large difference in expenditure on and access to PKU dietary products. This highlights the inequality between healthcare systems and access to special dietary products for people with PKU, ultimately leading to patients in some countries receiving better care than others.

Persistent dysphagia after removal of an adjustable gastric band for morbid obesity: a rare complication

Esophageal and gastric pouch dilatations are not uncommon after laparoscopic adjustable gastric banding for morbid obesity. Most of the cases are treated by gastric band deflation or removal. We report here the case of a 44-year-old woman with vomiting and severe dysphagia persisting despite gastric band removal, in relation with a scar stenosis and a gastric pouch trapped in the thorax, treated by laparoscopic surgery. This case underlines the usefulness of high-resolution manometry in the diagnostic work-up of these often difficult cases.

Gait analysis using a force-measuring gangway: intrasession repeatability in healthy adults

OBJECTIVES

The goal of the present study was to determine the repeatability of gait parameters measured by a force plate gait analysis system (Leonardo Mechanograph® GW).

METHODS

Fifteen healthy adult participants walked at a self-selected speed on a 10 m long walkway. Vertical ground reaction forces were measured in the central 6 m of the walkway. Each participant performed three trials while walking barefoot and three trials while wearing shoes, each trial consisting of three 10 m walks.

RESULTS

There were minimal differences between trials at each condition. All primary force, time, distance and velocity parameters had intraclass correlation coefficients above 0.90 and coefficients of variation in the order of 2% to 4%. Compared to walking barefoot, walking in shoes resulted in 14% lower maximal vertical ground reaction force, 5% longer step length and 2% higher average velocity and caused less lateral translation of the center of force.

CONCLUSIONS

In this group of healthy adults, gait analysis with a force plate system produced repeatable intra-day results. The observation that barefoot and shod walking yield different results indicates that it is important to standardize test conditions.

Spatial distribution and habitat selection of Barrow’s and Common goldeneyes wintering in the St. Lawrence marine system

Our study addresses winter spatial distribution of Barrow’s Goldeneyes ( Bucephala islandica (Gmelin, 1789)) and Common Goldeneyes ( Bucephala clangula (L., 1758)) at the scale of the St. Lawrence marine system (estuary and northwestern gulf), eastern Canada. Our objectives were (i) to identify and compare the physical factors that control their distributions, (ii) to quantify the level of sympatry between the two species, and (iii) to compare their distribution patterns. We analyzed large-scale synoptic views of winter distribution of both goldeneye species obtained through helicopter-borne surveys. Habitat description was obtained through spatial analyses and remote sensing. Both species showed strong preference for the tidal zone and river mouths. A multiscale analysis showed a decreasing level of sympatry as spatial resolution was refined. The distribution of the Barrow’s Goldeneye was more clustered compared with that of the Common Goldeneye, and Barrow’s Goldeneye was repeatedly observed in the same few areas. A use-availability analysis identified the northern coast of the St. Lawrence estuary as the main wintering ground for Barrow’s Goldeneye in eastern North America.

Detection of Bonamia ostreae and B. exitiosa (Haplosporidia) in Ostrea edulis from the Adriatic Sea (Italy)

The flat oyster Ostrea edulis L. is widespread along the Italian coasts. In particular, the Manfredonia Gulf (Adriatic Sea) represents an important site where natural beds subsist. Previous monitoring conducted in 1990 by light microscopy and ultrastructural studies revealed the presence of Bonamia-like microcell parasites in some flat oysters: following this observation, a new sampling of O. edulis was carried out at this location in 2007. Of 750 oysters collected, 3 showed the presence of uninucleated microcells (2 to 3 microm diameter) free or inside the haemocyte cytoplasm by cytology and histopathology. Molecular analysis confirmed that the microcells in 2 oysters were B. exitiosa, whereas in the third oyster the microcells were B. ostreae. Moreover, molecular studies were carried out to confirm the existence of Bonamia sp. in archived samples, confirming the presence of B. ostreae in the Manfredonia Gulf since 1990.

Comparative experimental infection of the copepod Paracartia grani with Marteilia refringens and Marteilia maurini

Paracartia grani (Copepoda) has been identified as a potential intermediate host in the life cycle of Marteilia refringens, a paramyxean parasite infecting flat oysters. However, no intermediate host has yet been identified for Marteilia maurini that infects mussels. A better understanding of the life cycle of these two Marteilia types would clarify their taxonomic relationship and hypothesized co-specificity. For this purpose, experimental infections of copepods, P. grani, were performed using naturally infected flat oysters and mussels. Infection patterns were different depending whether copepods were infected from oysters or mussels. M. maurini did not proliferate in copepods while M. refringens rapidly proliferated in infected copepods. Previously unrecognized developmental stages of M. refringens were found during this study.

Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia. Monocentric prospective study of 106 cases

BACKGROUND

Heller myotomy (HM) combined with an anti-reflux procedure has been shown to be effective for the treatment of achalasia, as postoperative gastro-esophageal reflux (GER) is observed in about 10% of the cases. Laparoscopy has brought an undeniable benefit in providing excellent visualisation of the gastro-esophageal junction (GEJ) without lateral and posterior dissection. Respecting the anatomical fixation of the GEJ seems to permit the performing of HM without an anti-reflux procedure, the need for which is therefore debatable. The purpose of this study was to analyse the results of this controversial procedure.

METHODS

A monocentric prospective study was carried out on 106 patients who underwent HM without an anti-reflux procedure. The postoperative assessment consisted of a manometry and a 24-hour pH study two months after surgery, and a yearly clinical examination for a minimum of five years. The data capture was done using a statistical analysis.

RESULTS

There was no mortality, one conversion to an open procedure, and four mucosal perforations. Postoperative morbidity was 2%. The average follow-up period was 55 months (range, 2 to 166), with 10 patients lost to follow-up. Good functional results were observed in 91.4% of patients at one year, and 78.6% at five years. Two months after surgery, a 9.4% prevalence of GER was detected in the pH study, and the lower esophageal sphincter pressure had significantly decreased. After a long term follow-up we observed an 11.3% global rate of GER. No repeat surgery was necessary to control postoperative GER.

CONCLUSIONS

Laparoscopic HM without anti-reflux procedure gives good functional results provided the anatomical fixation of the GOJ is respected.

Sténose acquise non hypertrophique du pylore chez l'enfant

Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated.

MATERIAL AND METHOD

Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002.

RESULTS

Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed.

DISCUSSION

We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective.

CONCLUSION

The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.

Evidence for the involvement of pathogenic bacteria in summer mortalities of the Pacific oyster Crassostrea gigas

A study was conducted to investigate the involvement of bacteria in oyster mortalities during summer. Moribund and apparently healthy oysters were sampled during mortality events along the French coast and in rearing facilities, usually when temperature reached 19 degrees C or higher, and oysters were in the gonadal maturation phase. Hemolymph samples were aseptically withdrawn and submitted to bacteriological analysis. In healthy oysters, bacteria colonized hemolymph at low concentrations depending on the location. In most moribund oysters, bacteria were present in hemolymph and other tissues. These bacterial populations were more often diverse in oysters originating from the open sea than from facilities where animals were generally infected by a single type of bacterium. Only the dominant colonies were identified by phenotypic and genotypic characters (RFLP of GyrB gene and partial sequence of 16S rRNA gene). They belonged to a limited number of species including Vibrio aestuarianus, members of the V. splendidus group, V. natriegens, V. parahaemolyticus, and Pseudoalteromonas sp. The most frequently encountered species was V. aestuarianus (56% of isolates), which was composed of several strains closely related by their 16S rRNA gene but diverse by their phenotypic characters. They appeared intimately linked to oysters. The species within the V. splendidus group were less prevalent (25% of isolates) and more taxonomically dispersed. A majority of the dominant strains of V. aestuarianus and V. splendidus group injected to oysters induced mortality, whereas others belonging to the same species, particularly those found in mixture, appeared innocuous.

Tau and Tauopathies

Tau protein is a neuronal microtubule-associated protein (MAP), which localizes primarily in the axon. It is one of the major and most widely distributed MAPs in the central nervous system. Its biochemistry and molecular pathology is being increasingly studied. Tau is a key component of neurofbrillary tangles in Alzheimer's disease (AD). Disorders with neuronal, oligodendroglial or astrocytic filamentous tau inclusions are now grouped under the common rubric of tauopathies. The discovery of mutations in the tau gene, located on Chromosome 17 and its relationship to frontotemporal dementia with Parkinsonism (FTDP-17) has enhanced the importance of tau protein in cognitive neurology. Aberrant aggregates of tau have been documented in most of the neurodegenerative diseases with filamentous inclusions. The role of cerebrospinal fluid tau in the diagnosis of dementias is being investigated quite extensively. Recently, it has been shown that Abeta immunotherapy leads to the clearance of early tau pathology. It is becoming clearer that understanding tau better will lead to better understanding of many neurodegenerative diseases that may help develop interventional strategies.

Modalités de prise en charge des invaginations intestinales aiguës en France en 2004 : enquête commune du Groupe de pathologie infectieuse pédiatrique (GPIP), du Groupe francophone d'urgences et de réanimation pédiatrique (GFRUP) et de la Société française de chirurgie pédiatrique (SFCP)

OBJECTIVES

To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS.

MATERIAL AND METHODS

A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised.

RESULTS

One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%).

CONCLUSION

The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.

[Pathologic childhood aerophagia]

"Air swallowing" described as being part of functional gastrointestinal disorders in "Rome criteria" in 1999 is often misdiagnosed, particularly in non-mentally deficient children.

AIMS

To recognize "air swallowing" child and to describe any progress according to the treatment.

POPULATION AND METHODS

This retrospective study reports 13 cases of children without mental deficiency or neuromuscular disease. Clinical elements and precise histories are detailed and we have contacted consulting doctors or families for news.

RESULTS

Ten boys and 3 girls, from 2,5 years to 10 years old, were referred for long lasting pain or abdominal distension. Numerous laboratory investigations were always normal. Diagnosis relied upon the observation of air swallowing and X-Rays views of gastric distension. Air swallowing was observed 7 times, 9 children had twitches and 3 language troubles. In 10 cases, X-rays showed gastric and colic distension. Three children have Chilaïditi syndrome. Favourable results followed in 12 cases after an average of 28 months of treatment. One case was lost for follow-up. Treatment was long, often disappointing and required the intervention of a psychiatrist, a paediatrician and (temporarily) a speech therapist.

CONCLUSION

Pathological childhood aerophagia is often underdiagnosed and deserves to be better known by paediatricians, psychiatrists and surgeons. A late diagnosis leads to many negative results and causes anxiety. An early diagnosis should lead to a multidisciplinary care.

Lead contamination of small cetaceans in European waters--the use of stable isotopes for identifying the sources of lead exposure

Lead concentrations and isotopic composition have been measured in bone and teeth of small cetaceans belonging to three species (Delphinus delphis, Phocoena phocoena and Stenella coeruleoalba), to evaluate the toxicological risk and to determine sources of lead in the European waters. Lead concentrations, far lower than threshold value inducing toxic effects in human, were higher in teeth than in bones, but highly correlated between the two tissues (r=0.92, p<0.001). Large variations of 206Pb/207Pb values in bone tissue showed that cetaceans must be submitted to various atmospheric influences. No geographical differences appeared which is consistent with studies on their distribution indicating seasonal movements between Brittany waters and the Bay of Biscay. The negative correlation between 206Pb/207Pb ratios and age of the individuals reflected the decrease in the production of alkyl lead in Europe, i.e., the increasing use of unleaded gasoline.

Colloid interaction and pair correlation function of one-dimensional colloid-polymer systems

The interaction and pair correlation function of weakly charged colloidal particles in quasi-one-dimensional colloid-polymer systems are determined by enhanced video microscopy and digital image analysis. The pair correlation function is found to depend not only on the polymer concentration, but also on the degree of confinement; in particular, it depends on whether the channel width is such that mutual passage of the colloid particles is possible or not. These findings are compared with exact results on short-range order in linear continuous systems.

One-dimensional diffusion of colloids in polymer solutions

For colloid-polymer systems confined in one-dimensional channels, the diffusion of the colloidal particles is obtained by tracking individual particles using enhanced video microscopy and digital image analysis. For short times, the diffusion is normal, of the Fickian type, with mean-squared displacement varying linearly with time. For long times, however, the mean-squared displacement is found to increase more slowly with time, being proportional to the square root of time, in agreement with the theoretical prediction for diffusion of hard rods in one dimension in which mutual crossing of the particles cannot take place. The crossover from short-time to long-time diffusion is observed and is found to depend on the colloid and polymer concentrations. Unexpectedly, for small polymer-to-colloid size ratios, it is the polymer rather than the colloid concentration which has a leading effect on the colloid diffusion.

Neuropsychiatric manifestations systemic lupus erythematosus: A study from South India

CONTEXT

Neuropsychiatric systemic lupus erythematosus (NPSLE) has varied manifestations.

AIMS

To study the pattern of neuropsychiatric (NP) involvement in systemic lupus erythematosus (SLE).

SETTINGS AND DESIGN

Hospital based cross sectional and retrospective study.

PATIENTS AND METHODS

Patients admitted with a diagnosis of SLE, during a period of 16 months, were evaluated and any NP syndrome present classified as per the American College of Rheumatology (ACR) nomenclature.

STATISTICAL ANALYSIS

SPSS software Version 10 was used for descriptive analysis and correlative study.

RESULTS

Out of 50 patients with SLE, all the patients with NPSLE [39 (78%)] were females, mean age 25.66 years (range: 11-44). The commonest manifestation was headache [20 (55.6%)]. Seizures were seen in 8 (20.51%) and psychosis in 6 (16.2%). Fine distal tremor was seen in 8 (20.51%) of patients.

CONCLUSIONS

Headache is a frequent NP syndrome. Fine distal tremor is a syndrome not included in ACR classification but seen is 20% of our patients with NPSLE.

[Inborn errors of metabolism: new developments and challenges]

The concept "inborn error of metabolism" (IEM) arose from the observations of Sir A. Garrod at the beginning of the XXth century. The exponential development, during the last decades, of our knowledge in cellular biology and molecular genetics, and the availability of increasingly more precise diagnostic tools, allow the identification of a still growing number of inborn errors of metabolism. Their physiopathology is better understood. Treatments have considerably improved: more specific diets, new medical treatments, enzyme replacement therapy, organ transplantation, hepatocyte or stem cell transplantation... New techniques are under development, including various strategies of gene therapy. Improved therapeutic efficacy combined with earlier diagnosis have dramatically changed the prognosis of many disorders. As a consequence, new challenging questions have to be answered. Today, patients with an IEM, because of the extreme complexity of their management, need to be looked after by a multidisciplinary team of physicians (pediatricians and internists), dieticians, social workers, psychologists... It is essential, in this complex and rapidly expanding field, that experiences should be shared at national and international level, in order to provide the most adequate care for patients.