[Reliability of endocervical curettage after conservative treatment of intraepithelial neoplasia of the cervix]

OBJECTIVE

To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN.

PATIENTS AND METHODS

Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up.

RESULTS

Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively.

CONCLUSION

The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer.

Inline high frequency ultrasonic particle sizer

This paper reports the development of a new method of particle sizing in a liquid. This method uses high frequency focused ultrasounds to detect particles crossing the focal zone of an ultrasonic sensor and to determine their size distribution by processing the reflected echoes. The major advantage of this technique compared to optical sizing methods is its ability to measure the size of particles suspended in an opaque liquid without any dedicated sample preparation. Validations of ultrasonic measurements were achieved on suspensions of polymethyl methacrylate beads in a size range extending from a few micrometer to several hundred micrometer with a temporal resolution of 1 s. The inline detection of aggregate formation was also demonstrated.

Ultrasonic measurement of bulk and shear moduli variations in porous alumina media

In this paper we studied some acoustical parameters of a porous medium based on the Biot's theory. The basic idea was to find, using an inversion method, variations in the bulk modulus K(b) and the shear modulus G(b) in the frequency domain. This was achieved by comparing the theoretical and experimental results obtained on a selection of porous alumina samples with different physical characteristics. Then, using the transmission coefficient, a numerical process was applied to a virtual porous alumina medium in order to find K(b) and G(b) values at low frequency under static conditions. Using a frequency range of 50kHz to 600kHz, fast and slow waves were considered and both were included in the transmission coefficient.

Outcome Improvement in RPA I or II Patients With 1 or 2 Brain Metastases by Combined Surgery and Radiotherapy

Background

To evaluate the role of surgery and postoperative radiotherapy in the management of brain metastases (BM): a retrospective analysis for overall survival (OS), local and brain control (LC and BC) of a series of 329 patients with recursive partitioning analysis (RPA) I or II with 1 or 2 BM in a single institution.

Methods

Patients were treated either with combined surgical resection and whole brain radiation therapy (WBRT) in 104 cases (31.6%) or with WBRT alone in 225 cases (68.4%). Ninety-five patients (91.4%) who underwent surgery and WBRT and 147 (65.3%) who underwent WBRT alone benefited from a radiation boost to the metastatic site.

Results

The median OS was higher for patients RPA I compared to RPA II: 21.3 and 5.9 months (P < 0.0001), as well as for the surgical group compared to the radiation group: 20.2 vs 5.3 months (P < 0.0001), respectively. After the multivariate analysis, the improved OS was significantly associated with control of primary tumor (P = 0.0002) after surgical resection and with type of primary tumor (P = 0.002), absence of extracranial metastases (ECM) (P = 0.006), and high Karnofsky performance status (90 - 100 vs 70 - 80) (P = 0.003) after radiotherapy alone. The 12-, 24- and 36-months LC rates were 91.1%, 91.1% and 83.9%, respectively, after surgical resection and 81.2%, 63.1% and 57.3%, respectively, after radiotherapy alone (P = 0.005). In a univariate analysis, improved LC for the surgical group was also associated with the absence of ECM (P = 0.01) and for the radiation group, with a radiation boost (P = 0.01). The BC rates at 12, 24 and 36 months were 73.2%, 66.9% and 56%, respectively, in the surgical group and 75.7%, 49.6% and 42.4%, respectively, in the radiation group (P = 0.2). In our univariate analysis, improved BC after surgical resection was associated with control of primary tumor (P = 0.02). For patients in the radiation group, gender (P = 0.03) and a radiation boost (P = 0.0003) were significant prognostic factors in a univariate analysis. In our multivariate analysis, only the radiation boost was significant (P = 0.001).

Conclusions

Surgical resection followed by WBRT leads to a better outcome compared to WBRT alone for RPA I or II patients with 1 or 2 BM.

Microporous Silicon Nitride-Based Solid Bases

High surface area, microporous, amorphous silicon imidonitride, characterized by infrared spectroscopy, MAS 29Si NMR and surface area and porosity measurements has been prepared by the treatment of co-oligomers of methylsilazane and dimethyl silazanes with gaseous ammonia at temperatures up to 700°C. The material has a narrow pore-size distribution showing a maximum in the range associated with wide- pore zeolites (ca. 0.72 nm mean). Variation of the organic content of the silazane is a means of controlling the surface area of the resulting solid. The Knoevenagel condensation reaction of benzaldehyde with a series of active methylene compounds has been used to probe the basicity and size-selectivity of these microporous solid base catalysts.

An evaluation of indices of gross pathology associated with the nematode Anguillicoloides crassus in eels

This study compares two alternative indices for quantifying the gross pathology of the swimbladder of eels, Anguilla anguilla (L.), infected with the nematode Anguillicoloides crassus. Two observers recorded twice the scores obtained by the two indices on the same set of 71 wild caught eels (from elver to silver eels, French Mediterranean lagoons). The Length Ratio Index (LRI), performed better than the Swimbladder Degenerative Index (SDI), in three of four predefined criteria of decision. First, the LRI better correlated with an estimate of the swimbladder volume reduction, a functional consequence of the infection (representativeness). Also, the LRI was less prone to subjectivity (inter-observer variability) and more precise (intra-observer variability), although less easy to generate (time needed for measurement/assessment). Using a sub-sample of 32 unaffected eels (showing minor if any swimbladder damage and no living worms at autopsy), we ascertained a linear relationship between the swimbladder length and the total body length, a prerequisite of isometric growth, to definitively accept the new ratio index as a valid alternative to the SDI. Also, because the LRI can be recorded on live specimens with radio-imagery (non-invasive method), we recommend its use, and provide a graph of correspondence between the SDI scores, the LRI scores and the estimated proportion of gas loss in the swimbladder.

[Popliteal venous thrombosis associated with a false aneurysm revealing femoral exostosis in a child]

Recent unprovoked and symptomatic thrombosis of the left popliteal vein was diagnosed in a 9-year-old girl. Treatment with low-molecular-weight heparin was initiated in association with vitamin K antagonist (INR 2.5), and compressive stockings. Two and a half months later, the ultrasound examination revealed a false aneurysm of the left distal superficial femoral artery. Knee X-rays showed a distal femoral exostosis. MRI clarified the relationship between the false aneurysm and the exostosis. Bone scintigraphy eliminated multiple exostoses. Resection of the false aneurysm associated with end-to-end femoro-popliteal saphenous bypass and exostosectomy in the same operative time were performed. On histopathological examination there was no sign of malignant transformation. Vascular complications of exostoses are infrequent and the association with deep venous thrombosis and false aneurysm is exceptional. This case report illustrates the contribution of knee X-rays to unravel this unusual clinical presentation.

Continuing utilisation of specialised health services in extremely preterm infants

OBJECTIVE

To compare healthcare use from neonatal discharge to 18 months corrected age (CA) of two groups of extremely preterm neonates (23-25 vs 26-28 weeks).

DESIGN

Cohort study.

PATIENTS

Infants born at < or =28 weeks and admitted in three hospital centres in Quebec, Canada (n=254).

MAIN OUTCOME MEASURES

Neurodevelopmental outcomes and healthcare use from neonatal discharge to 18 months CA.

RESULTS

Re-hospitalisation rates occurred in 57% of children born at 23-25 weeks and in 49% of those born at 26-28 weeks. In these two age groups, by 18 months, 61% vs 59% were followed in physical or occupational therapy, 29% vs 17% were enrolled in a long-term rehabilitation program, 38% vs 28% used prescribed medication, and 59% vs 33% required medical assistive devices, respectively. Risk of re-hospitalisation was related to bronchopulmonary dysplasia (BPD), severe brain injury, use of home oxygen or an apnoea monitor and older age at neonatal discharge. Multiple births, BPD, severe brain injury, older age at neonatal discharge and single parenthood were associated with risk of using out-patient health services above average (>2 services).

CONCLUSION

Extremely preterm children are frequently re-hospitalised during infancy and use a substantial amount of healthcare resources. These results highlight the importance of resource allocation to preterm infants for medical and rehabilitation services after discharge from the neonatal intensive care unit.

Use of cutaneous flap for continent cystostomy (daoud technique)

PURPOSE

We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.

MATERIALS AND METHODS

A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.

RESULTS

Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.

CONCLUSIONS

We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

Huge intramedullar neurenteric cyst with intrathoracic development in a 1 month-old boy: excision though the anterior approach. A case report and review of the literature

Spinal neurenteric cyst is a rare congenital lesion that may occur either alone or in the context of a complex malformative disorder. Our case is unusual because of its rare intramedullary location, the association with an important intrathoracic development, and the age of the child at presentation (1 month). An anterior approach through a right-sided lateral thoracotomy was performed for a total resection of the intrathoracic part and a subtotal resection for the intramedullar portion. During 2 years of follow-up, the child presented no neurological deficit and post-operative magnetic resonance imaging found a small residue fixed on the anterior spinal cord without progression.