[Study of the talus and calcaneus using microdurometry, penetrometry and compression]

The authors give the results of various methods such as hardness micrometry, indentation tests and the radiographic study of fracture patterns, which they have applied to the talus and to the calcaneus. It appeared to them that: --these techniques outline the phenomenon of rupture behaviour of both talus and calcaneus; --the talus behaves as a fragile type of material whereas the calcaneus is of the intermediate type. The authors therefore think that these methods can be of great interest in a better understanding of the biomechanical properties of bone.

[Prognosis of nephrosis]

Renal biopsy, the introduction of immunohistologic methods and electron microscopy have allowed the differentiation of clinicopathologic entities associated to nephrotic syndrome. Two main categories must be differentiated: in the first, diffuse lesions of the glomerulus, including those secondary to specific diseases the same as those that are apparently primary, are responsible for the increased permeability of glomerular capillaries. Any one of the following clinical signs suggests this category: acute onset with nephritic syndrome, moderate nephritic syndrome, moderate nephrotic syndrome, gross hematuria, persistent hypertension and/or renal failure, poor selectivity of proteinuria and drop in complement serum levels (C3). In the second category, known as idiopathic nephrotic syndrome, the mechanism of disorder of the glomerular capillary is unknown and the nephrotic syndrome is more marked. In most cases with idiopathic nephrotic syndrome, minimal glomerular lesions (MGL) are present. The clinicopathologic correlation among these three types of lesions shows that the type with MGL is characterized by selective proteinuria, absence of hematuria, good response to corticosteroids and good outlook; whereas in types with diffuse mesangial proliferation (DMP) and segmentary sclerosis, proteinuria is frequently non selective, hematuria shows in 50 to 75% of the patients; prognosis is poor. However, MGL, DMP and focal segmentary glomerular sclerosis are not different entities, but represent variants of the same disease. Considering that corticosensitive nephrosis to this moment is the most common cause of the nephrotic syndrome, especially in children under 8 years, renal biopsy should be done only under two circumstances: a) when the clinical symptoms suggest diffuse glomerular lesions and b), when resistance to corticosteroids becomes evident.

Treatment of the idiopathic nephrotic syndrome

Most of the paediatric patients presenting with nephrotic syndrome (NS) have a nephrosis (minimal glomerular changes with or without focal lesion NS) and most of them are characterized by a clear-cut steroid response: a complete remission is rapidly obtained with high dose of glucocorticoids. Many of them, however, relapse during or after the treatment's withdrawal. Most often, these patients can be managed for several years with long-term alternate-day steroid therapy. Alkylating agents must be used exclusively when the doses of steroids required result in severe toxicity. In other types of NS (steroid resistant nephrosis, membranous and membranoproliferative glomerulonephritides) the efficiency of drugs is not established. Whatever the cause for the NS, adequate supportive therapy is necessary. The constant aim is to allow the patient a normal physical, school and social activity.

Deformation and orientation of red blood cells in a simple shear flow. Theoretical study and approach at small angle light scattering

On the basis of a simple theoretical model representing the rheological behaviour of the erythrocyte membrane, the authors have proceeded with a theoretical and experimental investigation on the light-scattering diagrams at small angles of normal red blood cells subjected to Couette flow. The results show that the light-scattering diagrams take into account not only cell deformation, but also cell orientation. The prospects for applying this method to the analytical separation of cells with different deformabilities are considered.

[Continuous enteral feeding in pediatric nephrology. Long-term results in children with congenital nephrotic syndrome, severe cystinosis and renal failure (author's transl)]

This is the report of the results obtained with continuous enteral feeding in congenital nephrotic syndrome (3 cases), cystinosis (3 cases) and renal failure (3 cases). Ages of patients at the beginning of treatment ranged from 10 days to 3 years. Enteral nutrition was given for periods ranging from 4 to 37 months; mean energetic intake was 116% of the levels recommended according to developmental age and protein diets were 138%; 115% and 84% of the recommended amounts in nephrotic syndromes, cystinosis and renal failure, respectively. This treatment obtained the survival of most patients. In congenital nephrotic syndromes, growth improved clearly with acceleration of the curve and restoration of plasma albumin level. In cystinosis, a better fluid and electrolyte balance was obtained and growth curve sometimes improved in a spectacular fashion. Finally, in renal failure, effect on growth was favourable in 2 cases and nil in the third: these findings show that normalization of energetic intakes does not induce normal growth in children with uremia.

[Anatomy of the right atrioventricular valve (valva atrio-ventricularis dextra or valva tricuspidalis). Description of a new type of chordae: the mixed chordae]

The authors, continuing their work concerning the tricuspid valve which was communicated at the Fourth European Anatomical Meeting (Bále, 1977), now present a study of twenty anatomical preparations according to the Mac ALPINE technique of perfusion-fixation, giving to the preparation a morphology comparable to that of the heart at the end of the diastole. The present work consists in a descriptive and morphological study of one type of tendinous cord, not described until now, and denominated mixed cord. It defines itself by its valvular insertions which are situated on the four areas of the tricuspid valve described by SILVER and al. It is a cylindric tendinous cord, always ramified either into two branches which are in turn greatly ramified, or into a fan shaped spreading. Each ramification is attached to the valve by an expansion which is either perpendicular or parallel to the ring. This work specifies: the number of tendinous cords, their distribution to the three cusps of the tricuspid valve, the number of their ramifications and their valvular insertions.

[Anatomical study and systematization of veins in the foot]

From the dissection and the injection of the foot veins on 70 anatomical pieces, the authors have found the 4 systems usually described:--Lejar's plantar venous rete;--the supra-fascial dorsal venous rete;--the dorsal veins of the foot;--the median and lateral plantar veins. All these systems communicate largely with one another and are practically without any valvula. Among the most interesting systems, one should notice the closely woven plantar rete predominating at the level of the anterior and posterior weight-bearing points, and the importance of the muscular plantar veins close to the weight-bearing points. From those anatomical data 3 conclusions follow: 1) the major importance of the superficial venous drainage in comparison with the deep one, which makes one think of the preponderant role of that system as venous motor at the level the weight-bearing points, while walking; 2) the easy opacification of all those systems in phlebography; 3) the uselessness of any complementary surgical action i the submalleolar regions during the cure of varices.

[Acute aortic dissection. Prognostic factors, therapeutic indications. 137 cases (author's transl)]

137 patients (92 men and 45 women) with an average age of 58 years (range: 19 to 90 years) were hospitalised between January 1970 and June 1977 for acute aortic dissection. In 107 patients (and in 91 cases during the first 24 hours of hospitalisation) aortography was performed. This examination was found to be greatly reliable when its findings were compared with those at surgical exploration. In the absence of surgical treatment, 69 patients died and 5 survived. Amongst the patients undergoing surgery, 37 died and 27 survived. With the exception of type III dissections, survival appeared to be markedly increased by surgical treatment. Preoperative factors indicative of a poor prognosis included a neurological deficit of central origin, oligoanuria, raised blood urea, disseminated intravascular coagulation and dissection of the superior mesenteric artery or the coeliac trunk.

Changes of serum gonadotropin concentrations in premature babies submitted to phototherapy

In order to determine if phototherapy was influencing any change in plasma gonadotropin levels, we have compared a group of 8 premature infants (4 males and 4 females) who have been treated with phototherapy because of jaundice, to a control group of 6 premature infants who did not require phototherapy. During the third and fourth week of life, luteinizing hormone (LH) and folicule stimulating hormone (FSH), increased simultaneously in a significant range in phototherapy treated females. In the group of treated males, LH but not FSH increased significantly. Constant phototherapy and/or the sudden stopping of the treatment in the jaundiced premature newborn female is responsible for a marked and transient elevation of gonadotropins. A clear mechanism of the observed phenomenon with pathways including the retina, pineal gland and hypothalamus, is not apparent.