Gated cardiac CT in infants: What can we expect from deep learning image reconstruction algorithm?

BACKGROUND

ECG-gated cardiac CT is now widely used in infants with congenital heart disease (CHD). Deep Learning Image Reconstruction (DLIR) could improve image quality while minimizing the radiation dose.

OBJECTIVES

To define the potential dose reduction using DLIR with an anthropomorphic phantom.

METHOD

An anthropomorphic pediatric phantom was scanned with an ECG-gated cardiac CT at four dose levels. Images were reconstructed with an iterative and a deep-learning reconstruction algorithm (ASIR-V and DLIR). Detectability of high-contrast vessels were computed using a mathematical observer. Discrimination between two vessels was assessed by measuring the CT spatial resolution. The potential dose reduction while keeping a similar level of image quality was assessed.

RESULTS

DLIR-H enhances detectability by 2.4% and discrimination performances by 20.9% in comparison with ASIR-V 50. To maintain a similar level of detection, the dose could be reduced by 64% using high-strength DLIR in comparison with ASIR-V50.

CONCLUSION

DLIR offers the potential for a substantial dose reduction while preserving image quality compared to ASIR-V.

Variability in repeated economic games: comparing trust game decisions to other social trust measures

Economic games are well-established tools that offer a convenient approach to study social behaviour. Although widely used, recent evidence suggests that decisions made in the context of standard economic games are less predictive of real-world behaviour than previously assumed self-reported questionnaires. A possible explanation for this discrepancy is that economic games decisions in the laboratory are more likely to be influenced by the current situation, while questionnaires are specifically designed to measure people's average behaviour across a long period of time. To test this hypothesis, we performed a longitudinal study where 275 respondents played 16 Trust games every two days within a three-week period, and filled out a questionnaire that measures social trust. This study confirmed the instability of our measure of trust behaviour over time and the substantial stability of questionnaire responses. However, we found a significant association between self-reported social trust and participants' average behaviour in the trust game measured across sessions, but also with participants' behaviour measured only in Session 1. Nevertheless, analysis of behavioural changes in the Trust games over time revealed different behavioural profiles, highlighting how economic games and questionnaires can complement each other in the study of social trust.

"When did you decide to receive the Covid-19 vaccine?" Survey in a high-volume vaccination center

Highly efficient and safe Covid-19 vaccines are available in Europe in amounts that theoretically allow for a high immune coverage. However, a notable proportion of the population is reluctant toward immunization. We aimed to determine, among people who chose to be vaccinated, when they made the decision and whether they would have preferred an earlier vaccination. A survey was conducted in a high-volume Covid-19 vaccination center in France from 28 May to 9 July 2021 through an anonymous questionnaire. The 2519 participants (54.1% males; median age 39 years) attributed lower efficacy and safety to Covid-19 vaccines than to vaccines in general. When asked when they decided to receive the vaccine, 15.5% and 16.0% answered "less than one month ago" and "less than one week ago," respectively; age <40 and female sex were independently associated with these responses. When asked whether they would have preferred to have been vaccinated earlier, 57.6% answered "definitely no," "rather no," or "neither yes nor no"; female sex (independently from age) was associated with these answers. When asked whether they would have preferred to receive the vaccine as early as January 2021, 65.2% answered "definitely no," "rather no," or "neither yes nor no"; age <40 and female sex were independently associated with these responses. In conclusion, one-third people had made the decision to be vaccinated only recently, while more than half would not have preferred an earlier vaccination, in particular women and those aged <40 years. Vaccine campaigns should take such short-term decision-making processes into account.

Disease, perceived infectability and threat reactivity: A COVID-19 study

Using a two-wave online experiment, we investigate whether COVID-19 exposure changes participants' threat-detection threshold. Threat reactivity was measured in a signal detection task among 277 British adults who also reported how vulnerable they felt to infectious diseases. Participants' data were then matched to the local number of confirmed COVID-19 cases announced by the NHS every day. We found that participants who perceive themselves as more likely to catch infectious diseases displayed higher threat reactivity in response to increased COVID-19 cases.

Childhood environmental adversity is not linked to lower levels of cooperative behaviour in economic games

Cooperation is a universal phenomenon, it is present in all human cultures from hunter-gatherers to industrialised societies, and it constitutes a fundamental aspect of social relationships. There is, however, variability in the amount of resources people invest in cooperative activities. Recent findings indicate that this variability may be partly explained as a contextually appropriate response to environmental conditions. Specifically, adverse environments seem to be associated with less cooperation and recent findings suggest that this effect is partly mediated by differences in individuals' life-history strategy. In this paper, we set out to replicate and extend these findings by measuring actual cooperative behaviour in three economic games - a Dictator game, a Trust game and a Public Goods game - on a nationally representative sample of 612 people. Although we found that the cooperation and life-history strategy latent variables were adequately captured by the models, the hypothesised relationship between childhood environmental adversity and adult cooperation and the mediation effect by life-history strategy were not found.

Environmental adversity is associated with lower investment in collective actions

Environmental adversity is associated with a wide range of biological outcomes and behaviors that seem to fulfill a need to favor immediate over long-term benefits. Adversity is also associated with decreased investment in cooperation, which is defined as a long-term strategy. Beyond establishing the correlation between adversity and cooperation, the channel through which this relationship arises remains unclear. We propose that this relationship is mediated by a present bias at the psychological level, which is embodied in the reproduction-maintenance trade-off at the biological level. We report two pre-registered studies applying structural equation models to test this relationship on large-scale datasets (the European Values Study and the World Values Survey). The present study replicates existing research linking adverse environments (both in childhood and in adulthood) with decreased investment in adult cooperation and finds that this association is indeed mediated by variations in individuals’ reproduction-maintenance trade-off.

Behavioral disorders and new psychoactive substances abuse, a French case series

Introduction

Range of drugs has largely increased the past few years, especially with the emergence of the New Psychoactive Substances (NPS) sold online. In front of serious risks they cause on human health, they are more and more regulated by the law.

Objectives

To describe cases of extreme behavioral disorders and highlight risks of potential forensic complications linked to these consumptions.

Methods

We present a case series of serious auto or hetero-aggressive behavioral disorders related to NPS abuse and notified to the Parisian addictovigilance center.

Results

Twenty cases were identified between 2010 and 2015. Users were exclusively men, with mean age of 35.5 years (min: 20, max: 51). Synthetic cathinones are the predominant class of reported NPS (65%). An association between NPS and sexuality is found in 60% of cases (12); among them cathinones are used by 11 men. We observed 6 deaths among which, 5 were associated to sexual practice. Two cases of consumptions of cathinones induced torture and barbarian acts. Concerning aggressive behavioral disorders, we quote 3 cases of hetero-aggressivity (one by stab wound and 2 others developed an hypersexuality ± exhibitionism) and 9 cases of auto-aggressivity characterized by genital mutilations (1), defenestration (3), suicidal attempt (3), and acute psychiatric disorder with endangering life (2). Only four cases have been confirmed by toxicological analysis.

Conclusion

Behavioral disorders inducing forensics complications exist with NPS and particularly with cathinones. The problematic is certainly undervalued. A collaboration between addictovigilance and forensic services has to be improved.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Postmortem CT Angiography Compared with Autopsy: A Forensic Multicenter Study

Purpose

To determine if postmortem computed tomography (CT) and postmortem CT angiography help to detect more lesions than autopsy in postmortem examinations, to evaluate the strengths and weaknesses of each method, and to define their indications.

Materials and Methods

Postmortem CT angiography was performed on 500 human corpses and followed by conventional autopsy. Nine centers were involved. All CT images were read by an experienced team including one forensic pathologist and one radiologist, blinded to the autopsy results. All findings were recorded for each method and categorized by anatomic structure (bone, organ parenchyma, soft tissue, and vascular) and relative importance in the forensic case (essential, useful, and unimportant).

Results

Among 18 654 findings, autopsies helped to identify 61.3% (11 433 of 18 654), postmortem CT helped to identify 76.0% (14 179 of 18 654), and postmortem CT angiography helped to identify 89.9% (16 780 of 18 654; P < .001). Postmortem CT angiography was superior to autopsy, especially at helping to identify essential skeletal lesions (96.1% [625 of 650] vs 65.4% [425 of 650], respectively; P < .001) and vascular lesions (93.5% [938 of 1003] vs 65.3% [655 of 1003], respectively; P < .001). Among the forensically essential findings, 23.4% (1029 of 4393) were not detected at autopsy, while only 9.7% (428 of 4393) were missed at postmortem CT angiography (P < .001). The best results were obtained when postmortem CT angiography was combined with autopsy.

Conclusion

Postmortem CT and postmortem CT angiography and autopsy each detect important lesions not detected by the other method. More lesions were identified by combining postmortem CT angiography and autopsy, which may increase the quality of postmortem diagnosis.

Online supplemental material is available for this article.

Cannabinoid hyperemesis syndrome: A Parisian case series

Introduction

Currently, cannabis remains the most widely used illicit psychoactive substance in the world. Its main pharmacological properties are known and its use for therapeutic purpose is still expanding. Also, its acute and chronic toxicity become more described, even if some mechanisms of pharmacotoxicology still remain to clarify as the cannabinoid hyperemesis syndrome (CHS).

Objectives

To describe cases of CHS, to highlight the clinical presentation and all the complexity of the medical exploration for making an accurate diagnosis.

Method

We present a case series of CHS related to cannabis use and notified to the Parisian addictovigilance center.

Results

Eight cases were collected between 2011 and 2016. The users are almost exclusively men (7/8), with a median age of 31 years and some of them present a history of psychiatric disorder. All of them report important daily cannabis consumption (up to 15 joints by day) with duration of consumption averaged at 10 years. All patients present recurrences of clinical signs of the syndrome including vomiting (8/8) and abdominal pains (8/8) leading to repeated hospitalizations. Despite the presence of compulsive taking hot showers notion (7/8), specific sign of the CHS, its diagnosis were made by a physician in 5 cases. Carried out medical examinations are often complete, invasive, even going to an explorative laparotomy for one patient.

Conclusion

The CHS remains not well known. A better understanding of this syndrome will enable better patient care while avoiding costly spending unnecessary investigations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Example of alert and reporting system of scopolamine poisoning among Parisian cocaine users at regional, national and European levels

Introduction

In the literature, few intoxications are related to scopolamine due to its presence in cocaine, heroin or even in counterfeit rohypnol tablets. Nonetheless, during summer 2016, several cases of non-fatal intoxication appeared in the region of Paris.

Objectives

Demonstrate how clinical detection of rare toxic events are fostered by exchanges in close collaboration with different territorial level.

Aims

Improve the detection of short toxic epidemic.

Methods

Suspected cases of scopolamine poisoning notified to Parisian Addictovigilance centre were reported. Information shared through different levels of the alert process contributed to strengthen their assessment.

Results

Seventeen cases of probable scopolamine poisoning among cocaine users were registered between the 6 and 24 of July. In the first 4 cases, toxicological analysis, of blood samples were scopolamine positive, with high concentration between 7 ng/mL and 25 ng/mL (usual therapeutic range: 0.1 to 1.1 ng/mL). A collected sample of this cocaine powder had a purity of 23.2%, with 15.2% of scopolamine. Half time of scopolamine is longer than half time of cocaine (3–8 hours versus 1–2 hours): this could explain why the observed effects lasted over 24 hours (8/17). Main clinical features were mydriasis (15/17), high blood pressure (12/17), tachycardia (13/17), behavioural disorder with agitation (13/17), hallucinations (5/17), and coma (8/17). Practitioner's responsiveness and the extensive information sharing [MM1] between regional and European level were congruent.

Conclusions

Adulterated street drugs can lead to short toxic epidemic which could be unnoticed. Emerging event should require careful assessment with linkage between risk assessors and risk managers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

E-cigarettes and tobacco cessation: An online survey of electronic cigarette users in France

Introduction

E-cigarettes (EC) are widely used in general population and may facilitate smoking cessation. However, efficacy and addictive potential of EC remain insufficiently studied.

Objectives

To characterize e-cigarette use and its impact on tobacco use/cessation.

Methods

Online survey was available on CEIP website (September 2014–March 2015). Questionnaire assessed smoking status, tobacco and e-cigarette use, including reasons for use, efficacy, adverse effects and dependence (Fagerström test of cigarette dependence [F] and an adapted version to e-cigarette use [Fm]).

Results

One thousand one hundred and twenty-one EC users answered (1008 ex-smokers, 113 current smokers), with mean age of 39 ± 10 years and 72% female. Ninety-six percent e-cigarette users agreed that vaping is useful for tobacco cessation, 80% succeeded to quit/reduce their smoking. Reasons for EC use are partial/complete alternative to smoking, lower toxicity, less side effects and lower cost. Most of ex-smokers (66%) has no/low dependence to EC (Fm ≤ 4) since current smokers reduced dramatically their tobacco consumption by EC use. Among all EC users, 75% had a craving for EC. Use of EC is described as pleasant as tobacco for 59% ex-smokers and 39% smokers. Eighty-three percent of ex-smokers and 68% of smokers do not intend to stop vaping.

Conclusion

E-cigarettes are used primarily for smoking cessation and show effectiveness for harm-reduction, but a secondary dependence to nicotine contains in EC can be observed (Figure 1).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

“Dual disorder with drugs”: Comparison of two French databases

Context

Dual diagnosis (substance used disorders (SUD) and mental illness) represents 3% of general population. Among United States population, 42.3% of SUD patients have psychiatric troubles (without tobacco). Moreover, SUD can concern all psychoactive substances (PAS) or illicit PAS only named “dual disorder with drugs” (DDD).

Methods

A quantitative analysis of DDD data from January 2013 to July 2014 of two epidemiological tools has been performed: PMSI database (Programme Médicalisé des Systeme d’Information) hospital discharge data is made up of data providing medical information for all patients discharged in Paris public hospital system (AP–HP) and NOT'S is a vigilance database of spontaneous NOTifications of drug abuse and dependence. We propose a descriptive analysis of DDD in Paris metropolitan area.

Results

With PMSI, 9.2% of SUD inpatients (n = 617) have DDD, with mean age of 46 years (62% of men). In comparison, NOT'S reports 36% of SUD with DDD (n = 302) with mean age of 39.5 years (68% of men). Suicide attempt is also listed and reach 23% of cases.

Conclusion

These two databases (Fig. 1) show the difficulty of DDD diagnosis with the discordance in results. DDD miss in PMSI database since addictovigilance database shows a first prevalence of DDD. Despite the high rates of DDD, the problem is often under diagnosed by clinicians practising. It is also important to promote the collaboration among health care workers (addictologist and psychiatrist) because these patients require intensive mental and substance abuse care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Postmortem circulation: a new model for testing endovascular devices and training clinicians in their use

The development of new medical devices, such as aortic valves, requires numerous preliminary studies on animals and training of personnel on cadavers before the devices can be used in patients. Postmortem circulation, a technique used for postmortem angiography, allows the vascular system to be reperfused in a way similar to that in living persons. This technique is used for postmortem investigations to visualize the human vascular system and to make vascular diagnoses. Specific material for reperfusing a human body was developed recently. Our aim was to investigate whether postmortem circulation that imitates in vivo conditions allows for the testing of medical materials on cadavers. We did this by delivering an aortic valve using minimally invasive methods. Postmortem circulation was established in eight corpses to recreate an environment as close as possible to in vivo conditions. Mobile fluoroscopy and a percutaneous catheterization technique were used to deliver the material to the correct place. Once the valve was implanted, the heart and primary vessels were extracted to confirm its position. Postmortem circulation proved to be essential in several of the cadavers because it helped the clinicians to deliver the material and improve their implantation techniques. Due to the intravascular circulation, sites with substantial arteriosclerotic stenosis could be bypassed, which would have been impossible without perfusion. Although originally developed for postmortem investigations, this reperfusion technique could be useful for testing new medical devices intended for living patients.

Detection of hemorrhage source: the diagnostic value of post-mortem CT-angiography

The aim of this study was to compare the diagnostic value of post-mortem computed tomography angiography (PMCTA) to conventional, ante-mortem computed tomography (CT)-scan, CT-angiography (CTA) and digital subtraction angiography (DSA) in the detection and localization of the source of bleeding in cases of acute hemorrhage with fatal outcomes. The medical records and imaging scans of nine individuals who underwent a conventional, ante-mortem CT-scan, CTA or DSA and later died in the hospital as a result of an acute hemorrhage were reviewed. Post-mortem computed tomography angiography, using multi-phase post-mortem CTA, as well as medico-legal autopsies were performed. Localization accuracy of the bleeding was assessed by comparing the diagnostic findings of the different techniques. The results revealed that data from ante-mortem and post-mortem radiological examinations were similar, though the PMCTA showed a higher sensitivity for detecting the hemorrhage source than did ante-mortem radiological investigations. By comparing the results of PMCTA and conventional autopsy, much higher sensitivity was noted in PMCTA in identifying the source of the bleeding. In fact, the vessels involved were identified in eight out of nine cases using PMCTA and only in three cases through conventional autopsy. Our study showed that PMCTA, similar to clinical radiological investigations, is able to precisely identify lesions of arterial and/or venous vessels and thus determine the source of bleeding in cases of acute hemorrhages with fatal outcomes.

Bilan hydrologique d'un marais littoral à vocation agricole : Le marais de Moëze (Charente-Maritime, France)

En France, les sécheresses consécutives des années 1985, 1986, 1989 et 1990 ont mis en lumière les problèmes relatifs à l'alimentation en eau potable, l'irrigation des terres agricoles et la préservation des écosystèmes aquatiques. Dans le cas des zones humides, continentales et littorales, caractérisées par une compartimentation hydraulique souvent complexe, le manque de connaissance se fait particulièrement sentir. Bien que de nombreux travaux aient permis d'évaluer l'évaporation des masses d'eau et l'évapotranspiration de certaines espèces d'hydrophytes et d'hélophytes, les études débouchant sur des bilans quantitatifs restent peu fréquentes. Le bilan hydrologique du marais de Moëze (2250 ha) a été calculé par décade entre le 11/06/89 et le 31/08/89. Il prend en compte le débit au droit de l'ouvrage d'alimentation, les volumes prélevés pour l'irrigation hors marais, les infiltrations et l'évapotransplration sur les 318 km de canaux. L'estimation de la consommation d'eau des parcelles est globalisée au niveau des mesures d'infiltration.

Les pertes par infiltration sont secondaires (9,4 %) au regard des volumes prélevés pour l'irrigation (38,0 %) et évapotransplrés par les canaux (43,7 %) dont 51,1 % uniquement par les 28,6 % des plans d'eau colonisés par Typha latifolia.

L'optimisation de la gestion estivale de l'eau d'un marais littoral agricole nécessite dans un premier temps de minimiser les pertes. C'est essentiellement sur la consommation d'eau des canaux colonisés par les hélophytes que l'on peut intervenir. Nous proposons un abaque qui permet d'évaluer l'importance des économies d'eau réalisées en fonction de plusieurs scénarios d'aménagement du réseau hydraulique.

[Treatment of isolated nocturnal enuresis: alarm or desmopressin?]

BACKGROUND

Monosymptomatic nocturnal enuresis is common in healthy school children. Treatment is often required because of social and psychological convenience. We therefore conducted a randomized prospective trial using either desmopressin (D) or alarm (A).

PATIENTS AND METHODS

Patients (n = 135) aged 6 to 16 years were enrolled between January 1992 and December 1994. Desmopressin (Minirin spray, Ferring SA) was given intranasally at a dose of 20 micrograms at bedtime and increased to 40 micrograms after 2 weeks if partial result was obtained. The alarm was a pad-bell device (Wet-stop, Sega) and the sound source was attached to the upper part of the pajamas. Inclusion criteria were: primary monosymptomatic nocturnal enuresis in healthy children, age > or = 6 years, absence of previous treatment using either desmopressin or alarm. The aim of the treatment was to achieve 100% dry nights. Patients were evaluated after 15 days on therapy by phone call and thereafter by attending the outpatient clinic at 2-3 and 4-6 months. At the time of the second evaluation, a switch from alarm to desmopressin (or vice-versa) was proposed to those who did not respond to the initial treatment.

RESULTS

In group D (n = 62), only 27 children were included since 12 (19%) were switched to alarm and 23 (37%) were excluded because they were either non-compliant or lost to follow-up. In group A (n = 73), only 31 were included since six (8%) were switched to desmopressin and 36 (49%) were excluded for the same reasons as in group D. Prior to inclusion, the percentage of dry nights was 21% in group D and 14% in group A. After 15 days on therapy, patients from group D achieved 80% dry nights compared to 50% in group A (P = 0.001). After 3 months, patients from group D attained 85% dry nights vs 90% in group A. After 6 months, children from group A achieved 94% dry nights vs 78% in group D (P = 0.01).

CONCLUSION

Desmopressin offers better short-term results than enuresis alarm but the latter is significantly more efficient in the long term. In France, the alarm device is not reimbursed by the national health service and therefore is poorly accepted, as suggested from the high rate of patients lost to follow-up.

[Renal function after nephrectomy for Wilms' tumor]

BACKGROUND

Most children with Wilms tumour recover after nephrectomy, chemotherapy and sometimes radiotherapy. It is therefore important to assess their long-term renal function.

POPULATION AND METHODS

Thirty-three patients with Wilms tumour experienced unilateral nephrectomy between 1986 and 1993: three were excluded; 23 were staged as grade I, one at grade II, two at grade III and four at grade IV. They were treated with SIOP 6 and SIOP 9 protocols. The results were compared to five controls who underwent unilateral nephrectomy including three for renal trauma. The glomerular filtration rate (GFR) was measured by inulin clearance and the renal plasma flow (RPF) by para-amino-hippuric acid clearance.

RESULTS

The mean age at nephrectomy was 3.4 +/- 2.5 years (median: 3, range: 0.2-10.6) and the duration of follow-up was 4.6 +/- 3.1 years (median: 4.5, range: 1-8.5), the GFR was 93 +/- 13 mL/min/1.73 m2 (median: 93, range: 73-130), the RPF was 441 +/- 85 mL/min/1.73 m2 (median: 453, range: 236-650) and the filtrated fraction (FF) was 0.21 +/- 0.03 (median: 0.20, range: 0.18-0.31). The difference in renal function between patients and controls was not significant (GRF: 86 +/- 12 mL/min/1.73 m2, RPF: 486 +/- 185 mL/min/1.73 m2, FF: 0.22 +/- 0.03). The electrolyte reabsorption rate was normal and none of the patients suffered from arterial hypertension. Fourteen children had urinary albumin: creatinine ratio > 2 g/mol. When comparing patients according to the duration of follow-up after nephrectomy (< 4 years vs > 4 years), the renal function was not statistically different. The age at nephrectomy (< 2 years vs > 2 years) did not increase the risk of renal impairment.

CONCLUSION

Children with Wilms tumour who were treated with nephrectomy and non-nephrotoxic drugs (actinomycin, vincristine, epiadriamycin) have a good long-term renal outcome. It is speculated that systematic renal investigation should be limited to those children with increased microalbuminuria and/or elevated blood pressure.

Effect of kappa-casein split peptides on platelet aggregation and on thrombus formation in the guinea-pig

An undecapeptide (residues 106-116 of cow kappa-casein) is known to inhibit human platelet aggregation and fibrinogen binding through inhibition of the interaction between the fibrinogen gamma-chain C-terminus and alphaIIbbeta3. This was due to structural homologies with the fibrinogen gamma-chain C-terminal dodecapeptide. We have therefore compared in this work the in vitro anti-aggregating activity of kappa-casein split peptides and their in vivo potential antithrombotic activity in a model of arterial thrombosis triggered by laser-induced intimal injury in the guinea-pig. Caseinoglycopeptide (residues 106-169), the undecapeptide (residues 106-116) and the pentapeptide KNQDK (residues 112-116) from cow kappa-casein, were anti-aggregating peptides and exerted a significant antithrombotic activity in the guinea-pig. Caseinoglycopeptides from three species (cow, ewe and human) were also antithrombotic and the most potent being the human one. The antithrombotic activity was achieved in vivo for doses less than the one suspected from in vitro data and for which, ex vivo platelet aggregation was not decreased. In conclusion, the relative involvement of the fibrinogen gamma-chain C-terminal dodecapeptide could be much more important in in vivo thrombosis process than in in vitro platelet aggregation. Its specificity and activity in vivo unveiled an interesting potential way for inhibition of arterial thrombosis if alternative molecular presentation (i.e. peptidomimetics) and alternative route (i.e. per os) can be developed.

Unusual association of juvenile macular dystrophy with congenital hypotrichosis: occurrence in two siblings suggesting autosomal recessive inheritance

A familial association between juvenile macular dystrophy and congenital hypotrichosis is described in two siblings aged 25 and 23 years. We put forward arguments for locating the retinal alteration at the level of the retinal pigment epithelium and suggest that the hair disorder could be a Marie-Unna type hypotrichosis. This association is transmitted as an autosomal recessive condition.

High dose rate 60Co remote afterloading irradiation in cancer of the cervix in Haiti, 1977-1984

From 1977 through 1984, 293 previously untreated patients with biopsy proven carcinoma of the uterine cervix were treated by whole pelvis irradiation and high intensity 60Co remote afterloading (RAL) intrauterine tandem techniques in Haiti. The treatment results were analyzed retrospectively to evaluate the therapeutic results and prognostic factors of a strict protocol involving 40 Gy to the whole pelvis (2 Gy/day, 5 days/week). In addition, on the 5th day of the 3rd week, the first outpatient 60Co remote afterloading intracavitary insertion, delivering 7.5 Gy to point "A" with each insertion, repeated 3 times by a week separation for a total of 4 times. The total TDF for external beam plus RAL was 158 and 175 for early and late effects respectively. One hundred-four patients were evaluable after 1 year or more follow-up, with a median of 26.5 months. No evidence of disease (NED) by Stage at 1 year was: Stage I of 100% (3/3), Stage II of 82% (9/11), Stage III of 80% (47/59), and Stage IV of 58% (18/31). The post-therapeutic complication rate was 7.7%, with no fistulas or requirement of surgical intervention. Those with documented follow-up of at least 2 years (74 patients) had comparable survival to other high dose rate and low dose rate studies. This study shows that outpatient brachytherapy can be carried out without sophisticated and expensive equipment with minimal staff trained in radiation therapy. A detailed description of this outpatient RAL technique and results are described so that this method can be adapted to other developing and industrialized nations where cost containment is becoming a key issue.