[The interest of electroneuromyography in peripheral facial palsy]. / Apport de l'électroneuromyographie dans les paralysies faciales périphériques.

In case of peripheral facial palsy, electroneuromyogram of the facial nerve provides an indication of the nature (myelinic and/or axonal) and severity of nerve damage, thereby facilitating establishment of a prognosis, which is favorable for myelin damage, and guarded for severe axonal damage. The initial examination must be carried out during the second week. In case of severe axonal damage, examination results can be monitored at the third, and more particularly the sixth and the twelfth months. Stable neurophysiological data between the sixth and the twelfth months signal damage stability and open the way to possible palliative surgery. In the event of trigeminal damage, neurophysiological exploration furthers analysis of temporal muscle innervation. ENMG can confirm and precisely indicate peripheral hemifacial spasm.

[Management of upper obstetrical brachial plexus palsy. Long-term results of non-operative treatment in 22 children]. / Traitement conservateur des paralysies obstétricales hautes du plexus brachial. Résultats à long terme chez 22 enfants.

INTRODUCTION: Treatment of obstetrical brachial plexus palsy (OBPP) is always debated, especially for upper plexus palsy. Some authors perform early surgical treatment in case of absence of biceps contraction at the age of 3 months. Others prefer to wait until the age of 6 months before considering a surgical procedure when no suspicion of root avulsion is found. We think that a conservative approach with intensive rehabilitation program can obtain good functional outcome for patients who will recover biceps function spontaneously between 3 and 6 months, and that it is not necessary to perform surgery at 3 months. To argue our choice, we have compared the long-term outcome of two groups of children with upper OBPP conservatively treated regarding the age of biceps recovery (before or after 3 months). PATIENTS AND METHODS: Twenty-two patients with non operated upper roots birth palsy, followed in Timone's Hospital of Marseille by a multidisciplinary team, have recovered a biceps contraction between 1 and 8 months and were retrospectively included in this study. All children underwent an intensive rehabilitation program since birth, performed by a specialized physiotherapist. Patients were reviewed, and their shoulder function was assessed using Mallet score. The score was analysed regarding the age of biceps recovery. RESULTS: The mean follow up was 8.2 years. Nine children recovered a biceps contraction at 3 months of age or before; the mean global Mallet score was 4.11. Thirteen children recovered a biceps contraction after 3 months of age (between 3 and 8 months); the mean global Mallet score was 3.92. The difference was not statistically significant. CONCLUSION: This study shows that global shoulder function is comparable for two groups. The children who did not recover a biceps contraction at 3 months of age had a global shoulder function as good as the one who recovered biceps function earlier. We think our intensive rehabilitation program allowed us to avoid a useless early surgery. Surgical plexus treatment was indicated for children who did not have biceps contraction after 6 months of age.

[Low circulating anti-Müllerian hormone and normal follicle stimulating hormone levels: which prognosis in an IVF program?]. / Pronostic en fécondation in vitro des patientes ayant une AMH basse et une FSH normale.

OBJECTIVE: To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL). PATIENTS AND METHODS: A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve). RESULTS: IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. DISCUSSION AND CONCLUSIONS: This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.

What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome?

Entrapment of the pudendal nerve may be at the origin of chronic perineal pain. This syndrome must be diagnosed because this can result in the indication of surgical decompression of the entrapped nerve for pain relief. Electroneuromyographic (ENMG) investigation is often performed in this context, based on needle electromyography and the study of sacral reflex and pudendal nerve motor latencies. The limits of ENMG investigation, owing to various pathophysiological and technical considerations, should be known. The employed techniques do not assess directly the pathophysiological mechanisms of pain but rather correlate to structural alterations of the pudendal nerve (demyelination or axonal loss). In addition, only direct or reflex motor innervation is investigated, whereas sensory nerve conduction studies should be more sensitive to detect nerve compression. Finally, ENMG cannot differentiate entrapment from other causes of pudendal nerve lesion (stretch induced by surgical procedures, obstetrical damage, chronic constipation...). Thus, perineal ENMG has a limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms. Pudendal neuralgia related to nerve entrapment is mainly suspected on specific clinical features and perineal ENMG examination provides additional, but no definitive clues, for the diagnosis or the localization of the site of compression. In fact, the main value of ENMG is to assess objectively pudendal motor innervation when a surgical decompression is considered. Perineal ENMG might predict the outcome of surgery but is of no value for intraoperative monitoring.

[Metal logarithmic scale titration as a tool for complexing ligand distribution determination: an application by DPASV]. / Titration en mode logarithmique comme methode de determination d'une distribution de ligands: une application par DPASV.

A new logarithmic scale titration is proposed for the characterisation of natural organic matter-trace metals interactions in natural systems. The Suwannee River Fulvic Acid complexation with Cd and Pb ions has been analysed by this technique, using Differential Pulse Anodic Stripping Voltammetry (DPASV) for labile metal concentrations measurement. Results of titrations have been modelled by four ligands. Their complexing properties (CLi, Ki(Cd), Ki(Pb)) have been determined by a non-linear optimisation based on the speciation program MINEQL, coupled with a simplex. These ligands were called "very weak, weak, strong and very strong" with respect to their complexing constants (Ki(Cd), Ki(Pb)) ranging from 10(4) to 10(11). The obtained ligands concentrations (CLi) are respectively 1.9 microM, 150 nM, 25.1 nM and 21.1 nM for a 7.9 ppm carbon content. Moreover, this model takes account of the pH dependency and metals competition respectively by experiments at pH 7.8 and 4.6, and by definition of stability constants for each ligand toward each analysed metal. As a conclusion, the authors suggest a systematic use of the logarithmic scale titrations when full characterisation of the metal-organic matter interactions is necessary.

Effects of UV-visible irradiation on natural organic matter from the Amazon basin.

The aim of this work was to evaluate the effects of UV-visible irradiation on organic carbon concentration, fluorescence intensity and metal transport ability of the natural organic matter (NOM) at fixed pH values and under several types of atmosphere (air, N(2), O(2)). The water samples were obtained from various sampling sites along the Rio Negro (Amazon basin) and the NOM metal transport ability was determined with regard to Cu(2+). As a first step we measured the concentration of total organic carbon (TOC) and its fluorescence intensity before and after an irradiation for a given time. The results demonstrated that when photodegradation happened, the dominant reactions involved O(2) and the fluorescent sites were among the first to be altered. Then we determined by spectrofluorometry the complexing capacity (C(L)) before and after irradiation. Fluorescence and complexing site densities (C(L)/TOC ratio) increased after a short irradiation time (20 min, i.e. before the photodegradation happened) and decreased after longer irradiation times. Therefore, we conclude that a change of the macromolecular structure activates previously inactive fluorophores and complexing sites prior to photodegradation.

[Measurement and differentiation method of carbon in municipal solid waste incineration (MSWI) bottom ash using differential scanning calorimetry (DSC)]. / Methode de mesure et de differenciation du carbone present dans les machefers d'incineration d'ordures menageres (MIOM) par calorimetrie differentielle a balayage (DSC).

In this study, Differential Scanning Calorimetry (DSC) is applied to speciation and evaluation of carbon in Municipal Solid Waste Incineration (MSWI) bottom ash. This innovative recognition approach highlights and quantifies different types of carboned materials in bottom ash: Labile Organic Carbon (LOC) and Refractory Carbon (RC). The Labile Organic Carbon contains small molecules unburnt or decomposed and volatile. This organic material (LOC) is oxidized at medium temperatures (between 300 and 325 degrees C). The Refractory Carbon contains Elementary Carbon (EC) and Resistant Organic Carbon (ROC) in the form of complex molecules of high molecular weight. This is oxidized at high temperatures (between 435 and 470 degrees C).

Excitation-emission fluorescence matrix to study pH influence on organic matter fluorescence in the Amazon basin rivers.

A study of the three-dimensional excitation-emission fluorescence matrix (EEFM) of organic matter from the Amazon basin rivers is reported in this paper. The EEFM, applied to the fractions obtained from sequential tangential ultrafiltration (STUF), give spectroscopic informations on the fluorescent properties of particulate (>0.22 microm), colloidal and dissolved (< 5 kD) organic matter. STUF process does not seem to alter the characteristic peaks position of humic material. Two characteristic excitation-emission peaks were observed in all fractions of the samples investigated, one stimulated by UV excitation (peak A) and one by visible excitation (peak C). Increasing the pH, fluorescence intensities of the fluorophores A and C, respectively, I(A) and I(C), responded in the same manner to pH, increasing with increasing pH. However, the fluorophore A seems more sensitive to this pH variation because its fluorescence intensity enhancement is always higher. Thus the chemical behaviour of the two fluorophores must be somewhat differentiated. The evolution of the I(A)/I(C) ratio with pH is studied for all samples. This investigation showed a linear relation between I(A)/I(C) and pH. Moreover, this behaviour is water type (black or white) and molecular size independent. Indeed, this linear relationship is observed for all samples and all fractions.

[Charcot Marie Tooth disease: exacerbation in pregnancy]. / Maladie de Charcot Marie Tooth: aggravation lors de la grossesse.

We report a case which illustrates the fact that an exacerbation of Charcot Marie Tooth disease, while rare, is possible during pregnancy. Moreover our case suggests the possibility of a positive effect of corticosteroids on such a complication, with an improvement of clinical symptoms as well as of electrophysiological results.

[Results of nerve sutures in the wrist in children]. / Résultats des sutures nerveuses au poignet chez l'enfant.

INTRODUCTION: Wounds involving the peripheral nerves cause serious damage in the upper limb. The prognosis for recovery remains uncertain despite microsurgery. It is commonly accepted that the results are far better in children than in adults. We sought to confirm this idea on the basis of objective recovery criteria, discriminating between peripheral axonal regeneration and the child's own capacity to adapt. In other words, do nerves regenerate better in children? MATERIALS AND METHODS: The clinical results of 25 nerve sutures of the wrist, in children under 15, were analysed with a minimum follow-up of 12 months. The subjects were reviewed clinically and had an electromyogram. The resulting data was compared to that for adults found in the literature. RESULTS: Clinically, the overall function of the hand was always satisfactory. The sensory results were often excellent (S4 or S3+ in 23 cases/25). The mean value muscular testing was between M2 and M3. With respect to the EMG results, the values we recorded were rarely representative of the functional results. The motor recordings were mostly poor, demonstrating that the nerve supply was compensated by a phenomenon involving collateral innervation. DISCUSSION: The poor results of peripheral nerve surgery are only due to the quality of the restored innervation. Dellon and Mackinnon demonstrated that they were also due to the incapacity of the nerve centres to integrate a change in the profile of sensory information. It would therefore seem that not only the quantity of nerve tissue repair is insufficient, but also the quality. Children have a superior cerebral capacity to adapt than adults and probably benefit from better cortical acquisition processes and are thus capable of putting the changes in the nerve messages to better use. The analysis of the clinical and EMG results also reveals a trend demonstrated partial nerve repair in children. We think that the functional results suggest that children have a better central capacity to adapt.

[Pseudo-paralysis of the brachial biceps in obstetrical brachial plexus lesions (OBPL):concerning the "overly optimistic" EMG in OBPL]. / Pseudo-paralysie du biceps brachial dans les paralysies obstétricales du plexus brachial (POPB)--à propos de l'"optimisme" de l'EMG.

In birth palsy of the brachial plexus, the mixed interference pattern recorded for the brachial biceps on the electromyogram often conflicts with the muscle's inability to flex the elbow. We report our observations of a six-month-old infant who presented paralysis of the upper and medial elements of the brachial plexus, in whom we demonstrated early biceps-triceps co-contractions, which may explain this discrepancy and 'pseudo-paralysis' of the biceps. We analyse and discuss the practical consequences of these findings, and notably the possible therapeutic use of triceps-to-biceps surgical transposition.

Adolescent girls and pelvic inflammatory disease: experience and practices of emergency department pediatricians.

OBJECTIVE: To describe the experience and practices of emergency department pediatricians in the United States related to the diagnosis and management of pelvic inflammatory disease (PID) in adolescent girls and to compare this experience with Centers for Disease Control and Prevention recommended management guidelines. DESIGN: National telephone survey. SUBJECTS: One hundred four pediatricians randomly selected from the 659 members of the Section on Emergency Medicine of the American Academy of Pediatrics. Response rate was 56%. MEASURES: A 42-item structured interview questionnaire assessed physician demographics, practice characteristics, PID diagnosis and management, and attitudes about sexually transmitted diseases in adolescents. RESULTS: Fifty-one (94%) of 54 emergency department pediatricians had diagnosed PID in adolescents at least once within the past 2 years, and 35 (69%) had diagnosed PID, on average, once per month or more. Less than half the pediatricians (23/51 [45%]) routinely recommended hospital admission for adolescents with PID as suggested by the Centers for Disease Control and Prevention, and among those treating adolescents with PID as outpatients,just over half (20/37 [54%]) arranged close follow-up within 72 hours of initiating antibiotic treatment. Although most emergency department pediatricians routinely suggested condom use (47/54 [87%]) and human immunodeficiency virus testing (34/54 [63%]) after diagnosing a sexually transmitted disease, a minority routinely provided contraceptive counseling (23/54 [43%]) or written partner notification (17/54 [31%]). Approximately two thirds of pediatricians surveyed indicated that they thought that the care of an adolescent with a sexually transmitted disease should be different from that of an adult (35/54 [65%]) and that this age group was more prone to medical complications (38/54 [70%]). CONCLUSIONS: The results of this survey suggest that emergency department pediatricians frequently diagnose PID in adolescent girls and understand the high risk of medical complications in this age group, but their management is often less aggressive than that recommended by Centers for Disease Control and Prevention guidelines and sexually transmitted disease experts.

[Activities of a family planning clinic incorporated to a public medical service over a 4-year period]. / Rapport sur l'activité d'une clinique de planification familiale, incorporée dans un service de médecine publique, pendant quatre années.

Over a period of four years, 1769 women, all of whom were married with at least 2 children, agreed to use an intra-uterine contraceptive device (IUD), 1199 women (predominantly unmarried) preferred to use an oral contraceptive (in most cases, two- or three-phase, low-estrogen pills) and 62 a local contraceptive (spermicide or diaphragm). The period of use was 89.65% for the IUDs, with a single case of acute inflammation of the genital tract. As expected, we diagnosed a large number of cases of asymptomatic Chlamydia trachomatis infections in 24% of the women using oral contraceptives and in 15% of the women fitted with an IUD. Symptomatic cases took the form of abdominal discomfort, vaginal discharge and metrorrhagia. In the opinion of the authors, the successful results obtained were due to the cooperation between the GP and the gynecologist and to a clear and firm policy towards the choice of the optimum method of contraception. In this article, the authors describe the principles behind this policy.

The correlation between Chlamydia antigen, antibody, vaginal colonization and contraceptive method in young unmarried women.

In a group of 55 unmarried women, mean age 25 years, attending a family planning clinic and having minor gynecological complaints, the correlation between Chlamydia trachomatis (CT) antigen, CT antibodies, vaginal colonization by Candida or bacteria and the method of contraception was investigated. The correlation between CT antigen and CT antibodies (IgG) was significant in oral contraceptive users (p = 0.003), as was the correlation with vaginal colonization by Candida and potential pathologic bacteria. In the group using the natural family planning method, a statistically significant correlation was found between CT antigen, IgG (p = 0.002), IgA (p = 0.02) antibodies, and vaginal candidiasis (p = 0.002), but not with bacterial colonization (p = 0.90). The discrepancy between CT antigen and antibodies is discussed. Differences in the prevalence of Chlamydia trachomatis infection were found among groups using different birth control methods, indicating an association between Chlamydia infection and the contraceptive method used.

[A case of compression of the posterior tibial nerve by a synovial cyst with impact on the superior tibiofibular joint]. / Un cas de compression du nerf tibial postérieur par un kyste synovial développé aux dépens de l'articulation péronéo-tibiale supérieure.

The authors report a case of compression of the posterior tibial nerve by a cyst originating from the superior tibio-fibular joint. The clinical signs were dysesthesia of the sole of the foot and paresis of the toe flexors. The diagnosis was obtained by electromyographic studies. The patient recovered completely after surgical excision of the cyst, which had developed beneath the tendinous arch of origin of the soleus muscle.