Plenitud ótica como primer síntoma en patología del espacio parafaríngeo / Otic fullness as a first symptom in parapharyngeal space pathology

RESUMEN Los tumores del espacio parafaríngeo (EP) son poco frecuentes, representando el 0,5%-1% de las neoplasias de cabeza y cuello. La distribución de los tumores del EP constituye: 40% tumores de glándulas salivales, seguidos de tumores neurogénicos y adenopatías. Presentamos un caso de una paciente de 52 años que acude por presentar sensación de taponamiento ótico izquierdo y molestias faríngeas de 3 meses de evolución. Tras una exploración otorrinolaringológica completa se sospecha patología del espacio parafaríngeo, que se confirma con las pruebas de imagen. Se realiza exéresis quirúrgica mediante abordaje transcervical-transparotídeo, con buena evolución posoperatoria y sin recidiva tras 1 año de seguimiento. El estudio anatomopatológico informa adenoma pleomorfo de parótida. En este trabajo se ha realizado una revisión de la etiopatogenia, diagnóstico y tratamiento de estas lesiones. Consideramos crucial realizar una exploración física otorrinolaringológica completa ante la presencia de un paciente con sintomatología inespecífica ya que el EP constituye un área anatómica difícil de explorar y que a menudo pasa desapercibida, por lo que la patología del EP representa un reto diagnóstico y terapéutico.

ABSTRACT Parapharyngeal space (PPS) tumors are infrequent and account for 0.5%-1% of head and neck neoplasms. Therefore, they represent a diagnostic challenge. The distribution of PPS tumors is as follows: 40% salivary tumors, followed by neurogenic tumors and adenopathies. We report a case of a 50 year old woman that presented with a 3-month history of otic fullness and pharyngeal disturbances. The otolaryngological examination showed PPS pathology that was confirmed by radiological images. Surgical excision by transcervical-transparotid approach was performed followed by uncomplicated healing with no recurrence in one year. The histological examination reported a pleomorphic parotid adenoma. The authors provide a discussion of the etiopathogenesis, diagnosis and treatment of this type of lesions. This clinical manuscript may shed light on the importance of a complete otolaryngological examination in a patient with unspecific symptoms considering that the PPS is a complex anatomic region and its pathology can easily go unnoticed.

Single-molecule magnet behaviour in a tetranuclear DyIII complex formed from a novel tetrazine-centered hydrazone Schiff base ligand.

Two analogous tetranuclear lanthanide complexes have been synthesized with the general formula [Ln4(vht)4(MeOH)8](NO3)4·aMeOH·bH2O, where H2vht = (3,6-bis(vanillidenehydrazinyl)-1,2,4,5-tetrazine) and Ln = DyIII (1), GdIII (2). These complexes are characterized by several techniques; including single-crystal X-ray diffraction, SQUID magnetometry and single-crystal micro-SQUID hysteresis loop measurements. Elucidation of the crystal structure of the complexes shows that the lanthanide ions are bridged by a tetrazine ring, a rare bridging moiety for lanthanide ions. Magnetic studies reveal that both 1 and 2 exhibit weak ferromagnetic exchange interactions between Ln ions, and 1 displaying Single-Molecule Magnet (SMM) behaviour with a magnetisation reversal barrier of Ueff = 158 K (τ0 = 1.06 × 10-7 s).

Terminal solvent effects on the anisotropy barriers of Dy2 systems.

A family of three dinuclear dysprosium complexes have been successfully synthesized and studied in terms of their magnetic properties. Complexes 1 and 2 share the formula [Dy2(ovph)2Cl2(solvent)2], where H2ovph = pyridine-2-carboxylic acid [(2-hydroxy-3-methoxyphenyl)methylene] hydrazide, and solvent = DMF (1), i-PrOH (2), while complex 3, [Dy2(ovph)2Cl2(H2O)3(EtOH)], exhibits differences in terms of the identity and number of coordinated solvent molecules. Thus, we investigate the impact of terminally bonded solvent molecules on the slow relaxation dynamics of {Dy2} SMMs, a parameter which can sometimes be overlooked in the quest to attain higher energy barriers. Notably, the exchange of DMF for i-PrOH, both of which coordinate through a single oxygen atom, results in a near 2-fold increase in Ueff, from 58 to 98 K, for 1 and 2, respectively.

[The contribution of legal medicine in child protection: Presentation of a multidisciplinary approach]. / Apport de la médecine légale à la protection de l'enfance : présentation d'un mode d'évaluation pluridisciplinaire.

INTRODUCTION: Maltreatment is a complex issue and therefore, requires a multidisciplinary approach, which has been commonly used in North America since the 1980s but remains unsystematic in France. Since 1999, the Centre d'Accueil en Urgence des Victimes d'Agression (emergency unit for victims of assault) of the Bordeaux University Hospital has brought together various medical, paramedical, and social actors on this issue. A standardized psychosocial assessment procedure has been introduced and is detailed in this paper, and was consistently conducted in all cases of suspicion of abuse on a minor. METHOD: The authors studied 74 cases of minors having undergone a psychosocial assessment following suspicions of maltreatment between 1 July 2014 and 30 June 2015 that were not referred to the courts. RESULTS: Forty-five girls and 29 boys, mean age 7 years, claiming mainly (75 %) to have been subjected to sexual violence, were addressed to us by internal partners (n=15) and external partners (n=37) and 22 who came to our unit by self-referral. Following our assessment, 35 returned to their home and 36 went to court following a police complaint (n=17) and a report filed to the public prosecutor of the Republic (n=19). Three of these cases were subjected to a report on matters of concern sent to the departmental council. CONCLUSION: Given the absence of a national consensus on the methodology used for assessing suspicions of maltreatment on minors, our psychosocial assessment can facilitate the task with its peer review as well as the detection and judicialization of the maltreatment. The authors also highlight the recent modification of article 226-14 of the Penal Code, which aims at protecting professionals reporting matters to legal authorities from any legal proceeding, except if it is established that the individual did not act in good faith.

Small fields output factors measurements and correction factors determination for several detectors for a CyberKnife® and linear accelerators equipped with microMLC and circular cones.

PURPOSE: The use of small photon fields is now an established practice in stereotactic radiosurgery and radiotherapy. However, due to a lack of lateral electron equilibrium and high dose gradients, it is difficult to accurately measure the dosimetric quantities required for the commissioning of such systems. Moreover, there is still no metrological dosimetric reference for this kind of beam today. In this context, the first objective of this work was to determine and to compare small fields output factors (OF) measured with different types of active detectors and passive dosimeters for three types of facilities: a CyberKnife(®) system, a dedicated medical linear accelerator (Novalis) equipped with m3 microMLC and circular cones, and an adaptive medical linear accelerator (Clinac 2100) equipped with an additional m3 microMLC. The second one was to determine the kQclin,Qmsr (fclin,fmsr) correction factors introduced in a recently proposed small field dosimetry formalism for different active detectors. METHODS: Small field sizes were defined either by microMLC down to 6 × 6 mm(2) or by circular cones down to 4 mm in diameter. OF measurements were performed with several commercially available active detectors dedicated to measurements in small fields (high resolution diodes: IBA SFD, Sun Nuclear EDGE, PTW 60016, PTW 60017; ionizing chambers: PTW 31014 PinPoint chamber, PTW 31018 microLion liquid chamber, and PTW 60003 natural diamond). Two types of passive dosimeters were used: LiF microcubes and EBT2 radiochromic films. RESULTS: Significant differences between the results obtained by several dosimetric systems were observed, particularly for the smallest field size for which the difference in the measured OF reaches more than 20%. For passive dosimeters, an excellent agreement was observed (better than 2%) between EBT2 and LiF microcubes for all OF measurements. Moreover, it has been shown that these passive dosimeters do not require correction factors and can then be used as reference dosimeters. Correction factors for the active detectors have then been determined from the mean experimental OF measured by the passive dosimeters. CONCLUSIONS: Four sets of correction factors needed to apply the new small field dosimetry formalism are provided for several active detectors. A protocol for small photon beams OF determination based on passive dosimeters measurements has been recently proposed to French radiotherapy treatment centers.

[Intensity modulated radiation therapy: analysis of patient specific quality control results, experience of René-Gauducheau Centre]. / Radiothérapie conformationnelle avec modulation d'intensité: analyse des résultats des contrôles précliniques, expérience du centre René-Gauducheau.

PURPOSE: Systematic verifications of patient's specific intensity-modulated radiation treatments are usually performed with absolute and relative measurements. The results constitute a database which allows the identification of potential systematic errors. MATERIAL AND METHODS: We analyzed 1270 beams distributed in 232 treatment plans. Step-and-shoot intensity-modulated radiation treatments were performed with a Clinac (6 and 23 MV) and sliding window intensity-modulated radiation treatments with a Novalis (6 MV). RESULTS: The distributions obtained do not show systematic error and all the control meet specified tolerances. CONCLUSION: These results allow us to reduce controls specific patients for treatments performed under identical conditions (location, optimization and segmentation parameters of treatment planning system, etc.).

Achilles tendon pain intensity and level of neovascularization in athletes as determined by color Doppler ultrasound.

The cause of pain in Achilles tendinopathy is thought to be related to the presence of neovascularization in the tendon as seen on color Doppler ultrasound. Asymptomatic pathology has been observed in patellar tendons of elite athletes. The purpose of this study was to examine the prevalence of Achilles tendon pain and the characteristics of Achilles tendons in a young athletic population. Sixty-four varsity athletes underwent color Doppler ultrasound imaging to determine tendon thickness, presence of degeneration and neovascularization. The presence of swelling and tenderness was determined, and Achilles tendon pain was rated on three visual analogue scales (VAS) (pain during exercise, pain at rest, pain during daily activities) as well as on the VISA-A scale. Tendon symptoms were not related to the presence of neovascularization. There was a low prevalence of Achilles tendinopathy, tenderness, and neovascularization in this population. Neovascularization was seen in both a painful and a non-painful tendon.

Long-term complications of total body irradiation in adults.

PURPOSE: To report long-term pulmonary, thyroid, and ocular complications in patients who had conditioning regimens including total body irradiation (TBI) before bone marrow transplantation (BMT). METHODS AND MATERIALS: Between June 1986 and December 1995, 478 patients received TBI in our institution. The present study includes 186 adult patients who had complete remission lasting one year or more after BMT. There were 108 males and 78 females. Median age was 36.5 years (range 15-60). Initial diagnoses were lymphomas (50%), acute lymphoid leukemias (16%), acute myeloid leukemias (16%), chronic myeloid leukemia (13%), aplastic anemia (3%), and myelodysplasia (2%). At the time of BMT, 43.5% of patients were in complete response and 56.5% in partial response. Treatment consisted of a single dose TBI at 10 Gy in 9% and fractionated TBI delivering 12 to 13.5 Gy in 6 fractions in 91%. From 1986 to October 1991, TBI was performed in lateral position with 9 MV energy (57% of patients) and thereafter in alternate prone and supine positions with 15 MV energy (43%). Chemical conditioning regimen was cyclophosphamide (60 mg/kg at D-4 and D-3) in 69% and CBV (cyclophosphamide 1500 mg/m(2) from D-6 to D-3, BCNU 300 mg/m(2) at D-6, VP-16 200 mg/m(2) from D-6 to D-4) in 25%. Fifty eight percent of patients received autologous and 42% allogeneic BMT. All patients had clinical, biologic, and functional examinations at one-year intervals. RESULTS: Median follow-up from BMT was 49 months (range 12-136). Late pulmonary effects were observed only in functional explorations, without clinical effect, including restrictive syndrome in 8% and alteration in the diffusing capacity of carbon monoxide in 12%. No patient showed clinical thyroid symptoms, and 10% developed biologic dysfunction: hypothyroidism (6.5%), thyroiditis (3%), and Basedow disease (0.5%). Ocular complications occurred in 29.5%, including cataract (15%), dry syndrome (13%), and keratitis (1.5%). In univariate and multivariate analysis, pulmonary complications were statistically increased by chronicle graft vs. host disease (GVHD) vs. no (p = 0.02), prone and supine vs. lateral TBI position (p = 0.02), and with 15 MV vs. 9 MV beam energy (p = 0.02). Cataract occurred less frequently with fractionated than with single-dose TBI (p = 0.000002). No differences were observed regarding age, sex, initial diagnosis, status at the time of BMT, conditioning chemotherapy regimen, and total dose of TBI. CONCLUSION: From this retrospective study it was shown that long-term complications of TBI were not symptomatic in most patients. The role of parameters of irradiation and especially position of treatment and beam energy should be emphasized and assessed with a longer follow-up.

Transrectal ultrasound-guided biopsy of the prostate: relation between ASA use and bleeding complications.

OBJECTIVE: To determine the relation between ASA ingestion and the incidence of bleeding complications after transrectal ultrasound (TRUS)-guided biopsy of the prostate. METHODS: Overall, 1810 patients with suspected prostate disease were followed after biopsy. ASA use was determined before the procedure. A TRUS-guided sextant biopsy was performed and patients were contacted immediately and by follow-up telephone call to determine whether there were any immediate or delayed bleeding complications. RESULTS: Overall, 46 subjects (2.5%) had bleeding complications. Of the 54 subjects reporting current use of ASA, 2 (3.7%) had such complications. This difference was not significant. CONCLUSION: There was no evidence of an association between the use of ASA and postbiopsy bleeding complications.

Genealogical study of oculopharyngeal muscular dystrophy in France.

This work is based on 54 probands affected by oculopharyngeal muscular dystrophy (OPMD). The muscle biopsy of all these patients showed the presence of the intranuclear inclusions, specific of this disease. The residence of the probands is concentrated in three clusters: the Paris, Marseilles and Bordeaux regions. The genealogical study was carried out on 43 probands, 10 of which did not have any ascendance in France for more than two generations. The geographic origin of the 33 patients of French descent was distributed over numerous regions, not including the Paris and Marseilles regions where many patients lived. This geographic dispersion and the rarity of common genealogies of the probands, did not suggest the existence of a recent founder effect, in contrast to what is observed in the French-Canadian community. The existence of a link between French and French-Canadian families is currently being investigated.

Stay or leave? Individual choice and family logic: the destinations of children born in the Valserine Valley (French Jura) in the eighteenth and nineteenth centuries.

"To study inheritance, it is necessary in the first place to know the number of heirs in each family, how property was divided between them, and whether their inheritance was sufficient to enable them to maintain and support several children in the parish. This study examines the process by which the populations of the parishes of Valserine Valley in France reproduce themselves from one generation to the next, by means of examining the ¿effective' progeny of couples to determine how many of them produce children (heirs) who continue to live in the Valley. The ultimate goal of these researches is to establish the characteristics of those who leave the Valley, and how these differ from those who choose to stay. The article examines whether it is possible to discern a family strategy in the way these decisions are made, and whether behavior of the persons in question is determined by individual choice."

[The reproduction of the population in the seventeenth, eighteenth, and nineteenth centuries. Examples from France and Quebec]. / La reproduction de la population aux XVIIe, XVIIIe et XIXe siècles. Exemples français et québecois.

This article examines the descendants of four cohorts of couples formed in the seventeenth and eighteenth centuries (two cohorts in two French mountain valleys and one on the Ile-d'Orléans in Quebec). The children are separated into four categories according to their fate (deceased while still unmarried, unknown fate, married but childless, "useful children"). "Useful children", a concept used in population genetics, are those who in turn bear children. In all three places, the useful children represent only from 26 to 31% of births. The study goes on to measure the contributions made by these couples to the next generation. In the mean, each couple gave birth to little over one useful child. But the contributions of couples turns out to be very unequal. Depending on the place, from 36 to 53% of couples left no useful children behind them, while a small minority of couples made an ample contribution to the next generation. The same measure is reproduced in the constitution of the next generation, thereby showing that inequality of couples in terms of reproduction is perpetuated.

Age of mother at last birth in two historical populations.

This study uses sets of historical family reconstitutions from all of Quebec and from four villages of the Haut-Jura, France--first marriages of 2226 and 994 women, respectively--to investigate the physiological and social factors affecting age of mother at last birth before and during fertility transition. Age remained high throughout the period covered in Quebec, under 'natural' conditions, but showed a steady decline in the French material which extends to late 19th century generations practising family limitation. Age at marriage had no influence in Quebec; in France, however, women with the most surviving children at age 35 continued childbearing the latest. There was no link between biological ability to achieve a live birth, or in health status or aging rhythm, and age at last birth. Behaviour of mothers and daughters showed no relation. The variability in age at last birth thus appears to be random under natural conditions; with the onset of controls, social differences seem to influence not only the end of childbearing, but all aspects of behaviour governing final family size and child survival.

PIP: The study of the cessation of childbearing in natural fertility populations has yielded mixed results. This study examined the physiological and social factors affecting the maternal age at last birth before and during fertility transition. Data were obtained from linked registries of baptisms, marriages, and burials compiled at the University of Montreal. The data set of 2226 women born between 1624 and 1715 included the entire French Canadian population living in the Province of Quebec between 1608 and 1765 for births and 1799 for deaths. This time period corresponded to a natural fertility regimen, and toward the end of the period the youngest had begun spacing of the last birth interval. Another data set of 994 women born before 1900 pertained to four French villages of Haut-Jura from 1680 through the French fertility transition. The sample included only women with an exact birth date, a first marriage, and the last child born being born around the age of 30 years. The Canadian women had a mean and median age of marriage of 21 years and a mode of 19 years. Early marriage was prevalent, and 50% of births occurred after 1694. About 50% of women had 8-12 children, with the average being 11 children; the highest number was 20 or more. The French women spanned 2.5 centuries and the mean was the year 1800. The average marriage age was 23.7 years and the average number of children was 6; 14 children was the highest number. The results showed that the French Canadian women bore their last child at an average age of 41.5 years compared to 39.5 years for the French women. The age at last birth declined over time in the French sample to below 38 years after 1840. The French Canadian sample showed 50% of women ending childbearing around the age of 40 years and 70% of women doing so in the 37-44 age span. Marriage age was unrelated to last birth in the Quebec sample, and length of first birth interval was unrelated in either sample. The French sample showed that age at last birth increased with age at marriage, thereby suggesting stopping behavior. Mothers with 4 children at the age of 35 years had their last child a year later than those with 3 children. Age at last birth was not related to daughter's age at last birth. Stopping behavior was more related to age than norms about appropriate numbers of children.

[Populations and heredity: at an intersection]. / Populations et hérédité: à la croisée des pistes.

A population can be defined using different criteria, for example criteria of a geographical or medical nature. Researchers, or even patients and journalists, have complementary or contradictory views of this notion. Heredity is not only a biological fact; it is also a social fact. A systematic study of the genealogical corpus of a group of patients makes it possible to evaluate the soundness of the phenotypic criterion used to define a subpopulation that shares a common pathological heredity.

[The difference in mortality between biological children and foster children: the example of Druillat (Ain) in the seventeenth century]. / Mortalité différentielle des enfants indigènes et des enfants en nourrice. L'exemple de Druillat (Ain) au XVIIe siècle.

Druillat, a parish in Bresse, welcomed a lot of abandoned infants who had been found a foster home by Lyons Hôtel-Dieu (hospital) during the second half of the eighteenth century. After specifying the annual volume of this incoming flow, the arrival of each infant at its foster home is considered. The notion of foster home covers in diversified family situations as far as the number of native children and infants are concerned. Through the comparison of deaths recorded locally and the Hôtel-Dieu register keeping lists of the infants' placements, the mortality of foster infants can be precise and compared to that of natives. The age at which they were put out to nurses and the host family standards of living, plays a fundamental role as far as the infant mortality risks are concerned.

Diffusion of a particular 4.1(-) hereditary elliptocytosis allele in the French Northern Alps.

Heterozygous 4.1(-) hereditary elliptocytosis results from the absence of one haploid set of protein 4.1, a major component of the red cell skeleton. Two successive epidemiological investigations revealed fifteen probands in the French Northern Alps. The frequency of this disease seems to be very high in four small villages isolated in the Aravis mountains. The genealogical study shows that eleven probands share common ancestors who lived eight or ten generations ago in these villages. Thus there was probably a founder effect from one pair of ancestors, strengthened by endogamy. In contrast, four probands originate from another area and are not genealogically related. Recent results in molecular genetics support the present data.