Acute infantile encephalopathy predominantly affecting the frontal lobe (AIEF): a European case.

Acute infantile encephalopathy predominantly affecting the frontal lobes (AIEF) has been described as a new entity, based on MRI findings (acute abnormal diffusion-weighted imaging signals in the frontal lobes followed by atrophy) and exclusion of other acute encephalopathies. Patients present with acute onset of fever, status epilepticus, and coma. Different causal mechanisms have been suggested such as localized viral infection, toxic insult due to cytokines, or postictal damage. Only children of Japanese descent have been described. We report the case of a Caucasian girl whose history and MRI findings were similar to the Japanese cases. She had a massive regression with verbal apraxia, while cognitive development was less affected; she initially presented with a cluster of complex partial seizures (and not convulsive status epilepticus), making epileptic or post anoxic-ischemic sequelae highly unlikely. The place of this proposed entity among other recently described acute encephalopathies with abnormal diffusion on MRI is discussed.

In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars.

OBJECTIVES: The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. METHODS: One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. RESULTS: Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D(0), n=40) showed significantly lower laser fluorescence measurements than carious sites (D(1-4), n=77) (Mann-Whitney test, P<0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D(0-2) (n=74) and D(3,4) (n=43), the results were also different by a statistically significant amount (P<0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P<0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P=0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P<0.01). CONCLUSION: The device may be an adjunct tool in the approximal detection of caries along with established procedures.

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars.

OBJECTIVES: To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D(0)-D(1-4); D(0-2)-D(3,4)) in permanent molars. METHODS: In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n=86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n=34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann-Whitney test, Spearman's rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. RESULTS: Sound sites (n=13) had significantly minor fluorescence values than carious sites (n=107) (P<0.0001) as had sites with no/enamel caries (n=63) compared to dentinal caries (n=57). The AUCs for the same discriminations were 0.92 and 0.78 (P<0.001). For the D(0)-D(1-4) threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D(0-2)-D(3,4) threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho=+0.57, P=0.01). CONCLUSION: Within this study, the device's discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

Influence of professional cleaning and drying of occlusal surfaces on laser fluorescence in vivo.

Three dentists recorded laser fluorescence (LF) values on 117 teeth in 70 patients, in the sequence: (1) moist, uncleaned; (2) dried, uncleaned; (3) moist, cleaned; (4) dried, cleaned. LF values varied significantly with surface status (p < 0.01). The optimal cutoffs were up to 5 units lower on uncleaned, moist surfaces compared to the other states. Drying uncleaned surfaces significantly increased LF readings for dentinal caries (p < 0.01). It was concluded that occlusal surfaces should be clean and dry, for precise longitudinal monitoring of caries with LF as well as for detailed visual inspection, which should precede LF measurements.

Molecular markers linked to the apple scab resistance gene Vbj derived from Malus baccata jackii.

Breeding for scab-resistant apple cultivars by pyramiding several resistance genes in the same genetic background is a promising way to control apple scab caused by the fungus Venturia inaequalis. To achieve this goal, DNA markers linked to the genes of interest are required in order to select seedlings with the desired resistance allele combinations. For several apple scab resistance genes, molecular markers are already available; but until now, none existed for the apple scab resistance gene Vbj originating from the crab apple Malus baccata jackii. Using bulk segregant analysis, three RAPD markers linked to Vbj were first identified. These markers were transformed into more reliable sequence-characterised amplified region (SCAR) markers that proved to be co-dominant. In addition, three SSR markers and one SCAR were identified by comparing homologous linkage groups of existing genetic maps. Discarding plants showing genotype-phenotype incongruence (GPI plants) plants, a linkage map was calculated. Vbj mapped between the markers CH05e03 (SSR) and T6-SCAR, at 0.6 cM from CH05e03 and at 3.9 cM from T6-SCAR. Without the removal of the GPI plants, Vbj was placed 15 cM away from the closest markers. Problems and pitfalls due to GPI plants and the consequences for mapping the resistance gene accurately are discussed. Finally, the usefulness of co-dominant markers for pedigree analysis is also demonstrated.

In vivo performance of the new non-instrumentation technology (NIT) for root canal obturation.

AIM: The aim of this in vivo study was to compare the radiographic quality of root fillings performed by the NIT-obturation method versus conventional mechanical obturation. METHODOLOGY: Sixty-six patients needing root canal treatment participated in this study. The treatments were performed by three private practitioners. The root canals were instrumented with K-Flexofiles to a master apical file between sizes 25 and 60, followed by step-back flaring up to size 70. Copious irrigation was used throughout the instrumentation procedure with NaOCl (3%). The teeth were obturated either by lateral condensation, the McSpadden technique (control) or by the new non-instrumentation technology (NIT) with and without using gutta-percha points. In the NIT method, a low pressure was created within the tooth, and AH 26 sealer was sucked into the root canal system. Radiographs of the root-filled teeth were analysed and the length of the root filling, the presence of voids and the area of any other fillings determined. RESULTS: The root canal fillings of the control group (0.1 +/- 0.1 mm) and those of the NIT/gutta-percha group (0.3 +/- 0.1 mm) were both overextended when taking the apical constriction as a reference point. Root canal fillings of the NIT/gutta-percha group were statistically (P < 0.05) significantly longer than those of the NIT without gutta-percha group. The latter showed slightly underextended root canal fillings (-0.14 +/- 0.1 mm). CONCLUSIONS: The present investigation demonstrated the performance of the NIT-obturation method in vivo. Root canals filled by the reduced-pressure-method using sealer combined with gutta-percha cones exhibited equivalent radiographic quality compared to conventionally filled canals.

[Limbic encephalitis and SIADH revealing small-cell anaplastic lung cancer: MRI and immunologic findings]. / Encéphalite limbique et SIADH révélant un cancer pulmonaire anaplasique à petites cellules. Aspects IRM et immunologiques.

Paraneoplastic limbic encephalitis (PLE) is a manifestation of clinico pathological entity encephalo-myelo-neuropathy associated with anti-neuronal antibodies type 1 (ANNA-1 also called anti-Hu). Isolated PLE is rare. We reported a case of PLE in a 61-year-old heavy smoker man. An inappropriate antidiuretic hormone secretion syndrome was associated. Cranial MRI showed hyperintensity in amygdalo-hippocampic regions on T2 weighted sequences which appeared hypointense on T1-weighted sequences without gadolinium enhancement. Anti-Hu antibodies were absent in serum and in CSF. Despite chemotherapy, he died 18 months after disease onset. Our patient presented PLE without myelonouropathy and without ANNA-1 which suggests a different immunopathology.

Iatrogenic damage to adjacent teeth during classical approximal box preparation.

OBJECTIVES: Cutting and finishing approximal preparations with conventional instrumentation and methods may produce iatrogenic damage in adjacent tooth surfaces which subsequently requires restoration. The objective of this investigation was to determine the occurrence of iatrogenic damage and whether, under everyday working conditions in dental practice, such damage could be reduced significantly by using an alternative method and instrumentation designed especially for the purpose. METHODS: Dental practitioners were asked to take impressions of teeth scheduled for Class II amalgam restorations. One group (control) prepared the teeth with conventional rotary instrumentation (n = 71), while the test group used a new method and instrumentation (n = 63). These comprised a set of files, a right-angle handpiece with reduced stroke, 36 fixed (rotation-locked) positions for the files and a cylindrical bur with a recessed front-end cutting surface. Damage to the adjacent teeth was assessed under a stereomicroscope. RESULTS: Using conventional methods, all adjacent tooth surfaces showed damage, often exposing deep layers of dental tissues. There was a clinical and statistically significant reduction of incidence and severity of iatrogenic preparation trauma in the test group. CONCLUSION: It appears that conventional approximal box preparation results in significant damage to adjacent tooth surfaces. With the system tested, damage to adjacent tooth surfaces during preparation of proximal boxes can be significantly reduced. This should have an impact on the subsequent rate of restoration for the adjacent surfaces.

[Surinfected osteo-chondroplastic bronchopathy. Apropos of a case]. / Bronchopathie ostéo-chondroplastique surinfectée. A propos d'un cas.

We report a new case of tracheobronchopathia osteoplastica revealed by bronchopulmonary infections. The review of the literature enables us to summarize the clinical, endoscopic, morphological features, as well as pathogenic hypotheses.

Immune functions of veal calves fed low amounts of iron.

Immune functions were studied in male calves fed milk replacer (MR) containing 10 or 50 mg iron (Fe)/kg. Calves fed 10 mg Fe/kg MR developed marked hypoferremia and anemia, whereas serum-Fe and haemoglobin concentration of calves fed 50 mg Fe/kg MR were normal. Growth performance was reduced, while feed/gain ratio, incidence of infections (especially pneumonias), febrile body temperatures and antibiotic treatments were higher in calves fed 10 than 50 mg Fe/kg MR (p < 0.05). Whereas antibody production (to horse erythrocytes) and lymphocyte stimulation (by mitogens) were not significantly altered, cell-mediated immunity (measured as cutaneous delayed-type hypersensitivity reaction to dinitrofluoro-benzene), number of neutrophils with phagocytic capacity, activity of the Fe-containing enzyme myeloperoxidase, blood serum IgG concentration and the number and diameter of germinal centres as a measure of the number and production of B-cells in cervical superficial lymph nodes in calves fed 10 mg Fe/kg MR were reduced when compared with calves fed 50 mg Fe/kg MR (p < 0.05). In conclusion, severe Fe deficiency caused reduced growth performance, associated with and partly due to higher incidence of infections because of defective immune reactions.

[Diagnosis of hydroxyapatite disease]. / Beitrag zur Diagnostik der Hydroxyapatitkrankheit.

The possibility of detecting hydroxyapatite crystals in synovia in a routine setting has been studied prospectively. Coloration of the crystals with alizarin red-S was the method of choice. The diagnostic results were markedly improved by simultaneous observation of a freshly prepared positive control synovia.

[Malignant primary intrathoracic histiocytofibroma]. / Histiocytofibrome malin primitif intrathoracique.

Malignant primary intrathoracic fibrous histiocytoma (MFH) is a rare tumour: since it was first described in 1979, hardly more than 80 cases have been published. We present a large MFH which had started in the pleura and was intrathoracic. The tumour was typical, being comprised of malignant fibroblastic and histiocytoid cells in storiform arrangement. It was revealed by spinal bone metastases which multiplied over the whole skeleton in spite of chemotherapy. The patient died of cerebral metastasis developed 8 months after the onset of the disease. The cases found in the literature are gathered together and commented.

[Primary bronchial cancer in subjects aged 40 or younger]. / Cancer bronchique primitif chez le sujet de 40 ans et moins.

Between 1985 and 1989, 395 patients with primary lung cancer were treated at the Percy military teaching hospital, Paris. Among them were 16 patients (4%) aged between 29 and 40 years (mean: 34 years) and smokers (mean cumulative tobacco consumption 24 P.A.). Six of these (37%) had lung parenchyma dystrophy with bilateral apical bullae of emphysema, 1 had a clean cavity left by a previous lung abscess and 1 had microcytic fibrosis resulting from histiocytosis X of the lungs and bones. In all cases cancer had developed in contact with bullous lesions or sequelae. Cancer was discovered during radiological mass screening in 6 cases (37.5%), on the finding of systemic or thoracic symptoms in 5 cases and because of a distant metastasis in 5 other cases. Pathological examination revealed an adenocarcinoma in 8 out of 16 patients and only one small-cell carcinoma. Nearly two-thirds of the patients had reached an advanced stage: 3 were in stage III A, 1 in stage III B and 6 in stage IV. Eight patients underwent curative surgery (7 lobectomies, 1 pneumonectomy). Survival was known with precision in 14 patients: 8 died after a mean follow-up of 15 months (range: 3 and 31 months); 3 were alive with an active cancer and 4 are still alive in complete remission after curative surgery. Six published studies totalling 387 cases are concordant in demonstrating that primary lung cancer is severe in adults below 40 years of age and that surgery is useful in such cases, even with N2 lymph node involvement.

A new method for finishing minicavities.

Minicavities were prepared in 26 caries-free teeth. Cavity preparation and the finishing of the occlusal area and the gingival floor was done with diamond burs (diameter 1 mm, grain sizes 90 micron and 15 micron, respectively). For the finishing of the axial box margin and the proximo-cervical curved border, a new set was developed: It is composed of an EVA-system with the total amplitude reduced to 0.34 mm, and a highly flexible file (Cavishape, grain 15 micron). The shape of this file had to be modified in order to follow the proximo-cervical curvature. The efficiency of the new device was compared with the axial margin trimmer by means of scanning electron microscopy and a score system. The new device allowed a significantly better finishing of the proximo-cervical curvature and of the axial box margin.

Immunofluorescent studies of bovine hypersensitivity pneumonitis.

Antigens of Micropolyspora faeni were located by immunofluorescence in apparent association with alveolar macrophages within sections of lung from cases of bovine interstitial pneumonia. Pretreatment of frozen sections with pH 2.8 glycine-HC1 buffer was a necessary prerequisite for specific staining. Bovine immunoglobulin and bovine complement were identified in similar locations.