Age-Related Differences in Cortical and Subcortical Activities during Observation and Motor Imagery of Dynamic Postural Tasks: An fMRI Study.

Age-related changes in brain activation other than in the primary motor cortex are not well known with respect to dynamic balance control. Therefore, the current study aimed to explore age-related differences in the control of static and dynamic postural tasks using fMRI during mental simulation of balance tasks. For this purpose, 16 elderly (72 ± 5 years) and 16 young adults (27 ± 5 years) were asked to mentally simulate a static and a dynamic balance task by motor imagery (MI), action observation (AO), or the combination of AO and MI (AO + MI). Age-related differences were detected in the form of larger brain activations in elderly compared to young participants, especially in the challenging dynamic task when applying AO + MI. Interestingly, when MI (no visual input) was contrasted to AO (visual input), elderly participants revealed deactivation of subcortical areas. The finding that the elderly demonstrated overactivation in mostly cortical areas in challenging postural conditions with visual input (AO + MI and AO) but deactivation in subcortical areas during MI (no vision) may indicate that elderly individuals allocate more cortical resources to the internal representation of dynamic postural tasks. Furthermore, it might be assumed that they depend more strongly on visual input to activate subcortical internal representations.

Real T1 relaxation time measurement and diurnal variation analysis of intervertebral discs in a healthy population of 50 volunteers.

PURPOSE: To measure the real T1 relaxation time of the lumbar intervertebral discs in a young and healthy population, using different inversion recovery times, and assess diurnal variation. MATERIAL AND METHODS: Intervertebral discs from D12 to S1 of 50 healthy volunteers from 18 to 25 years old were evaluated twice the same day, in the morning and in the late afternoon. Dedicated MRI sequences with different inversion recovery times (from 100 to 2500ms) were used to calculate the real T1 relaxation time. Three regions of interest (ROIs) were defined in each disc, the middle representing the nucleus pulposus (NP) and the outer parts the annulus fibrosus (AF) anterior and posterior. Diurnal variation and differences between each disc level were analyzed. RESULTS: T1 mean values in the NP were 1142±12ms in the morning and 1085±13ms in the afternoon, showing a highly significant decrease of 57ms (p<0.001). A highly significant difference between the levels of the spine was found. The mean T1 of the anterior part of the AF was 577±9ms in the morning and 554±8ms in the afternoon. For the posterior part, the mean values were 633±8ms in the morning and 581±7ms in the evening. It shows a highly significant decrease of 23ms for the anterior part and 51ms for the posterior part (all p<0.001). CONCLUSION: T1 mapping is a promising method of intervertebral disc evaluation. Significant diurnal variation and difference between levels of the lumbar spine were demonstrated. A potential use for longitudinal study in post-operative follow up or sport medicine needs to be evaluated.

A Case Report: Pseudoangiomatous Stromal Hyperplasia Tumor Presenting as a Palpable Mass.

We report a case of woman with a palpable lump on her left breast. On mammography, a huge mass located between the inner and the outer inferior breast quadrants of the left breast was found. The ultrasound examination realized later revealed a heterogeneous mass with smooth and lobulated borders. An MRI was also performed, showing an oval mass with heterogeneous areas of enhancement. Finally, a core biopsy under sonographic guidance revealed a pseudoangiomatous stromal hyperplasia of the breast.

Two case reports of a malignant germ cell tumor of ovary and a granulosa cell tumor: interest of tumoral immunochemistry in the identification and management.

OBJECTIVE: In this article, we present two case reports. The first case was a malignant germ cell tumor of the right ovary in a 23-year old woman and the second case was a bilateral undifferentiated granulosa cell tumor in a 71-year old woman. The aim of these reports is to illustrate the interest of the immunohistochemical analysis to define the correct diagnosis, to better classify these ovarian tumors and improve their management. METHODS: In this study, we report two cases. The first case concerns a 23-year old woman (A) with a mixed germ cell tumor of the right ovary [dysgerminoma (75%), yolk sac tumor (20%), and a mature teratoma (5%)], and the second case concerns a 71-year old woman (B) with a bilateral non-differentiated and necrotic granulosa cell tumor of both ovaries. The staging system was used according to both the classifications: International Federation of Gynaecology and Obstetrics 1987 for ovarian cancer and TNM code 2009. RESULTS: The immunostaining establishes the malignancy and the immunochemistry contributes to confirm effectively the right diagnosis (Tables 2 and 3). CONCLUSION: An immunohistochemical analysis is mandatory for the choice of chemotherapy to obtain a better response of the disease and improve the survival prognosis. The efficiency of the chemotherapy authorizes a conservative surgery including a unilateral salpingo-oophorectomy preserving fertility (A). Concerning the non-dysgerminoma tumor (B), and after a surgical staging and debulking, chemotherapy was recommended. The type of tumor and its histological feature conditioned the choice of treatment. The benefit of the immunohistological analysis in this case allowed the right adjuvant treatment.

Refined methodology for implantation of a head fixation device and chronic recording chambers in non-human primates.

The present study was aimed at developing a new strategy to design and anchor custom-fitted implants, consisting of a head fixation device and a chronic recording chamber, on the skull of adult macaque monkeys. This was done without the use of dental resin or orthopedic cement, as these modes of fixation exert a detrimental effect on the bone. The implants were made of titanium or tekapeek and anchored to the skull with titanium screws. Two adult macaque monkeys were initially implanted with the head fixation device several months previous to electrophysiological investigation, to allow optimal osseous-integration, including growth of the bone above the implant's footplate. In a second step, the chronic recording chamber was implanted above the brain region of interest. The present study proposes two original approaches for both implants. First, based on a CT scan of the monkey, a plastic replicate of the skull was obtained in the form of a 3D print, used to accurately shape and position the two implants. This would ensure a perfect match with the skull surface. Second, the part of the implants in contact with the bone was coated with hydroxyapatite, presenting chemical similarity to natural bone, thus promoting excellent osseous-integration. The longevity of the implants used here was 4 years for the head fixation device and 1.5 years for the chronic chamber. There were no adverse events and daily care was easy. This is clear evidence that the present implanting strategy was successful and provokes less discomfort to the animals.

Enhanced tumour growth and impaired cellular antitumoural defense in hepatic colorectal carcinoma metastasis in rats after laparoscopy compared to open surgery.

BACKGROUND: This study aims to assess postoperative hepatic growth of colorectal adenocarcinoma metastasis and peritumoural macrophage counts after laparoscopy in an experimental animal model. METHODS: Thirty male syngenic WAG/Rij rats were randomised into two surgical groups: laparoscopy (LS; n = 15) using CO(2) at 12 mmHg and laparotomy (LT; n = 15; negative control) during an operating time of 90 min. At 45 min after setup, CC531s colon adenocarcinoma cells were injected into two liver lobes. Postoperative tumour volumes were determined by abdominal magnetic resonance imaging (MRI) and computed three-dimensional volumetry. Peritumoural macrophages were counted by local stereology using a confocal laser-scanning fluorescence microscope. RESULTS: The median postoperative tumour volume was significantly higher after LS in both lobes (L): after 10, 15 and 20 days in L2 and L5: 24/12, 54/38, 275/62 mm(3) and 0/0, 15/11, 55/24 mm(3) (LS/LT). Significantly fewer peritumoural macrophages were found after LS at all postoperative time points (Mann-Whitney: p < 0.05). CONCLUSIONS: Increased hepatic growth of colorectal adenocarcinoma metastasis and impaired cellular antitumoural defence after LS cast doubt on the use of LS in colorectal cancer and needs further clinical investigation.

[Practice guidelines: conservative treatment of fibroids]. / Traitement conservateur des fibromes: recommandations pour la pratique.

The conservative treatment of uterine fibroids is essentially based on symptomatology and patient's choice of treatment. The gynaecologist must develop a clear therapeutic protocol based on clinical examination, available test results and consideration of patient preference. The therapeutic options include close surveillance, hormonal treatments, conservative operative endoscopy and arterial embolization.

Treatment of proximal humerus fracture using multiple intramedullary flexible nails.

A total of 61 patients with a proximal humeral fracture was treated between January 1996 and March 1998 by closed reduction and fracture fixation with intramedullary Prévot (or Nancy) nails. Of these, 28 female and 25 male patients with a mean age of 52 years (range 3-91 years) were reviewed clinically and radiologically with a mean follow-up of 17 months (range 4-30 months). The mean Constant score was 63, the mean Neer score 74 and the mean visual analogue scale (VAS) 73. The 14 patients under 24 years old achieved a Constant score of 86, a Neer score of 99 and a VAS of 97, while 13 patients aged between 25 and 60 years had a Constant score of 67, a Neer score of 75 and a VAS of 71. The 26 patients older than 61 years had a Constant score of 48, a Neer score of 61 and a VAS of 61. One patient with total and 6 with partial humeral head necrosis as well as 5 pseudarthroses were noted. Proximal nail perforation of the humeral head due to fracture collapse was seen in 22 cases. Complications were more frequently observed in the elderly. End results were not related to the type of fracture. This minimally invasive technique decreases the rate of occurrence of avascular necrosis of the humeral head. However, fractures are not sufficiently stabilised, mainly because of bone loss induced by impaction and osteoporosis. Bone loss remains an unsolved problem, and alternative methods such as the use of bone substitute combined with minimally invasive techniques should be studied.

Recovery of severe sciatica.

STUDY DESIGN: A prospective study of patients with acute severe sciatica. OBJECTIVES: To 1) describe the characteristics of patients with acute severe sciatica and the agreement among different diagnostic tests, 2) describe overall recovery during 1 year in terms of perceived disability, and pain, and 3) explore acute-phase predictors of failure to recover at 1 year. SUMMARY OF BACKGROUND DATA: The development of imaging techniques has been very impressive during recent decades. However, different authors have highlighted the prevalence of abnormal images among asymptomatic subjects. These findings increase the difficulty of interpreting the results from the diagnostic techniques used with each individual patient. Furthermore, other clinical and biopsychosocial variables need to be explored for their associations with recovery or failure to recover. This study aimed to explore those associations. METHODS: Consecutive patients admitted to the hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires that included items on demographics, pain, perceived disability, and quality of life. Imaging and blood samples were collected at the first visit, and an electromyogram was taken for sciatica lasting at least 3 weeks. RESULTS: The study included 82 consecutive patients (66% men) with a mean age of 43 +/- 10.3 years. The mean intensity of pain, on a visual analog scale of 0 to 100 (VAS) at Visit 1, was 73. The straight leg raising test was positive in 78% of the patients, with a mean value of 59 degrees +/- 18 degrees. The contralateral straight leg raising test was positive in 20% of the patients. Imaging was positive for disc herniation in 74% and electromyogram was positive in 62% of cases. These two diagnostic tests showed a good to excellent total agreement (58-87%) with the straight leg raising tests and the presence of radiating pain below the knee. The recovery of clinical symptoms and signs was observed mainly within the first 3 months. However, clinical recovery and perceived recovery was not complete in most cases. CONCLUSIONS: In most cases, there was good to excellent agreement among the different diagnostic tests. None of the tests was predictive of recovery. The presence of blood antibodies against 3'LM1 (IgM + IgG) and GD1a (IgM) was significantly associated (P < 0.023) with neurologic symptoms and signs. However, the meaning of these antibodies remains unclear. Only a minority of the patients (29%) had fully recovered after 12 months. Within the 1-year follow-up, one third of the patients had surgery.

A new catheter type for superselective angiography and embolization.

UNLABELLED: PURPOSE AND MATERIAL: A new family of catheters was developed to overcome the shortcomings of conventional catheters and to avoid the use of coaxial catheters in superselective angiography and embolization. The new catheter is nylon, 1.67 mm (JF) long, and has a rigid proximal part (to ensure torque control and pushability) and a long 2-step flexible tip (to follow arterial tortuosities). It has a hydrophilic coating, and a long-lasting shape memory. This new catheter type was compared experimentally with conventional catheters. RESULTS: Clear advantages were found with the new catheters in pushability and trackability as they, more often than conventional catheters, permitted us to reach the periphery of an artery. Departmental experience with the new catheters currently amounts to over 500 arterial procedures. CONCLUSION: The new catheters could frequently replace coaxial catheters, which would contribute towards reducing the costs of intravascular procedures.

[Transvascular percutaneous intervention in tumors: principles and indications]. / Transvaskuläre perkutane Intervention bei Tumoren: Prinzipien und Indikationen.

The techniques of interventional radiology in cancer therapy have been known for several years. Like other radiologic specialties it has benefited from rapid developments in imaging and catheter technology. The indications for percutaneous vascular therapy of tumors are generally palliative and have a curative intention only in rare conditions. Interventional techniques are useful in therapy of tumor bleeding and preoperatively to lessen the risk of hemorrhage. They effectively reduce tumor bulk and provide symptomatic relief. The techniques, indications, results and complications of transvascular therapy of tumors are described.

Iobitridol 300 compared to iopromide 300--a double-blind randomized phase-III study of clinical tolerance in total body CT.

UNLABELLED: PURPOSE, MATERIAL AND METHODS: The clinical safety of iobitriodol 300 mg I/ml and iopromide 300 mg I/ml were compared in a randomized double blind phase-III study conducted on 60 patients undergoing abdominal CT for a variety of indications. Each examination was rated as diagnostic or nondiagnostic and the image quality was noted. Nature, onset, intensity as well as outcome of each adverse reaction were recorded. RESULTS: There was no significant difference in imaging quality and side effects between the contrast media. In this study, both iobitridol and iopromide provided excellent image quality and a low rate of side effects. CONCLUSION: Iobitridol is a safe and effective nonionic contrast agent for contrast-enhanced body CT.

Long-term follow-up of the Günther basket inferior vena cava filter: does mechanical instability cause complications?

PURPOSE: The Günther basket inferior vena cava filter (GBF) has been withdrawn from the market because of its mechanical instability, but a number of patients still live with the device. METHODS: In a two-center study, we evaluated the long-term follow-up of the GBF, based on clinical data in 78 patients, and on imaging studies including plain radiographs, Doppler ultrasound, angiography, or computed tomography (CT) in 50 patients. RESULTS: In a mean period of 3 years, pulmonary embolism was diagnosed in five patients (6.4%), with an overall rate of 0.02 embolic episodes per patient per year. None of these patients required hospitalization, and there were no deaths due to pulmonary embolism. Inferior vena cava thrombosis was documented in three patients (3.9%), and occlusive venous thrombosis at the access site in seven patients (9%). Spontaneous migration was documented in 43% of the examined filters and spontaneous disruption in 77%. Dislocated filter fragments were localized by CT in the adjacent retroperitoneum in 11%, in the aortic lumen in 2%, and in a peripheral pulmonary artery in 7%. None of the patients had symptoms attributable to filter migration or disruption. CONCLUSION: Our results indicate that the rate of clinically relevant complications with the GBF is no higher than with other vena cava filters. Because mechanical instability of the GBF had no clinical consequences, we conclude that patients who live with this device may be observed and treated in a manner similar to patients with other vena cava filters.

Gamekeeper thumb: identification of the Stener lesion with US.

PURPOSE: To determine the value of ultrasound (US) in recognizing the ligamentary dislocation occasionally associated with gamekeeper thumb (Stener lesion). Detecting such dislocations is important because they require surgical repair, whereas nondisplaced ruptured ligaments respond to conservative treatment. This dislocation cannot be reliably diagnosed with standard methods, leading to unnecessary surgical procedures. MATERIALS AND METHODS: Forty-eight hyperabduction injuries of the thumb were included. The thumbs were either unstable or unexaminable because of tenderness. No fractures were seen on standard radiographs. RESULTS: Sonograms were positive in 13 patients, who then underwent surgery. A Stener lesion was found in 10 patients and a partial Stener lesion in three. Three patients with negative sonograms also underwent surgery, and no dislocation was found. The other 32 patients with negative US findings were treated conservatively, and none developed subsequent instability. CONCLUSION: US proved to be a reliable, simple, and easily reproducible tool for recognition of the Stener lesion.

Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty.

Alignment of the anatomical and mechanical axes of the lower extremities was analyzed using standardized radiographs in two series of 66 femur and 44 tibia specimens. A new anatomical axis, the distal femoral anatomical axis, was introduced. This axis corresponds to the overall femoral anatomical axis and encloses a valgus angle of 6 degrees with the mechanical axis of the femur. It allows for design of shorter intramedullary guiding instruments that will still be in congruency with true femur geometry. Comparison with computerized calculations of angles on computed tomography scans on a series of 38 bones shows a high precision of measurement on standard radiographs in neutral rotation.

Uncommon origin for the iliopsoas sign.

The term "iliopsoas sign" has different meanings in the medical literature. Among musculoskeletal disorders, iliopsoas bursitis is probably the most common cause of this clinical sign. Here we report an unexpected vascular pathology in a young man. The only clinical manifestation on examination was an iliopsoas sign.