[Abdominal necrotizing fasciitis after caesarean delivery]. / Fasciite nécrosante de la paroi abdominale post-césarienne.

Necrotizing fasciitis (NF) is a rare infection (0,2 to 0,4/100,000 adults) of the dermis and hypodermis extending along muscular fascia1. The absence of pathognomonic symptoms makes its diagnosis difficult. Rapidly progressive, it is a life-threatening emergency whose prognosis is letal in 30 % of cases. Treatment of necrotizing fasciitis is mixed and involves aggressive surgical debridement and medical treatment with antibiotics and supportive agents. This article is presenting the case of a young woman who developed abdominal necrotizing fasciitis following a caesarean section. In forty-eight hours, the patient developed septic shock with an extensive and rapid destruction of her abdominal wall. After hysterectomy and multiple surgical debridements, evolution was favorable. After one month, a reconstruction of the abdominal wall could be performed.

La fasciite nécrosante (NF) est une infection rare (0,2 à 0,4/100.000 adultes) caractérisée par une dermo-hypodermite nécrosante s'étendant le long des fascias sous-cutanés. L'absence de symptôme pathognomonique rend son diagnostic difficile. D'évolution rapidement progressive, il s'agit d'une urgence vitale dont le pronostic est fatal dans 30 % des cas. Le traitement est mixte et associe un débridement chirurgical agressif à un traitement médical à base d'antibiotiques et d'agents supportifs. Cet article reprend le cas d'une jeune femme ayant développé une fasciite nécrosante abdominale suite à une césarienne. En quarante-huit heures, la patiente a présenté un choc septique avec une destruction extensive et rapide de sa paroi abdominale. Une hystérectomie et de multiples débridements chirurgicaux ont permis une évolution favorable. Après un mois, une reconstruction de sa paroi abdominale a pu être effectuée.

Conformational stability and activity of p73 require a second helix in the tetramerization domain.

p73 and p63, the two ancestral members of the p53 family, are involved in neurogenesis, epithelial stem cell maintenance and quality control of female germ cells. The highly conserved oligomerization domain (OD) of tumor suppressor p53 is essential for its biological functions, and its structure was believed to be the prototype for all three proteins. However, we report that the ODs of p73 and p63 differ from the OD of p53 by containing an additional alpha-helix that is not present in the structure of the p53 OD. Deletion of this helix causes a dissociation of the OD into dimers; it also causes conformational instability and reduces the transcriptional activity of p73. Moreover, we show that ODs of p73 and p63 strongly interact and that a large number of different heterotetramers are supported by the additional helix. Detailed analysis shows that the heterotetramer consisting of two homodimers is thermodynamically more stable than the two homotetramers. No heterooligomerization between p53 and the p73/p63 subfamily was observed, supporting the notion of functional orthogonality within the p53 family.

Ultrasound bone measurements in pre-adolescent girls: interaction between ethnicity and lifestyle factors.

AIM: We obtained calcaneal ultrasound measurements in 198 girls between 7.5 and 11.7 y of age, representing ethnic groups (black [n = 80], white [n = 41], mixed ancestral origin [n = 77]) in South Africa. METHODS: Anthropometry was assessed. Demographics, physical activity, habitual dietary calcium intake and pubertal development were quantified by questionnaires. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the left calcaneus were measured. Girls in Tanner breast stage 5 and/or those menstruating were excluded from analysis. RESULTS: Black girls were lighter than white girls (31.4 +/- 7.8 vs 34.8 +/- 7.5 kg; p < 0.05), and shorter than girls of mixed ancestral origin (1.29 +/- 0.08 vs 1.34 +/- 0.07 m; p < 0.001) and white girls (1.35 +/- 0.07 m; p < 0.001), after adjusting for age. Reported calcium intake scores were higher in black than white girls (21.6 +/- 11.1 vs 16.1 +/- 8.4; p < 0.01). Total peak bone strain score (TPBSS) was higher in white compared to black girls (6.8 +/- 4.8 vs 5.0 +/- 4.7; p < 0.05), while walking energy expenditure (MET h/wk) was higher in black girls compared to the other groups (p < 0.001). BUA and SOS were higher in the black girls (59.6 +/- 13.7 dB/MHz; 1575.1 +/- 22.6 m/s; p < 0.001) and girls of mixed ancestral origin (59.0 +/- 12.5 dB/MHz; 1567.8 +/- 26.1 m/s; p < 0.01) than in the white girls (50.4 +/- 8.7 dB/MHz; 1552.1 +/- 19.5 m/s). Co-varying for age and weight did not affect these results. Walking energy expenditure (r = 0.20) and calcium score (r = 0.17) were correlated (p < 0.05) with SOS for the whole group. CONCLUSION: Ultrasound parameters were lower in the white compared to the black girls, who consumed more calcium on average, but who were lighter, shorter and performed less impact activity. This suggests that interactions between ethnicity and lifestyle factors determine bone quality in premenarcheal girls.

Verrucous carcinoma or epithelioma cuniculatum plantare.

Verrucous carcinoma is a rare form of squamous cell carcinoma. It behaves as a slow-growing, locally aggressive and rarely metastasizing tumour. Three clinical cases are presented, with emphasis on clinical presentation, pathological diagnosis and therapeutic approach. The pathogenesis of verrucous carcinoma, including chronic inflammation and human papillomavirus, is also discussed.

[Analysis of 156 breast reconstructions by transverse rectus abdominis muscle flap (TRAM)]. / Analyse de 156 reconstructions mammaires par TRAM.

The myocutaneous rectus abdominis flap described by Hartrampf was used for 156 breast reconstructions between 1982 and 1992. 107 reconstructions were done with one pedicle. 142 were delayed reconstructions. Partial necrosis of the flap occurred in 10% of the cases in bipedicled flaps and 20% in unilateral flaps. No hernia occurred in this series. Cosmetic results are considered satisfactory or very satisfactory in 59% of the cases when evaluated by the medical team and 76.5% when evaluated by the patients. As a conclusion of this study, the TRAM flap is preferred in delayed reconstructions when local and general conditions are suitable, rather than latissimus dorsi flap reconstructions which require an implant.

Blood cadmium and lead levels among school children in Cracow.

An assessment of school children's exposure to cadmium and lead was carried out in Cracow and in a rural area in the years 1987-1989. The metal concentrations were determined in blood, which seems to be the best indicator of recent and current exposure. Simultaneously the levels of cadmium and lead in the air and dust-fall were measured. The study included 431 urban children aged about 12, living in two quarters of Cracow: the old central part of the city with high traffic density (Sródmiescie) and the modern part close to the steel and iron plant (Nowa Huta). The rural control group was composed of 152 individuals of the same age. The blood cadmium in children did not exceed the value of 1 microgram/dl, accepted as an upper limit for the general population. An average of 0.33 microgram Cd/dl in young residents of Nowa Huta quarter was found and it was significantly higher than that of the city center (Sródmiescie)--0.29 microgram/dl. This was related to higher industrial cadmium pollution observed in Nowa Huta. Unexpectedly, the highest blood cadmium levels (0.39 microgram/dl) were found in the groups from the rural area. Although these results were lower than those derived from other regions of Poland, they were considerably higher than those reported from other countries. Children's exposure to lead was much more dangerous. About 70% of the results from the city center exceeded the controversial upper limit of 20 micrograms Pb/dl, reaching the mean value of 30.5 micrograms/dl. In the group from Nowa Huta blood lead concentrations were markedly lower (20.4 micrograms/dl), corresponding to the degree of environmental pollution. The rural control group also had elevated blood lead levels (22.5 micrograms/dl), probably caused by transboundary emissions. The results obtained point to high environmental lead exposure in Cracow, comparable with those recorded in heavily polluted industrial areas.

Chronic pain: illusion or pathology? A case report of a vascular leiomyoma in the leg.

Patients with chronic pain constitute a major problem for the surgeon as the cause of their pain is often difficult to diagnose and is only rarely a well circumscribed lesion which is amenable to surgical or other treatment. We report a case of chronic pain due to a vascular leiomyoma beneath the deep fascia of the leg. Angioleiomyomas are rare tumours that are usually found in the subcutaneous tissue.