[Quick screening for Body Dysmorphic Disorder in a plastic surgery population in France]. / Dépistage rapide du Body Dysmorphic Disorder en consultation de chirurgie plastique en France.

INTRODUCTION: All plastic surgeons are frequently faced with patients with Body Dysmorphic Disorder (BDD). However, no screening test exists in French to help the plastic surgeons to diagnose this disease. The Body Dysmorphic Disorder Questionnaire (BDDQ) is the Gold Standard to easily detect BDD in consultation with any non-psychiatric physician. The aim of this study was to translate and validate the BDDQ into French to help plastic surgeons to detect BDD before the surgery. This way, plastic surgeons will be able to provide an optimal medical care and to reduce the risk of psychiatric collapse. METHODS: We asked Katherine Philipps for her approval to use her BDDQ for our study, and thereafter we translated it respecting the criteria of the World Health Organization. We first evaluated the psychometric qualities of the BDDQ in French and then its reproducibility and its sensitivity to change. RESULTS: A French version of the BDDQ appeared to be reliable and comprehensible. The questionnaire has been tested on a sample of patients in plastic surgery consultation, at a T moment and a T plus one month to certify its reproducibility and its sensitivity to change. CONCLUSION: These results permit to claim that the French version of the BDDQ is now validated to detect patients with a BDD in a plastic surgery consultation.

Our 35 years' experience on postburn heterotopic ossification: A three-step treatment.

Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment - excision surgery, early rehabilitation, and antalgia - seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging.

[Self-inflicted burns in our burns center between 2011 and 2016]. / Immolation dans notre centre de traitement des brûlés de 2011 à 2016.

The prevalence of immolation by fire in France is uncertain. We carried out a retrospective epidemiological study on immolations between 2011 and 2016 at the burn treatment centre at the hôpital Saint-Louis in Paris. We studied the prevalence and characteristics of patients entering hospital for this reason. Between 2011 and 2016, a total of 1098 patients were hospitalized in the centre, of which 50 were admitted for immolation, i.e. five percent of the hospitalized population. The average age at entry was 46 years, and they were mostly men (62%). All but one was a suicide attempt. The average total burn area was 34.5%, and the average length of stay in the centre was 53 days. The products used for the immolation were mostly white spirit, alcohol or gasoline. Nine (18%) out of the 50 patients died, burned at 62.5% on average. A psychiatric history was reported in 35 patients and 21 had previously attempted suicide; nine patients were chronic alcoholics and four were drug addicts. The most frequently reported reasons for the suicide attempt were sentimental breakdown, death of a relative or financial problem. The prevalence of immolation in our study is very low compared to that found in developing countries. The majority of our cohort is composed of patients with a history of psychiatric disorders. The history of attempted suicide is also a major risk factor for committing suicidal acts by immolation. Prevention measures should be implemented to reduce this risk.

Respiratory Epithelium Lined Cyst of the Maxilla: Differential Diagnosis.

Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed. The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus.

The effect of repetitive arm cycling on post stroke spasticity and motor control: repetitive arm cycling and spasticity.

This study's aims were (1) to test whether training on an arm ergometer improves motor performance, and (2) to develop a technique to quantify individual muscle spasticity. Nine patients with a stabilized hemisyndrome (in average 22 months after ischemic stroke in the territory of middle cerebral artery) underwent a 3-week training on an arm ergometer, 5 days/week. The patients were tested one week before training, at training onset, at the end of training and 2 weeks after training. Spasticity was quantified by (1) the Ashworth Scale of the elbow flexors and extensors, (2) the maximum active extension of the biceps, and (3) the minimum torque on the lesioned side during arm cycling. The data were standardized, pooled and a 2-way ANOVA revealed a decrease of the spasticity by the training (p=0.076). Similarly muscle force was evaluated by the Rivermead Motorik Assessment, the Motricity Index and the cycling force, and the range of active movement as the sum of the angles at a maximum shoulder flexion, shoulder abduction, elbow flexion and elbow extension. The training increased the force (p<0.01) and also the range of motion (p<0.05) significantly. The patients confirmed the clinical relevance of the results. The spasticity index - the relation between the muscle activity modulation on the normal and lesioned side - was shown to be a useful tool in quantifying individual muscle spasticity. It was concluded that cycling on an arm ergometer is a useful tool for rehabilitation.

Fatal herpetic hepatitis in pregnancy.

BACKGROUND: Disseminated herpetic infections during pregnancy have been reported in the literature. CASE: This case presentation describes a pregnant patient who presented with fever, elevated liver enzymes, and upper abdominal tenderness and succumbed from fulminant herpetic hepatitis. CONCLUSION: Early diagnosis and treatment are essential because of the high mortality rate.

Alteration in age-specific risks for chromosomal trisomy by maternal serum alpha-fetoprotein and human chorionic gonadotropin screening.

Maternal serum screening for alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) increases the detection rate of Down's syndrome (DS) pregnancies. To estimate the risk of a DS pregnancy for a particular woman, Wald et al. combine a trivariate function of AFP, hCG, and unconjugated oestriol with age-specific risk. Calculation of independent likelihood ratios (LRs) for AFP and hCG has allowed us to examine the predictive value of each test alone and the combination. AFP and hCG were measured in stored serum samples from 672 normal, 8 trisomy 21 (DS), 9 trisomy 18, and 2 trisomy 13 pregnancies. AFP and hCG multiples of the median (MOM) were calculated for each sample. The LRs for AFP MOM and hCG MOM were calculated and combined with age-specific risk. Of eight DS pregnancies, six had increased risk based on age and AFP. Addition of hCG detected two additional DS pregnancies. Of nine trisomy 18 pregnancies, four (44 per cent) had hCG MOM under 0.25. Three out of nine would have been classified as high risk by AFP, but none by combined AFP and hCG. Amniocentesis would have been recommended in 74 per cent of aneuploid pregnancies if both age and serum screening were used. Abandonment of amniocentesis based on age alone would have excluded two abnormal pregnancies from detection. Screening programmes should note that combined risk figures are specific for DS and do not include other trisomies. Detection of other trisomies requires inclusion of low hCG level as a discriminator and continuation of age-based testing.

Amniotic and thromboembolism.

Embolic phenomena in pregnancy demand rapid investigation and treatment. Regardless, some patients will not survive due to the enormity of the insult. Optimally, such patients should be treated in tertiary care centers, but this is not always possible.

[Variations of enzymatic activities in an asporogenic mutant of Bacillus megaterium for various nutritional deficiencies]. / Variations d'activités enzymatiques chez un mutant asporogène de Bacillus megaterium pour différentes carences nutritionelles

An asporogenous mutant of Bacillus megaterium KM, blocked at stage I of sporulation, is cultivated in different conditions which usually lead to sporulation (Nitrogen, carbon, phosphate starvation). Aklaline phosphatase appears only in inorganic phosphate starvation like the wild type, but a glucose dehydrogenase activity also appears in phosphate starvation and so, is dissociated from sporulation.

[Variations in enzyme activities in different sporulation conditions of Bacillus megaterium]. / Variations d'activités enzymatiques chez Bacillus megaterium dans différentes conditions de sporulation

Glucose dehydrogenase and alkaline phosphatase activities have been studied for various conditions of sporulation of Bacillus megaterium KM (carbon, nitrogen, phosphate starvation). Glucose dehydrogenase appears in all conditions of sporulation, even with excess of glucose or gluconate. Alkaline phosphatase, usually dereprimed in phosphate starvation, does not increase during sporulation of Bacillus megaterium when phosphate is present.