Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis.

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

Trayectoria de vida de profesionales universitarios con déficit auditivo: estudio exploratorio de aspectos significativos para inclusión laboral / Life trajectories of university graduates with hearing impairments: exploratory study of meaningful aspects to labor inclusion

El presente estudio ha tenido como propósito conocer los aspectos significativos en el proceso de inclusión laboral de dos profesionales universitarios con hipoacusia severa de la Región Metropolitana, por medio de la realización de entrevistas focalizadas en el desempeño laboral, de manera de avanzar en el conocimiento de estrategias que permitan mejorar las oportunidades de empleo para esta población. Es un estudio de tipo exploratorio, retrospectivo y transversal. Para la recolección de datos se diseñó una entrevista semiestructurada, solicitando previamente el consentimiento informado. La entrevista abarca sus trayectorias de vida focalizándola en el desempeño laboral. Se identifican como aspectos significativos las siguientes categorías: familia nuclear, familia de origen, déficit auditivo, desempeño educativo, desempeño laboral y redes de apoyo. En base a éstas se observa la importancia del capital cultural y económico, las estrategias personales para acceder a la información oral, el origen del déficit, el grado de interacción requerido en sus puestos de trabajo actuales, entre otros aspectos.

This study aims to know the meaningful aspects to the process of labor inclusion to two college graduates with several hypoacusis in the Metropolitan Region, through interviews focused on job performance to advance the understanding of strategies to improve employment opportunities for this population. It is an exploratory, retrospective and transversal study. It has designed a semistructured interview, previously requesting informed consent, for to collect the data. The interview covers their life trajectories focuses on job performance. They are identified as respects the following categories: nuclear family, family of origin, hearing loss, educational performance, work performance and their social support network. As a result of the former to emerge the importance of cultural and economic capital, personal strategies to access oral information, the source of the deficit, the degree of interaction required in their current jobs, among others.

Perforating folliculitis associated with tumour necrosis factor-alpha inhibitors administered for rheumatoid arthritis.

Perforating dermatoses are characterized by transepithelial elimination of dermal structures. We report a 61-year-old man with rheumatoid arthritis who developed a perforating folliculitis following the administration of two tumour necrosis factor (TNF)-alpha inhibitors, infliximab and etanercept. To our knowledge, no perforating disorders have been reported associated with these drugs. This report suggests, for the first time, a role for TNF-alpha in the pathogenesis of perforating folliculitis.

Estimation of plant diversity at landscape level: a methodological approach applied to three Spanish rural areas.

Approaches linking biodiversity assessment with landscape structure are necessary in the framework of sustainable rural development. The present paper describes a methodology to estimate plant diversity involving landscape structure as a proportional weight associated with different plant communities found in the landscape mosaic. The area occupied by a plant community, its patch number or its spatial distribution of patches are variables that could be expressed in gamma plant diversity of a territory. The methodology applies (1) remote sensing information, to identify land cover and land use types; (2) aspect, to discriminate composition of plant communities in each land cover type; (3) multi-scale field techniques, to asses plant diversity; (4) affinity analysis of plant community composition, to validate the stratified random sampling design and (5) the additive model that partitions gamma diversity into its alpha and beta components. The method was applied to three Spanish rural areas and was able to record 150-260 species per ha. Species richness, Shannon information index and Simpson concentration index were used to measure diversity in each area. The estimation using Shannon diversity index and the product of patch number and patch interspersion as weighting of plant community diversity was found to be the most appropriate method of measuring plant diversity at the landscape level.

[Iodine-125 transperineal prostate brachytherapy with preplanning technique: pre and post-implant dosimetry results analysis]. / Curiethérapie prostatique transpérinéale par iode 125 avec dosimétrie prévisionnelle: analyse des résultats dosimétriques pré- et post-implantation.

PURPOSE: Post-implant CT-based dosimetry is the only method of assessing the quality of permanent prostate brachytherapy. As a consequence of our permanent feedback with the preplanned technique, geometric and dosimetric criteria for optimal seed implantation are proposed and pre and post-implantation dosimetric results are presented. PATIENTS AND METHODS: In 2000 and 2001, one hundred and twenty patients with early stage prostate cancer were treated with transperineal I-125 preplanned brachytherapy (RAPID Strand, Amersham Health). The prescription dose was 145 Gy to the planning target volume. For the pre-planning and post-implant dosimetry the Variseed 6.7 version software was used (Varian Medical Systems). The D90, V100 and V150 values, the position of the dose peak [Dose] peak) and the full width at half maximum (FWHM) on differential dose volume histogram from both planned and post-implant dosimetry were compared for all patients. RESULTS: For preplanned dosimetry, the mean values for D90, V100, V150, [Dose] peak, FWMH were respectively of 199Gy, 100%, 70%, 220Gy, 113Gy. For post-implantation, these values became respectively of 157Gy, 90%, 62%, 220Gy, 194Gy. CONCLUSION: In our practice, differences are noted between preplanned and post-implant dosimetry parameters that should be anticipated to assure optimal definitive result. A working methodology both for performing the preplanned dosimetry and for evaluating the post-implantation dosimetric results is proposed.

Pelvic staging of advanced and recurrent gynecologic cancers: contribution of endosonography.

From January 1988 to December 1992, 106 patients with advanced gynecologic cancer were preoperatively explored by clinical examination (CE) and endosonography (ESG) under anesthesia and by computed tomography (CT). Sixty-one tumors were primary and 45 recurrent; the main locations were cervical (73 cases), ovarian (10 cases), and endometrial (8 cases). All the patients were operated. This prospective study compares the data from clinical and imaging examinations with the histologic findings and the surgical reports. Accuracy of the CE, ESG, cytoscopy, and CT was respectively 79, 90, 82, and 80% for vesical involvement (ESG versus CT: P < 0.05). For vesicovaginal septum extension, accuracy of ESG (92%) was statistically better than that of CE (80%) and CT (77%). Accuracy of the CE, ESG, and CT was respectively 93, 97, and 89% for rectal involvement (ESG versus CT: P < 0.02). For rectovaginal septum extension, accuracy of ESG (96%) was statistically better than that of CE (85%) and CT (85%). Endosonography is valuable in the assessment of regional staging of advanced gynecologic cancers. Since it is realized during the clinical examination under anesthesia, this low-cost procedure is easily performed and provided no discomfort to the patients.

[Pilot study of screening of prostate cancer by the assay of prostate specific antigen in occupational milieu]. / Etude pilote de dépistage du cancer de la prostate par le dosage de l'antigène spécifique de la prostate en milieu professionnel.

The goal of this study was to confirm the capacity of occupational medicine to become involved in cooperative screening programs with a dosage of the PSA (Prostate Specific Antigen) determined by immunoradiometric assay. Two thousands and five hundred seventy three salaried workers in the building sector, between 50 and 65 years old, participated in this investigation. Thirty seven individual ie 1.4% had a PSA level above or equal to 10 micrograms/l. Among them, 35 were checked within three months and 17 were found to have a persistently elevated PSA level. In this subgroup 15 pathologies including two cancers were found. We observed a great variability in the results of PSA determination in the groups of individuals whose initial assay level was above or equal to 10 micrograms/l. The linear correlation coefficient between the two assays (on the same individual), carried out at a six week interval on average, was low (r = 0.52 for N = 35). In our series, 3.5% of patients followed up had undergone a rectal examination less than a year previously. Occupational medicine seems to be an efficient setting for screening intervention. However, the people mainly concerned by our study, (salaried workers seen through the physicians interviewed) did not seem very aware of this type of action.

Results of a prospective study with comparison of clinical, endosonographic, computed tomography, magnetic resonance imaging and pathologic staging of advanced gynecologic carcinoma and recurrence.

Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.

Staging of rectal cancer: a prospective study of digital examination and endosonography before and after preoperative radiotherapy.

Between January 1988 and January 1992, 34 patients with rectal cancer were evaluated both by clinical examination and endosonography before and after pre-operative radiotherapy. Two criteria were correlated with histologic findings: confinement to the rectal wall or spread beyond, the presence of mesorectal lymph node involvement. The 32 patients who underwent endosonography before radiotherapy were staged as: uT2: 4, uT3: 26, uT4: 2 cases. Fifteen days after irradiation, endosonography showed tumour regression in all cases; uT stage was different in 15 patients, uN stage in 4 cases. Comparison of the pre-operative local invasion beyond the rectal wall with postoperative histopathy revealed a correlation with: digital examination after radiotherapy in 20 of the 31 patients with palpable tumours; endosonography before irradiation in 18 of the 32 staged tumours; endosonography after irradiation in 25 of the 32 staged tumours. The presence of mesorectal lymph node involvement determined by histologic examination was correlated with the results of endosonography after radiotherapy for 22 of the 32 staged tumours. Endosonography provides a good assessment of the tumour stage before irradiation. Since radiotherapy alters endosonographic staging of rectal cancer, this staging should be included in survival studies.

[Locoregional extension of advanced cancer of the uterine cervix:prospective evaluation of results of clinical examination, endocavitary ultrasonography, TDM, MRI and histology]. / Extension locorégionale des cancers avancés du col utérin: évaluation prospective des résultats de l'examen clinique, des échographies endocavitaires, de la TDM, de l'IRM et de l'histologie.

Between January 1988 and January 1991, 37 advanced cervical cancer patients were operated and explorated by: clinical examination and endoluminal ultrasonography under general anesthesia (endovesical, endovaginal and endorectal US); tomodensitometry (26 cases); MR imaging (14 cases) and cytoscopy (33 cases). Results of these explorations have been compared with post-operative histopathology. Sensitivity, specificity, predictive values and accuracy of each exploration were calculated for several anatomical structures. Vesical posterior wall has been analysed in about 37 cases, vesico-vaginal structure in about 36 cases, rectal anterior wall and recto-vaginal structure in about 36 cases, parametrium and pelvic sides walls in about 35 cases. Accuracy for clinical examination, endoluminal US, TDM and IRM were respectively: 76, 85, 73, 86%, and respectively 85% by cytoscopy for vesical posterior wall; 72, 88, 65, 78% for vesico-vaginal structure; 92, 97, 83, 64% for rectal anterior wall; 78, 94, 74, 57% for recto-vaginal structure; 84, 89, 69, 73% for vagina; 81, 78, 81, 81% for parametrium; 94%, 93% and 87.5% by TDM and IRM for pelvic side wall. Contribution of endoluminal US is effective for advanced cervical cancer loco-regional staging. Endoluminal US have a good accuracy, are realised under general anesthesia without any discomfort for patients and are little expensive.

[Cancer of the rectum. Results of a prospective study comparing preoperative rectal touch and transrectal ultrasonography with postoperative histopathology before and after preoperative radiotherapy]. / Cancer du rectum. Résultats d'une étude prospective comparant les données du toucher rectal et de l'échographie endo-rectale, aux données de l'histologie, avant et après radiothérapie pré-opératoire.

Between January 1988 and December 1990, 23 patients with rectal cancer were evaluated by clinical staging (23) and transrectal sonography before (22, one complete stenosis) and after radiotherapy (21). Two criteria were correlated with histological findings: a) the confinement to the rectal wall or spread beyond and b) the presence of meso-rectal lymph node involvement. The 22 patients who underwent transrectal sonography before radiotherapy were staged as uT2: 3 cases, uT3: 17 cases and uT4:2 cases. Fifteen days after irradiation, transrectal sonography showed a regression on the tumor in all cases; the uT stage was different in 9 patients but there was no change in the uN stage. The comparison of the preoperative clinical and sonographic assessment of local invasion beyond the rectal wall with postoperative histopathology revealed a correlation: a) with digital examination in 13 of the 21 patients with palpable tumors, b) with transrectal sonography before irradiation in 12 of the 22 staged tumors, c) with transrectal sonography after irradiation in 17 of the 21 staged tumors. The presence of meso-rectal lymph node involvement determined by histologic examination was correlated with the results of transrectal sonography for 14 of the 21 staged tumors. Transrectal sonography provides a good assessment of the tumor stage before irradiation. This stage should be considered for the study of survival.

[The value of endo-anorectal echography in the evaluation of the loco-regional extension and the monitoring of cancers of the anal canal]. / Intérêt de l'échographie endo-ano-rectale dans le bilan d'extension loco-régional et la surveillance des cancers du canal anal.

The value of endorectal echography for the management of anus carcinoma was assessed in 10 patients, before and after radiotherapy. Echography was contributive for determining tumor extension in 7 patients and for diagnosing recurrence or residual tumor in 4 patients.

[Ultrasound-guided percutaneous ethanol injection of small malignant tumors of the liver. Results in 20 patients]. / Alcoolisation percutanée échoguidée des petites tumeurs malignes du foie. Résultats chez vingt patients.

The effectiveness of percutaneous ethanol injection therapy was investigated in 20 patients with hepatocellular carcinoma (six cases), or hepatic metastases (twenty-five cases). 131 ethanol injections were performed between december 1987 and march 1990 for 30 lesions. Indications for this procedure included inadequate response to conventional treatment and tumor diameter less than 5 cm. Histopathologic examination, performed in all cases, showed that the tumor was completely necrotic in 16 cases, partially necrotic in 8 cases and not modified in 6 cases (one patient was not evaluable). Alpha-feto-protein and CEA levels were decreased in 12/17 cases. 16 patients were still alive at the end of the study (the mean follow-up period was 11.3 months). We conclude that ethanol injection may be a valuable treatment for small hepatic tumors.

[Comparative study of fine needle aspiration and large caliber needle biopsy under echographic control for the diagnosis of abdominal tumors]. / Etude comparative de la cytologie à l'aiguille fine et de la biopsie à l'aiguille de fort calibre sous contrôle échographique dans le diagnostic des tumeurs abdominales.

The aim of this study was to compare the results of fine needle aspiration (22 G) with large caliber needle biopsy (18 G) in patients suspected of having abdominal malignancy. From November 1988 to December 1989, 73 patients aged 32 to 78 years (mean 66 years), suspected sonographically of having hepatic malignancy (66 cases) or extrahepatic tumors (7 cases), underwent ultrasonography guided percutaneous fine needle aspiration (22 G) and biopsy with a large caliber needle (18 G). There were no complications. Overall sensitivity for diagnosis of malignancy was significantly better (p less than 0.01) with 18 G needle biopsies (91.2 percent) than with fine needle cytology (71.4 percent). Specificity was 100 percent. The distinction between primary and secondary malignant tumor was possible in 87.5 percent with the large caliber needle and in only 42.9 percent with the fine needle (p less than 0.001). Histological findings were adequate hepatic metastases in 86.5 percent with the 18 gauge needle and in 51.4 percent with the 22 gauge needle (p less than 0.001). In the 7 extra-hepatic tumors, the 18 G biopsy was always positive whereas fine needle cytology was positive in only 5 out of 7 cases. Correct diagnosis for benign diseases was possible in 7 out of 10 cases with the large caliber needle whereas the fine needle cytology was always negative. These results show the superiority of large caliber needle (18 G) compared to fine needle (22 G) guided punction for both diagnosis of malignancy and origin of the tumor. Complications did not occur more frequently than with fine caliber needles.

[Treatment of minor hepatic tumors with ultrasonically guided percutaneous injection of absolute alcohol. Results in 8 patients]. / Traitement de petites tumeurs hépatiques par injection per-cutanée échoguidée d'alcool absolu. Résultats chez 8 patients.

The effectiveness of ultrasonically guided percutaneous ethanol injection therapy was investigated in 8 patients who had hepatocellular carcinoma (two cases), hepatic metastases from colorectal carcinoma (five cases) and hepatic metastasis from breast carcinoma (one case). Tumor diameter was less than 5 cm in all cases. Fifty-nine ethanol injection were performed for 11 lesions. Histopathologic examination, performed in all cases, showed that the tumor was completely necrotic in 4 cases, partially necrotic in 3 cases and unchanged in 4 cases. Serum alphafetoprotein and carcinoembryogenic antigen decreased in 5 out of 8 cases. Seven patients were still alive at the end of the study with a mean follow-up period of 10.7 months. We conclude that ethanol injection may be a valuable treatment for small hepatic tumors.