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Chylopericardium is the collection of lymph fluid inside the pericardial cavity. The incidence of chylopericardium is very low, as this diagnosis is rarely reported following cardiac procedures in children. While some reports were published worldwide on isolated chylopericardium after cardiac surgeries for diverse reasons, it has never been reported after repair for partial anomalous pulmonary venous return. In addition, management of this diagnosis ends up being surgical with minimal concentration on medical treatment which proved unsuccessful. We present a medical approach with corticosteroids as an effective method to treat isolated chylopericardium.
In this manuscript, we present an approach to treat isolated post-operative chylopericardium in a child following repair of partial anomalous pulmonary venous return. Chylous drainage responded to corticosteroids and completely ceased. There was no need for surgical intervention.
Until now, isolated chylopericardium has never been reported to occur with partial anomalous pulmonary venous return repair. A review of the literature showed that most patients follow a conservative approach consisting of diuretics and non-steroidal anti-inflammatory agents with some of them undergoing surgical re-intervention. With future research on the topic still needed, we hope that this will encourage physicians worldwide to consider administering a trial of corticosteroids as an option to treat chylopericardium.
Legionella pneumophila genotyping is important for epidemiological investigation of nosocomial and community-acquired outbreaks of legionellosis. The prevalence of legionellosis in pneumonia patients in the West Bank was monitored for the first time, and the sequence types (STs) from respiratory samples were compared with STs of environmental samples from different wards of the hospital. Sputum (n = 121) and bronchoalveolar lavage (BAL) (n = 74) specimens were cultured for L. pneumophila; genomic DNA was tested by 16S rRNA polymerase chain reaction (PCR) amplification. Nested PCR sequence-based typing (NPSBT) was implemented on DNA of the respiratory and environmental PCR-positive samples. Only one respiratory specimen was positive for L. pneumophila by culture. BAL gave a higher percentage of L. pneumophila-positive samples, 35% (26/74) than sputum, 15% (18/121) by PCR. NPSBT revealed the following STs: ST 1 (29%, 7/24), ST 461 (21%, 5/24), ST 1037 (4%, 1/24) from respiratory samples, STs from environmental samples: ST 1 (28.5%, 4/14), ST 187 (21.4%, 3/14) and ST 2070, ST 461, ST 1482 (7.1%, 1/14) each. This study emphasises the advantage of PCR over culture for the detection of L. pneumophila in countries where antibiotics are indiscriminately used prior to hospital admission. ST 1 was the predominant ST in both respiratory and environmental samples.
Organic greenhouse (OGH) production is characterized by different systems and agricultural practices with diverse environmental impact. Soil arthropods are widely used as bioindicators of ecological sustainability in open field studies, while there is a lack of research on organic production for protected systems. This study assessed the soil arthropod abundance and diversity over a 2-year crop rotation in three systems of OGH production in the Mediterranean. The systems under assessment differed in soil fertility management: SUBST – a simplified system of organic production, based on an input substitution approach (use of guano and organic liquid fertilizers), AGROCOM – soil fertility mainly based on compost application and agroecological services crops (ASC) cultivation (tailored use of cover crops) as part of crop rotation, and AGROMAN – animal manure and ASC cultivation as part of crop rotation. Monitoring of soil fauna was performed by using pitfall traps and seven taxa were considered: Carabidae, Staphylinidae, Araneae, Opiliones, Isopoda, Myriapoda, and Collembola. Results demonstrated high potential of ASC cultivation as a technique for beneficial soil arthropod conservation in OGH conditions. SUBST system was dominated by Collembola in all crops, while AGROMAN and AGROCOM had more balanced relative abundance of Isopoda, Staphylinidae, and Aranea. Opiliones and Myriapoda were more affected by season, while Carabidae were poorly represented in the whole monitoring period. Despite the fact that all three production systems are in accordance with the European Union regulation on organic farming, findings of this study displayed significant differences among them and confirmed the suitability of soil arthropods as bioindicators in protected systems of organic farming.
To study and review the short- and long-term effects of intranasal steroids on obstructive adenoids.
In this prospective cohort study, 19 children previously treated with mometasone furoate for 3 months were contacted at 3, 6 and 12 months after cessation of treatment. Main outcome measures included: change in severity of nasal obstruction, allergic rhinitis and obstructive symptoms. A systematic review of literature was also performed.
By one year, 25 per cent of patients required adenoidectomy; the remaining children had no significant change in clinical score (p = 0.464), obstruction severity (p = 0.191) or allergic symptoms (p = 0.284). Fourteen pertinent studies were identified; all but one study showed improvement in the patients’ symptoms and/or degree of obstruction. Two studies with follow up reaching 25 months showed positive effects.
The short-term positive effect of some intranasal steroids on obstructive adenoids seems to persist in a significant number of patients after the cessation of treatment.
To assess the effectiveness and safety of coblation in relieving inferior turbinate hypertrophy in children.
An observational cohort study was undertaken. The severity of allergic rhinitis and the severity and degree of nasal obstruction were assessed using subjective and clinical symptom grading tools, a visual analogue scale, and endoscopy. Any post-operative complications were noted at 1 week, and at 1, 3, 6 and 12 months post-operatively. Data from extended follow-up periods were included when available. The statistical significance of changes in parameter values was assessed using the Wilcoxon signed-rank test.
Thirty-two patients were recruited (mean age, 11.28 years; range, 6–17 years). Significant post-operative improvement (p < 0.001) was noted in the severity and degree of nasal obstruction. This improvement was maintained after a mean follow-up period of 10.5 months (range, 1 month to 4 years). No mucosal ulceration or adhesion was encountered. Minimal crusting was noted in 8.57 per cent of patients at 1-week follow up. Allergic rhinitis symptoms improved significantly.
Inferior turbinate reduction by coblation is an effective and safe procedure in children aged six years and older. The positive outcomes seem to be long-lasting.
Ascending aortic pseudoaneurysms are a rare complication following cardiac surgery. Their traditional surgical management carries high morbidity and mortality, especially in patients with multiple comorbidities. Transcatheter closure of these pseudoaneurysms using a septal occluder device has been previously reported in adults as an alternative approach with fewer complications. We report the first case of a novel percutaneous femoral arterial-transthoracic approach for exclusion of an ascending aortic pseudoaneurysm with an Amplatzer atrial septal occluder device in a 9-year-old child with Takayasu's arteritis.
Present soil moisture and ocean salinity maps retrieved by remote sensing are characterized by a coarse spatial resolution. Hydrological, meteorological and climatological applications would benefit greatly from a better spatial resolution. Owing to the dimensions of the satellite structure and to the degradation of the instrument’s radiometric sensitivity, such improvement cannot be achieved with classical interferometry. Then, in order to achieve this goal an original concept for passive interferometric measurements is described. This concept should allow to achieve a much finer spatial resolution, which can be further improved with the application of disaggregation methods. The results will then allow the integration of global soil moisture maps into hydrological models, a better management of water resources at small scales and an improvement in spatial precision for various applications.
In France, the surveillance of hospitalized cases of pandemic influenza was implemented in July 2009 and restricted to intensive-care unit (ICU) patients in November. We described the characteristics of the 1065 adult patients admitted to ICUs and analysed risk factors for severe outcome (mechanical ventilation or death). Eighty-seven percent of cases were aged 15–64 years. The case-fatality ratio was 20%. The risk for severe outcome increased with age and obesity while this association was negative for chronic respiratory disease. Late antiviral therapy was associated with a severe outcome in ICU patients with risk factors (adjusted OR 2·0, 95% CI 1·4–3·0). This study confirms the considerable contribution of young adults to A(H1N1) 2009 mortality. It shows the role of obesity as an independent risk factor for severe disease, and of early antiviral therapy as a protective factor, at least in patients with risk factors.
To compare the reproducibility of semi-automated vessel analysis software to manual measurement of carotid artery stenosis on computed tomography angiography (CTA).
Two observers separately analyzed 81 carotid artery CTAs using semi-automated vessel analysis software according to a blinded protocol. The software measured the narrowest stenosis in millimeters (mm), distal internal carotid artery (ICA) in mm, and calculated percent stenosis based on NASCET criteria. One observer performed this task twice on each carotid, the second analysis delayed two months in order to mitigate recall bias. Two other observers manually measured the narrowest stenosis in mm, distal ICA in mm, and calculated NASCET percent stenosis in a blinded fashion. Correlation coefficients were calculated for each group comparing the narrowest stenosis in mm, distal ICA in mm, and NASCET percent stenosis.
The semi-automated vessel analysis software provided excellent intraobserver correlation for narrowest stenosis in mm, distal ICA in mm, and NACSET percent stenosis (Pearson correlation coefficients of 0.985, 0.954, and 0.977 respectively). The semi-automated vessel analysis software provided excellent interobserver correlation (0.925, 0.881, and 0.892 respectively). The interobserver correlation for manual measurement was good (0.595, 0.625, and 0.555 respectively). There was a statistically significant difference in the interobserver correlation between the semi-automated vessel analysis software observers and the manual measurement observers (P < 0.001).
Semi-automated vessel analysis software is a highly reproducible method of quantifying carotid artery stenosis on CTA. In this study, semi-automated vessel analysis software determination of carotid stenosis was shown to be more reproducible than manual measurement.
The worldwide spread of severe acute respiratory syndrome (SARS) raised questions about the risk of importation of such infection, in particular by air travel. Entry screening was implemented in some countries although poor evidence on its effectiveness is reported. We developed a model to estimate the number of imported SARS cases between regions, using the 2003 SARS epidemic data to apply this model for two scenarios: from Beijing to Frankfurt and from Hong Kong to London. We back-calculated the data to estimate individuals’ time of infection and built a model where every individual has a probability of being isolated, of traveling, and of being undetected at arrival. The findings, consistent with what was observed in 2003, suggest that entry screening does not affect the predicted number of imported cases. Inversely, importation depends on the transmission dynamic in the country of origin (including control measures in place) and on the intensity of air travel between regions.
Despite the hydroid fauna of the Mediterranean Sea being considered one of the best known in the world, the eastern basin of the Mediterranean Sea remains nearly unexplored. This paper reports on 38 species collected along the Levant Sea coast (mainly Lebanon), of which three are new records for the Mediterranean and nine for the Levant Sea. Six alien species, i.e. Eudendrium carneum, Sertularia marginata, Sertularia techocarpa, Macrorhynchia philippina, Diphasia digitalis and Dynamena quadridentata, are described in detail and illustrated on the basis of Levant Sea material. The last four species are considered as immigrants from the Red Sea. The synonymy of Sertularia stechowi, described from Japan, with S. techocarpa is established. Taken as a whole, the collection comprised a majority of circum-(sub)tropical species, and a reduced proportion of Atlantic–Mediterranean elements and Mediterranean endemics. The ecology (seasonality, depth distribution and habitat preference) of the indigenous species resulted similar to what is known for the more studied western Mediterranean, with some exceptions. Adding the present species inventory to the scanty published information, the total of hydroid species known from the Levant Sea rises to 70, indicating the need for future investigation in this sector of the Mediterranean Sea.
Legionnaires' disease (LD) is an aetiology of community-acquired bacterial pneumonia in adults, with a high case-fatality ratio (CFR). We conducted a matched case-control study to identify risk factors for sporadic, community-acquired LD. Cases of sporadic, community-acquired and biologically confirmed LD, in metropolitan France from 1 September 2002 to 31 September 2004, were matched with a control subject according to age, sex, underlying illness and location of residence within 5 km. We performed a conditional logistic regression on various host-related factors and exposures. Analysis was done on 546 matched pairs. The CFR was 3·5%. Age ranged from 18–93 years (mean 57 years), with a 3·6 male:female sex ratio. Cases were more likely to have smoked with the documentation of a dose-effect relation, to have travelled with a stay in a hotel (OR 6·1, 95% CI 2·6–14·2), or to have used a wash-hand basin for personal hygiene (OR 3·5, 95% CI 1·6–7·7) than controls. Tobacco and travel have been previously described as risk factors for LD, but this is the first time that such a dose-effect for tobacco has been documented among sporadic cases. These findings will provide helpful knowledge about LD and help practitioners in identifying patients at high risk.
Five new species of sponges are described from the coast of Lebanon in the eastern Mediterranean, Levantine Basin. Euryspongia raouchensis (Dysideidae), Liosina blastifera (Dictyonellidae) and Niphates toxifera (Niphatidae) belong to genera that are new for the Mediterranean but widely distributed in the tropics. Cinachyrella levantinensis (Tetillidae) and Ciocalypta carballoi (Halichondriidae) are described in genera with a restricted distribution in the Mediterranean, which have affinities with species from the Atlantic West African coast. These species do not appear to be lessepsian migrants, but are interpreted as remnants of an ancient thermophilous fauna that survived in the easternmost part of the Mediterranean.
La radiothérapie interne ou vectorisée consiste à injecter aux patients des radiopharmaceutiques afin de délivrer des doses de rayonnements aux tumeurs ou organes ciblés. La réalisation d’études dosimétriques est nécessaire pour chaque patient traité par radiothérapie vectorisée ainsi que pour les sujets contaminés par inhalation, blessure ou ingestion. Afin d’atteindre la précision requise dans de tels cas, nous avons développé une méthode dosimétrique, basée sur le code Monte-Carlo de transport des particules MCNPX. L’anatomie de chaque patient ou sujet contaminé est prise en compte sous forme d’une géométrie voxélisée créée à partir d’images tomodensitométriques (CT) ou de résonance magnétique (IRM). Cet outil baptisé ŒDIPE (acronyme d’outil d’évaluation de la dose interne personnalisée) permet de réaliser des études dosimétriques à l’échelle des organes et du voxel. La validation d’un tel outil est complexe car les sources de variations du calcul dosimétrique sont multiples : méthodes de calcul, définitions et représentativité de la géométrie. L’étude présentée ici a pour but de valider l’outil ŒDIPE par comparaison de ses résultats avec des mesures expérimentales obtenues à l’aide de fils thermoluminescents. La comparaison des doses moyennes calculées et mesurées est satisfaisante. Cependant, la mesure et le calcul des distributions spatiales de dose le long des fils thermoluminescents, bien qu’ayant des allures comparables, présentent des écarts significatifs. Cela est dû au fait qu’il est impossible de faire correspondre exactement une portion de fil à un voxel donné.
Maëlle Molmeret, Department of Microbiology and Immunology, University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA,
Dina M. Bitar, Department of Microbiology and Department of Medical Microbiology and Immunology, Faculty of Medicine, Al-Quds University, Jerusalem, 19356, Israel,
Yousef Abu Kwaik, Department of Microbiology and Immunology, University of Kentucky Chandler Medical Center, Lexington, Kentucky 40536-0084, USA
Legionella pneumophila, a Gram-negative bacillus that is ubiquitous in aquatic environments, is responsible for Legionnaires' disease. It is a facultative intracellular pathogen that can replicate within eukaryotic host cells such as protozoan and macrophages. In water, L. pneumophila grows within protozoan hosts. There are at least 13 species of amoebae and 2 species of ciliated protozoa that support intracellular replication of L. pneumophila (Fields, 1996). Among the most predominant amoebae in water sources are hartmannellae and acanthamoebae, which have also been isolated from water sources associated with Legionnaires' disease outbreaks (Fields, 1996). Interaction between L. pneumophila and protozoa is considered to be central to the pathogenesis and ecology of L. pneumophila (Rowbotham, 1986; Harb et al., 2000). In humans, L. pneumophila reaches the lungs after inhalation of contaminated aerosol droplets (Fields, 1996; Fliermans, 1996; also see Fig. 5.1). The main sources of contaminated water droplets are hot water and air-conditioning systems, but the bacteria have been isolated from fountains, spas, pools, dental and hospital units, and other man-made water systems (Fliermans, 1996; also see Fig. 5.1). No person-to-person transmission has been described. Once in the lungs, L. pneumophila are ingested in alveolar macrophages, the major site of bacterial replication. This results in an acute and severe pneumonia. In addition to Legionnaires' disease, L. pneumophila also causes Pontiac fever, which is a self-limiting flu-like illness that is not well understood but is not lethal. Approximately one half of the 48 species of Legionella have been associated with human disease.
Two new species of lithistid sponges, Gastrophanellaphoeniciensis sp. nov. (Siphonidiidae) and Microscleroderma lamina sp. nov. (Scleritodermidae) are described from a submarine cave, depth 2–3 m, in Lebanon. They are the first Mediterranean records of two genera with a mainly tropical distribution, Gastrophanella being known from the western Atlantic (Caribbean, Brazil), central eastern Pacific (Mexico) and South Africa, and Microscleroderma from the Indo-Pacific and the eastern Atlantic (Senegal). They are interpreted as remnants of a warmer period in the Mediterranean that survived the subsequent cooling only in the warmer eastern basin. Gastrophanella phoeniciensis sp. nov. is closely related to G. cavernicola from Brazil and Belize, from which it differs essentially in its shape. Microscleroderma lamina sp. nov. is characterized by a lamellar shape, short oxeas and having hair-like oxeas arranged around the aquiferous openings.
The geographic distribution of Verruca stroemia and V. spengleri are reviewed. Verruca stroemia ranges from the White, Barents, Norwegian, and North Seas south to Portugal to the Algarve and to Gorringe Bank. All of the records of this species from the Mediterranean Sea are considered to be V. spengleri. Verruca spengleri occurs in the Azores and Madeira archipelagos, in southern Spain (Cádiz), throughout the Mediterranean Sea from Gibraltar to Lebanon, and in the Black Sea. But a distinct deep-water Verruca species seems to occur in the deep Mediterranean.
Rheumatic carditis is a major manifestation of acute rheumatic fever. Conventional therapy includes the use of salicylates and steroids. To date, however, such therapy has not been proven to have a clear benefit in reducing valvar heart disease. We report the use of high-dose intravenous immunoglobulin in two chidlren with acute rheumatic carditis in whom we have been able to document the beneficial effect.
Dans cette étude, les auteurs font le point sur les principaux résultats obtenus chez le zébu Gobra. La croissance est de 280 g/j dans les conditions d'élevage du C. R. Z de Dahra. Elle peut atteindre cependant 736 g chez des mâles recevant dès la naissance une alimentation équilibrée et 1 080 g dans des unités d'embouche. Les caractéristiques de carcasse sont bonnes et comparables à celles de la plupart des races à viande spécialisées. L'âge à la lère mise-bas (1 365,6±24 j) et l'intervalle entre mise-bas (15,5 mois) sont élevés mais sont susceptibles de diminuer lorsque les conditions d'élevage sont améliorées.