Complications of ENT infections: pseudoaneurysm of the internal carotid artery

Ear, nose and throat infections are common, especially in children and young adults. Since the advent of antibiotics, complications from tonsillitis and pharyngeal abscess are rare, but potentially lethal. Vascular complications can be imaged with Doppler ultrasound and CT scan. The treatment of infectious vascular complications represents a significant challenge. We describe the case of a young girl presenting with a pseudoaneurysm of the internal carotid and thrombosis of the internal jugular vein. Endovascular therapy was utilized to treat the patient.     

Adiponectin gene polymorphisms and adiponectin levels are independently associated with the development of hyperglycemia during a 3-year period: the epidemiologic data on the insulin resistance syndrome prospective study

The plasma concentration of the adipocyte-derived peptide adiponectin is decreased in patients with obesity and type 2 diabetes. The adiponectin gene is located on chromosome 3q27, where a diabetes susceptibility locus has been mapped. Adiponectin gene polymorphisms (single nucleotide polymorphisms [SNPs]) have been associated with BMI, insulin sensitivity, and type 2 diabetes in some cross-sectional studies. Our aim was to assess the contribution of these SNPs in the development of features of the insulin resistance syndrome in a 3-year prospective study in approximately 4,500 French Caucasian subjects from the Epidemiologic Data on the Insulin Resistance Syndrome (DESIR) cohort. For subjects who were normoglycemic at baseline, the 3-year risk of becoming hyperglycemic (diabetes or impaired fasting glucose) was affected by two SNPs: G-11391A and T45G. For G-11391A, the risk was increased in GA carriers (odds ratio [OR] adjusted for sex [versus GG] = 1.60 [95% CI 1.16-2.20]; P = 0.004). For T45G, it was increased in GG carriers (OR [versus TT] = 2.71 [1.31-5.60]; P = 0.007). After 3 years, GG subjects had a greater increase in BMI (P = 0.009) and waist-to-hip ratio (P = 0.007). Adiponectin levels at baseline were associated with the development of hyperglycemia (P = 0.005), but the predictive effects on the risk for hyperglycemia were independent of adiponectin genotypes. In conclusion, in the DESIR study, variations at the adiponectin locus affect body weight gain, body fat distribution, and onset of hyperglycemia, as well as adiponectin levels. Adiponectin gene SNPs may have several phenotypic effects that co-occur with the development of the metabolic syndrome.     

Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements

AIM: To compare vaginal digital assessment with dynamometric measurements for determining the maximal strength of the pelvic floor muscles (PFM). MATERIALS AND METHODS: Eighty-nine women aged between 21 and 44 participated in the study. An experienced physiotherapist evaluated the maximal strength of the PFM of these women using the modified Oxford grading system (six categories, range 0-5) and dynamometric measurements. The mean maximal forces obtained for all women with the instrumented speculum for each category of digital assessment were compared using ANOVAs. Spearman's rho coefficients were calculated to assess the correlation between the dynamometric and the digital assessments. RESULTS: According to their symptoms and pad test results, 30 women were continent and 59 had stress urinary incontinence (SUI). Based on dynamometric measurements, important overlaps were observed between each category of digital assessment. The ANOVAs indicated that force values differ across categories (F = 10.08; P < 0.001), although contrast analyses revealed no differences in the mean maximal forces between adjacent digital-assessment categories (1-2, 2-3, 3-4, 4-5). Mean force values differed significantly only between non-adjacent levels in digital assessment, for example, between 1 and 3; 1 and 4; 1 and 5; 2 and 4; 2 and 5 (P < 0.05). Significant correlations were found between the two measurements with coefficients of r = 0.727, r = 0.450, and r = 0.564 for continent, incontinent, and all women, respectively (P < 0.01). CONCLUSIONS: Even if the dynamometric mean forces of the PFM increased across subsequent categories of digital assessment, the force values between two adjacent categories do not differ. This limitation of digital assessment should be considered by clinicians and researchers when choosing treatment orientation and evaluating treatment outcomes.     

Parametrically defined cerebral blood vessels as non-invasive blood input functions for brain PET studies

A non-invasive alternative to arterial blood sampling for the generation of a blood input function for brain positron emission tomography (PET) studies is presented. The method aims to extract the dimensions of the blood vessel directly from PET images and to simultaneously correct the radioactivity concentration for partial volume and spillover. This involves simulation of the tomographic imaging process to generate images of different blood vessel and background geometries and selecting the one that best fits, in a least-squares sense, the acquired PET image. A phantom experiment was conducted to validate the method which was then applied to eight subjects injected with 6-[18F]fluoro-L-DOPA and one subject injected with [11C]CO-labelled red blood cells. In the phantom study, the diameter of syringes filled with an 11C solution and inserted into a water-filled cylinder were estimated with an accuracy of half a pixel (1 mm). The radioactivity concentration was recovered to 100 +/- 4% in the 8.7 mm diameter syringe, the one that most closely approximated the superior sagittal sinus. In the human studies, the method systematically overestimated the calibre of the superior sagittal sinus by 2-3 mm compared to measurements made in magnetic resonance venograms on the same subjects. Sources of discrepancies related to the anatomy of the blood vessel were found not to be fundamental limitations to the applicability of the method to human subjects. This method has the potential to provide accurate quantification of blood radioactivity concentration from PET images without the need for blood samples, corrections for delay and dispersion, co-registered anatomical images, or manually defined regions of interest.     

Alcohol consumption and insulin resistance syndrome parameters: associations and evolutions in a longitudinal analysis of the French DESIR cohort

PURPOSE: To determine the effects of average alcohol consumption and changes in alcohol intake on the insulin resistance syndrome parameters in a 3-year follow-up study. METHODS: Longitudinal study of 1856 and 1529 alcohol drinking men and women in the French DESIR study (Data from an Epidemiological Study on the Insulin Resistance syndrome), aged 30 to 64 years. RESULTS: In men, fasting glucose, body mass index, waist circumference, systolic blood pressure, and HDL-cholesterol were positively associated with average alcohol consumption while there was no association with insulin or triglycerides concentrations. A change in alcohol intake was positively associated with HDL-cholesterol concentration and systolic blood pressure at follow-up. These effects of alcohol could not be attributed specifically to the intake of wine. In women, while the alcohol HDL-cholesterol relation was similar to that found in the men, the only significant effect of average alcohol intake was an increase in systolic blood pressure, with a spurious decrease in blood pressure related to a 3-year increase in alcohol intake. CONCLUSIONS: Alcohol only provided a beneficial effect on HDL-cholesterol. The beneficial effect seen by other authors of moderate alcohol drinking on diabetes and cardiovascular risk may be due to effects on parameters other than those included in the current definitions of the insulin resistance syndrome.     

Molecular screening of the 11beta-HSD1 gene in men characterized by the metabolic syndrome

Adipose tissue type 1 11beta-hydroxysteroid dehydrogenase (11beta-HSD1), which generates hormonally active cortisol from inactive cortisone, has been shown to play a central role in adipocyte differentiation and abdominal obesity-related metabolic complications. The objective was to investigate whether genetic variations in the human 11beta-HSD1 gene are associated with the metabolic syndrome among French-Canadian men. We sequenced all exons, the exon-intron splicing boundaries, and 5' and 3' regions of the human 11beta-HSD1 gene in 36 men with the metabolic syndrome, as defined by the National Cholesterol Education Program-Adult Treatment Panel III, and two controls. Three intronic sequence variants were identified: two single-nucleotide polymorphisms in intron 3 (g.4478T>G) and intron 4 (g.10733G>C) and one insertion in intron 3 (g.4437-4438insA). The relative allele frequency was 19.6%, 22.1%, and 19.6% for the g.4478G, g.10733C, and g.4438insA alleles, respectively. One single-nucleotide polymorphism was identified in exon 6 (c.744G>C or G248G). The frequency of the c.744C allele was only 0.46% in a sample of 217 men. Variants were not associated with components of the metabolic syndrome except for plasma apolipoprotein B levels. In conclusion, molecular screening of the 11beta-HSD1 gene did not reveal any sequence variations that can significantly contribute to the etiology of the metabolic syndrome among French-Canadians.     

Effect of a nutritional intervention promoting the Mediterranean food pattern on electrophoretic characteristics of low-density lipoprotein particles in healthy women from the Québec City metropolitan area

The objective of the present study was to evaluate the effect of a nutritional intervention promoting the Mediterranean food pattern in free-living conditions on LDL electrophoretic characteristics in a group of seventy-one healthy women, aged between 30 and 65 years. The 12-week nutritional intervention consisted of two courses on nutrition and seven individual sessions with a dietitian. The first course provided information on the Mediterranean food pattern and the second was a cooking lesson. LDL peak particle diameter (LDL-PPD) and cholesterol levels in small (LDL-cholesterol<255 A) and large LDL fractions (LDL-cholesterol>260 A) were obtained by 2-16 % polyacrylamide gel electrophoresis of whole plasma. The sample was divided on the basis of baseline LDL-PPD using tertiles of the distribution (258.4 A and 260.0 A). Among the total sample of women, no significant change in LDL-PPD was observed in response to the nutritional intervention. However, subjects who at baseline were in the first tertile of the LDL-PPD distribution (<258.4 A) showed a significant increase in LDL-PPD and in the proportion of LDL %>260 A in response to the 12-week nutritional intervention (P<0.05). In contrast, LDL-PPD decreased significantly (P=0.007) among women with large LDL particles at baseline (LDL-PPD >260 A) while the proportion of LDL %<255 A and of LDL %>260 A remained unchanged. To conclude, changes in the food pattern, in response to a nutritional intervention promoting the Mediterranean food pattern, were accompanied by beneficial modifications in LDL electrophoretic characteristics in women who were characterised at baseline by smaller LDL particles.     

Two-dimensional echocardiography estimation of right ventricular ejection fraction by wall motion score index

BACKGROUND: Radionuclide angiography (RNA) and echocardiography (biplane Simpson method) are the most accepted methods for right ventricular ejection fraction (RVEF) evaluation. The authors tried to determine a new method to measure RVEF based on wall motion score index (WMSI). OBJECTIVES: One hundred forty-one patients with RV dysfunction had transthoracic echocardiography (TTE) evaluation of the right ventricle. In a first group of 54 patients, a correlation between RVEF using the biplane Simpson method (four chamber and two chamber [4C+2C]) and RV-WMSI was established from a polar map using an eight-segment model to find a regression equation. With the second group of 51 subsequent patients, this equation (RVEF=73.07-20.7 x WMSI), comparing the RVEF-WMSI with the biplane Simpson RVEF (4C+2C), was validated. In a third group of 36 consecutive patients with abnormal RV contractility, the RVEF was calculated by RNA and this RVEF was correlated to the RV-WMSI. RESULTS: The first group of 54 patients had a correlation coefficient of 0.84 between WMSI and RVEF (biplane Simpson method). The results from the second group of 51 patients with RVEF derived from the estimated regression equation correlated well with the biplane Simpson RVEF (r=0.84). The correlation coefficient for these two groups taken together (105 patients), that is, between WMSI and RVEF (biplane Simpson method), was 0.92. The third group of 36 patients with RNA-EF displayed a correlation coefficient of 0.83 with RV-WMSI. CONCLUSION: This new semiquantitative method for estimating RVEF from RV-WMSI is easy to use in routine TTE and shows an excellent correlation with the biplane Simpson method and RNA.     

Life events and trauma in chronic negligent mothers

The present study examines more closely the chronic behaviors of maltreating mothers. Events that these mothers have experienced during childhood are examined, experiences including abuse, placement, separation, bereavement, rejection, neglect, lack of love and role reversal. Signs of unresolved trauma found in the discourse of mothers, such as dissociation, are also studied. It is proposed that negligent mothers from the chronic group will evoke more negative experiences and/or more intense negative experiences which occurred during childhood than the mothers from the transitory group. The chronic group will also show more signs of dissociation. From a six years follow-up study, a sample of 20 mothers was recruited from the Child Protection Services, including the cases of 10 chronic maltreating mothers and 10 transitory maltreating mothers. Two main measures were used: the Child Abuse Potential Inventory (CAPI) and the Adult Attachment Interview (AAI) (Main et Goldwyn, 1998). The experiences from childhood and complete discourse in AAI were analysed with the method used by Main et Goldwyn (1998). Non parametric analysis indicate that mothers from the chronic group evoke more negative and very negative childhood experiences than the mothers from the transitory group. Content analysis show that chronic maltreating mothers relate having gone through more potentially traumatic events such as foster care placements, separations and abuse. The analysis of the Adult Attachment Interview according to Main and Goldwyn's system demonstrate that the majority of the chronic maltreating mothers have two times more unresolved traumas.