Topographic anatomy of the tibial nerve in the medial malleolus: application to the effect of nerve block anesthesia

To better understand the anatomical variations and pathogeny of tarsal tunnel syndrome, the tibial nerve were dissected in 20 ankles of fresh black African cadavers. The tibial nerve located to 1.75 cm on average from the posterior side of the malleolus and to 2 cm from medial side of the calcaneus tendon. The nerve always ended according to dichotomic method. 90% cases of bifurcation were noted under the flexor retinaculum at 1 cm from the malléolo_calcaneus line; in 10% of dissections, we found proximal bifurcation at 5 cm from this line. The medal calcaneus branch which is a collateral branch of tibial nerve was constant, unique in 80% of cases and double in 20% of cases. The anatomical constatations allow a more precise anesthesia of tibial nerve block. We use constant anatomical marks formed by calcaneus tendon and internal malleolus tip. Olso we more understand the possibility of lesion of tibial nerve at the ankle during the synovites, or ossifications of flexor rétinaculum.     

Plasma homocysteine measurement: a study of pre-analytical variation factors for conditions for total plasma homocysteine concentration

An increase in homocysteine, a sulphur amino acid, is nowdays considered as a risk factor for cardiovascular diseases, and is independent of other risk factors. Reference range for total plasma homocysteine level in adults is usually 5-15 mmol/l. Hyperhomocysteinemia is defined as a fasting total plasma homocysteine level > 15 mmol/l. There may be also graded increased risks for subjects with homocysteinemia from 10 to 15 mmol/l. However, no threshold has been defined, partly because of the lack of standardization in pre-analytical and analytical steps. The aim of the present work was to evaluate three pre-analytical parameters on plasma homocysteine levels: i) the influence of three anticoagulants (EDTA, sodium citrate and lithium heparin); ii) the delay period of blood sample on ice before centrifugation; and iii) the advantages of strong acidic citrate at room temperature. The mean concentrations of total plasma homocysteine were different in function of the anticoagulant. These differences (EDTA minus lithium heparin or EDTA minus sodium citrate) were less than 10% however the used methods and could explain the good correlation between the results. However we recommend to keep the anticoagulant constant in the same study. When EDTA blood samples were immediately put on crushed ice, the maximum delay period before centrifugation could reach 4 hours. If ice is unavailable, strong acidic citrate at room temperature is a good alternative until for 4 hours.     

Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip

Abstract: Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments a medial compartment for the main tendon and a lateral compartment for the accessory tendon.     

Transferrine soluble receptors' contribution to the assessment of iron status in homozygous drepanocytic anemia

Sickle cell anemia does not cause martial deprivation per se, but may worsen when iron deficiency exists, notably in tropical zone where infectious diseases and malnutrition are endemic mainly during childhood. This study was aimed to assess iron deficiency prevalence among children with sickle cell disease (SCD) and to determine the best parameters for its diagnosis. In addition to classical parameters, we measured transferrine's soluble receptors which can reveal an iron deficiency, either isolated or associated to another condition since its level is not influenced by chronic anemia. Assays were carried out in 40 homozygous SCD patients, aged 3 to 18 years, having an hemoglobin level < 11 g/dL and in 30 age-paired controls assumed to be healthy and having a negative Emmel test and an hemoglobin level < 11 g/dL. The results showed hyposideremia (serum iron < 60 microg/dL) in 17.5% of the patients. Ferritinemia, transferrinemia as well as total iron fixation capacity were in the normal range for the majority of SCD patients in spite of the frequency of hyposideremia and microcytic anemia (20%). Transferrine's saturation coefficient was low in 22.5% of patients, which can be due to martial deprivation or to inflammatory status. These results confirm the limitations of usual biochemical parameters in the diagnosis of iron deficiency in homozygous drepanocytosis. Soluble receptors' levels were increased in 60% of controls; that proves that iron deficiency prevalence is high in our countries. Higher levels were found in 97.5% of patients. However, receptors' levels are increased during haemolysis, thus it is difficult to ascertain the origin of the increase, but taking into account its index value can reduces misinterpretation. In addition, considering simultaneously microcytosis, hypochromia, transferrine's soluble receptor level and its index, we can speculate that martial deficiency occurs in 20% of SCD patients, a percentage close to the 17.1% obtained by other authors using only the combination of microcytosis and hypochromia. It results from this study that associating microcytosis and hypochromia could validly assess iron deficiency during drepanocytosis.     

Solution properties and chain dimensions of poly(trimethylene sulfide)

Poly(trimethylene sulfide) (PTS) synthesized by means of anionic polymerization was studied with regard to its solubility behaviour and unperturbed chain dimensions. The Flory-Huggins interaction parameter was used to determine the solubility parameter of PTS, δ = 10,0 cal^1/2 · cm^?3/2, which agrees with the calculated one. PTS fractions were isolated by means of fractional precipitation from chloroform/hexane at 50°C. Their number-average molecular weight, M?_n, and the intrinsic viscosity, [η], were measured in chloroform at 25°C. From these data the relation [η] = 3,10 · 10^?4 M? was estimated. A value of the characteristic ratio, 〈r²〉₀/(n l²) = 4,0, was determined from the Burchard-Stockmayer-Fixman plot, which shows that this chain molecule has high flexibility.     

Arterial vascularization of the human thalamus: extra-parenchymal arterial groups

The problem of the arterial vascularization of the human thalamus has been debated at length. Anatomical references concerning the thalamic arterial groups are contradictory and complex, preventing any solid application in practice. It is, therefore, difficult to produce reliable anatomical radio-clinical correlation. In this work, 12 adult human cerebellums (24 hemispheres) were dissected after intra-vascular injection. With care for clarification and standardization, the extra-parenchymal thalamic arteries were classified in six groups: pre-mamillary artery, perforating thalamic arteries, thalamo-geniculate arteries, perforating branches of the postero-medial, postero-lateral and anterior choroidal arteries. Variations in the pre-mamillary artery were rare. The origin of the perforating thalamic artery was unilateral in two of three cases. The origin of the thalamo-geniculate arteries arose between the posterior cerebral artery (53%) and the posterior choroidal arteries (43%). The postero-median choroidal artery was most often single and usually gave the perforating branches for the medial aspect of the thalamus. The postero-lateral choroidal artery was frequently multiple and essentially gave the perforating branches for the superior aspect of the thalamus. The pulvinarian branches most often rose from the postero-lateral choroidal arteries (two thirds of cases) and more rarely from the postero-median choroidal arteries (one third of cases). The anterior choroidal artery is a source of thalamic vascularization by its cisternal branches running towards the lateral thalamus. It can also participate in the vascularization of the pulvinar by the plexiform branches crossing the temporal horn of the lateral ventricle. This study has allowed definition of the intra-parenchymatous arterial map of the thalamus. This mapping is essential for producing anatomical radio-clinical correlations which are pertinent for therapeutic decisions.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at .

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Vascularisation artérielle du thalamus humain: groupes artériels extra-parenchymateux

Résumé La vascularisation artérielle du thalamus humain est un problème débattu de longue date. Les références anatomiques concernant les groupes artériels thalamiques sont contradictoires et complexes interdisant toute application concrète en pratique. Il est donc difficile de réaliser des corrélations anatomo-radio-cliniques fiables. Dans ce travail, nous avons disséqué 12 encéphales adultes humains (24 hémisphères) après injection intra-vasculaire. Avec un souci de clarification et de standardisation, nous avons classé les artères thalamiques extra-parenchymateuses en 6 groupes : artère pré-mamillaire, artères thalamo-perforantes, artères thalamo-géniculées, rameaux perforants des artères choroïdiennes postéro-médiale, postéro-latérale et antérieure. Les variations de l'artère pré-mamillaire sont rares. L'origine des artères thalamo-perforantes est unilatérale dans 2/3 des cas. La naissance des artères thalamo-géniculées se partage entre l'artère cérébrale postérieure (53%) et les artères choroïdiennes postérieures (43%). L'artère choroïdienne postéro-médiane est le plus souvent unique et donne préférentiellement des rameaux perforants pour la face médiale du thalamus. L'artère choroïdienne postéro-latérale est fréquemment multiple et donne essentiellement des rameaux perforants pour la face supérieure du thalamus. Les rameaux pulvinariens naissent le plus souvent des artères choroïdiennes postéro-latérales (dans 2/3 des cas) et plus rarement des artères choroïdiennes postéro-médianes (tiers des cas). L'artère choroïdienne antérieure est une source de vascularisation du thalamus par ses branches cisternales se dirigeant vers le thalamus latéral. Elle peut également participer à la vascularisation du pulvinar par des branches plexuelles traversant la corne temporale du ventricule latéral. La poursuite de ce travail doit permettre de préciser les cartographies artérielles intra-parenchymateuses du thalamus. Ces cartographies sont indispensables à la réalisation de corrélations anatomo-radio-cliniques pertinentes pour la prise de décision thérapeutique.

     

Dynamic mechanical behaviour of chlorinated polyethylene

Dynamic mechanical measurements of chlorinated polyethylenes with chlorine contents ranging from 5,4 to 31 wt.-% were carried out using a dynamic viscoelastometer. The complex modulus and loss factor were determined at four frequencies in the temperature range from ?150°C to 100°C. Two relaxation processes (α and γ) were observed. The first one occurs at temperatures ranging from 21°C to 40°C, depending on the chlorine content; there is a minimum in the temperature of the α process at about 20 wt.-% of chlorine. The activation energies for this α process are higher than 100 kcal/mol, and therefore this α relaxation is considered to be different from the α relaxation in linear polyethylene. On the other hand, the α relaxation of chlorinated polyethylenes is similar to that of the parent polyethylene, taking place at temperatures ranging from ?137°C to ?116°C (at 3,5 Hz). The activation energies for this α process range from 14 to 26 kcal/mol (1 kcal = 4,184 kJ).     

Association of prenatal lipid‐based nutritional supplementation with fetal growth in rural Gambia

Prenatal supplementation with protein‐energy (PE) and/or multiple‐micronutrients (MMNs) may improve fetal growth, but trials of lipid‐based nutritional supplements (LNSs) have reported inconsistent results. We conducted a post‐hoc analysis of non‐primary outcomes in a trial in Gambia, with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status. The sample comprised 620 pregnant women in an individually randomized, partially blinded trial with four arms: (a) iron and folic acid (FeFol) tablet (usual care, referent group), (b) MMN tablet, (c) PE LNS, and (d) PE + MMN LNS. Analysis of variance examined unadjusted differences in fetal biometry z‐scores at 20 and 30 weeks and neonatal anthropometry z‐scores, while regression tested for modification of intervention‐outcome associations by season and maternal height, body mass index, and weight gain. Despite evidence of between‐arm differences in some fetal biometry, z‐scores at birth were not greater in the intervention arms than the FeFol arm (e.g., birth weight z‐scores: FeFol ?0.71, MMN ?0.63, PE ?0.64, PE + MMN ?0.62; group‐wise p = .796). In regression analyses, intervention associations with birth weight and head circumference were modified by maternal weight gain between booking and 30 weeks gestation (e.g., PE + MMN associations with birth weight were +0.462 z‐scores (95% CI [0.097, 0.826]) in the highest quartile of weight gain but –0.099 z‐scores (?0.459, 0.260) in the lowest). In conclusion, we found no strong evidence that a prenatal LNS intervention was associated with better fetal growth in the whole sample.     

Profils des réponses IgG dirigées contre CSP,GLURP et LSA-3NR2 dans le paludisme urbain à Dakar : influence sur l’hémoglobinémie et les parasitémies circulantes

Malaria remains a major health problem in sub- Saharan African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Vaccines candidates were mainly tested in rural endemic setting; however increasing proportion of the population is living in urban area. Evaluation of the qualitative or quantitative immune responses to key targets of anti-Plasmodium immunity requires further investigation in urban area. In a cohort of 144 patients with mild malaria living in Dakar, we analyzed IgG responses against target antigens of P. falciparum: CSP, LSA-3NR2 and GLURP by ELISA. A mean age of 15 yrs (4-65 yrs) was found and patients were separated in 59 adults (<15yrs) and 85 children (≤15 yrs). Parasites densities (0,01-15%) did not differ between the two age groups. In contrast, haemoglobin levels appeared lower in children (4.5-16.6 g/dl) (p<0.01). For the immune results, the most recognized antigens were GLURP and CSP compared to LSA-3NR2. Levels of IgG against these antigens were significantly different between the two age groups and they were positively correlated (rho = 0.32; p<0.001). In addition, levels of IgG anti-GLURP were associated with low parasitemia (≤1%) and absence of anemia (≥11g/dl), particularly in adults (p<0.001). In a multiple regression analysis, no significant relationship was found between parasite densities and IgG responses against all the tested antigens. Our study shows the implication of IgG anti-GLURP in humoral immune response against the parasite. The present work contributes to determine IgG levels that can be used as relevant immunologic biomarkers in urban clinical malaria.     

Utilisation des prélèvements capillaires sur buvard dans le diagnostic précoce de l’infection à VIH-1 chez des enfants nés de mères infectées dans le cadre de la prévention de la transmission mère–enfant au Bénin

The goal of this study was to evaluate using the molecular diagnosis, infection transmission rate of HIV in children born to HIV-1 positive mothers as part of the prevention of mother-to-child transmission (PMTCT) in Benin. The sample consisted of 524 dried blood spots (DBS) of children born to HIV-1 positive mothers, from 30 sites (PMTCT) taken between October 2009 and June 2010. The diagnosis of HIV-1 was performed by the qualitative detection of viral nucleic acids (RNA and DNA) in DBS on filter paper using the Abbott RealTime^® HIV-1 Qualitative assay. We found that 51 DBS were positive (9.7%) and 473 were negative (90.3%). The failure rate of PMTCT among 420 mothers who received antiretroviral prophylaxis was 6.7% (28/420). This failure rate was significantly higher among children born to infected mothers on antiretroviral monotherapy than on triple therapy (HAART). The results of our study enrich the data in the literature on highly active antiretroviral chemoprophylaxis to reduce the transmission of HIV-1 from mother to child.