The role of an immunologic survey prior to using collagen implants. Theoretical aspects and practical methods

Collagen implants (Zyderm and Zyplast) are effective and well tolerated. However, certain inflammatory reactions may occur. The immunological mechanisms responsible for such reactions are analysed: cell-mediated reactions, humoral reactions (specific antibodies) and the role--certainly major--of the genetic predisposition which modulates the expression of these reactions. The practical consequences are logically derived from the histological and serological findings observed, i.e. strict respect of the systemic contraindications (auto-immune diseases, severe atopy); rigorous conduct of a preoperative skin test to detect the great majority of reactive subjects; lastly, consideration, in the evaluation of the potential risk, of individual dysimmune susceptibility (family history, personal clinical or laboratory elements) in a very small proportion of patients.     

Desmoid tumor of the abdominal wall: Report of seven cases

Summary The authors report 7 cases of desmoid tumors of the abdominal wall treated between 1975 and 1996. The treatment of these infiltrating and recurrent connective tissue tumors can only be surgical, by means of wide parietal excision. The severe mutilations of the abdominal wall require different techniques of repair, often combining plastic procedures and the use of prosthetic material. In this short series no tumoral recurrence has so far been noted and the abdominal wall has been firmly restored.     

Mutation in DHP receptor alpha 1 subunit (CACLN1A3) gene in a Dutch family with hypokalaemic periodic paralysis.

Hypokalaemic periodic paralysis (HypoPP) is characterised by transient attacks of muscle weakness of varying duration and severity accompanied by a drop in serum potassium concentration during the attacks. The largest known HypoPP family is of Dutch origin and consists of 277 members in the last five generations, 55 of whom have HypoPP inherited in an autosomal dominant pattern. Forty-eight persons including 28 patients with a proven diagnosis of HypoPP were used for linkage analysis. Microsatellite markers were used to exclude 45 to 50% of the genome and linkage to chromosome 1q31-32 was found. No recombinants were found between HypoPP and D1S412 and a microsatellite contained within the DHP receptor alpha 1 subunit (CACLN1A3) gene. A previously reported G to A mutation causing an arginine to histidine substitution at residue 528 in the transmembrane segment IIS4 of the CACLN1A3 gene was shown in patients by restriction analysis of genomic PCR products.     

Agricultural activities and the incidence of Parkinson’s disease in the general French population

Most studies on pesticides and Parkinson’s disease (PD) focused on occupational exposure in farmers. Whether non-occupational exposure is associated with PD has been little explored. We investigated the association between agricultural characteristics and PD incidence in a French nationwide ecologic study. We hypothesized that persons living in regions with agricultural activities involving more intensive pesticide use would be at higher risk. We identified incident PD cases from French National Health Insurance databases (2010–2012). The proportion of land dedicated to 18 types of agricultural activities was defined at the canton of residence level. We examined the association between agricultural activities and PD age/sex-standardized incidence ratios using multivariable multilevel Poisson regression adjusted for smoking, deprivation index, density of neurologists, and rurality (proportion of agricultural land); we used a false discovery rate approach to correct for multiple comparisons and compute q-values. We also compared incidence in clusters of cantons with similar agricultural characteristics (k-means algorithm). We identified 69,010 incident PD cases. Rurality was associated with higher PD incidence (p < 0.001). Cantons with higher density of vineyards displayed the strongest association (RR_{top/bottom quartile} = 1.102, 95% CI = 1.049–1.158; q-trend = 0.040). This association was similar in men, women, and non-farmers, stronger in older than younger persons, and present in all French regions. Persons living in the cluster with greatest vineyards density had 8.5% (4.4–12.6%) higher PD incidence (p < 0.001). In France, vineyards rank among the crops that require most intense pesticide use. Regions with greater presence of vineyards are characterized by higher PD risk; non-professional pesticides exposure is a possible explanation.