Tissu adipeux : glande endocrine polyvalente

Research on the adipose tissue secretions has undergone a major inflection for a few years. The investigators became aware that the biology of the various cells of the stroma-vascular fraction of adipose tissue was to be taken into account to include/understand the diversity of the secretions. The adipose tissue is a site of production of adipokines (strictly synthesized and secreted by the adipocyte), of pro- or anti-inflammatory cytokines and of acute phase reactant proteins. Cells of the stroma-vascular fraction (monocytes/macrophages, microvascular endothelial cells…) have a secretory importance neglected up to now. The action of both major adipokines (leptin and adiponectin) will be more particularly evoked while considering the diversity of action of the other most current factors. Finally some secreted products more recently discovered (apelin, autotaxin, visfatin.), whose properties are still in the course of exploration, will be also mentioned.     

Extracorporeal membrane oxygenation for pediatric cardiopulmonary failure

Extracorporeal membrane oxygenation is now standard treatment of severe respiratory failure in newborn infants in our center (200 cases) and worldwide (over 2500 cases), but there are few reports of such trials in older children. We reviewed our experience with extracorporeal membrane oxygenation in 33 children aged 1 week to 18 years between 1971 and 1989. The modality was used when all other treatment failed. Extracorporeal membrane oxygenation provided excellent cardiopulmonary support for 1 to 25 days (average 7 1/2 days). The survival rate was 25% for cardiac support patients and 47% for respiratory failure patients (36% overall survival). Mechanical complications included membrane lung failure, tubing rupture, and pump failure, all managed without mortality. Physiologic complications included bleeding, pneumothorax, cardiac arrest, renal failure, hepatic failure, and brain injury. The major cause of death was irreversible injury to lung, heart, or brain. Extracorporeal life support is a reasonable approach for children with serious but reversible cardiopulmonary failure.     

Peripheral Blood Lymphocyte Surface Antigen Expression and Prognosis in Myeloma: Australian Leukaemia Study Group Study

The Australian Leukaemia Study Group myeloma study (MM1) aimed to determine the prognostic significance of clinical and immunophenotypic markers in patients with multiple myeloma. All patients were treated with standard dose melphalan and prednisone. Seventy-four patients were entered and the median survival was 27 months. Serum beta 2-microglobulin (βM) and albumin levels were the only significant clinical factors influencing survival (p = 0.007 and p = 0.008, respectively). Patients with raised levels of CD38+ lymphocytes at presentation had a significantly shorter survival than patients with normal levels (p = 0.01, logrank test, median 19 months vs 33 months). CD38 antigen expression was independent of β2M but patients with raised levels of CD38 had significantly lower levels of albumin than patients with normal levels (p = 0.001) which may explain their poorer survival. Salmon and Durie stage was not associated with antigen expression. No other B-cell antigens (CD10, CD19, CD20, CD21, CD22, CD23, FMC1 or FMC7) or plasma cell antigens tested (PCA-1) were found to be associated with prognosis. Patients who achieved plateau phase had a better prognosis than those who did not (p = 0.04 in a landmark analysis). Patients who achieved plateau phase following an objective response appeared to have a better prognosis than those who were in plateau phase at presentation (p = 0.09 in a landmark analysis). Light chain isotype suppression (LCIS) was not associated with a significant survival advantage and did not correlate with any known prognostic indicator. We conclude that phenotypic analysis of peripheral blood lymphocytes for CD38 antigen at diagnosis may be useful as a prognostic indicator in patients with myeloma.     

Locomotor development and oral reflexes

The newborn has a repertoire of oral zone reflexes which are intimately involved with experiences and expressions related to distress and pleasure. These help develop signaling which leads to relief of distress. The signaling involves bicycling of all limbs, with facial and vocal accompaniments, and thus the locomotor apparatus is intimately related to the oral zone reflexes. From these observations, it is hypothesized that trauma to oral zone reflexes would cause interference with the development of locomotion, initiation efforts, affect and attachment. These disturbances may be seen in different degrees in various deprivation states.     

Productivity loss due to deformity from leprosy in India

The productivity loss in India due to deformity from leprosy was assessed in a random sample of 550 leprosy patients from a rural and an urban area in the state of Tamil Nadu. Logistic and log-linear regression analyses on these leprosy patients showed that elimination of deformity would: a) raise the probability of gainful employment from 42.2% to 77.6%; b) increase annual earnings per patient gainfully employed from Rs 2948 to Rs 6469; and c) raise overall earnings for all patients from Rs 1259 to Rs 5023 per year. The earnings of 550 control subjects (adult family members of the leprosy patients) were consistent with these predictions. Extrapolation to all of India's estimated 645,000 leprosy patients with deformity suggests that elimination of deformity would raise productivity by +130 million per year. The authors conclude that the development and evaluation of programs to eliminate deformity from leprosy deserve high priority.     

Phase-derivative analysis in MR angiography: Reduced Venc dependency and improved vessel wall detection in laminar and disturbed flow

A problem of current MRA techniques is the inability to accurately depict the vascular anatomy, particularly in areas of disturbed flow. Various reasons, such as intravoxel phase dispersion, saturation, temporal variations, and maximum intensity projection (MIP) nonlinearity, cause a wrong delineation of vessel boundaries. A phase contrast (PC)-based postprocessing operation, the phase derivative (PhD), is introduced to detect phase fluctuations indicating flow. Two-dimensional and three-dimensional angiographic reconstruction algorithms are presented. Mathematical formulas are derived to predict the effect of sampling to flow profiles and the effect on the PhD of these profiles. Numerical, phantom, and preliminary in vivo experiments demonstrate that PhD images do not suffer from phase wraps and allow a velocity dynamic range extension only limited by a differential phase change. It is also shown that PhD MIPs produce higher signal-to-noise ratios than conventional PC angiograms and give a better impression of the anatomy of (stenotic) vessels and of their diameters for both laminar and disturbed flow.     

Endoscopic laser ablation of obstructing congenital duodenal webs in the newborn: a case report of limited success with criteria for patient selection.

Standard approaches to intrinsic obstructing duodenal lesions in the newborn include laparotomy with enteroenterostomy, bypassing the obstruction, or duoduodenotomy with excision. The advent of improved pediatric flexible fiberoptic endoscopes and fiberoptic laser technology makes endoscopic ablation of duodenal webs and windsocks in the newborn possible.     

Tissue characterization of symptomatic and asymptomatic disc herniations by quantitative magnetic resonance imaging

The purpose of this investigation was to determine differences in tissue composition of symptomatic and asymptomatic disc herniations as reflected in T₁ and T₂ relaxation times (quantitative magnetic resonance investigation of the lumber spine. The longitudinal and transverse magnetic rlaxation times (T₁ and T₂, respectively) were calculated from a set of 20 images obtained with five single-slice/multi-echo sequences at different repetition time values on a commercial whole-body system (1.5 T). Twenty-two symptomatic and asymptomatic disc herniations could be matched according to age, gender, disc level, and the extent of herniation (protrusion or extrusion) and were compared with regard to T₁ and T₂ relaxation times. Symptomatic disc herniations exhibited significantly (p_T1 < 0.04 and p_T2 < 0.003) shorter T₁(ΔT₁:–182.1 milliseconds, ?15%) and T₂(ΔT₂: ?11.0 milliseconds, ?21%) relaxation times than matched asymptomatic herniations. Symptomatic disc herniations also exhibited more advanced disc degeneration as graded by Pearce's criteria (p < 0.01). These results suggest that symptomatic and morphologically matched asymptomatic disc herniations differ with regard to disc matrix composition.