Inflammatory arteriopathy of the arms in the course of Horton disease. Report of six cases

We report 6 cases of upper limb involvement in giant cell arteritis; upper limb involvement revealed the disease in 4 cases and clinical symptoms were present in 5 (upper limb pain, Raynaud's phenomenon). Upper limb pulses were not palpable and blood pressure unmeasurable in all. Duplex ultrasonography found signs of inflammatory arteriopathy in 4 cases (hypoechogenous halo of the arterial wall and acceleration of flow velocity). Arteriography was performed in 5 cases and showed long and regular stenoses. In the last case, arteriography was not done because the duplex exploration gave an easier diagnosis. With this technique, the diagnosis of upper limb involvement, frequent in autopsy series of giant cell arteritis, might be made more often. Corticosteroid therapy is indicated and surgery should be discussed only in emergency situations.     

Parental smoking and the risk of childhood leukemia

Cigarette smoke has been linked to adult myeloid leukemia; however, the association between parental smoking and childhood leukemia remains unclear. Parental smoking and the risk of childhood leukemia were examined in the Northern California Childhood Leukemia Study, a case-control study, between 1995 and 2002. The present analysis included 327 acute childhood leukemia cases (281 acute lymphoblastic leukemia (ALL) and 46 acute myeloid leukemia (AML)) and 416 controls matched on age, sex, maternal race, and Hispanic ethnicity. Maternal smoking was not associated with an increased risk of either ALL or AML. Paternal preconception smoking was significantly associated with an increased risk of AML (odds ratio = 3.84, 95% confidence interval: 1.04, 14.17); an increased risk for ALL was suggestive for paternal preconception smoking (odds ratio = 1.32, 95% confidence interval: 0.86, 2.04). Greater risks of ALL were observed compared with the risk associated with paternal preconception smoking alone, when paternal preconception smoking was combined with maternal postnatal smoking (p(interaction) = 0.004) or postnatal passive smoking exposure (p(interaction) = 0.004). These results strongly suggest that exposure to paternal preconception smoking alone or in combination with postnatal passive smoking may be important in the risk of childhood leukemia.     

Maternal Pregnancy Loss,Birth Characteristics,and Childhood Leukemia (United States)

Objective: The authors evaluated the relation between maternal pregnancy loss, birth characteristics, and childhood leukemia in the Northern California Childhood Leukemia Study. Methods: Incident cases of childhood leukemia (age 0–14 years) were rapidly ascertained, and controls were randomly selected from birth records and individually matched to cases. A total of 366 cases [313 acute lymphoblastic leukemia (ALL) and 53 acute myeloid leukemia (AML)] and 460 controls were included in this analysis. The biological mothers of all subjects provided detailed reproductive history and birth characteristics of the index children during a personal interview. Odds ratio (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. Data on maternal pregnancy loss and birth characteristics were also available from the birth certificates of 96.3% of all subjects. Results: History of miscarriage was associated with a significantly increased risk of AML (OR = 2.94, 95% CI: 1.03, 8.34), but not ALL. Neither birth weight, birth order, or parental ages appeared to be an important predictor of the risk of ALL or AML. A comparison between data from two different sources (interview versus birth certificate) indicated good reproducibility and offered some evidence against recall bias. Conclusion: Maternal history of miscarriage is associated with an increased risk of childhood AML.     

Oral aphthae induced by nicorandil. Anatomopathologic aspects. Apropos of a case

Major apthous stomatitis induced by nicorandil is exceptional, the mechanism is still unknown and the histological aspect of these lesions have not been previously reported. Our case reports a man who was treated by nicorandil for coronary artery disease. He was referred for major aphtous stomatitis; one element was biopsied. The histological aspect was an aspecific sialadenitis, with granulous reaction, and without vasculitis or eosinophilic infiltration. We conclude that aphtous stomatitis induced by nicorandil could to be explain by a toxic effect, rather than a toxicallergic or immunologic mechanism.     

Clinical and mutational spectrum in a cohort of 105 unrelated patients with dilated cardiomyopathy

Dilated Cardiomyopathy (DCM) is one of the leading causes of heart failure with high morbidity and mortality. More than 30 genes have been reported to cause DCM. To provide new insights into the pathophysiology of dilated cardiomyopathy, a mutational screening on 4 DCM-causing genes (MYH7, TNNT2, TNNI3 and LMNA) was performed in a cohort of 105 unrelated DCM (64 familial cases and 41 sporadic cases) using a High Resolution Melting (HRM)/sequencing strategy. Screening of a highly conserved arginine/serine (RS)-rich region in exon 9 of RBM20 was also performed. Nineteen different mutations were identified in 20 index patients (19%), including 10 novels. These included 8 LMNA variants in 9 (8.6%) probands, 5 TNNT2 variants in 5 probands (4.8%), 4 MYH7 variants in 3 probands (3.8%), 1 TNNI3 variant in 1 proband (0.9%), and 1 RBM20 variant in 1 proband (0.9%). One proband was double-heterozygous. LMNA mutations represent the most prevalent genetic DCM cause. Most patients carrying LMNA mutations exhibit conduction system defects and/or cardiac arrhythmias. Our study also showed than prevalence of mutations affecting TNNI3 or the (RS)-rich region of RBM20 is lower than 1%. The discovery of novel DCM mutations is crucial for clinical management of patients and their families because pre-symptomatic diagnosis is possible and precocious intervention could prevent or ameliorate the prognosis.     

Parental social contact in the work place and the risk of childhood acute lymphoblastic leukaemia

To study the possible relation between parental social contact through occupation, a marker for a child's risk of infection, and childhood acute lymphoblastic leukaemia (ALL), the parents of 294 children with ALL aged 0-14.9 years and 376 matched controls were interviewed about their jobs after their child's birth up to the age of 3 years. Job titles were assigned to a level of social contact, and an index of occupational social contact months was created using the level and the job duration. Positive interactions between this index and rural residence associated with an increased risk of childhood ALL and common ALL (c-ALL) were observed (interaction P-value=0.02 for both, using tertiles of contact months; interaction P-value=0.05 and 0.02 for ALL and c-ALL, respectively, using continuous contact months); such findings were not observed when job durations were ignored. Our data suggest that duration of parental occupation may be important when examining the association between parental social contact in the workplace and childhood leukaemia.     

Étude comparative de l’évaluation clinique de l’angle poplité en décubitus dorsal versus décubitus latéral asymétrique,chez des sujets infirmes moteurs cérébraux et polyhandicapés (paralysés cérébraux)

Clinical assessment of lengthening possibilities of hamstring muscles is of great importance for cerebral palsied patients because of progressive and early diminution and its functional and orthopaedic consequences. Traditionally, a clinical assessment is carried out by measuring the popliteal angle with the patient in supine position and hip flexed at 90°. Nevertheless, for patients with CP, able to understand orders, popliteal angle data can change from one clinician to the other because of varying resistance of the muscles at lengthening. On the other hand, more patients relax spontaneously when lying in a lateral and asymmetrical position with the lower limb examined flexed, than in a supine position. In the case where the relaxed state is insufficient, we can use a specific maneuver in order to relax him more. The aim of this article is to report the results of a study made to compare popliteal angle in supine position versus lateral and asymmetrical position. Throughout the maneuvers, the degrees of contraction of the muscles were recorded by a surface electromyography. Variations of the angles were measured with electrical goniometers and verified, on obtaining the final popliteal angle by a mechanical goniometer. Data obtained at the end of the study with a group of 12 patients from 8 to 15 years old, showed that for all patients the angle is higher in the lateral and asymmetrical position than in the supine position, that is to say between 20° to 40° more. These results contest the choice of the decubitus dorsal position to assess the popliteal angle allowed by intrinsic lengthening possibilities (visco-elasticity) of the hamstring muscles and not active resistances due to muscular contraction from diverse pathological factors.     

Implications récentes des équipes françaises en oncologie radiothérapie et radiobiologie clinique

Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment.