Aortic aneurysm complicating bacterial endocarditis in childhood

Bacterial endocarditis is an uncommon diagnosis in childhood with significant morbidity and mortality. Aortic aneurysm as a complication is well described in adults but there are few reports in the paediatric literature. Two children with bacterial endocarditis are described, whose illnesses were complicated by aortic aneurysm formation requiring surgical intervention.     

Role of bacterial translocation in necrotizing enterocolitis

The intestinal mucosa functions as a major local defense barrier preventing bacteria that colonize the gut from invading organs and tissues. Under certain circumstances, bacteria colonizing the gastrointestinal tract can cross the gut mucosal barrier to infect the mesenteric lymph node and systemic organs via a process termed bacterial translocation. Factors that promote the translocation of bacteria or endotoxin from the gut include bacterial overgrowth with gram-negative enteric bacilli, impaired host immune defenses and injury to the gut mucosa resulting in increased intestinal permeability. These same promoting factors are present in patients at increased risk of developing necrotizing enterocolitis. Consequently, this review focuses on the potential role of bacterial and endotoxin translocation from the gut in the pathogenesis of necrotizing enterocolitis.     

Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis

One hundred and twenty eight Brazilian children with lymphoblastic leukaemia were intensively treated with a Berlin-Frankfurt-Munich based protocol. More children had a white cell count above 50 x 10(9)/l (31%) then observed in developed countries. After a median follow up of 31 months (11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white cell count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z = -1.28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score < -2 had a relapse risk of 8.2 (95% confidence interval 3.1 to 21.9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries.     

Model of the viscoelastic behaviour of skin in vivo and study of anisotropy

BACKGROUND: The single-axis extension test is relatively little used to study the mechanical properties of human skin in vivo. A campaign of tests was carried out with an original, modern machine developed in our laboratory. It can perform extension or compression tests using servo-controlled position or force in different directions. The load can either be of the extension or monotonous compression type, creep or relaxation. The results obtained were used to develop a viscoelastic model. The elastic modulus calculated helps us to determine the main directions of anisotropy on the forearm. METHODS: We use a new in vivo single-axis extension machine (patent no. FR03/09220 application in progress). With it, we can carry out monotonous, creep and relaxation tests on the forearm. An associated finite elements model enables conversion to the intrinsic parameters of the skin under stress and strain from external stress applied in force and displacement. From the tests, we can propose a viscoelastic model and the identification of his parameters. We carried out tests in four directions with respect to the axis of the forearm of 63 people of different ages. The present report is limited to a brief presentation of the experimental set-up used, and a more complete presentation of the viscoelastic model and how it is defined and also the work on the anisotropy in the elastic domain. RESULTS: The viscoelastic model proposed has only four intrinsic parameters: elasticity parameters E(e) and E(ve) and viscosity parameters epsilon(ve) and A. Skin being considered as orthotropic, we were able to determine the average main direction of 63 people, which is of 5.33+/-5.78 around the longitudinal axis of the arm. An average modulus E(1) (ave)=6.57E(5) (Pa) can be found in the direction close to the axis of the arm and E(2) (ave)=1.30E(5) (Pa) in the perpendicular direction and a G(12)=1.32E(5) (Pa) shear modulus. CONCLUSIONS: The parameters obtained with the viscoelastic model are independent of the type of load, the same coefficients enable a correct representation in creep and relaxation tests. The main directions vary from one person to another, Young's modulus in these directions could be an indicator for dermatologists and cosmeticians.     

Lanthanum carbonate for the treatment of hyperphosphataemia in renal failure and dialysis patients

Hyperphosphataemia is a usual accompaniment of end stage renal disease and dialysis, in the absence of dietary phosphate restriction or supplemental phosphate binders. It is associated with renal osteodystrophy, metastatic calcification and increased mortality and morbidity. Despite dietary restriction and dialysis, most patients will require a phosphate-binding agent to treat this condition. However, phosphate control has not significantly improved over the last two decades, mainly because of the lack of an ideal oral phosphate-binding agent. Aluminium- and calcium-based agents are associated with major side effects, despite their undoubted efficacy. Although sevel-amer hydrochloride represents a step forward in the management of hyperphosphataemia, it is not an ideal phosphate binder due to its cost and tablet burden. Lanthanum carbonate is the most recent non-calcium, non-aluminium, phosphate-binding agent. It is effective and well-tolerated, and no negative effects on bone histology have been observed.     

The deep South network for cancer control: eliminating cancer disparities through community-academic collaboration

African Americans have a substantially increased mortality rate compared to Whites in many cancers, including breast and cervix. The Deep South Network for Cancer Control (the Network) was established to develop sustainable community infrastructure to promote cancer awareness, enhance participation of African Americans and other special populations in clinical trials, recruit and train minority investigators, and develop and test innovative community-based cancer control measures to eliminate cancer mortality disparities in special populations. This article describes the steps necessary to form the network and the process and activities required to establish it as an effective infrastructure for eliminating disparities between Whites and African Americans in the United States.