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While the clever, detached, and entitled flâneur freely made his way about town, women historically were limited in their urban mobility, which made them invisible as critics of urban modernity. The flâneuse was an unimaginable notion.By hypothesizing an embodied flâneuse, this study will examine modern novels whose characters engage in flânerie in ways that may be at once similar and distinctive regarding the tradition. Three authors who present compelling figures of the flâneuse are the British author Jean Rhys, and American authors Djuna Barnes, and Anita Loos. The protagonists in these select texts obviously do not embody the “traditional” flâneur figure; however, their participation expands the timbre of flânerie by examining the urban and social populous from an alternative point of view.

INTRODUCTION: We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda. METHODS: In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related to pregnancy, delivery and post-partum. Data were censored at the date of child death. Using Cox proportional hazard model, we compared the hazard of death among HIV-exposed children and HIV non-exposed children. RESULTS: Of 1,455 HIV-exposed children, 29 (2.0%; 95% CI: 1.3%-2.7%) died by 6 months compared to 18 children of the 1,565 HIV non-exposed children (1.2%; 95% CI: 0.6%-1.7%). By 9 months, cumulative risks of death were 3.0% (95%; CI: 2.2%-3.9%) and 1.3% (96%; CI: 0.7%-1.8%) among HIV-exposed and HIV non-exposed children, respectively. By 2 years, the hazard of death among HIV-exposed children was more than 3 times higher (aHR:3.5; 95% CI: 1.8-6.9) among HIV-exposed versus non-exposed children. Risk of death by 9-24 months of age was 50% lower among mothers who attended 4 or more antenatal care (ANC) visits (aHR: 0.5, 95% CI: 0.3-0.9), and 26% lower among families who had more assets (aHR: 0.7, 95% CI: 0.5-1.0). CONCLUSION: Infant mortality was independent of perinatal HIV exposure among children by 6 months of age. However, HIV-exposed children were 3.5 times more likely to die by 2 years,. Fewer antenatal visits, lower household assets and maternal HIV seropositive status were associated with increased mortality by 9-24 months.

Isolation and restraint both aim to protect the patient. Their practice, monitored and assessed, must meet ethical, legal, clinical and organisational requirements. It has its advantages (pacification) and its limits (loss of freedom to make choices about one's care)., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

The quantitative analysis of compounds of clinical interest of low molecular weight (<1000 Da) in biological fluids is currently in most cases performed by liquid chromatography-mass spectrometry (LC-MS). Analysis of these compounds in biological fluids (plasma, urine, saliva, hair...) is a difficult task requiring a sample preparation. Sample preparation is a crucial part of chemical/biological analysis and in a sense is considered the bottleneck of the whole analytical process. The main objectives of sample preparation are the removal of potential interferences, analyte preconcentration, and converting (if needed) the analyte into a more suitable form for detection or separation. Without chromatographic separation, endogenous compounds, co-eluted products may affect a quantitative method in mass spectrometry performance. This work focuses on three distinct parts. First, quantitative bioanalysis will be defined, different matrices and sample preparation techniques currently used in bioanalysis by mass spectrometry of/for small molecules of clinical interest in biological fluids. In a second step the goals of sample preparation will be described. Finally, in a third step, sample preparation strategies will be made either directly ("dilute and shoot") or after precipitation.

Objectives: The goal of the study was to assess whether clinically significant cerebral hypoperfusion in awake patients would be associated with some alterations in the values of the bispectral index (BIS) monitoring., Study Design: Observational study., Population and Methods: We monitored the BIS during endovascular carotid artery occlusion testing in awake patients., Results: Twenty-eight patients were included. Twenty-one adequately tolerated the procedure. Their BIS value remained stable throughout the procedure. Four patients had poor angiographic tolerance, but no clinical symptoms. Their BIS value slightly decreased during the test (minimal BIS: 83 [79-87]). Three patients had poor clinical and angiographic tolerance of the occlusion. They all experienced an immediate and dramatic decrease in their BIS value (minimal BIS: ipsilateral to clamping: 50 [45-60]; contralateral to clamping: 48 [45-52]). In all patients, the clinical symptoms and the BIS normalized after deflating the occlusion balloon., Conclusion: In awake patients, the observed values of the BIS monitoring seem to be associated with clinically relevant cerebral hypoperfusion., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Computed tomography is important for the diagnosis and follow-up of chronic diffuse interstitial lung diseases. Image quality has improved from each generation of scanner to the next and this continues to allow a better characterization of extent of pathology, or even the nature of the pathological process (potentially reversible inflammatory lesions compared to fibrotic lesions). The diagnostic imaging approach has evolved at the same time as technological developments. We initially thought in terms of the predominant lesions (nodular, alveolar consolidation, ground-glass opacity), and then moved to reasoning based on patterns, which are a combination of several elementary lesions (typically for the diagnosis of idiopathic pulmonary fibrosis). Nowadays, studies are focused on building models characterizing a specific disease and which combine several distinct patterns (typically for ground-glass opacity analysis). CT also allows a quantification of the extent of lung disease, which is linked to the prognosis of the disease and helps to monitor its progression. This quantification is usually based on visual criteria, the principles of which are summarized here. The development of automated quantification software could in the near future, be a support for the radiologist., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

The spinal canal is an uncommon site for abscess formation resulting from bloodstream disseminated infection. Prognosis is often unfavorable. Rapid treatment is essential for satisfactory neurological recovery. Abscesses within the spinal canal are thus diagnostic and therapeutic emergencies. The neuro-infectious and inflammatory manifestations and laboratory findings vary considerably and are insufficient for diagnosis. MRI plays a decisive role. The most commonly reported signs are the presence of an intramedullary collection giving a low-intensity signal on T1-weighted images and a high-intensity signal on T2-weighted images with peripheral contrast uptake and generally extended adjacent medullary edema. We report here five cases of spinal canal abscesses diagnoses with MRI at different stages of development (pre-suppurative myelitis in two cases, constituted abscess in three cases). For each case we reviewed the clinical course and describe the details of the imaging findings. In our series, the collected abscesses presented as round lesions within the canal with contrast uptake. It is noteworthy that the periependymal gray matter adjacent to the lesion also took up the contrast agent in all patients with a collected abscess. This sign has not been described previously and appears to be a going argument orienting the diagnosis towards an infectious rather than tumoral formation.

Whipple's disease is a multisystem bacterial disease usually characterized by malabsorption, diarrhea and polyarthritis. Ocular manifestations include uveitis, vitreitis, retinis, myositis, papilledema and optic atrophy. We report a case of a chronic bilateral vitreitis in a 63 year-old man who had been treated for a Whipple's disease with gastrointestinal involvement 30 years before. The jejunal biopsy was negative but the polymerase-chain-reaction (PCR) revealed the presence of Trophyrema Whippelii in the vitreous prelevement of both eye. This new, original strategy of PCR is specific and more sensitive than histological diagnosis.

We report a case of a 31 year-old man who presented a bilateral ischemic optic neuropathy associated with headaches and severe systemic hypertension. This episode appeared after administration of ergotamine tartrate and macrolides. This medication probably led to a vasospasm which occurs in patients with hypertension. The cardiovascular and serum lipid evaluations were normal. A migraine optic neuropathy can be evoked.

Two siblings (one man, one woman), presenting with diarrhea, severe weight loss peripheral neuropathy, ophthalmoparesis, asymptomatic leukoencephalopathy were diagnosed as a new cases of Mitochondrial Neuro Gastro Intestinal Encephalomyopathy syndrome (MNGIE). Hirano (1994) defined four criteria for the diagnostic: peripheral neuropathy, ophthalmoparesis, gastro intestinal dysmotility, muscle biopsy with histologic features of mitochondrial myopathy (ragged-red fibers, muscle fibers with increased succinate deshydrogenase stain or ultra structurally abnormal mitochondria). In a review of the literature, we found 31 cases with MNGIE. With our two cases, we study this group of 33 patients. First symptoms begin about 13.5 years with a median of 10 years and extremes for 1 to 32 years. The first signs are gastro intestinal symptoms (recurrent nausea, vomiting or diarrhea with intestinal dysmotility) in 22 cases, an ophthalmoparesia in 4 cases, intestinal and ocular signs in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case, gait ataxia or peripheral neuropathy in 3 cases, hearing loss in 1 case. During the evolution, besides the cardinal signs, the following features have been observed with a variable frequency: hearing loss, short stature, facial palsy, dysphonia, dysarthria, sweating, orthostatic hypotension, bladder dysfunction, hepatomegalia, The laboratory features are: abnormal Nerve Condition Studies/EMG compatible with a sensory motor neuropathy, lactic acidosis, mitochondrial respiratory chain defect (essentially complex IV deficiency, complex I deficiency or multiple complex defect), MRI leukodystrophy, elevated CSF protein, heart block, ragged-red fibers or increased SDH stain. The prognosis is poor, due to a severe weight loss bordering on cachexia 13 patients died with a mean age of 28.5 years (median 24 years, extreme 3 years to 51 years). The prognosis seems to be worsened by a young age of onset. The 33 patients belong to 19 families with 7 cases of consanguinity. 25 patients had a brother, a sister or a cousin affected. The study of these families is compatible with an autosomic recessive transmission, suggesting a pathology of the nuclear genomi, probably impliying the control of the mitochondrial DNA replication. In fact, in 13 cases, a study of the mt DNA was realized: multiple deletions were founded in 6 cases, multiples mutations in one case, unique mutation in 1 case. In 5 cases ther was no evidence of abnormality. These precise etiology and pathophysiologic significance of the mt DNA deletions, and the heterogeneity of the modifications of the mt DNA remain unknown. However, the possibility of various phenotypes for a same genotype or inversely is known in mitochondriopathies.

Clinical outcome of gut's stromal tumors is difficult to predict by morphological data. The prognostic significance of a set of morphological criterias and immunostaining for proliferating cell nuclear antigen (PCNA) was studied. Thirty six tumours were classified benign (group A) or malignant (group B) according to ten year follow-up. Patient's sex and age, site of origin, tumour size, mitotic count and cytonuclear atypia were considered. Growth kinetic was studied by immunohistochemical analysis of PCNA (PC 10, DakoR). In univariate analysis, mitotic count, PCNA index, tumor size and cytonuclear atypia were associated with patient outcome. However, in multivariate analysis, only mitotic count and tumour size were independent prognosis factors. Thus, mitotic count remains the best prognostic indicator for these tumours since a cut off value of 2 mitosis/high power field allows an accurate prognosis in 33/36 tumors.

This case concerns a 27-year-old man with a very high level of anti-thyroid antibody and pretibial elephantiasis myxedema which developed progressively over several years following subtotal thyroidectomy for << hashitoxicosis >>. Complementary resection of the thyroid stump was performed ; under microscopic examination this stump presented an aspect of atrophic thyroiditis. This unusual development towards atrophic thyroiditis raises the problem of the relations between the various forms autoimmune thyroiditis.

The tubuloreticular inclusions (TRI) correspond to a modification of the endoplasmic reticulum, observed in different pathological conditions, the most frequent being immune disorders. In the systemic lupus erythematosus, they are present in 2.7% to 4.4% of circulating lymphocytes in 4 patients out of 5. Using an immunogold technique, the TRI were identified only in the T lymphocytes (26/331 T lymphocytes versus 0/79 B lymphocytes, p < 0.01 Chi square) and more precisely in the T4 "Helpers" (16/218 T4 versus 0/123 T8, p < 0.01 Chi square).

Weiss proposed 9 histologic criteria to evaluate the malignancy of adrenal cortical tumors. Each tumor is graded from 0 to 9 according to how many of the criteria are present. Eight of the 17 neoplasms from the present study were graded from 0 to 2; none of these 8 tumors metastasized or recurred. The grade of the nine other neoplasms ranged from 3 to 8; seven lesions metastasized (grade 4 to 8), one recurred (grade 5), and the last one neither metastasized nor recurred (grade 3) although this tumor was considered malignant according to Weiss' system. Even thought the results obtained using Weiss' system are similar to the results that were put forwards initially, and despite prognostic uncertainty with grade 3 tumors, we think that the later system provides a more objective evaluation of the prognosis of adrenal cortical tumors, compared with usual morphologic methods.

Adrenocortical tumors malignancy may be difficult to assess by morphological data. Twelve cases of such tumors were reviewed and classified benign (group I) or malignant (group II) according to follow yp. Using a peroxidase antiperoxidase method, nuclear affinity for anti-PCNA antibody was studied. The percentage of positive nuclei is significantly different in both groups: the mean value is 1.025% in benign tumors (range from 0.40 to 3.02%) and 16.765% (range from 5.62 to 31.40%) in malignant tumors (p < 0.01 according to Mann and Whitney U test). Although our study group is rather small, it suggests that analysis of nuclear affinity for PCNA could be helpful in assessment of adrenocortical tumors malignancy.