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RésuméLa gynécomastie est fréquemment retrouvée dans la pratique clinique de l’urologue ou du médecin généraliste. D’un point de vue physiopathologique, elle résulte d’un déséquilibre entre la concentration des œstrogènes et des androgènes. De multiples pathologies et traitements peuvent amener à cette perte d’équilibre. Il est important pour le clinicien de reconnaitre les signes de danger qui doivent faire suspecter une néoplasie maligne primaire du tissus mammaire ou secondaire ayant amené à la gynécomastie. Un bilan biologique de base permet le plus souvent de trouver la cause de la gynécomastie. Le traitement est le plus souvent sa cause. Pour certain cas particulier un traitement par le tamoxifène ou la radiothérapie peut être proposé. La chirurgie intervient lors de l’échec du traitement conservateur.

Background Clear cell renal carcinoma is known for its propensity for metastatic spread. Common sites of metastasis are the lungs, bones, lymph nodes, liver, adrenals and brain, but all organs can be affected. Contralateral ureteral metastasis is a rare phenomenon, and only a few cases have been reported in the literature. Case presentation We present the case of a 58-year-old Caucasian patient with a single contralateral ureteral metastasis of a clear cell renal carcinoma. Conclusion Ureteral metastasis of clear cell renal carcinoma is very rare, and there is no well-established treatment. For patients with low metastatic spread/volume, the aim should be to preserve kidney function, and thus metastasectomy should be considered.

ObjectiveThis secondary analysis of data of a randomized controlled trial (RCT) retrospectively investigated the performance of pulse oximetry in identifying children with severe illnesses, with and without respiratory signs/symptoms, in a cohort of children followed for morbid episodes in an intervention trial assessing the efficacy of Intermittent Preventive Treatment for malaria in infants (IPTi) in Papua New Guinea (PNG) from June 2006 to May 2010.SettingThe IPTi study was conducted in a paediatric population visiting two health centres on the north coast of PNG in the Mugil area of the Sumkar District.ParticipantsA total of 669 children visited the clinic and a total of 1921 illness episodes were recorded. Inclusion criteria were: age between 3 and 27 months, full clinical record (signs/symptoms) and pulse oximetry used systematically to assess sick children at all visits. Children were excluded if they visited the clinic in the previous 14 days.OutcomesThe outcome measures were severe illness, severe pneumonia, pneumonia, defined by the Integrated Management of Childhood Illness (IMCI) definitions, and hospitalization.ResultsOut of 1921 illness episodes, 1663 fulfilled the inclusion criteria. A total of 139 severe illnesses were identified, of which 93 were severe pneumonia. The ROC curves of pulse oximetry (continuous variable) showed an AUC of 0.63, 0.68 and 0.65 for prediction of severe illness, severe pneumonia and hospitalization, respectively. Pulse oximetry allowed better discrimination between severe and non-severe illness, severe and non-severe pneumonia, admitted and non-admitted patients, in children ≤12-months of age relative to older patients. For the threshold of peripheral arterial oxygen saturation ≤ 94% measured by pulse oximetry (SpO2), unadjusted odds ratios for severe illness, severe pneumonia and hospitalization were 6.1 (95% Confidence Interval (CI) 3.9-9.8), 8.5 (4.9-14.6) and 5.9 (3.4-10.3), respectively.ConclusionPulse oximetry was helpful in identifying children with severe illness in outpatient facilities in PNG. A SpO2 of 94% seems the most discriminative threshold. Considering its affordability and ease of use, pulse oximetry could be a valuable additional tool assisting the decision to admit for treatment.

Este artigo analisa as trajetórias de conversão para agricultura orgânica de agricultores familiares localizados na região metropolitana de São Paulo durante os anos 1990 e 2000. Esta conversão ocorreu sob o impulso inicial de indivíduos ligados ao movimento da teologia da libertação e depois da estruturação posterior de um mercado regional em torno da grande distribuição. O texto mostra como a integração desses agricultores em um sistema de mercado regido por lógicas capitalistas foi acompanhada, localmente, por uma profissionalização da agricultura e pela implantação de lógicas e estruturas empresariais. Mostra também como estas dinâmicas de modernização ecológica, embora contribuindo para a geração de uma nova elite rural e de novas formas de desigualdade social, parecem ao mesmo tempo poder contribuir para a manutenção da agricultura em um contexto de forte pressão urbana, para o retorno dos jovens a esta atividade e para a construção de territórios de qualidade ecológica. Nesse sentido, ele indaga se existiriam contextos nos quais a modernização ecológica seria um compromisso aceito por defensores de uma alternativa mais radical? Qualquer que seja a resposta a essa pergunta, a demonstração aqui proposta sublinha a importância de reintegrar a análise das trajetórias ecológicas agrícolas em um estudo mais geral das mudanças sociais, particularmente em seus componentes locais.AbstractThis paper analyzes small farmers’ trajectories in converting to organic farming in the metropolitan region of São Paulo during the 1990s and 2000s. The conversion occurred under the initial push of individuals connected the movement of the Theology of Liberation and after the structuring of a regional market around large-scale distribution. The paper shows how the integration of these farmers in a market system ruled by capitalist logic was accompanied, at the local level, by the professionalization of agriculture and by the implantation of corporate structures and logic. It also shows how these ecologic modernization dynamics, while contributing to the creation of a new rural elite and new forms of social inequality, seem to also be able to contribute to the maintenance of farming in a context of strong urban pressure, to the return ofyoung people to farming, and the construction of territories of ecologic quality.In this sense, it questions whether contexts exist in which ecologic modernization would be a compromise accepted by defenders of more radical alternatives? Whichever the answer to this question, the answer we propose underlines the importance of reintegrating the analysis of the ecologic farming trajectories to a broader study of social changes, mainly in its local components.

Quality of life (QoL) is of great importance to patients with schizophrenia and their families. Although the use of QoL measures may contribute to better adherence to therapeutic interventions, more satisfaction with care, improved health outcomes and reduction of health costs, QoL assessment remains underutilized in clinical practice. In this review, the authors propose a reflection on the limitations and lack of impact of QoL measures in clinical care. Our argument is based on three challenges regarding conceptual aspects and metrics, use and limits and the usefulness of measuring QoL. For each challenge, the authors have suggested pragmatic proposals and new research directions to promote the use of QoL measures in the future. These avenues of research involve a shared responsibility between QoL researchers, the medical community and decision makers. Close collaboration between all parties is necessary to promote the use of QoL measures in schizophrenia.

Nous abordons le sujet sur la base des recherches sur les natures urbaines lancées au Muséum dans les années 1990, concrétisées par un colloque (1996), deux journées d’études et deux opérations de recherche au sein de l’UMR Éco-Anthropologie et Ethnobiologie, le tout chevillé à des enseignements. La problématique initiale était celle des « villes naturalisées », qui a été commuée en « villes vivrières ». L’idée majeure qui se dégage de cette réflexion collective est l’enchaînement des représe...

Depuis le debut des annees 90, la contractualisation s’est imposee comme l’une des principales modalites de reponse aux enjeux de gestion de la biodiversite dans le Parc national des Cevennes. Elle est non seulement considere comme contribuant a une « bonne gouvernance » de la nature mais egalement presentee comme un levier pour la sensibilisation et l’engagement des populations locales en faveur de la gestion de la biodiversite. Cependant, comme nous le montrons ici a partir du cas du causse Mejean, vingt-cinq annees de gestion contractuelle n’ont guere fait entrer la biodiversite dans le quotidien des eleveurs. Si tel est le cas, c’est d’une part que cette derniere reste avant tout l’expression d’une forme technocratique de la nature, qu’elle s’est imposee aux eleveurs a travers une grammaire normee, incapable de s’integrer a leur environnement « vecu ». Mais si tel est le cas, c’est d’autre part que la gestion contractuelle telle qu’elle se presente localement n’est qu’une forme pervertie du principe de libre manifestation des interets de chacun qu’elle est censee incarner. En effet, dans les conditions actuelles de l’exercice de leur metier, les eleveurs ne sont guere « libres » de souscrire ces contrats. Cette tentative d’imposition d’elements de nature, qui implique une re-signification profonde du territoire vecu des eleveurs et passe par des logiques contractuelles devoyees, concoure ainsi a un faible niveau d’appropriation des enjeux de protection de la nature par les eleveurs et a la fragilite d’un dispositif de conservation toujours largement domine par des rapports conflictuels entre ces derniers et les representants du Parc national.

Ete 1940. Dans un pays assomme par la debâcle, les premieres manifestations du refus de l’occupant s’ebauchent dans Paris, en particulier au musee de l’Homme. Des noyaux de resistance naissent. Par contacts successifs, une nebuleuse rassemblant des groupes divers se developpe et se lance dans des actions variees : propagande, evasion, renseignement. Disseminee geographiquement, socialement et ideologiquement variee, cette desobeissance pionniere est rapidement en butte a une repression feroce. Ses principaux chefs de file, le linguiste Boris Vilde et l’anthropologue Anatole Lewitsky, sont juges et executes en fevrier 1942. Comment cette premiere Resistance s’est-elle structuree ? Quelles ont ete les motivations et les profils de ses membres ? La repression a-t-elle irremediablement decime les groupes qu’ils avaient mis sur pied ? Comment enfin l’histoire et la memoire de ces ephemeres constructions se sont-elles articulees de 1942 a nos jours ? Dans ce livre, Julien Blanc presente a la fois l’histoire singuliere d’une organisation de Resistance et un essai sur les premieres formes de la desobeissance en zone occupee.

Le « reseau du musee de l’Homme », organisation emblematique des debuts de la Resistance en zone occupee, semble bien connu. Une etude precise permet pourtant de souligner la richesse de ses composantes, la variete de ses activites ou encore l’originalite de son fonctionnement, loin de l’image d’Epinal qui s’est imposee. A travers le cas d’ecole du musee de l’Homme, ce sont quelques-unes des specificites de cette premiere desobeissance qui sont ici mises en lu-miere.

A mathematical model was developed to estimate the greenhouse gas (GHG) emissions due to the treatment of municipal sewage. The model took into account emissions from upstream, on-site and downstream activities. The emissions for three different sewage treatment configurations were estimated, consisting of an activated sludge system preceded by a primary settler, and by anaerobic pre-treatment (Upflow Anaerobic Sludge Blanket, UASB): with and without recovery of dissolved CH4 from the anaerobic effluent. The UASB-based configuration with dissolved CH4 recovery had the lowest direct emission of 6900 ton CO2 eq/y and the highest avoided emissions (4200 ton CO2 eq/y). In contrast, when dissolved CH4 recovery was not applied, the UASB-based configuration had the highest direct emissions: 25,500 ton CO2 eq/y. The primary clarification based configuration had similar emissions to the UASB-based configuration without CH4 recovery from the effluent. In addition to having the lowest GHG emissions, the UASB configu...