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Vitiligo has a major impact on health-related quality of life. Although a few vitiligo-specific quality of life instruments exist, there is no specific vitiligo burden tool. We developed and validated a specific vitiligo burden tool according to skin phototype. In total, 301 patients completed 35 items of the Vitiligo Impact Patient scale, of whom 235 were of skin phototype I to III and 66 of phototype IV to VI. The dimensionality of the items was evaluated using factor analyses, with results suggesting three factors in fair- and dark-skinned patients (“Psychological effects on daily life,” “Relationships and Sexuality,” and “Economic Constraints, Care & Management of Disease”). Unidimensionality was confirmed by higher order factor analysis. Cronbach’s α were high—and intradimensional coherences all demonstrated good reliability (α > 0.8). The final instrument consists of 29 items (19 items common to all patients, 3 specific to fair skin, and 7 to dark skin). The test-retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was greater than 0.90 for each population. External validity was confirmed by the correlation coefficients and Bland and Altman plots of the Vitiligo Impact Patient scale-Fair Skin and Vitiligo Impact Patient scale-Dark Skin versus the Short-Form-12, PVC Metra, Body Image States Scale, and Daily Life Quality Index assessment tools.

Étudier les résultats oncologiques et fonctionnels de l’HIFU en première intention dans le cancer de prostate localisé.

Évaluer l’évolution de la fonction rénale après néphrectomie partielle (NP) sur rein unique et rechercher des facteurs prédictifs d’altération de celle-ci.

Décrire la prévalence et les délais d’apparition des expositions vaginales après cure de prolapsus en fonction de la voie d’abord chirurgicale initiale. Décrire leur prise en charge thérapeutique.

Faire une revue de la littérature de l’efficacité et la tolérance de la toxine botulinique A (onabotulinumtoxinA, BOTOX®, Allergan, Irvine, CA, États-Unis) dans l’hyperactivité vésicale idiopathique (HAVi) réfractaire.

Évaluer à moyen terme l’efficacité et la morbidité de la bandelette sous-urétrale Advance®dans le traitement de l’incontinence urinaire postopératoire de l’homme, et déterminer des critères préopératoires prédictifs de succès ou d’échec.

The association of primary hyperaldosteronism and pheochromocytoma is very rare, but poses diagnostic and therapeutic problems exemplified in the following case. A 50-year-old man was referred for resistant and severe hypertension. Laboratory tests showed low serum potassium, primary hyperaldosteronism, and an increase in urinary norepinephrine and metanephrine. An adrenal scan indicated a nodule of the right gland of 35×30 mm with a spontaneous density of 12 HU. The initial diagnosis was that of a Conn’s adenoma. A right adrenalectomy was performed. The tissue removed was a pheochromocytoma. The postoperative course was marked by persistence of high blood pressure. On laboratory tests, levels of urinary metanephrines were normalized, but primary hyperaldosteronism was still present. Thus, the case was finally diagnosed as a bilateral adrenal hyperplasia and unilateral pheochromocytoma. Five cases of involvement of both the adrenal cortex and the medulla have been reported. The scarcity of the cases published favors a fortuitous association. However, other possibilities could be envisaged. A close relation between the cortical and medullary cells has been shown that may play an important role in the regulation of the endocrinal function. Another possibility could be stimulation by adrenaline of the release of adrenocorticotropic hormone and renin, inducing cortical hyperplasia and stimulating the secretion of aldosterone, which could become self-perpetuating. Finally, there may be a genetic predisposition to the endocrine dysplasias involving a double hormonal secretion by the adrenal gland. In conclusion, the association of pheochromocytoma and primary hyperaldosteronism can present in the same patient and needs to be considered on the basis of the clinical and biochemical findings.

Étudier la faisabilité de l’énucléation laser Holmium de la prostate (HoLEP) en chirurgie ambulatoire.

La neuromodulation sacrée (NMS) représente une des alternatives thérapeutiques dans la prise en charge de troubles fonctionnels urinaires aussi variés que l’hyperactivité vésicale (HAV), la rétention d’urine ou les syndromes douloureux pelviens. Avec l’augmentation croissante de l’utilisation de la NMS, nous devons faire face à la gestion de cette thérapie en postopératoire.

Les injections intra-détrusoriennes de toxine botulinique A ont maintenant une extension d’autorisation de mise sur le marché pour le traitement de l’hyperactivité réfractaire idiopathique. L’objectif de cette étude était de faire le point concernant ce traitement.

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management.

Définir des recommandations pour l’utilisation pratique de la toxine botulinique de type A (BoNTA) dans l’hyperactivité vésicale réfractaire idiopathique (HAVRI).

L’injection intraprostatique de toxine botulique a récemment été étudiée dans le traitement de l’hyperplasie bénigne de prostate (HBP). Elle semble permettre une amélioration importante des symptômes urinaires sans effets secondaires significatifs et pourrait donc représenter une alternative mini-invasive intéressante aux traitements classiques de l’HBP. Les principales études sur l’utilisation de la toxine botulique dans l’HBP sont présentées et analysées. Bien que ces premiers résultats soient très encourageants, une recommandation d’utilisation plus large de ce type de produit reste prématurée et devra attendre la réalisation d’une étude contrôlée randomisée de grande envergure.

L’objectif principal de cette étude était d’analyser les conséquences urodynamiques et fonctionnelles de la bandelette sous-urétrale transobturatrices (TOT) dans le traitement de l’incontinence urinaire d’effort (IUE).

BACKGROUND Complex visual hallucinations (VHs) occur in several pathologic conditions; however, the neural mechanisms underlying these symptoms remain unclear. Although dopamine may have a role, indirect evidence indicates that serotonin may also contribute to the pathogenesis of complex VHs, probably via involvement of the serotonin 2 receptor. OBJECTIVE To examine for the first time in vivo changes in serotonin 2A receptor neurotransmission among patients having Parkinson disease (PD) with VHs. DESIGN Case-control study. SETTING Academic research. PATIENTS Seven patients having PD with VHs and 7 age-matched patients having PD without VHs were recruited. MAIN OUTCOME MEASURES We used the selective serotonin 2A receptor ligand setoperone F 18 during positron emission tomography among nondemented patients having PD with VHs. RESULTS Patients having PD with VHs demonstrate increased serotonin 2A receptor binding in the ventral visual pathway (including the bilateral inferooccipital gyrus, right fusiform gyrus, and inferotemporal cortex) as well as the bilateral dorsolateral prefrontal cortex, medial orbitofrontal cortex, and insula. CONCLUSIONS This pilot study provides the first in vivo evidence suggesting a role for serotonin 2A receptors in mediating VHs via the ventral visual pathway in PD. Treatment studies should be performed using selective serotonin 2A receptor antagonists, which have important implications for the clinical management of VHs and psychosis in PD.Arch Neurol. 2010;67(4):416-421--

OBJECTIVE To examine the integrity of the default mode network in patients with Parkinson disease (PD). Previous functional neuroimaging experiments have studied executive deficits in patients with PD with regard to task-related brain activation. However, recent studies suggest that executive performance also relies on the integrity of the default mode network (ie, medial prefrontal cortex, posterior cingulate cortex, precuneus, and lateral parietal and medial temporal cortices), characterized by a deactivation of these cortical areas during the performance of executive tasks. DESIGN We used functional magnetic resonance imaging to investigate cortical deactivations during a card-sorting task (retrieval and manipulation of short-term memory contents) compared with a simple sensory-motor matching task. In addition, a functional connectivity analysis was performed. SETTING Tertiary outpatient clinic. PARTICIPANTS Seven patients with mild to moderate PD (not taking medication) and 7 healthy controls. MAIN OUTCOME MEASURE Cortical deactivations. RESULTS Both groups showed comparable deactivation of the medial prefrontal cortex but different deactivation in the posterior cingulate cortex and the precuneus. Compared with controls, patients with PD not only showed less deactivation of the posterior cingulate cortex and the precuneus, they even demonstrated a reversed pattern of activation and deactivation. Connectivity analysis yielded that in contrast to healthy individuals, medial prefrontal cortex and the rostral ventromedial caudate nucleus were functionally disconnected in PD. CONCLUSIONS We describe specific malfunctioning of the default mode network during an executive task in PD. This finding is plausibly linked to dopamine depletion and may critically contribute to the understanding of executive deficits in PD.Arch Neurol. 2009;66(7):877-883--

This report describes the perioperative management of disseminated intravascular coagulation occurring abruptly during a planned cystectomy for non-metastatic bladder papillary carcinoma. Peroperatively, profuse bleeding and an acute decrease in blood pressure were effectively treated by blood transfusions and fresh frozen plasma. Haematological tests indicated the presence of disseminated intravascular coagulation. On the following three days, acute renal failure, peripheral disseminated intravascular coagulation-related thrombocytopenia and haemolytic anemia with schistocytes were suggestive of thrombotic microangiopathy. Treatment by plasma exchange along with haemodialysis was commenced. An aetiological work-up remained negative. After 21 days of treatment, haemodialysis and plasma exchange were stopped. Urological outcome was favourable. The one-year follow-up did not show any residual renal insufficiency and laboratory parameters returned to normal. In the absence of evidence in favour of an infectious, drug-related or immunological aetiology, we postulated that this thrombotic microangiopathy was caused by disseminated intravascular coagulation and that the tumour manipulation during the surgical procedure was the triggering factor.

Background and Purpose: Bladder diverticulectomy is classically performed by open surgery (extravesical, intravesical, or combined) or, less frequently, by an endoscopic approach for small diverticula. We used a celioscopic approach to diverticulectomy in order to assess its feasibility and the operative and postoperative complications.Patients and Methods: Five patients aged 55 to 76 years (mean 64.2 years) were treated by celioscopy between October 1999 and October 2001. All the diverticula had occurred as a result of infravesical obstruction by benign prostatic hyperplasia, which was treated at the same time by endoscopic resection of the prostate. An ipsilateral ureteral catheter was inserted during endoscopy. After creation of an umbilical minilaparotomy with the patient in the dorsal decubitus position, a 10-mm optical trocar was inserted, then two 5-mm trocars into the right and left iliac fossae, and a 10-mm subpubic trocar. Diverticular dissection was performed with a peritoneal approach in order to free the diverticular neck. After resection, the neck was closed in two planes by interrupted absorbable sutures, and a tightness test was performed.Results: The average operating time was 160 minutes (range 120-230 minutes), and the average blood loss was 150 mL (range 80-200 mL). There was no conversion to open surgery. The probe was removed on day 5 (range 3-7 days). No complication occurred, and the mean hospital stay was 5 days (range 4-6 days) with resumption of satisfactory micturation.Conclusion: This technique is a promising alternative to classical surgery, as it is less aggressive and uses a smaller incision. Operative bleeding is minimal, and the technique is reproducible in experienced hands. However, the indications are limited with regard to the associated pathologies (size of the prostate in the present cases), the morphology, the site of the diverticulum, and the surgical history of the patient.

Fetal brain tumors are rare and teratoma is considered as the most common. Fetal MR Imaging is currently used to evaluate cases of ventricular dilatation. We report a case of cerebral immature teratoma detected by ultrasonography because of ventricular dilatation at 24 gestational weeks. MRI was the more accurate imaging method in depicting the tumor and its consequences on brain development as well as in taking a decision with regard to the management of pregnancy. Copyright © 2003 John Wiley & Sons, Ltd.

Five patients were successfully treated with a modified “on-top-plasty” technique, in which a finger stump is lengthened by transfer of an adjacent amputation stump with a reverse blood flow fingerstump. This technique can be performed in the acute phase or as a secondary procedure. A conventional on-top-plasty can be performed by transfer of a partially amputated index or ring finger to the “top” of the proximal phalanx of an amputated middle finger. Alternatively, the transferred part may be used in an intercalated fashion to reconstruct the middle phalanx, using a prosthesis to reconstruct the proximal interphalangeal joint. The results, complications and disadvantages of the technique are reported. We propose this procedure for the reconstruction of the middle ring finger when a free microneurovascular toe-to-hand transfer is contraindicated or refused by the patient.

AbstractThe separation of hydrogen isotopes is an essential element for tritium processing systems. A new process invented at the Savannah River Site, has been developed at Valduc facility: Thermal Cycling Absorption Process. This system uses palladium packed in a column to absorb a stream of hydrogen isotopes. By repeated heating and cooling cycles, the hydrogen isotopes successively desorb into a capacity and go back onto the column. The thermal cycling creates differences in the Pd separation factor for the hydrogen isotopes inducing the concentration of tritium at one end of the column and the concentration of the lighter isotopes at the other end. This paper presents experimental results obtained with a full-scale facility which has been installed in a glovebox so as to treat weakly tritiated gases. Experimental data collected on this device working with several isotopic mixtures are presented and compared to simulation results.

ABSTRACTCEA/Valduc has developed a Thermal Cycling Absorption Process (TCAP) experimental device dedicated to the study of the separation of hydrogen isotopes and particularly to the recovery of tritium from low concentrated mixtures (tritium molar fraction < 6%). Simultaneously an original and efficient dynamic simulation tool has been developed in collaboration with PROSIM Company. After a brief description of the TCAP process device developed and the establishment of the modelling approach adopted, a deeper understanding of the complex TCAP behavior is lighted on through some simulation results. Then, a sensitivity analysis of the TCAP operating parameters on its global performance and particularly on the tritium contamination in the head flow is presented. Finally, all these results are applied to propose an optimized operating sequence for the recovery of tritium from low concentrated hydrogen mixtures.