Qu’elles soient symptomatiques ou non, les infections néonatales à entérovirus (EV) peuvent être à l’origine d’infections nosocomiales dans les services de néonatologie et de réanimation pédiatrique. ...Nous décrivons 2 observations cliniques d’infections néonatales neuro-méningées à echovirus 11 et apportons la preuve moléculaire de la transmission nosocomiale de la souche dans un service de néonatalogie, grâce au génotypage et à l’analyse phylogénétique. Ces observations illustrent l’importance d’inclure les recherches moléculaires prospectives de ces infections dans tout bilan infectieux pour ne pas les sous-estimer chez les nouveau-nés, l’intérêt d’identifier les EV au-delà du genre et l’aide à la preuve de la transmission nosocomiale par l’analyse phylogénétique.
Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.
Prospective analysis of a consecutive series of adult patients with adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis.
To clinically and radiographically study two ...populations of adult patients with either adolescent idiopathic scoliosis of the adult or de novo degenerative scoliosis in a quantitative manner to identify reliable radiographic parameters that correlate with clinical symptoms.
Although there are many causes of spinal deformity in the adult, there are two main categories of adult scoliosis: adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis. Unlike pediatric scoliosis, in adults there are no established radiographic parameters or classification systems that reliably provide a clinical correlation or offer a useful language for communication among specialists. This study gathered complete clinical and radiographic information on 95 patients with adult scoliosis and established several radiographic parameters that correlated with clinical symptoms.
Each of the 95 patients completed a clinical questionnaire that included a self-reported visual analog scale and underwent full-length standing anteroposterior and lateral radiography. Radiographic analysis was performed by use of digital analysis and included measurement of the Cobb angle, the number of vertebrae in each curve, plumbline offset from T1 to the midsacral line, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurements included lumbar lordosis, thoracolumbar kyphosis, and the Sagittal Pelvic Tilt Index. Statistical analysis of both radiographic and clinical parameters of pain was performed to determine any significant correlations between the two.
This study showed that lateral vertebral olisthy, L3 and L4 endplate obliquity angles, lumbar lordosis, and thoracolumbar kyphosis were significantly correlated with pain.
This quantitative analysis identified several clinically relevant radiographic parameters in adult scoliosis patients. Additionally, excellent predictive formulas for self-reported pain levels were obtained.
The authors, in this retrospective study, examined a group of patients with flatback syndrome and a related kyphotic decompensation syndrome. Results of nonrealignment treatment as well as revision ...surgery with sagittal realignment were reviewed.
To determine effectiveness of physical therapy and limited surgical (instrumentation removal) as well as major realignment surgical treatment in the sagittally malaligned spine.
Flatback is a sagittal plane deformity associated with distraction instrumentation for scoliosis correction. Kyphotic decompensation syndrome involves malaligned fusions from the sacrum for disease other than scoliosis. Several studies describe surgical realignment for flatback involving instrumentation systems no longer commonly applied. Guidelines for a systematic approach to flatback and kyphotic decompensation syndromes are lacking.
Forty-eight patients with flatback and kyphotic decompensation syndromes were reviewed. Treatment groups were defined by treatment approach and level of previous fusion. Effectiveness of treatment was reviewed in terms of radiographic sagittal alignment and self-reported pain.
Twenty patients were treated without realignment revision surgery. Twenty-eight patients were treated with anterior and posterior osteotomies and realignment with instrumentation. For patients originally fused to the sacrum, realignment averaged 12 cm. Pain was reduced from 7 to 3 (10-point scale). In patients fused to L4 or L5, realignment averaged 7 cm. Pain was reduced from 6 to 2. Magnetic resonance imaging revealed viable caudal discs in four patients who were consequently spared extension of fusion to the sacrum.
Treatment without realignment surgery demonstrated long-term success in 27% of cases. The latter all had two intact discs below the previous fusion and sagittal malalignment less than 4 cm. Realignment surgery effectively reduced pain in patients failing a conservative approach.
Although enteroviruses generally cause asymptomatic or mild disease, neonates are at higher risk for severe illnesses, among which systemic disease characterized by multiorgan involvement is a ...potentially fatal condition. Enterovirus neonatal infections may be the source of nosocomial infections in neonatology or in pediatric intensive care units. We report central nervous system infections due to Echovirus 11 in two neonates and the molecular evidence of nosocomial transmission of this strain in a neonatal unit by enterovirus genotyping and phylogenetic analysis. This report illustrates the importance of including enterovirus genome detection in the sepsis screening concomitantly with bacteriological investigations performed at admission of a neonate. Rapid diagnosis and subsequent genotyping could have a beneficial impact on clinical practices at the individual level (reducing the length of antibiotic therapy) and public health policy at the collective level by reinforcing hygiene measures to prevent nosocomial infections, with nurseries and neonatal units being at greater risks.
le traitement de la bronchiolite oblitérante repose sur l’administration de méthylprednisolone en bolus (MPSIV) sur 3 jours. Les données dans la littérature restent limitées.
nous avons analysé les ...dossiers d’enfants ayant une atteinte bronchiolaire chronique sévère et traités par MPSIV entre 2000 et 2009. Les données démographiques, cliniques, biologiques et radiologiques ont été recueillies. Les résultats sont exprimés en médianes (extrêmes).
19 enfants (63 % garçons) ont été inclus : 57,8 % sont nés à terme, 42,1 % sont ex prématurés dont 75 % avec une dysplasie broncho-pulmonaire, 15,8 % ont une cardiopathie, 15,8 % ont un déficit immunitaire. Une hospitalisation antérieure est fréquente (73,6 %) et 52,6 % ont un agent étiologique identifié (9 virus, 1 mycoplasma pneumoniae). 5 ont eu une biopsie pulmonaire. L’âge des premiers symptômes est 1,5 mois (0-12) et le délai diagnostique de 6,25 mois (0,5-35). Les lésions pulmonaires quantifiées par TDM sont variables.
14 enfants ont une évolution favorable avec 1,5 cure (1-20), 2 défavorables (46 et 50 cures), 2 non évaluables (2 et 7 cures) et 1 décès.
Notre expérience montre une évolution favorable sous MPSIV dans 87,5 % des cas (14/16) avec une bonne tolérance du traitement.
In Belgium, public forests and wildlife are managed at the federated regional level. In the Walloon Region, which is located in the southern half of the country, forests cover 32% of the territory. ...About 50% is publicly owned and managed by the Nature and Forest Division (DNF). The DNFs organizational structure is based on the concept of territoriality and designed on a four-level decentralized hierarchy. In 1999, based on the conclusions of a general organizational diagnostic study dealing with computing topics, the DNF decided to develop a distributed information system. The challenge was to design a system that incorporated dynamics enabled by new technology now available, and the implications for specialization of tasks and functions at the organizational level. The objective of the paper is to describe the technical solution proposed for the sharing of spatial data and information by optimizing their use in a distributed mode. Case studies are used for problem presentation. Distinguishing data and information flows inside and outside the DNF justifies the technical solution developed. It relies on the “Web Mapping Specification” defined by the Open GIS Consortium, which adds interoperability to the cartographic component of the system.
New approaches to forest planning are needed to support the transition of European forests to sustainable management. The aim of this study is to review forest planning systems already in place ...throughout Europe by exploring a set of case-study countries reflecting the main silvicultural schools of Western Europe, including Belgium, Finland, France, Italy, Portugal, and Slovenia.
A literature review and case-study data were used to assess the scale factors (vertical logic) as well as the relationships between forest planning and other environmental/land-use planning sectors (horizontal logic). The influence of EU policy on the development of forest planning is also discussed. As assessed using the vertical logic, the multi-scale and multi-topic planning approaches adopted in the countries studied here are highly heterogeneous. The horizontal logic shows that despite the importance of an inter-sectoral and harmonic relational framework between forest planning and the planning efforts of other sectors such as landscape and urban planning, the various plans are barely consistent with each other across the European countries studied here. Although interest is growing in the multi-functionality of forests, their sustainable management calls for the development of better integrated planning approaches across Europe.
Radiographic analysis of a pediatric population with spondylolisthesis was performed to examine sagittal plane pelvic rotation and degree of slip over time.
To determine whether the degree of ...standing sagittal offset of L5 with respect to the acetabulum correlated with slip progression and symptoms.
The natural history of isthmic spondylolisthesis remains unclear. Attempts to predict slip progression in the clinical setting, and thus the possible need for eventual surgical intervention, remain imprecise. Predicting slip progression based on sagittal alignment of the L5 vertebra with respect to the acetabulum has been proposed by some investigators.
Fifty-two children and adolescents were followed clinically and radiographically for an average of 5.6 years. Serial lateral standing radiographs that included the hips and lumbar spine were measured to compute a sagittal pelvic tilt index. The latter value is a ratio of relative distances from the center of S2 to the projection of L5 and the center of the femoral heads on the horizontal.
Of the 52 patients studied, 38 have remained asymptomatic without significant slip progression or change in sagittal pelvic tilt index ratio. Of the original group, 13 patients had significant symptoms and revealed a decrease in the sagittal pelvic tilt index over time. Eight of the 13 stabilized at the end of adolescence, whereas 5 had continued decrease in the sagittal pelvic tilt index ratio. These five required operative treatment for pain and progressive slip.
The sagittal pelvic tilt index gives the examiner an objective measure of the stability of the lumbosacral junction by quantifying the relationship between S2, the center of the hip, and L5. A decreasing sagittal pelvic tilt index ratio in this preliminary series correlated with slip progression and risk of conservative treatment failure, whereas those patients with a stable sagittal pelvic tilt index did not progress and remained clinically asymptomatic.
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