Aberrant right hepatic artery with a prepancreatic course visualized prior to pancreaticoduodenectomy.

Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation.

Trace element partitioning in HP-LT metamorphic assemblages during subduction-related metamorphism, Ile de Groix, France: a detailed LA-ICPMS study

Devolatilization reactions and subsequent transfer of fluid from subducted oceanic crust into the overlying mantle wedge are important processes, which are responsible for the specific geochemical characteristics of subduction-related metamorphic rocks, as well as those of arc magmatism. To better understand the geochemical fingerprint induced by fluid mobilization during dehydration and rehydration processes related to subduction zone metamorphism, the trace element and rare earth element (REE) distribution patterns in HP-LT metamorphic assemblages in eclogite-, blueschist- and greenschist-facies rocks of the Ile de Groix were obtained by laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS) analysis. This study focuses on 10 massive basic rocks representing former hydrothermally altered mid-ocean ridge basalts (MORB), four banded basic rocks of volcano-sedimentary origin and one micaschist. The main hosts for incompatible trace elements are epidote (REE, Th, U, Pb, Sr), garnet [Y, heavy REE (HREE)], phengite (Cs, Rb, Ba, B), titanite [Ti, Nb, Ta, REE; HREE > LREE (light REE)], rutile (Ti, Nb, Ta) and apatite (REE, Sr). The trace element contents of omphacite, amphibole, albite and chlorite are low. The incompatible trace element contents of minerals are controlled by the stable metamorphic mineral assemblage and directly related to the appearance, disappearance and reappearance of minerals, especially epidote, garnet, titanite, rutile and phengite, during subduction zone metamorphism. Epidote is a key mineral in the trace element exchange process because of its large stability field, ranging from lower greenschist- to blueschist- and eclogite-facies conditions. Different generations of epidote are generally observed and related to the coexisting phases at different stages of the metamorphic cycle (e.g. lawsonite, garnet, titanite). Epidote thus controls most of the REE budget during the changing P-T conditions along the prograde and retrograde path. Phengite also plays an important role in determining the large ion lithophile element (LILE) budget, as it is stable to high P-T conditions. The breakdown of phengite causes the release of LILE during retrogression. A comparison of trace element abundances in whole-rocks and minerals shows that the HP-LT metamorphic rocks largely retain the geochemical characteristics of their basic, volcano-sedimentary and pelitic protoliths, including a hydrothermal alteration overprint before the subduction process. A large part of the incompatible trace elements remained trapped in the rocks and was recycled within the various metamorphic assemblages stable under changing metamorphic conditions during the subduction process, indicating that devolatilization reactions in massive basic rocks do not necessarily imply significant simultaneous trace element and REE release.

Sign language in Landau-Kleffner syndrome.

This article reviews the history of sign language (SL) and the rationale for its use in children with profound auditory agnosia due to Landau-Kleffner syndrome (LKS), illustrated by studies of children and adults followed for many years and rare cases from the literature. The reasons that SL was successful and brought some children out of isolation while it could not be implemented in others are discussed. The nowadays earlier recognition and treatment of LKS and better awareness of the crucial need to maintain communication have certainly improved the outcome of affected children. Alternatives to oral language, even for less severe cases, are increasingly accepted. SL can be learned at different ages with a clear benefit, but the ambivalence of the patients and their families with the world and culture of the deaf may sometimes explain its refusal or limited acceptance. There are no data to support the fear that SL learning may delay or prevent oral language recovery in children with LKS. On the contrary, SL may even facilitate this recovery by stimulating functionally connected core language networks and by helping speech therapy and auditory training.

2013 Update in addiction medicine for the generalist.

Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.

Towards the identification of a genetic basis for Landau-Kleffner syndrome.

OBJECTIVE: To establish the genetic basis of Landau-Kleffner syndrome (LKS) in a cohort of two discordant monozygotic (MZ) twin pairs and 11 isolated cases. METHODS: We used a multifaceted approach to identify genetic risk factors for LKS. Array comparative genomic hybridization (CGH) was performed using the Agilent 180K array. Whole genome methylation profiling was undertaken in the two discordant twin pairs, three isolated LKS cases, and 12 control samples using the Illumina 27K array. Exome sequencing was undertaken in 13 patients with LKS including two sets of discordant MZ twins. Data were analyzed with respect to novel and rare variants, overlapping genes, variants in reported epilepsy genes, and pathway enrichment. RESULTS: A variant (cG1553A) was found in a single patient in the GRIN2A gene, causing an arginine to histidine change at site 518, a predicted glutamate binding site. Following copy number variation (CNV), methylation, and exome sequencing analysis, no single candidate gene was identified to cause LKS in the remaining cohort. However, a number of interesting additional candidate variants were identified including variants in RELN, BSN, EPHB2, and NID2. SIGNIFICANCE: A single mutation was identified in the GRIN2A gene. This study has identified a number of additional candidate genes including RELN, BSN, EPHB2, and NID2. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

The Mont Collon mafic complex (Austroalpine Dent Blanche nappe) : permian evolution of the Western European mantle

Résumé: Le complexe du Mont Collon (nappe de la Dent Blanche, Austroalpin) est l'un des exemples les mieux préservés du magmatisme mafique permien des Alpes occidentales. Il est composé d'affleurements discontinus et d'une stratification magmatique en son centre (Dents de Bertol) et est composé à 95% de roches mafiques cumulatives (gabbros à olivine et/ou cpx, anorthositiques, troctolites, wehrlites et wehrlites à plagioclase) et localement de quelques gabbros pegmatitiques. Ces faciès sont recoupés par de nombreux filons acides (aphtes, pegmatites quartziques, microgranodiorites et filons anorthositiques) et mafiques tardifs (dikes mélanocrates riches en Fe et Ti). Les calculs thermométriques (équilibre olivine-augite) montrent des températures de 1070-1120 ± 6°C, tandis que le thermomètre amphibole-plagioclase indique une température de 740 ± 40°C à 0.5 GPa pour les amphiboles magmatiques tardives. La geobarométrie sur pyroxène donne des pressions moyennes de 0.3-0.6 GPa, indiquant un emplacement dans la croûte moyenne. De plus, les températures obtenues sur des amphiboles coronitiques indiquent des températures de l'ordre de 700 ± 40°C confirmant que les réactions coronitiques apparaissent dans des conditions subsolidus. Les âges concordants U/Pb sur zircons de 284.2 ± 0.6 et 282.9 ± 0.6 Ma obtenus sur un gabbro pegmatitique et une pegmatitique quartzique, sont interprétés comme des âges de cristallisation. Les datations 40Ar/39Ar sur amphiboles des filons mélanocrates donnent un âge plateau de 260.2 ± 0.7 Ma, qui est probablement très proche de l'âge de cristallisation. Ainsi, cet age 40Ar/39Ar indique un second évènement magmatique au sein du complexe. Les compositions des roches totales en éléments majeurs et traces montrent peu de variations, ainsi que le Mg# (75-80). Les éléments traces enregistrent le caractère cumulatif des roches (anomalie positive en Eu) et révèlent des anomalies négatives systématiques en Nb, Ta, Zr, Hf et Ti dans les faciès basiques. Le manque de corrélation entre éléments majeurs et traces est caractéristique d'un processus de cristallisation in situ impliquant une quantité variable de liquide interstitiel (L) entre les phases cumulus. Les distributions des éléments traces dans les minéraux sont homogènes, indiquant une rééquilibration .subsolidus entre cristaux et liquide interstitiel. Un modèle quantitatif basé sur les équations de cristallisation in situ de Langmuir reproduisent correctement les concentrations en terres rares légères des minéraux cumulatifs montrant la présence de 0 à 35% de liquide interstitiel L pour des degrés de différenciation F de 0 à 45%, par rapport au faciès les moins évolués du complexe. En outre, les valeurs de L sont bien corrélées avec les proportions modales d'amphibole interstitielle et les concentrations en éléments incompatibles des roches (Zr, Nb). Le liquide parental calculé des cumulats du Mont Collon est caractérisé par un enrichissement relatif en terres rares légères et Th, un appauvrissement en terres rares lourdes typique d'une affinité transitionnelle (T-MORB) et une forte anomalie négative en Nb-Ta. Les roches cumulatives montrent des compositions isotopiques en Nd-Sr proches de la terre globale silicatée (BSE), soit 0.6<εNdi<+3.2, 0.7045<87Sr/86Sri<0.7056. Les rapports initiaux en Pb indiquent une source dans le manteau enrichi subcontinental lithosphérique, préalablement contaminé par des sédiments océaniques. Les dikes mélanocrates Fe-Ti sont représentatifs de liquides et ont des spectres de terres rares enrichis, une anomalie positive en Nb-Ta et des εNdi de +7, des 87Sr/86Sri de 0.703 et des rapports initiaux en Pb, similaires à ceux des basaltes d'île océanique, indiquant une source asthénosphérique modérément appauvrie. Ainsi, la fusion partielle du manteau lithosphérique subcontinental est induite par l'amincissement post-orogénique et la remontée de l'asthénosphère. Les filons mélanocrates proviennent, après délamination du manteau lithosphérique, de la fusion de l'asthénosphère. Abstract The early Permian Mont Collon mafic complex (Dent Blanche nappe, Austroalpine nappe system) is one of the best preserved examples of the Permian mafic magmatism in the Western Alps. It is composed of discontinuous exposures and a well-preserved magmatic layering (the Dents de Bertol cliff) crops out in the center part of the complex. It mainly consists of cumulative mafic rocks, which represent 95 vol-% of the mafic complex (ol- and cpx-bearing gabbros and rare anorthositic layers, troctolites, wehrlites and plagioclase-wehrlites) and locally pegmatitic gabbros. All these facies are crosscut by widespread acidic (aplites, quartz-rich pegmatites, microgranodiorites) and late mafic Fe-Ti melanocratic dikes. Olivine-augite thermometric calculations yield a range of 1070-1120 ± 6°C, while amphibole-plagioclase thermometer yields a temperature of 740 ± 40°C at 0.5 GPa. Pyroxene geobarometry points to a pressure of 0.3-0.6 GPa, indicating a middle crustal level of emplacement. Moreover, temperature calculations on the Mont Conon coronitic amphiboles indicate temperatures of 700 ± 40°C, close to those calculated for magmatic amphiboles. These temperatures confirm that coronitic reactions occurred at subsolidus conditions. ID-TIMS U/Pb zircon ages of 284.2 ± 0.6 and 282.9 ± 0.6 Ma obtained on a pegmatitic gabbro and a quartz-pegmatitic dike, respectively, were interpreted as the crystallization ages of these rocks. 40Ar/39Ar dating on amphiboles from Fe-Ti melanocratic dikes yields a plateau age of 260.2 ± 0.7 Ma, which is probably very close to the crystallization age. Consequently, this 40Ar/P39Ar age indicates a second magmatic event. Whole-rock major- and trace-element compositions show little variation across the whole intrusion and Mg-number stays within a narrow range (75-80). Trace-element concentrations record the cumulative nature of the rocks (e.g. positive Eu anomaly) and reveal systematic Nb, Ta, Zr, Hf and Ti negative anomalies for all basic facies. The lack of correlation between major and trace elements is characteristic of an in situ crystallization process involving variable amounts of interstitial liquid (L) trapped between the cumulus mineral phases. LA-ICPMS measurements show that trace-element distributions in minerals are homogeneous, pointing to subsolidus re-equilibration between crystals and interstitial melts. A quantitative modeling based on Langmuir's in situ crystallization equation successfully reproduced the Rare Earth Element (REE) concentrations in cumulitic minerals. The calculated amounts of interstitial liquid L vary between 0 and 35% for degrees of differentiation F of 0 to 45%, relative to the least evolved facies of the intrusion. Furthermore, L values are well correlated with the modal proportions of interstitial amphibole and whole-rock incompatible trace-element concentrations (e.g. Zr, Nb) of the tested samples. The calculated parental melt of the Mont Collon cumulates is characterized by a relative enrichment in Light REE and Th, a depletion in Heavy REE, typical of a transitional affinity (T-MORB), and strong negative Nb-Ta anomaly. Cumulative rocks display Nd-Sr isotopic compositions close to the BSE (-0.6 < εNdi < +3.2, 0.7045 < 87Sr/86Sri < 0.7056). Initial Pb ratios point to an origin from the melting of an enriched subcontinental lithospheric mantle source, previously contaminated at the source by oceanic sediments. The contrasted alkaline Fe-Ti melanocratic dikes are representative of liquids. They display enriched fractionated REE patterns, a positive Nb-Ta anomaly and εNdi of +7, 87Sr/86Sri of 0.703 and initial Pb ratios, all reminiscent of Ocean Island Basalt-type rocks, pointing to a moderately

Contribution to the Development of the LHCb Vertex Locator Readout Electronics

L'expérience LHCb sera installée sur le futur accélérateur LHC du CERN. LHCb est un spectromètre à un bras consacré aux mesures de précision de la violation CP et à l'étude des désintégrations rares des particules qui contiennent un quark b. Actuellement LHCb se trouve dans la phase finale de recherche et développement et de conception. La construction a déjà commencé pour l'aimant et les calorimètres. Dans le Modèle Standard, la violation CP est causée par une phase complexe dans la matrice 3x3 CKM (Cabibbo-Kobayashi-Maskawa) de mélange des quarks. L'expérience LHCb compte utiliser les mesons B pour tester l'unitarité de cette matrice, en mesurant de diverses manières indépendantes tous les angles et côtés du "triangle d'unitarité". Cela permettra de surdéterminer le modèle et, peut-être, de mettre en évidence des incohérences qui seraient le signal de l'existence d'une physique au-delà du Modèle Standard. La reconstruction du vertex de désintégration des particules est une condition fondamentale pour l'expérience LHCb. La présence d'un vertex secondaire déplacé est une signature de la désintégration de particules avec un quark b. Cette signature est utilisée dans le trigger topologique du LHCb. Le Vertex Locator (VeLo) doit fournir des mesures précises de coordonnées de passage des traces près de la région d'interaction. Ces points sont ensuite utilisés pour reconstruire les trajectoires des particules et l'identification des vertices secondaires et la mesure des temps de vie des hadrons avec quark b. L'électronique du VeLo est une partie essentielle du système d'acquisition de données et doit se conformer aux spécifications de l'électronique de LHCb. La conception des circuits doit maximiser le rapport signal/bruit pour obtenir la meilleure performance de reconstruction des traces dans le détecteur. L'électronique, conçue en parallèle avec le développement du détecteur de silicium, a parcouru plusieurs phases de "prototyping" décrites dans cette thèse.<br/><br/>The LHCb experiment is being built at the future LHC accelerator at CERN. It is a forward single-arm spectrometer dedicated to precision measurements of CP violation and rare decays in the b quark sector. Presently it is finishing its R&D and final design stage. The construction already started for the magnet and calorimeters. In the Standard Model, CP violation arises via the complex phase of the 3 x 3 CKM (Cabibbo-Kobayashi-Maskawa) quark mixing matrix. The LHCb experiment will test the unitarity of this matrix by measuring in several theoretically unrelated ways all angles and sides of the so-called "unitary triangle". This will allow to over-constrain the model and - hopefully - to exhibit inconsistencies which will be a signal of physics beyond the Standard Model. The Vertex reconstruction is a fundamental requirement for the LHCb experiment. Displaced secondary vertices are a distinctive feature of b-hadron decays. This signature is used in the LHCb topology trigger. The Vertex Locator (VeLo) has to provide precise measurements of track coordinates close to the interaction region. These are used to reconstruct production and decay vertices of beauty-hadrons and to provide accurate measurements of their decay lifetimes. The Vertex Locator electronics is an essential part of the data acquisition system and must conform to the overall LHCb electronics specification. The design of the electronics must maximise the signal to noise ratio in order to achieve the best tracking reconstruction performance in the detector. The electronics is being designed in parallel with the silicon detector development and went trough several prototyping phases, which are described in this thesis.