Latissimus dorsi muscle-flap over Gore-Tex patch for coverage of large thoracic defects in paediatric Ewing sarcoma.

Primary rib involvement accounts for 16% of paediatric Ewing sarcoma (ES). Neo-adjuvant chemotherapy and surgical tumor resection may leave large thoracic wall defects requiring complex reconstruction in a growing individual. We report our experience in three children aged 3, 10, and 12 years, in whom single-stage resection and reconstruction were performed using a Gore-Tex Dualmesh patch, covered by a latissimus dorsi rotation flap harvested in continuity with the thoracolumbar fascia. The youngest patient also had a vertical expandable prosthetic titanium rib (VEPTR) anchored to help prevent subsequent scoliosis throughout growth.

Arythmies supraventriculaires chez les patients adultes porteurs d'une cardiopathie congénitale

Mon projet de recherche s'est articulé autour des arythmies supraventriculaires chez les patients adultes porteurs d'une cardiopathie congénitale (Adults with Congenital Heart Disease ou ACHD). Grâce aux progrès de la chirurgie cardiaque et de la cardiologie, la survie à l'âge adulte des enfants nés avec une malformation cardiaque est excellente et la population des ACHD ne cesse de croître, tout en vieillissant. Les arythmies cardiaques sont une complication à long terme bien connue chez ces patients et une des principales causes de mortalité et de morbidité. Mon travail de recherche comporte une perspective épidémiologique avec une étude de population et une perspective anatomique, avec une étude d'imagerie cardiaque par échographie. 1. Étude épidémiologique : Arythmies auriculaires (AA) chez les patients porteurs d'une cardiopathie congénitale. Sous le titre anglais Atrial Arrhythmias in Adults with Congenital Heart Disease, cette étude a été publiée dans le journal américain Circulation. A travers les résultats de cette étude, j'ai démontré, pour la première fois dans une aussi grande population, que les AA étaient fréquentes chez les patients ACHD, que le risque à long-terme pour ces patients de développer des AA était élevé, et que le développement d'AA avait un impact négatif en termes de mortalité, de morbidité et d'intervention. 2. Étude anatomique : Les paramètres échographiques associés à la fibrillation auriculaire (FA) chez les patients adultes porteurs d'une cardiopathie congénitale. Sous le titre anglais Mirror image atrial dilatation in Adult Patients with Atrial Fibrillation and Congenital Heart Disease, cette étude a été publiée dans le journal américain International Journal of Cardiology, j'ai démontré dans cette étude que les patients ACHD avec une pathologie isolée du coeur gauche présentaient une dilatation progressive de l'oreillette gauche (OG) lorsqu'ils développaient de la FA. Chez les patients avec une pathologie isolée du coeur droit, j'ai décrit une image « miroir » : l'oreillette droite (OD) était toujours plus grande que l'OG βί présentait une dilatation progressive lors de FA. Ces résultats soutiennent l'hypothèse que la FA pourrait provenir de l'OD dilatée chez les patients ACHD avec une pathologie du coeur droit et ouvrent de nouvelles perspectives diagnostiques et thérapeutiques chez ces patients:

Computational fluid dynamics of the right ventricular outflow tract and of the pulmonary artery: a bench model of flow dynamics.

OBJECTIVES: The reconstruction of the right ventricular outflow tract (RVOT) with valved conduits remains a challenge. The reoperation rate at 5 years can be as high as 25% and depends on age, type of conduit, conduit diameter and principal heart malformation. The aim of this study is to provide a bench model with computer fluid dynamics to analyse the haemodynamics of the RVOT, pulmonary artery, its bifurcation, and left and right pulmonary arteries that in the future may serve as a tool for analysis and prediction of outcome following RVOT reconstruction. METHODS: Pressure, flow and diameter at the RVOT, pulmonary artery, bifurcation of the pulmonary artery, and left and right pulmonary arteries were measured in five normal pigs with a mean weight of 24.6 ± 0.89 kg. Data obtained were used for a 3D computer fluid-dynamics simulation of flow conditions, focusing on the pressure, flow and shear stress profile of the pulmonary trunk to the level of the left and right pulmonary arteries. RESULTS: Three inlet steady flow profiles were obtained at 0.2, 0.29 and 0.36 m/s that correspond to the flow rates of 1.5, 2.0 and 2.5 l/min flow at the RVOT. The flow velocity profile was constant at the RVOT down to the bifurcation and decreased at the left and right pulmonary arteries. In all three inlet velocity profiles, low sheer stress and low-velocity areas were detected along the left wall of the pulmonary artery, at the pulmonary artery bifurcation and at the ostia of both pulmonary arteries. CONCLUSIONS: This computed fluid real-time model provides us with a realistic picture of fluid dynamics in the pulmonary tract area. Deep shear stress areas correspond to a turbulent flow profile that is a predictive factor for the development of vessel wall arteriosclerosis. We believe that this bench model may be a useful tool for further evaluation of RVOT pathology following surgical reconstructions.

Guidelines for imaging retinoblastoma: imaging principles and MRI standardization.

Retinoblastoma is the most common intraocular tumor in children. The diagnosis is usually established by the ophthalmologist on the basis of fundoscopy and US. Together with US, high-resolution MRI has emerged as an important imaging modality for pretreatment assessment, i.e. for diagnostic confirmation, detection of local tumor extent, detection of associated developmental malformation of the brain and detection of associated intracranial primitive neuroectodermal tumor (trilateral retinoblastoma). Minimum requirements for pretreatment diagnostic evaluation of retinoblastoma or mimicking lesions are presented, based on consensus among members of the European Retinoblastoma Imaging Collaboration (ERIC). The most appropriate techniques for imaging in a child with leukocoria are reviewed. CT is no longer recommended. Implementation of a standardized MRI protocol for retinoblastoma in clinical practice may benefit children worldwide, especially those with hereditary retinoblastoma, since a decreased use of CT reduces the exposure to ionizing radiation.

Infantile spasms is associated with deletion of the MAGI2 gene on chromosome 7q11.23-q21.11.

Infantile spasms (IS) is the most severe and common form of epilepsy occurring in the first year of life. At least half of IS cases are idiopathic in origin, with others presumed to arise because of brain insult or malformation. Here, we identify a locus for IS by high-resolution mapping of 7q11.23-q21.1 interstitial deletions in patients. The breakpoints delineate a 500 kb interval within the MAGI2 gene (1.4 Mb in size) that is hemizygously disrupted in 15 of 16 participants with IS or childhood epilepsy, but remains intact in 11 of 12 participants with no seizure history. MAGI2 encodes the synaptic scaffolding protein membrane-associated guanylate kinase inverted-2 that interacts with Stargazin, a protein also associated with epilepsy in the stargazer mouse.

16q24.1 microdeletion in a premature newborn: Usefulness of array-based comparative genomic hybridization in persistent pulmonary hypertension of the newborn.

OBJECTIVE:: Report of a 16q24.1 deletion in a premature newborn, demonstrating the usefulness of array-based comparative genomic hybridization in persistent pulmonary hypertension of the newborn and multiple congenital malformations. DESIGN:: Descriptive case report. SETTING:: Genetic department and neonatal intensive care unit of a tertiary care children's hospital. INTERVENTIONS:: None. PATIENT:: We report the case of a preterm male infant, born at 26 wks of gestation. A cardiac malformation and bilateral hydronephrosis were diagnosed at 19 wks of gestation. Karyotype analysis was normal, and a 22q11.2 microdeletion was excluded by fluorescence in situ hybridization analysis. A cesarean section was performed due to fetal distress. The patient developed persistent pulmonary hypertension unresponsive to mechanical ventilation and nitric oxide treatment and expired at 16 hrs of life. MEASUREMENTS AND MAIN RESULTS:: An autopsy revealed partial atrioventricular canal malformation and showed bilateral dilation of the renal pelvocaliceal system with bilateral ureteral stenosis and annular pancreas. Array-based comparative genomic hybridization analysis (Agilent oligoNT 44K, Agilent Technologies, Santa Clara, CA) showed an interstitial microdeletion encompassing the forkhead box gene cluster in 16q24.1. Review of the pulmonary microscopic examination showed the characteristic features of alveolar capillary dysplasia with misalignment of pulmonary veins. Some features were less prominent due to the gestational age. CONCLUSIONS:: Our review of the literature shows that alveolar capillary dysplasia with misalignment of pulmonary veins is rare but probably underreported. Prematurity is not a usual presentation, and histologic features are difficult to interpret. In our case, array-based comparative genomic hybridization revealed a 16q24.1 deletion, leading to the final diagnosis of alveolar capillary dysplasia with misalignment of pulmonary veins. It emphasizes the usefulness of array-based comparative genomic hybridization analysis as a diagnostic tool with implications for both prognosis and management decisions in newborns with refractory persistent pulmonary hypertension and multiple congenital malformations.

Novel Homozygous Rax Gene Mutation in Patients With Bilateral Anophthalmia

Purpose: To report the clinical and genetic study of one family and one isolated case of Egyptian origin with clinical anophthalmia. To further determine the role of RAX in anophthalmia and associated cerebral malformations. Methods: Three patients with clinical anophthalmia and first-degree relatives from 2 consanguineous families of Egyptian origin underwent full ophthalmologic, general and neurological examination, and blood drawing. Cerebral MRI was performed in the index case of the family and in the isolated case. Genomic DNA was prepared from venous leukocytes and direct sequencing of all the exons and intron-exon junctions of the RAX gene was performed after PCR amplification Results: Clinical bilateral anophthalmia was observed in all three patients. General and neurological examination was free in the family; obesity and psychomotor developmental delay was noticed in the isolated case. Orbital MRI showed the presence of cystic remnants and reduced optic nerves. Thin optic chiasm was the only observed cerebral malformation on MRI in the index case while the isolated case harboured diffuse cerebral atrophy and absence of the pituitary gland in addition. The three patients carried a novel homozygous mutation (IVS2-3G>A) in the RAX gene, while their parents were heterozygous healthy carriers. Conclusions: To our knowledge, only two isolated cases of anophthalmia have been found to be caused by compound heterozygote RAX mutations, three null and one missense, affecting nuclear localization or DNA-binding homeodomain. We identified a novel homozygous RAX mutation in three patients with bilateral anophthalmia from Northern Egypt. The mutation potentially affects splicing of the last exon and, if not submitted to non-stop decay, could result in a protein that has an aberrant homeodomain and no paired-tail domain. Functional consequences of this change still need to be characterized. This is the first report of homozygous RAX mutation associated with autosomal recessive bilateral anophthalmia

Repair of tracheomalacia with inflammatory defect and mediastinitis.

We describe a novel repair of an anterior inflammatory tracheal defect with mediastinitis, which occurred after external tracheal suspension of localized intrathoracic tracheomalacia. The malacic tracheal segment of 4-cm length containing the inflammatory tracheal defect was noncircumferentially resected. A temporary endotracheal silicone stent was introduced, and the trachea was closed by a pedicled pectoralis muscle flap reinforced with an embedded rib segment. Retrieval of the stent 5 months postoperatively resulted in a re-epithelialized, persistently stable, noncollapsible tracheal segment that showed the same diameter and configuration as the nonreconstructed part of the trachea.

Hints for a fast precessing relativistic radio jet in LS I+61·303

Here we discuss two consecutive MERLIN observations of the X-ray binary LS I +61◦303. The first observation shows a double-sided jet extending up to about 200 AU on both sides of a central source. The jet shows a bent S-shaped struct ure similar to the one displayed by the well-known precessing jet of SS 433. The precession suggested in the first MERLIN image becomes evident in the second one, showing a one-sided bent jet significantly rotated with respect to the jet of the day before. We conclude that the derived precession of the relativistic (β=0.6) jet explains puzzling previous VLBI results. Moreover , the fact that the precession is fast could be the explanation of the never understood short term (days) variability of the associated gamma-ray source 2CG 135 + 01 / 3EG J0241 + 6103.

VLA multifrequency observations of RSCVn binaries

We present multiepoch Very Large Array (VLA) observations at 1.4 GHz, 4.9 GHz, 8.5 GHz and 14.9 GHz for a sample of eight RS CVn binary systems. Circular polarization measurements of these systems are also reported. Most of the fluxes observed are consistent with incoherent emission from mildly relativistic electrons. Several systems show an increase of the degree of circular polarization with increasing frequency in the optically thin regime, in conflict with predictions by gyrosynchrotron models. We observed a reversal in the sense of circular polarization with increasing frequency in three non-eclipsing systems: EI Eri, DM Uma and HD 8358. We find clear evidence for coherent plasma emission at 1.4 GHz in the quiescent spectrum of HD 8358 during the helicity reversal. The degrees of polarization of the other two systems could also be accounted for by a coherent emission process. The observations of ER Vul revealed two U-shaped flux spectra at the highest frequencies. The U-shape of the spectra may be accounted for by an optically thin gyrosynchrotron source for the low frequency part whereas the high frequency part is dominated by a thermal emission component.

A search for microquasar candidates at low galactic latitudes

Recent studies of relativistic jet sources in the Galaxy, also known as microquasars, have been very useful in trying to understand the accretion/ejection processes that take place near compact objects. However, the number of sources involved in such studies is still small. In an attempt to increase the number of known microquasars we have carried out a search for new Radio Emitting X-ray Binaries (REXBs). These sources are the ones to be observed later with VLBI techniques to unveil their possible microquasar nature. To this end, we have performed a cross-identification between the X-ray ROSAT all sky survey Bright Source Catalog (RBSC) and the radio NRAO VLA Sky Survey (NVSS) catalogs under very restrictive selection criteria for sources with |b|<5 degrees. We have also conducted a deep observational radio and optical study for six of the selected candidates. At the end of this process two of the candidates appear to be promising, and deserve additional observations aimed to confirm their proposed microquasar nature.

One-sided jet at milliarcsecond scales in LSI+61·303

We present Very Long Baseline Interferometry (VLBI) observations of the high mass X-ray binary LSI+61303, carried out with the European VLBI Network (EVN). Over the 11 hour observing run, performed 10 days after a radio outburst, the radio source showed a constant flux density, which allowed sensitive imaging of the emission distribution. The structure in the map shows a clear extension to the southeast. Comparing our data with previous VLBI observations we interpret the extension as a collimated radio jet as found in several other X-ray binaries. Assuming that the structure is the result of an expansion that started at the onset of the outburst, we derive an apparent expansion velocity of 0.003 c, which, in the context of Doppler boosting, corresponds to an intrinsic velocity of at least 0.4 c for an ejection close to the line of sight. From the apparent velocity in all available epochs we are able to establish variations in the ejection angle which imply a precessing accretion disk. Finally we point out that LSI+61303, like SS433 and Cygnus X-1, shows evidence for an emission region almost orthogonal to the relativistic jet.

Search for very high energy gamma-ray emission from pulsar-pulsar wind nebula systems with the MAGIC telescope

The MAGIC collaboration has searched for high-energy gamma-ray emission of some of the most promising pulsar candidates above an energy threshold of 50 GeV, an energy not reachable up to now by other ground-based instruments. Neither pulsed nor steady gamma-ray emission has been observed at energies of 100 GeV from the classical radio pulsars PSR J0205+6449 and PSR J2229+6114 (and their nebulae 3C58 and Boomerang, respectively) and the millisecond pulsar PSR J0218+4232. Here, we present the flux upper limits for these sources and discuss their implications in the context of current model predictions.

Désir de grossesse après vasectomie: vasovasostomie ou procréation médicalement assistée [New child wish after vasectomy: vasovasostomy or assisted reproductive medicine?].

New child wish after vasectomy: vasovasostomy or assisted reproductive medicine? In the case of a new child wish after vasectomy, there are two options: vaso-vasostomy (VV) or biopsy of the testicle associated with intra-cytoplasmatic sperm injection (ICSI). Both methods are not reimbursed. The VV offers a cumulative pregnancy rate of 28-40%, depending on pre-, intra- and postoperative factors. The age of the female partner and the time after vasectomy are the most important factors. Pregnancy rates after ICSI are 29-41% per transfer. Cumulative pregnancy rates vary between 60-80%. Malformation rates after ICSI in this special collective are not investigated yet, the "general" ICSI-collective differs completely compared to the a priori fertile couples after vasectomy. Couples have to inform themselves about the experience of the doctors and their rate of success in order to minimize the risk of failure.

On the binary nature of the γ-ray sources AGL J2241+4454 (= MWC 656) and HESS J0632+057 (= MWC 148)

We present optical spectroscopy of MWC 656 and MWC 148, the proposed optical counterparts of the gamma-ray sources AGL J2241+4454 and HESS J0632+0 57, respectively. The main parameters of the Halpha emission line (EW, FWHM and centroid velocity) in these stars are modulated on the proposed orbital periods of 60.37 and 321 days, respectively. These modulations are likely produced by the resonant interaction of the Be discs with compact stars in eccentric orbits. We also present radial velocity curves of the optical stars folded on the above periods and obtain the first orbital elements of the two gamma-ray sources thus confirming their binary nature. Our orbital solution support eccentricities e~0.4 and 0.83+-0.08 for MWC 656 and MWC 148, respectively. Further, our orbital elements imply that the X-ray outbursts in HESS J0632+057/MWC 148 are delayed ~0.3 orbital phases after periastron passage, similarly to the case of LS I +61 303. In addition, the optical photometric light curve maxima in AGL J2241+4454/MWC 656 occur ~0.25 phases passed periastron, similar to what is seen in LS I +61 303. We also find that the orbital eccentricity is correlated with orbital period for the known gamma-ray binaries. This is explained by the fact that small stellar separations are required for the efficient triggering of VHE radiation. Another correlation between the EW of Halpha and orbital period is also observed, similarly to the case of Be/X-ray binaries. These correlations are useful to provide estimates of the key orbital parameters Porb and e from the Halpha line in future Be gamma-ray binary candidates.