International consensus conference on PFAPA syndrome: Evaluation of a new set of diagnostic criteria

The PFAPA syndrome is characterized by periodic fever, associated with pharyngitis, cervical adenitis and/or aphtous stomatitis and belongs to the auto-inflammatory diseases. Diagnostic criteria are based on clinical features and the exclusion of other periodic fever syndromes. An analysis of a large cohort of patients has shown weaknesses for these criteria and there is a lack of international consensus. An International Conference was held in Morges in November 2008 to propose a new set of classification criteria based on a consensus among experts in the field. We aimed to verify the applicability of the new set of classification criteria. 80 patients diagnosed with PFAPA syndrome from 3 centers (Genoa, Lausanne and Geneva) for pediatric rheumatology were included in the study. A detailed description of the clinical and laboratory features was obtained. The new classification criteria and the actual diagnostic criteria were applied to the patients. Only 43/80 patients (53.8%) fulfilled all criteria of the new classification. 31 patients were excluded because they didn't meet one of the 7 diagnostic criteria, 8 because of 2 criteria, and one because of 3 criteria. When we applied the current criteria to the same patients, 11/80 patients (13%) needed to be excluded. 8/80 patients (10%) were excluded from both sets. Exclusion was related only to some of the criteria. Number of patients for each not fulfilled criterion (new set of criteria/actual criteria): age (1/6), symptoms between episodes (2/2), delayed growth (3/3), main symptoms (21/0), periodicity, length of fever, interval between episodes, and length of disease (19/0). The application of some of the new criteria was not easy, as they were both very restrictive and needed precise information from the patients. Our work has shown that the new set of classification criteria can be applied to patients suspected for PFAPA syndrome, but it seems to be more restrictive than the actual diagnostic criteria. A further work of validation needs to be done for this new set of classification criteria in order to determine if these criteria allow a good discrimination between PFAPA patients and other causes of recurrent fever syndromes.

On the automatic application of inequality indexes in the analysis of the international distribution of environmental indicators

In recent years traditional inequality measures have been used to quite a considerable extent to examine the international distribution of environmental indicators. One of its main characteristics is that each one assigns different weights to the changes that occur in the different sections of the variable distribution and, consequently, the results they yield can potentially be very different. Hence, we suggest the appropriateness of using a range of well-recommended measures to achieve more robust results. We also provide an empirical test for the comparative behaviour of several suitable inequality measures and environmental indicators. Our findings support the hypothesis that in some cases there are differences among measures in both the sign of the evolution and its size. JEL codes: D39; Q43; Q56. Keywords: international environment factor distribution; Kaya factors; Inequality measurement

À propos de quelques fonctions des expertises judiciaires au pénal

En France, l'expert psychiatre ou psychologue est présenté dans le Code pénal comme un « technicien », disposant de compétences singulières, qui réalise un travail que le juge ne pourrait réaliser lui-même. À partir d'une recherche théorique et empirique, cet article s'intéresse aux relations juge-expert et interroge les fonctions recouvertes par les expertises psychiatriques et psychologiques en phase présentencielle au pénal, au-delà de la mission énoncée dans les textes et dans l'ordonnance de commission d'expertise. Nous sommes partis de l'hypothèse que les fonctions des expertises psychiatriques et psychologiques dépassent le cadre d'un écrit technique et d'une déposition technique en Cour d'assises tel qu'énoncé dans les textes et missions, pour recouvrir des fonctions variées et non explicitées dans le processus judicaire. Concerning certain functions of legal expertise in criminal justice. In France, the expert psychiatrist or psychologist is presented in the Penal Code as a "technician" with singular skills, who performs the work that the judge cannot do himself. Based on theoretical and empirical research, this article focuses on relationship between judge and expert. It also questions the psychiatric and psychological evidence based on psychiatric and psychological evaluations in the penal preparation stage and in the writing and technical evidence presented by the evaluation commission. This is based on the hypothesis that psychiatric and psychological evaluations go beyond the established framework of a technical report or a technical statement made in the criminal court. These texts and assignments refer to various functions, which are not made explicit during the judicial process. A propósito de algunas funciones de los peritajes judiciales en un pleito. En Francia, el experto psiquiatra o psicólogo está presentado en el código penal como un "técnico", que dispone de competencias profesionales particulares, lleva a cabo un trabajo que el juez no sabría realizar por sí mismo. Partiendo de una investigación teórica y empírica, este artículo está centrado en las relaciones juez-experto e interroga sobre las funciones cubiertas por los peritajes psiquiátricos y psicológicos en la fase pre-sentencia en lo penal, más allá de la misión enunciada en los textos y en la ordenanza de la comisión de peritaje. Nuestro punto de partida ha sido la hipótesis que las funciones de los peritajes psiquiátricos y psicológicos van más allá del marco de un escrito técnico y de una deposición técnica en el Tribunal de lo penal tal como queda enunciado en los textos y misiones, para abarcar funciones variadas sin explicitar en el proceso judicial.

Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy.

BACKGROUND AND PURPOSE: Carotid artery stenting (CAS) is associated with a higher risk of both hemodynamic depression and new ischemic brain lesions on diffusion-weighted imaging than carotid endarterectomy (CEA). We assessed whether the occurrence of hemodynamic depression is associated with these lesions in patients with symptomatic carotid stenosis treated by CAS or CEA in the randomized International Carotid Stenting Study (ICSS)-MRI substudy. METHODS: The number and total volume of new ischemic lesions on diffusion-weighted imaging 1 to 3 days after CAS or CEA was measured in the ICSS-MRI substudy. Hemodynamic depression was defined as periprocedural bradycardia, asystole, or hypotension requiring treatment. The number of new ischemic lesions was the primary outcome measure. We calculated risk ratios and 95% confidence intervals per treatment with Poisson regression comparing the number of lesions in patients with or without hemodynamic depression. RESULTS: A total of 229 patients were included (122 allocated CAS; 107 CEA). After CAS, patients with hemodynamic depression had a mean of 13 new diffusion-weighted imaging lesions, compared with a mean of 4 in those without hemodynamic depression (risk ratio, 3.36; 95% confidence interval, 1.73-6.50). The number of lesions after CEA was too small for reliable analysis. Lesion volumes did not differ between patients with or without hemodynamic depression. CONCLUSIONS: In patients treated by CAS, periprocedural hemodynamic depression is associated with an excess of new ischemic lesions on diffusion-weighted imaging. The findings support the hypothesis that hypoperfusion increases the susceptibility of the brain to embolism. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25337470.