Presse Med
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THORACIC PAINFUL SYNDROME: Penetrating atherosclerotic aortic ulcers represent a condition in which an atherosclerotic plaque ulcerates and disrupts the internal elastic lamina, allowing intramural hematoma formation into the aortic media. Recently individualized as an entity from all vascular thoracic painful syndromes, they affect preponderantly the elderly patients with a medical hypertensive and atherosclerotic history and with multiple cardiovascular risk factors. The descending thoracic aorta is most frequently involved. ⋯ In the absence of complication, progressive aneurysmal dilatation at the level of the ulcer is a rule. Pseudoaneurysms formation, embolization, and acute transmural aortic rupture can however occur and may justify, in selected cases, a preventive or curative surgical treatment. STENT-GRAFTING: Endovascular stent-grafting techniques may appear as a safe and effective less invasive choice in high-risk patients with suitable anatomical conditions.
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PRELIMINARY EXPLORATIONS: The advent of magnetic resonance imaging and its capacity to detect fine structural injury and SPECT and PET functional imaging as well as the generalization of EEG-video and the simplification of intracranial electrode implantation techniques has given a whole new life to surgery in epilepsy. Preoperative explorations are shorter and less invasive, allowing surgery without implantation of intracranial electrodes in more than 70% of the cases.
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The prevalence of childhood obesity increases dramatically in all industrialized countries. As in adults, it is defined by an increase in fat mass. ⋯ However, rapid changes in the way of life leads to consider that, in a near future, as much as 25% of the children in Europe could be concerned as well. A new epidemiological tool designed by the International Obesity Task Force takes as reference criteria the body mass index and will allow comparisons between countries as well as it will take into account the physiological variations of fat mass during growth.
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Juvenile spondylarthropathy accounts for about 20% of all cases of chronic juvenile idiopathic arthritis. The spondyloarthropathy concept includes chronic inflammatory rheumatic conditions involving the spine, peripheral joints, and tendon insertions. There is an HLA B27 linkage and the condition predominates in boys, mean age 11 years. ⋯ Nonsteroidal antiinflammatory drugs and local care are used. Sulfasalazine can be useful but its efficacy has not been proven. The functional prognosis is relatively good; spinal ankylosis is uncommon and hip involvement (destructive coxitis) occur in 30% of patients. About 80% of the patients have minor or no disability after a 10-year course.
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TUMOR NECROSIS FACTOR: TNF is a cytokine produced by several types of cells, but mainly by monocyte-macrophages, activated endothelial cells, fibroblasts, and joint cartilage chondrocytes. The circulating form of TNF alpha (homotrimere) is derived from its membrane form by cleavage induced by a metalloprotease called TACE. ⋯ ARGUMENTS FOR A PATHOGENIC ROLE: Transgenic mice carrying the human gene for TNF alpha develop polyarthritis suggesting this cytokine is directly implicated in the pathogenesis. In diverse cell types in rheumatoid joints, TNF alpha and its receptors can be identified by immunohistochemistry techniques as can TNF alpha mRNA by RT-PCR.