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Objective: To compare dentoskeletal changes produced by the maxillary splint headgear and cervical headgear appliance during the early phase of Class II treatment, specially the initial overjet and upper incisors position., Subjects and Methods: In this retrospective study, 28 Class II patients treated with the maxillary splint headgear (maxillary splint headgear or MSG, mean age 10.1 ± 1.9 years) and 28 Class II patients treated with cervical headgear (cervical headgear group or CHG, mean age 9.5 ± 1.9 years) were evaluated before and after treatment. Statistical comparisons between the two groups for cephalometric measurements at T1 and for T2-T1 changes were performed by means of independent sample t tests., Results: The MSG showed a significantly greater reduction of the overjet in comparison to the CHG (-2.4 mm and -0.7 mm, respectively) and a significantly greater maxillary incisor uprighting (-1.8 mm and 0.4 mm, respectively). In the MSG, overjet correction was due mainly to mandibular advancement (3.5 mm), while the correction of molar relationship (3.9 mm) was 64% skeletal and 36% dentoalveolar. In the CHG, the overjet correction was also more skeletal, due to mandibular growth (1.8 mm), while correction of molar relationship (3.5 mm) was 63% dentoalveolar and 37% skeletal., Conclusions: Both groups showed favorable skeletal mandibular changes, which was more significant in the MSG. Regarding tooth movement, the maxillary splint headgear was more effective in uprighting upper incisors and reducing the overjet than cervical headgear appliance.

Objectives: To provide clinical practice guidelines about fertility preservation (FP) for women with benign gynecologic disease (BGD) developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease., Methods: A steering committee composed of 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices related to FP for BGD. Then 114 key stakeholders including various healthcare professionals (n=108) and patient representatives (n=6) were asked to participate in a modified Delphi process via two online survey rounds from February to September 2020 and a final meeting. Due to the COVID-19 pandemic, this final meeting to reach consensus was held as a videoconference in November 2020., Results: Survey response of stakeholders was 75 % (86/114) for round 1 and 87 % (75/86) for round 2. Consensus was reached for the recommendations for 28 items, that have been distributed into five general categories: (i) Information to provide to women of reproductive age with a BGD, (ii) Technical aspects of FP for BGD, (iii) Indications for FP in endometriosis, (iv) Indications for FP for non-endometriosis BGD, (v) Indications for FP after a fortuitous diagnosis of an idiopathic diminished ovarian reserve., Conclusion: These guidelines provide some practice advice to help health professionals better inform women about the possibilities of cryopreserving their oocytes prior to the management of a BGD that may affect their ovarian reserve and fertility., Study Funding/competing Interest(s): The CNGOF (Collège National des Gynécologues Obstétriciens Français) funded the implementation of the Delphi process., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objectives: To review the definitions, diagnostic methods, risk factors, symptoms, and treatments for caesarean scar niche., Methods: Review of the literature, critical reflection, and pragmatic advice., Results: There is no consensus on the definition of caesarean scar niche. Some suggest an indentation≥2mm of the myometrium of the caesarean scar, but this is present in more than half of women with caesarean history and takes no account of woman's symptoms. The most popular diagnostic method is ultrasound±hysterosonography. Risks factors for niche are multiple Caesareans, Cesarean during labor with too low incision, and retroverted uterus. Symptoms include abnormal gynaecologic bleeding and pelvic pain, and their presence establish the "Caesarean scar syndrome". The risks of pregnancy with niche is poorly studied, but pregnancy is not contraindicated, even if the niche is untreated. The treatment of caesarean scar niche is mainly surgery and conservative. The former should be reserved for symptomatic patients, and those with secondary infertility and fertility treatment failure. Patients with residual myometrium thickness≥2.5mm may benefit from first-line hysteroscopic treatment, whereas a laparoscopic or vaginal approach could be offered in other cases., Conclusions: A pragmatic definition of caesarean scar niche as a disease including symptoms is the necessary prerequisite for the management of women. The treatment is mainly surgical, or conservative depending on the desire for subsequent pregnancy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the intertriginous areas. HS affects hair follicles causing perifollicular inflammation, resulting in the formation of nodules and painful abscesses. Intense pulsed light (IPL) uses selective photothermolysis to destroy the hair follicles., Objectives: To evaluate the effect of IPL hair removal as treatment for mild-to-moderate HS., Materials & Methods: We conducted a single-blinded, clinical randomized trial with patients with Hurley Stage I-II. Patients with symmetrical disease were randomized to monthly unilateral treatment of the axilla or groin. The contralateral side served as internal control. Concomitant treatment modalities for HS were not permitted throughout the study. Efficacy was assessed using Hidradenitis Suppurativa Clinical Response (HiSCR), modified Sartorius score (MSS) and patient-reported outcomes., Results: A total of 17 patients completed the trial and were included in the analysis. HiSCR was not evaluated in patients without abscesses or inflammatory nodules pre-treatment. HiSCR was insignificantly different between the intervention side (8/12) and control side (4/10), P=0.467. There was, however, a significant reduction in regional MSS on the intervention side with a median score decreasing from 8.5 (IQR: 6.3-13.5) to 4.5 (IQR 1.8-8.0) post-treatment, P=0.006, and an insignificant score reduction in the control side from 6.0 (IQR: 4.5-8.3) to 5.0 (IQR: 2.5-9.0), post-treatment P=0.492., Conclusion: IPL hair removal resulted in a significant reduction on MSS on the treated area with no significant reduction on the control side. Our study suggests that IPL may be an effective treatment for mild-to-moderate HS.

Competing Interests: Intérêts concurrents: Bram Rochwerg est un chercheur participant à un essai financé par une subvention des Instituts de recherche en santé du Canada qui évalue les effets des corticostéroïdes chez les patients atteints de la COVID-19. Aucun autre intérêt concurrent déclaré.

Predictive prospective studies of schizophrenia date back to the late 1950s. At the turn of the Millennium, an Australian research group initiated programs of early detection of schizophrenia and early therapeutic intervention. The theoretical foundations of early schizophrenia detection usually remain unaddressed. In this paper, we focus on the issue of prediction of future schizophrenia in the general population on the basis of a symptomatic picture. Several notions used in this research program such as disease, symptom, and clinical staging derive from a medical model, which in our view is not entirely adequate for grasping the nature of schizophrenia. Schizophrenia is a spectrum of disorders with a shared core Gestalt comprising dis-order of selfhood and intersubjectivity. This core Gestalt has manifold manifestations, often predominantly in the existential or experiential domain. It is not feasible to apply medical concepts to this symptomatically poorly demarcated spectrum for which we do not know robust biological validators. Moreover, there is increasing evidence that the current DSM and ICD criteria of schizophrenia distort the original concept of schizophrenia and are formulated on a very high severity level. This often results in incorrect diagnoses of young help-seeking patients. In sum, it seems more appropriate to detect psychosis among already help-seeking patients than to implement detection programs in the general population. We discuss a reorientation of psychiatry towards more refined psychopathological knowledge and assessment that are needed in order to optimize the treatment of young help-seeking patients., (© 2018 L’Encéphale, Paris.)

Severely immunocompromised patients are at increased risk for uncommon infectious diseases with atypical presentations. Fusarium sp., has been reported in patients with hematological malignancies and prompt diagnosis is necessary due to high mortality. We report a myelodysplastic syndrome (MDS) patient who presented Fusarium solani infection associated with granulocytic sarcoma as an initial presentation of acute myeloid leukemia (AML) transformation. We performed histological examination, immunohistochemistry analysis, culture of the biopsy tissue and DNA sequencing to make a conclusive diagnosis of F. solani and granulocytic sarcoma, reinforcing the necessity of performing complete evaluation of skin lesions in immunocompromised patients., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Many national and international guidelines have been established for venous thromboembolic disease (VTE). Homogeneous management practices could be expected in the different European countries. To verify this hypothesis, we compared practices in France, Italy and Spain., Method: We used data from the international RIETE registry to compare VTE management between France, Italy and Spain., Results: From 2001 January to 2011 January, patients were consecutively included in France (n=1548), Italy (n=2083) and Spain (29,824). All patients received anticoagulant treatment. Low molecular-weight heparin (LMWH) was the most frequently used drug as initial therapy in all three countries, but unfractionated heparin (UFH) was more frequently used in France and Italy than in Spain. In France, the proportion of patients receiving LMWH was lower than the proportion of patients with active cancer (cancer 22.5 %, long-term treatment with LMWH 17.4 %). A vena cava filter was significantly more frequently used in France (5.5 % in France, 3.2 % in Italy and 2 % in Spain, P<0.0001). High bleeding risk because of surgery with recent thromboembolic disease was the most frequent indication in France and Italy for vena cava filter placement (36.4 %, and 31.3 %, respectively)., Conclusion: Despite the publication of national and international guidelines, VTE management differs among the three major European countries included in the RIETE registry, France, Italy and Spain., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Angiomatoid fibrous histiocytoma (AFH) is a soft-tissue tumour of uncertain differentiation most often arising in the extremities of children and young adults. AFH is a little-known neoplasm and its rarity may result in it being misdiagnosed as either a reactive lesion or a benign or higher-grade tumour. We report 6 cases of AFH in children and we review the clinicopathological and molecular features of this neoplasm published in the literature., Patients and Methods: The children (aged 4 to 16 years) presented a single nodule involving the forearm (4/6), the trunk or the buttock, and all 5 nodules appeared spontaneously. Microscopic examination revealed well-circumscribed nodular lesions comprising a fibrous pseudo-capsule, haemorrhagic non-endothelial-lined pseudocystic spaces, and sheets of spindle and ovoid cells with dense surrounding lymphoplasmacytic infiltrate. Tumours were positive for desmin, CD68, CD99 and smooth-muscle actin markers. A fusion gene (EWSR1-ATF1) was found in the 3 cases in which molecular investigation was performed., Discussion: In our series, a diagnosis of AFH had in no event been evoked after clinical examination and radiological investigation. The diagnosis was based in all cases on recognition of characteristic features during histological examination and it was confirmed in 3 cases by the recognition of fusion genes. Complete excision with wide margins allowed complete cure in all cases, supporting a good prognosis of AFH, although long-term follow-up is still mandatory to rule out relapse or metastases, which although rare, are responsible for fatal cases. To avoid unnecessary surgery in patients with AFH, an ultrasound core-needle biopsy should be performed as a first step in order to provide precise diagnosis enabling complete excision to be performed, with the margins being decided in multidisciplinary meetings involving teams specialised in soft-tissue tumours., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Tattooing is characterized by the introduction in the dermis of exogenous pigments to obtain a permanent design. Whether it is a traditional tattoo applied on the skin or a cosmetic one (permanent make-up), its prevalence has boomed for the past 20 years. The increased prevalence of tattooed patients along with medical progresses, in the field of therapeutics or diagnostic means have lead to the discovery of "new" complications and unexpected issues. Medical imaging world has also been affected by the tattoo craze. It has been approximately 20 years when the first issues related to tattooing and permanent make-up aroused. However, cautions and questions as well as anecdotal severe case reports have sometimes led to an over-exaggerated response by some physicians such as the systematic avoidance of RMN imaging for tattooed individuals. This review is intended to summarize the risks but also the "myths" associated with tattoo in the daily practice of the radiologist for RMN, CT scan, mammography, Pet-scan and ultrasound imaging., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The adult film industry nowadays represents a legal multi-billion dollar business. The main health risks of adult performers are well known. They mainly include the transmission of sexually transmitted diseases such as HIV, hepatitis, gonorrhoea, Chlamydia, herpes and papillomavirus. However, despite regular follow-up, the frequency of STD remains significant in this high-risk population since a large part of the industry continues to reject systematic use of condoms. Besides, performers are also exposed to other physical and mental health issues often not known to the public. This article provides a comprehensive review of what is known about STD and other risks among the community of performers in the adult film industry., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

"Religious" stigmata describe body marks and sores that reflect the crucifixion wounds of Christ (hands and wrists, feet, flank, back, shoulders, forehead) and which are transferred to an individual through fervent prayer. "Non-religious" stigmata usually describe spontaneous episodes of bleeding with no identifiable cause outside any religious context. Irrespective of the setting in which they occur, such lesions are extremely striking. This review intends to summarize what is currently known about stigmata in the light of current medical knowledge, while stressing that the "spontaneous" nature of these lesions does not rule out a genuine medical cause., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Recreational or regular physical and sport activities may be responsible for a wide range of cutaneous complications. Among them, "sports purpura" is a peculiar symptom that can occur during a large number of sports. "Effort purpura" defines any purpura occurring within the context of physical exercise irrespective of its cause. Therefore this clinical diagnosis includes various aetiologies. Diagnosis of traumatic purpura is often easy if the sport is mentioned in the anamnesis; cutaneous exercise - induced vasculitis must be also noted. Purpura can reveal systemic diseases or internal haemorrhage, such as spleen rupture, thrombopathies or systemic vasculitis, and other effort purpuras must be taken into account, including those related to the environment (cold, sun exposure...). Knowledge of a physical activity before the occurrence of purpura should be known by practitioner to avoid unnecessary and costly explorations in most of the cases., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

The estimated prevalence of tattooed individuals in Europe and in France is around 10%. The current "tattooed generation" was born mainly between 1975 and 1986, and according to a recent German study, the "typical tattooed" individual is a 30-year-old male or female with a mean tattooed area of 300 cm(2) or over in 61% of cases and more than one tattoo in 65% of cases. As this population gradually ages, physicians will be increasingly called on to treat tattooed areas, either for surgical removal of the tattoo itself or for excision of a suspect lesion or skin tumour, or for incision of the skin in a setting of either elective or emergency visceral surgery. This review focuses on the surgical situations potentially arising in tattooed patients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Body piercing has gained tremendous popularity since the mid nineties. Genital piercings constitute a peculiar variant of piercing due to its sensitive localization. Health care providers are often very little informed about those piercings. Besides, negative stereotypes are often attributed to the bearers of such piercings. This review focuses not only on the medical aspects of genital piercings but also on the social, cultural and psychological background that surround those piercings., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Sauna bathing is a traditional activity in Finland that has become popular for the past decades in Europe and in the United States. However, it is still considered that patients with cardiovascular pathologies should avoid sauna bathing. Clinical studies have nevertheless showed that sauna was safe for patients with a stable heart condition (hypertension, coronary disease, stable controlled chronic heart failure). Besides, results from recent Japanese studies seem to point out potential benefits for patients with chronic congestive heart failure, but the results need confirmation., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Purpose: During continuous epidural anesthesia with lidocaine, plasma monoethylglycinexylidide (MEGX), an active metabolite of lidocaine, increases continuously. We assessed the effect of epinephrine on the absorption of lidocaine and the accumulation of MEGX during continuous epidural anesthesia in children., Methods: Anesthesia was administered as an initial bolus of 5 mg x kg(-1) of 1% lidocaine solution followed by continuous infusion at 2.5 mg x kg(-1) x hr(-1). Patients in the control group (n = 8) received lidocaine alone, while patients in the epinephrine group (n = 8) received lidocaine + epinephrine (5 microg x mL(-1)). Concentrations of lidocaine and its active metabolite, MEGX, were measured in plasma samples obtained after 15 min, 30 min, and one, two, three, four, and five hours of infusion using high-performance liquid chromatography with ultraviolet detection., Results: Plasma lidocaine concentrations were higher in samples from the control group for the first hour; however, after two hours the levels were the same in all samples. Plasma MEGX levels increased continuously in both groups and were significantly higher in the control group samples. The sum of lidocaine + MEGX was higher in the control group for the first two hours but there was no significant difference between groups after three hours., Conclusions: Reduction of the potential for systemic toxicity by the addition of epinephrine to lidocaine is limited, because the reduction of the sum of the plasma concentrations of lidocaine and its active metabolite MEGX is small and limited to the initial phase of infusion.