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International audience; PURPOSE: This study aimed at assessing the prevalence of adverse cardiac events, as identified in the media, in world-class athletes according to their sex and sports discipline. METHODS: All female and male’ athletes, from 30 individual Olympic sports, ranked in the international yearly top 10 between 2006-2018, were included. The name of each of them was associated in a Google search with selected key terms related to heart disease and/or acute cardiac events after their inclusion date. Global and sex-specific adverse cardiac event hazard function λ were calculated for each sport. Global and sex-specific prevalence of cardiac events were calculated, then compared (Fisher’s exact test) between all sports. RESULTS: From the 2471 athletes included, 15 cases of cardiac events (prevalence 0.61%) were reported; 2 sudden cardiac deaths (0.08%) occurred in male athletes. The other events were related to arrhythmic events (n = 13), mainly supra-ventricular arrhythmias (n = 9). All surviving athletes were able to continue their career, mostly after ablation procedure. Male endurance athletes accounted for 7 events among which 3 events occurred among short-distance triathletes. Events among women were comparatively rare (n = 4), and all were observed among short-distance triathletes. CONCLUSIONS: A relatively unexpected high prevalence of cardiac events in endurance elite athletes, was observed as compared to other sports, mainly in short-distance male and female triathletes. This raises the question of particular cardiovascular constraints in this discipline, and underlines the urge of international longitudinal follow-up studies in these kinds of athletes.

info:eu-repo/semantics/published

Introduction: malaria remains a major issue in the armed forces. There are therefore still many cases of infections, some fatal. The prevention of this disease can reduce its incidence. This is organized within the military institution, based on 3 pillars, which are vector control, chemoprophylaxis, and the duo early diagnosis and early treatment of the disease. The effectiveness of the employed preventive measures has been demonstrated, but the soldier’s compliance about their application remains weak. It seems that it is at the level of education that the effort has to be made. Therefore, we must understand how health education is made. Methods: we did an observational, multi-centric, descriptive study, by questionnaire, designed to produce an update on practice in health education organized within the infirmary. Results: we got 138 responses. It is mainly the forces GP (80-89.8%) who carries out health education, then the nurse (34.7% -56.0%). 56.9% promote individualized health information, 35.3% collective information. 84% of them think that individualized, small group or workshop-exchange methods would be more effective. Half of the practitioners spent less than 8 hours per year on health education. Discussion: our study shows that health education is mostly done on an individual way and/or in collective groups. These methods tend to lean towards paternalistic medicine. However, the current paradigm is about health promotion. Thus, several practices should be developed: exchange groups and e-learning. Educating managers in health issues would increase collective subscription. These practices requires that the GPs and nurses of the forces be better trained in these practices. Conclusion: the current malaria education practices do not fit into the current health promotion paradigm. It seems necessary to improve discussion groups, e-learning and paying particular attention to the education of contact managers. The caretaker staff of the SSA must be better prepared., Introduction : le paludisme reste une problématique majeure dans les armées. On compte de nombreuses infections, parfois mortels. La prévention est primordiale pour faire diminuer son incidence. Elle se base sur 3 piliers : la lutte antivectorielle, la chimioprophylaxie, et le duo diagnostic et traitement précoce. L’efficacité des moyens de prévention employés est démontrée, mais l’observance des militaires est médiocre. C’est au niveau de l’éducation que l’effort est à mener. Il faut analyser les manières de faire de l’information sanitaire. Matériel et méthode : notre étude est descriptive, observationnelle, multicentrique, par questionnaire, ayant pour but de faire un état des lieux des pratiques d’éducation sanitaire organisées au sein des antennes médicales. Résultats : nous avons obtenu 138 réponses. C’est principalement le médecin des forces (80-89,8%) qui réalise l’éducation sanitaire, puis l’infirmier (34,7%-56,0%). 56,9% privilégiais des informations sanitaires individualisés, 35,3% des informations collectives. 84% d’entre eux pensent que les méthodes individualisées, en petit groupe ou sous forme d’atelier-échange serait plus efficace. La moitié des praticiens consacraient moins de 8h par an à l’éducation sanitaire. Discussion : notre étude montre que l’éducation sanitaire se fait majoritairement de façon individualisée ou en groupes collectifs. Ces méthodes s’inscrivent dans une médecine paternaliste. Or, le paradigme actuel est à celui de la promotion de la santé. Ainsi, plusieurs pratiques devraient être développées : les groupes d’échange et le e-learning. La formation des cadres permettrait d’augmenter l’adhésion collective. Les médecins et infirmiers doivent être formés à ces pratiques. Conclusion : les pratiques d’éducation sur le paludisme ne s’inscrivent pas dans le paradigme de promotion pour la santé. Il faut développer les groupes d’échange, le e-learning et éduquer les cadres de contact. Les personnels soignants du SSA doivent être formés.

Introduction : Un remodelage cardiaque électrique et morphologique survient chez les athlètes. Cependant, peu d’article se sont intéressés à la quantité d’entrainement nécessaire pour l’obtenir. Méthode : Cette étude avait pour but de décrire le remodelage cardiaque électrique (évalué par ECG) et morphologique (évalué par échocardiographie) chez des sportifs ayant un volume d’entrainement différent : des athlètes élite (AE) s’entrainant plus de 12 h/semaine (n =126), des athlètes s’entrainant de 4 à 12 h/semaine (n=151) en comparaison avec un groupe de non-athlète (NA), s’entrainant moins de 4 h/semaine (n =121).Résultats : Les AE s’entrainaient 18 heures/semaine [17,5 ; 20] contre 7 [5 ; 10] pour les Athlètes et 1 [0 ; 3] pour les sujets NA. Le remodelage électrique et morphologique était présent chez les Athlètes et AE. Nous avons retrouvé une fréquence cardiaque (FC) significativement plus basse chez les AE par rapport aux Athlètes et NA (53,9 ± 9,6 bpm contre respectivement 62,0 ± 12,5 bpm et 66,0 ± 12,6 bpm, p31mm/m2.Les modifications de la géométrie du VG était plus marqué chez les AE dont seulement 74,1% sont dans la normale contre 89,3% pour les Athlètes et 99,0% pour les NA (p

Le carcinome canalaire in situ (CCIS) est au coeur du depistage, compte tenu des difficultes du diagnostic histologique, du probleme des limites d’exerese et des strategies de traitement [1].

Uterine angiomyolipomas are rare lesions composed of mature adipose tissue, smooth muscle, fibrous connective tissue, and blood vessels in varying proportions. We reported the first case of angiomyolipoma associated with a normal pregnancy. Initially, the tumor developed intramurally and could have been confused with a partial molar gestation. After delivery, tumor development was extensive and subserosal, making differential diagnosis from a sarcoma difficult. The question of histological diagnosis, as well as that of immunocytochemical analysis which seems to be helpful in such cases, is discussed here.

International audience

Recurrence is the main problem in temporo-mandibular joint ankylosis treatment. Two therapy are used against this, physiotherapy and surgical joint interposition. Following ankylosis removal, many materials can be interposed but, for us, fullthickness skin graft using Popescu and Vasiliu technique seems to be the best and simplest one. This retrospective study of 31 cases, 20 with long-term follow-up, shows that good results are obtained using this skin graft, with 90% successful rate.

Ankylosis of the temporomandibular joint was treated by resection of the ankylosed block and arthroplasty with an osteo-cartilage graft from the rib. The main feature was attaching the cartilage to the bony surface and the appearance of enchondral ossification. The value of this method is discussed.

The authors report on 40 cases using acrylic-metal prosthesis after ablative cancer surgery and compare them with the literature. The long-term complications (prosthesis extrusion or infection) are important, but the short-term follow-up (3 months) is more than 80% of success, any material used. The prosthesis keep a physiological position to the mandible, against scar sequelae. The use of soft tissue closure without post-operative radiotherapy increase the success of a simple-used and low-priced device of mandibular reconstruction.

International audience; BACKGROUND: Areas endemic for Plasmodium falciparum, hepatitis B virus (HBV) and hepatitis C virus (HCV) overlap in many parts of sub-Saharan Africa. HBV and HCV infections develop in the liver, where takes place the first development stage of P. falciparum before its further spread in blood. The complex mechanisms involved in the development of hepatitis may potentially influence the development of the liver stage of malaria parasites. Understanding the molecular mechanisms of these interactions could provide new pathophysiological insights for treatment strategies in Malaria. METHODOLOGY: We studied a cohort of 319 individuals living in a village where the three infections are prevalent. The patients were initially given a curative antimalarial treatment and were then monitored for the emergence of asexual P. falciparum forms in blood, fortnightly for one year, by microscopy and polymerase chain reaction. PRINCIPAL FINDINGS: At inclusion, 65 (20.4%) subjects had detectable malaria parasites in blood, 36 (11.3%) were HBV chronic carriers, and 61 (18.9%) were HCV chronic carriers. During follow-up, asexual P. falciparum forms were detected in the blood of 203 patients. The median time to P. falciparum emergence in blood was respectively 140 and 120 days in HBV- and HBV+ individuals, and 135 and 224 days in HCV- and HCV+ individuals. HCV carriage was associated with delayed emergence of asexual P. falciparum forms in blood relative to patients without HCV infection. CONCLUSIONS: This pilot study represents first tentative evidence of a potential epidemiological interaction between HBV, HCV and P. falciparum infections. Age is an important confounding factor in this setting however multivariate analysis points to an interaction between P. falciparum and HCV at the hepatic level with a slower emergence of P. falciparum in HCV chronic carriers. More in depth analysis are necessary to unravel the basis of hepatic interactions between these two pathogens, which could help in identifying new therapeutic approaches against malaria.

TMJ arthroscopy is a little invasive and of poor morbidity procedure of both investigation and treatment of temporomandibular pathology. A highly equipped operating room (double instrumentation) together with fine skill and proper knowledge of arthroscopic joint anatomy can easily prevent the rare complications described (articular, vascular, neurologic and otologic).

In four cases, the authors analyse the medical and legal factors which lead the expert to his conclusions in french law, concerning temporo-mandibular joint dysfunction after whiplash injury indemnification. An uncertain direct link between the injury and the damage together with the patient's dental prior state to the accident, lead to retain an incomplete legal imputability. The compensation awarded to the victim will consist of an overvalued extra-patrimonial damage which will eventually be able to balance a low physiological deficit price.

Arthroscopy is an interesting and enlarging technique that visualise the temporomandibular joint and allows surgical technics such as lysis and lavage, prediscal section, retrodiscal cauterisation, oblic protuberance cauterisation, disc suturing or shavering of the articular surfaces.

In 7 cases of mandibular laterognathia caused by condylar hypertrophy, the authors specify the clinical and teleradiological features in adolescents. They emphasize the inadequacy of lateral teleradiography and of its measurements, and the need for three-dimensional investigation. In adolescents, secondary deformations, either spontaneous or therapeutic, are rare, and the treatment preferred is condylectomy based on the study of casts. The immediate results of this techniques are satisfactory. The long-term consequences on growth and temporomandibular pathology have been studied.

With reference to a case reported here, the authors emphasize the importance of reducing the length of the ramus of the jaw in rather exceptional forms of gaps between the upper and lower jaws with an increase in the posterior height of the face. This procedure provides more stable results and the patient's gums are no longer revealed when smiling.

Diagnostic arthroscopy is reserved to patients who suffer from internal temporo-mandibular joint derangements resisting to conservative treatments. This technique allows an acute diagnostic approach to the intra-articular lesions of the superior compartment.

Posterolateral segmentary maxillary impaction osteotomy has a role to play in the treatment of gaps between the upper and lower jaws. It has several advantages, especially an uncomplicated postoperative period and the single-maxillary contention it provides. The indication must be established after an articulator assessment in order to take into account the mandibular protrusion caused by autorotation and to prevent a sagittal shift. Associated marginal glossectomy will frequently be required. Similarly, in case of vertical excess, genioplasty for vertical reduction will improve the facial balance. This technique may also be proposed as "pre-prosthetic surgery" in cases of egression in the premolar and molar areas, for which it has shown excellent results.

Synovial chondromatosis of the temporo-mandibular joint is a rare and mild disorder. Three cases are reported, one with an histological aspect of chondrosarcoma. The evolution is favourable after removing the loose particles and the synovial tissues.

The TMJ arthroscopy is an investigation method reserved for those who does not respond to non invasive treatments. The technical aspects of the puncture and the normal arthroscopic anatomy are studied.

We are yielding a case of recurring melanotic neuroectodermal tumor of infancy situated in the premaxilla, with a very quick evolution, haemorrhage, and which has precociously recurred after surgical removal. This tumor is studied on the paraclinical (CT scan, M.I.R.) and on the histological hand (immunohistochemical and ultra-microscopy). This observation is then compared with those of literature in which we find about 200 cases. The neurocristopathic histogenesis is actually doing the unanimity. The prognosis must now be quite reserved because of the recurrences (one case for six) and the possibility of malignant forms, some with metastasis.