Amniocele associated with placental abruption: a case report

Amniocele is a rare condition involving herniation of the amniotic sac through a uterine breach. Our case is of a 29-year-old pregnant woman at 31 weeks of pregnancy who presented to the maternity triage of the Mirebalais Teaching Hospital for abdominal pain and the passage of blood through the vagina. After an ultrasonographic evaluation, the diagnosis of amniocele was made. In practice, for a third-trimester, nonlaboring pregnant woman with this symptomatology, the most common diagnoses that come to mind are placenta previa and placental abruption. This case highlights that a diagnosis of silent uterine rupture should also be kept in mind knowing that a uterine rupture is a life-threatening event for both the mother and the fetus, therefore, early diagnosis is very important to improve the maternal-fetal prognosis.

Vulvar leiomyosarcoma: A case report

Vulvar leiomyosarcoma is a rare malignant smooth muscle tumor and the most common type of vulvar sarcoma. It can mimic benign tumors, and misdiagnosis may delay appropriate treatment. A 35-year-old woman presented to the outpatient gynecology clinic at the Mirebalais Teaching Hospital for a right vulvar mass. A complete excision of the mass was performed. Histopathology with immunohistochemistry demonstrated leiomyosarcoma. We describe the contextual challenges that ultimately compromised her care, highlighting the challenges to safe delivery of cancer care in our setting.

Conservatism and novelty in the genetic architecture of adaptation in Heliconius butterflies

Understanding the genetic architecture of adaptive traits has been at the centre of modern evolutionary biology since Fisher; however, evaluating how the genetic architecture of ecologically important traits influences their diversification has been hampered by the scarcity of empirical data. Now, high-throughput genomics facilitates the detailed exploration of variation in the genome-to-phenotype map among closely related taxa. Here, we investigate the evolution of wing pattern diversity in Heliconius, a clade of neotropical butterflies that have undergone an adaptive radiation for wing-pattern mimicry and are influenced by distinct selection regimes. Using crosses between natural wing-pattern variants, we used genome-wide restriction site-associated DNA (RAD) genotyping, traditional linkage mapping and multivariate image analysis to study the evolution of the architecture of adaptive variation in two closely related species: Heliconius hecale and H. ismenius. We implemented a new morphometric procedure for the analysis of whole-wing pattern variation, which allows visualising spatial heatmaps of genotype-to-phenotype association for each quantitative trait locus separately. We used the H. melpomene reference genome to fine-map variation for each major wing-patterning region uncovered, evaluated the role of candidate genes and compared genetic architectures across the genus. Our results show that, although the loci responding to mimicry selection are highly conserved between species, their effect size and phenotypic action vary throughout the clade. Multilocus architecture is ancestral and maintained across species under directional selection, whereas the single-locus (supergene) inheritance controlling polymorphism in H. numata appears to have evolved only once. Nevertheless, the conservatism in the wing-patterning toolkit found throughout the genus does not appear to constrain phenotypic evolution towards local adaptive optima.

Induced superconductivity in graphene grown on rhenium

We report a new way to strongly couple graphene to a superconductor. The graphene monolayer has been grown directly on top of a superconducting Re(0001) thin film and characterized by scanning tunneling microscopy and spectroscopy. We observed a moiré pattern due to the mismatch between Re and graphene lattice parameters that we have simulated with ab initio calculations. The density of states around the Fermi energy appears to be position dependent on this moiré pattern. Tunneling spectroscopy performed at 50 mK shows that the superconducting behavior of graphene on Re is well described by the Bardeen-Cooper-Schrieffer theory and stands for a very good interface between the graphene and its metallic substrate.

A portable transfer chamber for electrochemical measurements on electrodes prepared in ultra-high vacuum

This paper describes a versatile, light weight, and portable chamber dedicated to the transfer of electrodes from ultra-high vacuum (UHV) to atmospheric pressure and the liquid phase. This chamber can be connected to a liquid-phase reaction cell to perform electrochemical measurements and transfer back the electrode to the UHV environment. The experimental set-up can also be turned in order to make the electrode the bottom of the electrochemical cell. The validity and the efficiency of the experimental set-up were tested with a Pt(111) surface that provides unique electrochemical features in acidic sulphate-containing solution. This transfer chamber concept provides the surface science community with a new and versatile tool, complementary to existing systems, which allows fast electrolyte purging or electrochemical measurements under well-controlled mass transport conditions.

In Situ Stress and Strain Measurements During the Growth of Cu/Ni (001) Multilayers

Cu/Ni (001) multilayers have been grown by molecular beam epitaxy at room temperature. In-situ electron diffraction and curvature measurements performed during the growth are presented. The average lattice parameter in the equiatomic multilayers evolves gradually towards the alloy lattice parameter. The in-plane lattice parameter of both Cu and Ni evolves continuously towards the bulk lattice parameter with no evidence of pseudomorphic growth. The combination of diffraction and curvature measurements suggests that the Ni on Cu interface is diffuse. This is attributed to the surfactant behaviour of Cu. This results shed new insights into the interesting magnetic properties of Ni films on Cu (001).

The Growth of Ni Overlayers on Au(100) Buffers Deposited on GaAs(100) and MgO(100) Substrates

High quality single-crystal Au(100) buffers have been grown on GaAs(100) or MgO(100) substrates via a thin bcc Fe(100) nucleation layer. Using RHEED, LEED and Auger spectroscopy the growth of Ni overlayers at room temperature was observed to follow an epitaxial layer-by-layer mode for 2 monolayers, after which islanding occured. Detailed analysis of the Auger signal reveals that atomic mixing appears within the first completed layer. Grazing incidence diffraction has been used to investigate the structure of 5–10 nm films. A mixture of (100) and (110) grains have been characterized; the latter orientation shows a large number of stacking faults along the [111] direction in agreement with the Au[001] direction.

Residual Stresses in Ultrathin Metal Sublayers Within Au/Ni Multilayers

Metallic Multilayers (MLs) have attracted a considerable interest during these last years because of their unusual properties. In small periods ML's (a few nm) the high density of interfaces give rise to structures very far from equilibrium. Au/Ni multilayers have been grown in the (111) orientation by M.B.E. on Si(100) via a Cu(100) buffer layer. Two different parameters have been studied: the Au:Ni ratio at constant (4 nm) superperiod and the superperiod at constant (1:1) Au:Ni ratio. The full strain state of Au and of Ni has been determined via x-ray diffraction measurements. The high lattice parameter misfit beween Au and Ni (14%) implies that all the layers are partially relaxed. Residual strains as high as several % are encountered. The residual strain in the Au layers is clearly correlated with their thickness. A residual stress as high as 3.9 GPa is determined in the thinner layers.

Ferromagnetic hcp chromium in Cr/Ru(0001) superlattices

We report the first observation of a weak ferromagnetic state of Cr in Cr/Ru(0001) superlattices, based on magnetic hysteresis and corroborated by x-ray magnetic circular dichroism at the CrL(2,3) edges. In situ reflection high-energy electron diffraction, x-ray diffraction, and Cr K-edge polarized x-ray absorption investigations have shown that the Cr layers thinner than 8 angstroms adopt a slightly distorted hcp structure, accompanied by a large atomic volume expansion of up to 14% compared to the bcc packing volume. The expanded hcp structure clearly induces the observed ferromagnetism, in agreement with theory.

[Marchiafava-Bignani disease of good prognosis. Two cases]

BACKGROUND

Marchiafava-Bignami disease or corpus callosum necrosis, is an uncommon complication of chronic alcoholism. Prognosis is severe.

CASE REPORTS

Two young adults with chronic alcoholism who developed Marchiafava-Bignami disease initially improved clinically.

DISCUSSION

Diagnosis has been facilitated with MRI. An MRI exploration should be performed in chronic alcoholic patients presenting chronic encephalopathy with dementia, dysarthria, hypertonia, and ataxia, or acute encephalopathy with confusion, dumbness, seizures, and hypertonia. Necrosis of the corpus callosum gives the diagnosis of Marchiafava-Bignami disease.

Mapping of TH1 helper T-cell epitopes on major secreted mycobacterial antigen 85A in mice infected with live Mycobacterium bovis BCG

TH1 cytokine secretion was examined in response to synthetic peptides of the 85A component of the major secreted, fibronectin-binding antigen 85 complex from Mycobacterium tuberculosis in seven different mouse strains infected with live M. bovis BCG. Twenty-eight overlapping 20-mer peptides covering the complete mature 295-amino-acid (AA) protein were synthesized. Significant interleukin-2 (IL-2) and gamma interferon (IFN-gamma) secretion could be measured following in vitro stimulation of spleen cells with these peptides. H-2d haplotype mice reacted preferentially against the amino-terminal half of the protein, i.e., against peptide 5 (AA 41 to 60) and especially against peptide 11 (AA 101 to 120), which contained an I-Ed binding motif. H-2b haplotype mice, on the other hand, reacted against peptides from both amino- and carboxy-terminal halves of the protein, peptide 25 (AA 241 to 260) being the most potent stimulator of IL-2 and IFN-gamma production. (BALB/c x C57BL/6)F1 animals with the H-2d/b haplotype weakly recognized peptides specific for both parental lines. Finally, CBA/J (H-2k) and major histocompatibility complex class II mutant B6.C.bm12 mice, carrying a mutant I-A beta bm12 allele on an H-2b background, reacted only very weakly to the 85A peptides. Reactive T cells isolated from lungs of BCG-infected H-2b haplotype mice recognized the same epitopes as spleen cells, especially peptide 25. These data confirm previous findings regarding the powerful IL-2 and IFN-gamma-inducing properties of antigen 85 during infection with live M. bovis BCG.

Metered dose inhalers for bronchodilator delivery in intubated, mechanically ventilated patients

We determined the relative efficacy of two bronchodilator aerosol delivery methods in 18 intubated mechanically ventilated patients with airways obstruction. Two treatment arms, consisting of albuterol 270 micrograms (three puffs) from a metered dose inhaler and albuterol 2.5 mg from a saline solution nebulized with an updraft inhaler, were compared in a single blind, randomized crossover design. Pulmonary function was evaluated using an interrupter technique. Changes in passive expiratory flow at respiratory system recoil pressures between 6 and 10 cm H2O provided the therapeutic endpoints. Paired measurements were made before and 30 minutes after drug delivery. The MDI and NEB resulted in similar improvements in iso-recoil flow (mean increase for both groups = 0.1 L/s). Treatment sequence, severity of obstruction, and bronchodilator responsiveness had no effect on relative efficacy. Albuterol caused a small but significant increase in heart rate that was similar following both delivery methods. We conclude that bronchodilator aerosol delivery with metered dose inhalers provides a viable alternative to nebulizer therapy in intubated mechanically ventilated patients and may result in a cost savings to hospitals and patients.

The video invasion of rehabilitation

Motivating burned children to participate actively in rehabilitation at the burn unit demands many creative ideas. To avoid resistance from the child towards the exercises, it is important to offer a variety of techniques. A new play technique is outlined here, based on the use of video games, that is capable of motivating and stimulating children of all ages--even the youngest--towards active participation in rehabilitation.

Impact of facial burns on the family

At the University Burn Unit in Leuven (Belgium), we have been working for 4 years now with a multidisciplinary reintegration program. Our team consists of a plastic surgeon (head of the unit), a physical therapist, a social worker and a child psychiatrist. We set up family, context-oriented counselling for the families of seriously burned patients. In this paper, we would like to illustrate some aspects of the importance of facial scars in our society as well as the consequences of such scars for the families of patients. These are 2 essential aspects which have to be taken into account so that the counsellors and family do not reach a deadlock. We discuss how this therapy can be applied. Cooperation with the school is a keystone in the application of such therapy. The teacher is involved as a reflection of the feelings of the parents. Via this intermediary they learn how to cope with their feelings and to talk about them. The team has experienced this as an important step in the construction of family therapy.

[A severe form of external otitis: necrosing diabetic otitis]

Otitis externa are of usual observation in inter-tropical regions. Pseudomonas aeruginosa is responsible generally. But, when immunodeficiency is associated or on diabetic diathesis, such an otitis externa can be extremely dangerous: extensive osteitis of the base of the skull, paralysis of the last pairs of cervical nerves rapidly creeping, built a clinical identity called malignant external otitis, leading to death in 50% of the cases.

Reciprocal ST segment changes in acute inferior myocardial infarction: clinical, haemodynamic and angiographic implications

Reciprocal ST segment changes are frequent during acute inferior myocardial infarction, yet their significance remains controversial. In order to investigate the implications of these changes, the ECG obtained on admission for 83 patients with acute inferior myocardial infarction was compared with the clinical course and the results of angiographic and coronary arteriographic studies performed an average of 3 weeks after the onset of symptoms. Group 1 consisted of 59 patients with at least 1 mm of horizontal on downsloping ST segment depression in at least 1 of leads V1 to V4. Groups 2 consisted of 24 patients without precordial ST depression in this area. Group 1 patients were generally older than group 2 patients (59.6 +/- 6.4 versus 54 +/- 5.3 yr, P less than 0.01) had higher total creatine kinase (CK) levels and MB fractions (1835 +/- 940 versus 875 +/- 305, P less than 0.01, 269 +/- 102 versus 95 +/- 35 for MB fraction) and more complications during the hospital course (80% versus 38% P less than 0.01) and greater left ventricular dysfunction (ejection fraction 52.2 +/- 6% for group 1 versus 59.2 +/- 7% for group 2; cardiac index 2.75 +/- 0.41 min-1 m-2 for group 1 versus 3.25 +/- 0.31 min-1 m-2 for group 2 P less than 0.005). No difference was observed on biplane angiography as far as left ventricular wall kinesis was concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of ST segment depression in the precordial leads during the acute phase of inferior myocardial infarction]

Reciprocal changes of the ST segment in the acute phase of inferior myocardial infarction are common but their significance remain controversial. We studied this problem by comparing the ECG on admission of 83 patients with acute inferior myocardial infarction, with the clinical outcome and haemodynamic and angiographic data obtained on average 3 weeks after the onset of symptoms. Fifty nine patients (Group I) had ST depression greater than or equal to 1 mm in at least one of the leads V1 to V4; 24 patients (Group II) had no ST depression in this territory. The patients in Group I were older (59.6 +/- 6.4 vs 54 +/- 5.3 years, p less than 0.01), had higher total CPK (1 835 +/- 940 vs 875 +/- 305, p less than 0.01) and MB fractions (269 +/- 102 vs 95 +/- 35), more complications during the hospital period (80%, mainly haemodynamic vs 38%, p less than 0.01) and more severe left ventricular dysfunction: ejection fraction 52.2 +/- 6% vs 59.2 +/- 7%, p less than 0.05; cardiac index 2.75 +/- 0.4 l/min/m2 vs 3.25 +/- 0.3 l/min/m2, p less than 0.005). There was no difference in left ventricular wall motion between the groups on biplane angiography. However, coronary angiography showed left coronary disease to be more common in Group I (84%) than in Group II (37%), p less than 0.005. Left anterior descending and left circumflex disease was equally common. Patients with persistent ST depression after 48 hours had lower ejection fractions than those in whom it regressed within 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)