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OBJECTIVES: Adequate management of haemophilia patients requires early detection of joint impairment in relatively asymptomatic patients. This study sought to quantify the impact of the ankle's structural impairment on muscle strength in children, adolescent and young adults with haemophilia (CAAwH). METHODS: Twenty-three CAAwH underwent bilateral magnetic resonance imaging (MRI) assessing the anatomical status of tibiotalar joint (TTJ) and subtalar joint (STJ) using the International Prophylaxis Study Group MRI scale. An isokinetic dynamometer enabled a detailed evaluation of muscle strength at slow and fast speed. In parallel, 10 typically developing healthy boys (TDB) participated in a 1-week interval test-retest assessment to assess the test's reliability. RESULTS: Forty-six MRI ankle scores were obtained, with 11 patients unilaterally affected and one bilaterally. Of the 13 affected feet, nine showed abnormalities at TTJ, three at the posterior STJ and the remaining one at both joints. Muscle strength was not reduced in CAAwH exhibiting TTJ and/or STJ arthropathy, as compared to healthy TDB, nor was there any difference between the CAAwH's affected or unaffected sides. CONCLUSION: Contrarily to adult patients, CAAwH with repeated ankle bleeding may be less impaired than current structural evaluations imply, with possibly a latency between the occurrence of structural and functional damage.

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BACKGROUND AND OBJECTIVES: The particularly high rate of urbanization in Kinshasa (Democratic Republic of Congo) is associated with environmental degradation. Outdoor and indoor air pollution, as well as water pollution and waste accumulation, are issues of major concern. However, little documented information exists on the nature and extent of this pollution. A biomonitoring study was conducted to document exposure to trace elements in a representative sample of the population in Kinshasa. METHODS: Fifteen trace elements were measured by ICP-MS, CV-AAS, or HG-AFS in spot urine samples from 220 individuals (50.5% women) aged 6-70 years living in the urban area and from 50 additional subjects from the rural area of Kinshasa. Data were compiled as geometric means and selected percentiles, expressed without (µg/L) or with creatinine adjustment (µg/g cr). RESULTS: Overall, living in urban Kinshasa was associated with elevated levels of several parameters in urine as compared to the population living in the rural area (Asi, Ba, Cd, Cr, and V) as well as compared to an urban population of the southeast of Congo (Al, As, Cd, Cr, Cu, Pb, Mn, Ni, Se, V, and Zn). Elevated levels were also found by comparison with the reference values in databases involving American, Canadian, French, or German populations. CONCLUSIONS: This study provides the first biomonitoring database in the population of Kinshasa, revealing elevated levels for most urinary TE as compared to other databases. Toxicologically relevant elements such as Al, As, Cd, Pb, and Hg reach levels of public health concern.

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Although foot orthoses are often prescribed to patients with haemophilia (PWH) and ankle arthropathy, the efficacy and biomechanical effects of such devices are not fully understood. We experimentally investigated the effects of orthopedic insoles (OI) and shoes (OS) in PWH presenting ankle arthropathy, with specific attention being paid to pain, spatiotemporal parameters, kinematics and kinetics of lower limb joints, as well mechanical and energetic variables. Using three-dimensional gait analysis (3DGA), synchronous kinematics, kinetics, spatiotemporal, mechanics, and metabolic gait parameters were measured in 16 PWH with ankle arthropathy. The revised Foot Function Index (FFI-R) and 3DGA were determined in patients wearing neutral running shoes at two time points (T0 and T1), with OI (n = 11) or OS (n=5) being subsequently prescribed. Patients, while wearing their orthoses, were re-evaluated using 3DGA, FFI-R, and satisfaction questionnaires (T2). OI and OS provided significant pain relief and comfort improvement in more than half of the patients, with minimal side effects. OI had limited impact on gait pattern, whereas OS significantly improved the propulsive function of the ankle. Biomechanical changes induced by OI and OS were independent of their ability to improve comfort, while being insufficient to influence knee and hip kinematics and kinetics, or mechanical and energetic variables. These findings suggest that OI and OS may have beneficial effects on ankle joints in PWH. Self-reported clinical tools such as FFI-R and satisfaction questionnaires are sufficiently sensitive for assessing the efficacy of foot orthoses in PWH.

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CONTEXT: Hypothyroidism has been observed in the fifties and sixties as an undesirable side-effect of cobalt therapy used for its erythropoietic properties in the treatment of anemia. OBJECTIVE: This study aims at evaluating the possible impact of both cumulative (long-term) and recent occupational exposure to cobalt on thyroid function and red blood cells. METHODS AND SETTING: A cross-sectional survey was conducted from February 2008 to August 2009 in a population of 249 male workers from a cobalt production department in the North of Belgium. The possible effect of cobalt exposure on thyroid and red blood cells was investigated through multiple regression analyses. RESULTS: Blood cobalt ranged from undetectable to 3.20 µg/100ml (median 0.10); urinary cobalt from 0.30 to 204.30 µg/g(creat) (median 3.90) and long-term exposure to cobalt ranged from 0.15 to 6990.46 µg/g(creat) · years (median 106.09). No effect of cobalt exposure on thyroid or red blood cell parameters was observed at these levels of exposure. CONCLUSION: The results support the absence of effects on the thyroid and red blood cells when occupational exposure to cobalt is kept below the recommended biological limit of occupational exposure (15 µg Co/g(creat) in urine).

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In the past two years, we have been using the EEA stapler for anastomoses of the extra-peritoneal rectum. With this technique, we have been able to preserve the anal sphincter in all cases of tumor at or above 6 cm from the anal verge. The results of 24 consecutive cases demonstrate the safety of the mechanical anastomoses of the mid-rectum with no death, nor anastomotic dehiscence in 15 cases. Complications occurred in the lowest locations which would have been otherwise treated by an abdomino-perineal excision or pull through procedure: 1 death from peritonitis and stress ulcer 3 temporary leaks and 3 stenoses, easily treated by digital dilatation. The potential danger of anastomotic leaks justifies in the very low anastomoses a temporary colostomy : healing then occurs after a few weeks. The final result is an intact anatomy and sphincteric function.

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Breast cancer is a chronic disease, often generalized at the time of diagnosis. Present treatments are efficient only if the tumor is still localized so that results are relatively disappointing. Careful clinical appraisal will define the chances of a disabling treatment and the limits of a curative treatment. Systematic histologic study of axillary nodes completes the clinical examination, is a reliable measure of the risk of dissemination at the time of treatment and indicates the necessity for complementary chemotherapy. The main choices of treatment for initial stages are presented. Radical mastectomy, according to the literature appears best as it adds a precise diagnosis to a safe result. Mastectomy without resection of the pectoralis major is a cosmetic alternative with statistical and experimental soundness. Complementary prophylactic irradiation for radical mastectomy should be reserved for high risk of local recurrence and for control of metastases to the internal mammary nodes.

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The authors report one case of false aneurysm of the right external iliac artery following perforation of the acetabulum by a Böhler nail, which was placed twenty-two years before. Clinical signs were a no-pulsating tumor of the right fossa iliaca, deep venous thrombosis of the right leg and severe anemia. Treatment included resection of the false aneurysm, suture of the arterial wound and removal of the Böhler nail. The authors report the place held by vascular lesions in bone surgery, and diagnostic difficulties due to the delayed clinical manifestations.

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The authors report 4 observations of severe involvement induced by sub-clavian catheterization: - 2 catheter-embolisms; - 1 venous thrombosis and one hydrothoraxx. One embolism and the hydrothorax were caused by a faulty puncturing. The thrombosis was the result of a relative stenosis of the vein induced by a loop of the catheter in the Pirogoff confluent. Next, the authors develop the facts given by the literature bearing upon each one of these complications.

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