Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report

Objective and importance While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. Clinical presentation A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. Intervention As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. Conclusions To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration

Micronutrient Deficiencies in Medical and Surgical Inpatients

Inpatients are threatened by global malnutrition, but also by specific micronutrient (i.e., trace element and vitamins) deficiencies that frequently are overseen in the differential diagnosis of major organ dysfunctions. Some of them are related to specific geographic risks (iodine, iron, selenium, zinc, vitamin A), while others are pathology related, and finally many are associated with specific feeding patterns, including low dose enteral feeding. Among the pathologies in which laboratory blood investigations should include a micronutrient outwork, anemia is in the front line, followed by obesity with bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies and heart failure. The micronutrients at the highest risk are iron, zinc, thiamine, vitamin B12 and vitamin C. Admission to hospital has been linked with an additional risk of malnutrition-feeding below 1500 kcal/day was frequent and has been associated with a structural additional risk of insufficient micronutrient intake to cover basal needs. Although not evidence based, systematic administration of liberal thiamine doses upon admission, and daily complementation of inpatients' food and enteral feeding solutions with multi-micronutrient tablets might be considered

Les cancers de l’orbite etude retrospective à propos de 31 cas

locorégionale rendant le traitement difficile et mutilant. Dans ce travail, nous rapportons notre expérience dans la prise en charge diagnostique et thérapeutique de ces tumeurs. Matériels et méthodes : Notre étude rétrospective a concerné 31 cas de cancers de l’orbite colligés sur 13 ans (1993- 2005). Tous les patients ont bénéficié d’un examen clinique complet, d’une imagerie du massif facial (TDM et/ou IRM) et d’une biopsie de la tumeur. Le traitement a été basé sur la chirurgie, la radiothérapie et/ou la chimiothérapie. Résultats : La symptomatologie clinique était dominée par les signes ophtalmologiques et les algies faciales. L’imagerie a montré dans tous les cas un processus expansif tissulaire à point de départ orbitaire, avec lyse osseuse orbitaire chez 16 patients (51,6%), une extension au massif facial chez 7 patients (22,6%), endocrâniennes chez 6 patients (19,4%) et des formes bilatérales atteignant les deux orbites dans 3 cas (9,7%) l’anatomopathologie montrait une prédominance des lymphomes malins non hodgkiniens (32,3%) et des carcinomes épidermoïdes (32,3%), suivis des rhabdomyosarcomes embryonnaires (19,4 %). Douze patients ont été traités par chirurgie et radiothérapie postopératoire, dix patients par une association radio-chimiothérapie, et neuf autres par une chimiothérapie néo-adjuvante. La survie globale était de 67,8% à 3 ans, 48,4% à 5 ans et 22,6% à 10 ans. Conclusion : Les cancers de l’orbite sont de mauvais pronostic. Un diagnostic précoce et un traitement radical et adapté au type histologique permet d’améliorer la survie et la qualité de vie chez les patients atteints de ces tumeurs.Mots-clés : Orbite, cancer, lymphome, carcinome épidermoïde, rhabdomyosarcom

The Most Common Comorbidities in Dandy-Walker Syndrome Patients: A Systematic Review of Case Reports.

OBJECTIVE: Dandy-Walker syndrome (DWS) is a rare neurologic multi-entity malformation. This review aimed at reporting its main nonneurologic comorbidities. METHODS: Following PRISMA guidelines, search in Medline was conducted (2000-2014, keyword: dandy-walker). Age, sex, country, DWS type, consanguinity or siblings with DWS, and recorded coexistent conditions (by ICD10 category) were extracted for 187 patients (46.5% male, 43% from Asia) from 168 case reports. RESULTS: Diagnosis was most often set in 12 years old (27.8%). One-third of cases had a chromosomal abnormality or syndrome (n = 8 PHACE), 27% had a cardiovascular condition (n = 7 Patent Ductus Arteriosus), 24% had a disease of eye and ear (n = 9 cataract); most common malignancy was nephroblastoma (n = 8, all Asian). Almost one-fifth had a mental illness diagnosis; only 6.4% had mild or severe intellectual disability. CONCLUSION: The spread of comorbidities calls for early diagnosis and multidisciplinary research and practice, especially as many cases remain clinically asymptomatic for years

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses.

BACKGROUND: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. METHODS: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. RESULTS: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. CONCLUSIONS: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities

Adaptive Oblivious Transfer and Generalization

International audienceOblivious Transfer (OT) protocols were introduced in the seminal paper of Rabin, and allow a user to retrieve a given number of lines (usually one) in a database, without revealing which ones to the server. The server is ensured that only this given number of lines can be accessed per interaction, and so the others are protected; while the user is ensured that the server does not learn the numbers of the lines required. This primitive has a huge interest in practice, for example in secure multi-party computation, and directly echoes to Symmetrically Private Information Retrieval (SPIR). Recent Oblivious Transfer instantiations secure in the UC framework suf- fer from a drastic fallback. After the first query, there is no improvement on the global scheme complexity and so subsequent queries each have a global complexity of O(|DB|) meaning that there is no gain compared to running completely independent queries. In this paper, we propose a new protocol solving this issue, and allowing to have subsequent queries with a complexity of O(log(|DB|)), and prove the protocol security in the UC framework with adaptive corruptions and reliable erasures. As a second contribution, we show that the techniques we use for Obliv- ious Transfer can be generalized to a new framework we call Oblivi- ous Language-Based Envelope (OLBE). It is of practical interest since it seems more and more unrealistic to consider a database with uncontrolled access in access control scenarii. Our approach generalizes Oblivious Signature-Based Envelope, to handle more expressive credentials and requests from the user. Naturally, OLBE encompasses both OT and OSBE, but it also allows to achieve Oblivious Transfer with fine grain access over each line. For example, a user can access a line if and only if he possesses a certificate granting him access to such line. We show how to generically and efficiently instantiate such primitive, and prove them secure in the Universal Composability framework, with adaptive corruptions assuming reliable erasures. We provide the new UC ideal functionalities when needed, or we show that the existing ones fit in our new framework. The security of such designs allows to preserve both the secrecy of the database values and the user credentials. This symmetry allows to view our new approach as a generalization of the notion of Symmetrically PIR

Structure-Preserving Smooth Projective Hashing

International audienceSmooth projective hashing has proven to be an extremely useful primitive, in particular when used in conjunction with commitments to provide implicit decommitment. This has lead to applications proven secure in the UC framework, even in presence of an adversary which can do adaptive corruptions, like for example Password Authenticated Key Exchange (PAKE), and 1-out-of-m Oblivious Transfer (OT). However such solutions still lack in efficiency, since they heavily scale on the underlying message length. Structure-preserving cryptography aims at providing elegant and efficient schemes based on classical assumptions and standard group operations on group elements. Recent trend focuses on constructions of structure- preserving signatures, which require message, signature and verification keys to lie in the base group, while the verification equations only consist of pairing-product equations. Classical constructions of Smooth Projective Hash Function suffer from the same limitation as classical signatures: at least one part of the computation (messages for signature, witnesses for SPHF) is a scalar. In this work, we introduce and instantiate the concept of Structure- Preserving Smooth Projective Hash Function, and give as applications more efficient instantiations for one-round PAKE and three-round OT, and information retrieval thanks to Anonymous Credentials, all UC- secure against adaptive adversaries