A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis.

The performance of ultrasound (US) in the diagnosis of acute gouty (MSU) arthritis and calcium pyrophosphate (CPP) arthritis is not yet well defined. Most studies evaluated US as the basis for diagnosing crystal arthritis in already diagnosed cases of gout and few prospective studies have been performed. One hundred nine consecutive patients who presented an acute arthritis of suspected microcrystalline arthritis were prospectively included. All underwent an US of the symptomatic joints(s) and of knees, ankles and 1(st) metatarsopalangeal (MTP) joints by a rheumatologist "blinded" to the clinical history. 92 also had standard X-rays. Crystal identification was the gold standard. Fifty-one patients had MSU, 28 CPP and 9 had both crystals by microscopic analysis. No crystals were detected in 21. One had septic arthritis. Based on US signs in the symptomatic joint, the sensitivity of US for both gout and CPP was low (60% for both). In gout, the presence of US signs in the symptomatic joint was highly predictive of the diagnosis (PPV = 92%). When US diagnosis was based on an examination of multiple joints, the sensitivity for both gout and CPP rose significantly but the specificity and the PPV decreased. In the absence of US signs in all the joints studied, CPP arthritis was unlikely (NPV = 87%) particularly in patients with no previous crisis (NPV = 94%). X-ray of the symptomatic joints was confirmed to be not useful in diagnosing gout and was equally sensitive or specific as US in CPP arthritis. Arthrocenthesis remains the key investigation for the diagnosis of microcrystalline acute arthritis. Although US can help in the diagnostic process, its diagnostic performance is only moderate. US should not be limited to the symptomatic joint. Examination of multiple joints gives a better diagnostic sensitivity but lower specificity

Mapping trabecular disconnection "hotspots" in aged human spine and hip

Trabecular bone disconnection is an independent factor in age-related skeletal failure where real termini (ReTm; rare in youth) may cause weakness disproportionate to tissue loss, yet their structural contribution at vulnerable locations remains uncertain. ReTm (previously recorded at the iliac crest) were mapped in "normal" aged vertebral bodies (T11-L5 autopsy; 20 females, 10 males) and corresponding proximal femora (autopsy; 10 females). Results were compared with biomechanically failed femora from orthopaedic subjects aged >. 58. yr (osteoporosis OP, 10 females; osteoarthritis OA, 10 females). A novel direct 2D/3D histological method was applied to large, thick (300. μm) slices superficially silver-stained to separate ReTm (unstained) from apparent termini (planar artefacts, brown). Light microscope field co-ordinates enabled ReTm mapping and statistical testing relative to i) sex, ii) tissue sector and iii) slicing plane. In men ReTm populations were small and random while in women they were large and sector-specific. In vertebrae they clustered anterior/superior being rare posterior/inferior; in the femoral head they concentrated distal/superior and also near the fovea, being fewer distal/inferior. A distribution polarity was evident with 100% more ReTm observed transversely (i.e., on tensile-related cross struts) than longitudinally (i.e., on compression-related vertical struts). Their numbers rose in OP (BV/TV. . 14%), remaining polarised and sector-specific in OP only. Comparative experimentation by marrow elution of an OP animal model demonstrated "floating segments" as a possible outcome. Conclusions were supported statistically that trabecular disconnection "hotspots" at vulnerable locations are sex- and sector-specific, mainly transaxial, and subject to disease modulation

Recension de Ulrich Herbert, Das Dritte Reich. Geschichte einer Diktatur, München (C. H. Beck) 2016, 133 S. (C. H. Beck Wissen, 2859), ISBN 978-3-406-69778-4

Compte-rendu de lectur

Erwin Rommel. Le temps des retraites dans les années de défaites (1942-1944)

Les contributeurs étudient l'émergence de personnalités en rupture avec les héros traditionnels, dans un contexte de guerres et de dictatures au XXe siècle, qui se caractérisent par la renonciation. Ils examinent notamment le cas d'A. Suarez, d'Adam Czeniakow et de R. Delavignette et établissent des correspondances avec les héros de fiction insoumis de T. Ungerer et J.M.G. Le Clézio. Electre 202

Erwin Rommel. Le temps des retraites dans les années de défaites (1942-1944)

Les contributeurs étudient l'émergence de personnalités en rupture avec les héros traditionnels, dans un contexte de guerres et de dictatures au XXe siècle, qui se caractérisent par la renonciation. Ils examinent notamment le cas d'A. Suarez, d'Adam Czeniakow et de R. Delavignette et établissent des correspondances avec les héros de fiction insoumis de T. Ungerer et J.M.G. Le Clézio. Electre 202

Notes de lectures : Nicolas Stargardt, La Guerre allemande. Portrait d’un peuple en guerre 1939-1945, traduit de l’anglais par Aude de Saint-Loup et Pierre-Emmanuel Dauzat, Paris, La Librairie Vuibert, 2017, 800 p.

Note de lectur