Multimodality management and outcomes of brain arterio-venous malformations (AVMs) in children: personal experience and review of the literature, with specific emphasis on age at first AVM bleed.

PURPOSE: The purpose of this paper is to study the presentation and analyse the results of multimodality treatment of brain arterio-venous malformations (AVMs) in children at our centre and review age at first AVM rupture in the literature. METHODS: Of 52 patients aged <18 years, 47 with brain AVMs (27 males and 20 females) aged 4-17 years (mean 12.2) were retrospectively reviewed. PubMed search revealed five additional studies including 267 patients where the prevalence of age-related AVMs rupture was analysed. RESULTS: In our study, 37 patients had bled, 9 were symptomatic without haemorrhage and 1 was incidental. Spetzler-Martin score distribution was 5 cases grade I, 18 grade II, 21 grade III and 3 grade IV. Appropriate imaging was performed, either CT/MRI angiogram only (in emergency cases) or catheter angiogram, prior to definitive treatment. There were 40 supratentorial and 7 infratentorial AVMs. Twenty-nine patients had microsurgery alone and 9 patients were treated by radiosurgery only. Three patients were embolised, all followed by radiosurgery, with one requiring surgery too, while 4 patients had combined surgery and radiosurgery. One patient is awaiting radiosurgery while another was not treated. Good outcomes, classified as modified Rankin score (mRS) 0-2 improved significantly after intervention to 89.4% from 38.3% pre-treatment (p value <0.0001). Angiography confirmed 96.6% obliteration after first planned operation. Repeat cerebral angiogram around age 18 was negative in all previously cured patients. Reviewing the literature, 82.0% (95% CI = [77-87]; N = 267) of children diagnosed with brain AVMs (mean age 11.4 ± 0.4) presented with a bleed in the last 22 years. Males significantly outnumbered females (136 vs 84) (p < 0.001). Ninety-five patients underwent surgical intervention alone when compared to other treatment modalities (p < 0.001). CONCLUSIONS: Microsurgical excision of surgically accessible intracranial AVMs remains the primary treatment option with very good outcomes. A significant number of patients' AVMs ruptured around puberty; therefore, understanding the pathophysiology of AVM instability at this age may aid future therapy

School readers in the Empire and the creation of postcolonial taste

A consideration of how Nelsons West Indian Readers in particular influenced the creative work of several generations of writers from the Caribbea

Growth and characterisation of bulk Sr2CuO2Cl2 single crystals

Large bulk single crystals of the Sr2CuO2Cl2 compound with dimensions of 15 x 6 x 4 mm(3) have been grown directly from the melt by the floating-zone method using a light-image furnace. The optimal growth conditions are found in a mixed atmosphere of 0.2 bar oxygen and 1.2 bar argon. Results of the characterisation have revealed thr high quality of the as-grown crystals. Furthermore, a possible congruent route of formation from the melt as well as the chemical stability of this compound is discussed

L errance dans l oeuvre de Meddeb entre islam, soufisme et Occident (lecture d un interculturel du possible)

Cette recherche propose une analyse du rapport interculturel entre l'islam et l Occident à travers la thématique de l'errance dans l'oeuvre d Abdelwahab Meddeb. Nous voulons montrer la corrélation entre l errance et l interculturalité, en nous nous appuyant sur trois axes dégagés dans l'oeuvre de Meddeb : l'autobiographie, l'écriture et l'islam et le soufisme. L'interculturalité est portée par le personnage même de l'auteur, à travers la double généalogie, arabo-musulmane et occidentale, et dont les deux pôles sont Ibn 'Arabi et Dante, ce qui nous conduit à examiner l inscription autobiographique dans l'oeuvre de Meddeb sous le prisme de l'errance. Cette analyse nous a permis de relever l hétérogénéité de cette autobiographie. En exhibant les multiples composantes de la personnalité du personnage de son oeuvre, Meddeb veut souligner que l'identité est composite et non monolithique, qu'elle n est point figée, mais en devenir. La généalogie cosmopolite du personnage entraîne une écriture fondée sur l errance. Il convient de voir, comment le récit circule entre plusieurs références ; linguistiques, culturelles et religieuses. Mû par sa double généalogie, le narrateur circule entre ses différentes appartenances, ses différentes références pour y puiser la matière et le matériau de son écriture. Cette porosité identitaire du personnage nous permet par exemple, d analyser l'évocation du vin à l aune de la mystique soufie. Enfin, nous proposons, à partir de l'oeuvre de Meddeb, une lecture de l'islam et du soufisme en rapport avec l errance. A travers des exemples précis tirés de l'oeuvre de Meddeb et des textes coranique et soufis nous avons observé que la religion mahométane et sa mystique sont nourries dès leurs racines par la sève de l'errance, de la cosmogonie aux pratiques rituelles, tout converge vers l'errance. Étant bâtis donc dans et autour de l errance, l'islam et le soufisme, sont prédisposés à l épreuve de l'interculturelThis paper will examine the intercultural link between Islam and the West through the notion of wandering in Abdelwahab Meddeb s work. The correlation between errance and interculturality will be explored under three perspectives taken from Meddeb s work: autobiography, writing and tasawwuf. The very author personifies interculturality with his dual-genealogy, Arab-Muslim and Western. His two centers are Ibn Arabi and Dante, hence the interest of the autobiographic inscription and the notion of errance in his work. This perspective reveals the heterogeneity of this autobiography. Meddeb exhibits the multiple components of his character s personality and thereby underlines how the essence of identity evokes mixed origins. Identity is not qualified as monolithic but rather as becoming and moving. The character s cosmopolite genealogy leads to the inscription of errance in the writing process. How does the narrative evolve through linguistic, cultural and religious references? Driven by his dual-genealogy, the narrator draws his writing material from his different senses of belonging and references. For instance, the character s porous identity enables us to analyze the evocation of wine at the standpoint of mystic Sufism. A reading of Islam and Sufism will finally be offered in relation with errance . Precise examples taken from Meddeb s work as well as texts from Sufism and the Koran demonstrate how errance fills the Mahometan religion. From cosmogony to concrete rituals, all seems to converge towards errance . Therefore built within and around errance , Islam and Sufism seem particularly adapted to the trial of interculturalityRENNES2-BU Centrale (352382101) / SudocSudocFranceF

Nonlinear susceptibility measurements in heavy fermion systems

We discuss the nonlinear susceptibility (χ3) as a probe of higher-order spin correlations in heavy fermion materials, with particular emphasis on U Ru2Si2 and U Be13. The sharp discontinuity of χ in U Ru2Si2 is contrasted with two other antiferromagnets U2Zn17 and U0.95Th0.05Pt3 with larger moments. Nonlinear magnetic properties of URu2Si2 can be understood simply in terms of Landau-Ginzberg theory for a large hidden, itinerant order parameter. In UBe13 we discuss how χ3 can be used to probe the presence of quadrupolar fluctuations. © 1994