Chronic non-bacterial osteomyelitis in children

Background: Chronic recurrent multifocal osteomyelitis (CRMO) in children is a chronic non-suppurative inflammation involving multiple sites. Some children affected by chronic non-bacterial osteomyelitis (CNO) do not have multiple lesions or a recurrent course. Objective: To characterise the long term outcome of children with the full spectrum of CNO. Methods: 30 children diagnosed with CNO were followed up for a mean of 5.6 years and their disease assessed using a clinical score, multiple imaging, and a diagnostic biopsy, including extensive microbial analysis. Results: 9 patients had unifocal non-relapsing disease, 3 unifocal lesions with relapses, 9 multifocal lesions without relapses, and 9 multifocal lesions with relapses (CRMO). Granulocytes were present significantly more often in CRMO than in unifocal and non-recurrent lesions. Pustulosis was more common in multifocal cases regardless of recurrence. Mean duration of treatment in 15 children with a single occurrence was 9.2 months. Naproxen treatment was generally effective. Naproxen treatment in 12 patients with relapses lasted 25 months. However, 7 of these were not effectively treated with naproxen alone. Five were treated with oral glucocorticoids for 27 days in addition to naproxen, which induced remission in four, lasting for at least 1.5 years. Longitudinal growth of affected bones was not altered, except for the development of hyperostosis. Conclusion: CNO is a spectrum of inflammatory conditions, with CRMO being the most severe. Most children with CNO have a favourable outcome of the disease. Oral glucocorticoids may be necessary in severe recurrent cases

Document collections, mobilized regulations, and the making of customary law at the end of the Middle Ages

Using late medieval examples from Switzerland, this paper argues that the emergence of formally organized archives around 1500 was part of an important shift in how documents could be deployed. However, this shift was not away from an oral and toward a literate culture, as argued in some earlier studies, but rather away from seeing documents as testimony that reminded a community about past authoritative actors, and toward relating the texts of documents to other texts, that is, to contexts. This shift took place largely through the appropriation of methods for using and organizing written material that had been developed in the realms of scholastic theology and liturgy, and applying them to secular lordship and administration. These methods provided new models for organizing collections of parchments and papers into connected archives and gave rise to new forms of text collection such as reorganized versions of law books (Spiegel, Coutumiers) containing new search tools such as tables of contents (capitulationes) and indices (abecedaria). Individual charters and scattered legal norms were also organized into textus–glossae structures in larger and smaller administrative units. In the Swiss case, the contextualization of legal texts was accompanied by an increased attribution of authority to ‘custom’ in general, because the community-oriented attribution of meaning found in earlier use was lost. Ultimately, recasting individual documents as part of larger textual contexts increased the power of rulers and ushered in an age of lawyers and of archives