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Resume Il n’existe a l’heure actuelle aucun traitement neuroprotecteur permettant de reduire la progression de la maladie de Parkinson (MP). Au debut du vingtieme siecle, trois grandes caracteristiques neuropathologiques ont ete decrites : la degenerescence des neurones dopaminergiques, les corps de Lewy, et l’accumulation en fer au niveau de la substance noire (SN). Cette accumulation en fer ainsi que sa grande toxicite ont ete confirmees dans toutes les formes de MP. Par crainte d’induire une anemie, aucune strategie therapeutique basee sur la chelation du fer n’avait ete developpee chez l’humain. Cependant, grâce au concept de chelation conservatrice du fer, nous avons etabli une nouvelle strategie de neuroprotection utilisant la molecule prototype deferiprone et mis en place des essais cliniques actuellement en phase II et III. La decouverte recente d’un nouveau mecanisme de mort cellulaire programmee non apoptotique dependante du fer, appelee ferroptose, qui predomine dans la MP, permettrait a la fois d’expliquer le mecanisme d’action de la chelation du fer tout en ouvrant de nouvelles perspectives therapeutiques de molecules anti-ferroptotiques.

The percutaneous aortic valve replacement (TAVI) is the most recent and promising procedure in the area of interventional cardiology with a rapidly growing number of interventions worldwide. The transfemoral approach being less invasive, it has become the predominant access for the device delivery. The prevention of vascular complications by an optimal risk stratification using appropriate imaging techniques (vascular CT scan and angiography), optimised techniques for femoral puncture (active control of the arterial punction, crossover...) and skilled teams for peripheral angioplasty and percutaneous arterial closure devices (Prostar) has become mandatory given the fragile target population for TAVI. Vascular complications remain indeed one of the most frequent complication although the trend toward reduced sheeths size led to significant reduction This is mandatory regarding the needed size of the vascular arterial access - itself with constant improvement by minimising the initial 24 French with mandatory real chirurgical closure to the actual 18-19 French and soon 16 French. The improvement of the implanted devices is due to the recent evidence of the promising future of this technique and the important technological effort realised by the industry not only on the implanted aortic prosthesis but also on their delivering catheters.

Le pseudo-anevrisme arteriel (PAA) de la femorale superficielle (FS) sur fracture de stent est une entite rare selon notre revue de la litterature. Nous rapportons le cas d’un homme de 73 ans qui consultait en urgence pour claudication a la marche d’apparition recente du membre inferieur droit. Antecedent de pose de stent de la FS en 2008. Au Doppler, on enregistrait un flux typiquement alternant de la femorale commune. Decouverte d’un PAA partiellement thrombose developpe aux depens de la jonction femorale superficielle (FS)–poplitee sus-articulaire (PSA) en regard du stent. Un angioscanner en urgence confirmait la presence d’un volumineux PAA mesurant 7 cm de hauteur, 6 cm de large et 5 cm d’epaisseur partiellement thrombose. Il etait situe au niveau d’une zone de discontinuite du stent avec visualisation d’une breche sur son versant posterieur. La prise en charge fut chirurgicale avec mise a plat greffe femoro-poplitee sus-articulaire prothetique SILVER® de 8 mm. Le choix de la chirurgie a ete fait par necessite d’un abord chirurgical pour evacuer la compression liee a l’anevrisme et egalement en l’absence de stent couvert de taille correspondante dans le contexte d’urgence. Les suites operatoires ont ete simples et le controle au scanner fut satisfaisant avec un retour du patient a son domicile au 4e jour postoperatoire.

We present here the optical properties of humic-like substances (HULIS) isolated from the fine fraction of biomass-burning aerosol collected in the Amazon basin during the LBA-SMOCC (Large scale Biosphere atmosphere experiment in Amazonia – SMOke aerosols, Clouds, rainfall and Climate) experiment in September 2002. From the isolated HULIS, aerosol particles were generated and their scattering and absorption coefficients measured. The size distribution and mass of the particles were also recorded. The value of the index of refraction was derived from "closure" calculations based on particle size, scattering and absorption measurements. On average, the complex index of refraction at 532 nm of HULIS collected during day and nighttime was 1.65–0.0019i and 1.69–0.0016i, respectively. In addition, the imaginary part of the complex index of refraction was calculated using the measured absorption coefficient of the bulk HULIS. The mass absorption coefficient of the HULIS at 532 nm was found to be quite low (0.031 and 0.029 m2 g−1 for the day and night samples, respectively). However, due to the high absorption Ångström exponent (6–7) of HULIS, the specific absorption increases substantially towards shorter wavelengths (~2–3 m2 g−1 at 300 nm), causing a relatively high (up to 50%) contribution to the light absorption of our Amazonian aerosol at 300 nm. For the relative contribution of HULIS to light absorption in the entire solar spectrum, lower values (6.4–8.6%) are obtained, but those are still not negligible.

As part of the Large Scale Biosphere-Atmosphere Experiment in Amazonia – Smoke, Aerosols, Clouds, Rainfall and Climate (LBA-SMOCC) campaign, detailed surface and airborne aerosol measurements were performed over the Amazon Basin during the dry to wet season from 16 September to 14 November 2002. Optical and physical properties of aerosols at the surface, and in the boundary layer (BL) and free troposphere (FT) during the dry season are discussed in this article. Carbon monoxide (CO) is used as a tracer for biomass burning emissions. At the surface, good correlation among the light scattering coefficient (σs at 545 nm), PM2.5, and CO indicates that biomass burning is the main source of aerosols. Accumulation of haze during some of the large-scale biomass burning events led to high PM2.5 (225 μg m−3), σs (1435 Mm−1), aerosol optical depth at 500 nm (3.0), and CO (3000 ppb). A few rainy episodes reduced the PM2.5, number concentration (CN) and CO concentration by two orders of magnitude. The correlation analysis between σs and aerosol optical thickness shows that most of the optically active aerosols are confined to a layer with a scale height of 1617 m during the burning season. This is confirmed by aircraft profiles. The average mass scattering and absorption efficiencies (545 nm) for small particles (diameter Dp2 g−1, respectively, when relating the aerosol optical properties to PM2.5 aerosols. The observed mean single scattering albedo (ωo at 545 nm) for submicron aerosols at the surface is 0.92±0.02. The light scattering by particles (Δσs/Δ CN) increase 2–10 times from the surface to the FT, most probably due to the combined affects of coagulation and condensation.

Whether in person or in the guise of some fictional character, the figure of Eugène-François Vidocq appears regularly in the literature of the nineteenth century. In the present article, I study the figure's literary posterity and examines how the ex-convict who rose to the rank of chief of police was treated by some French and English authors of the time, including Jerrold, Balzac and Collins. By doing so I establish the various processes involved in the making of a legend and explore the different stages in the development of the adventurer as a social type in the nineteenth century.

We investigated the size distribution, scattering and absorption properties of Amazonian aerosols and the optical thickness of the aerosol layer under the pristine background conditions typical of the wet season, as well as during the biomass-burning-influenced dry season. The measurements were made during two campaigns in 1999 as part of the European contribution to the Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA-EUSTACH). In moving from the wet to the dry season, median particle numbers were observed to increase from values comparable to those of the remote marine boundary layer (~400 cm-3) to values more commonly associated with urban smog (~4000 cm-3), due to a massive injection of submicron smoke particles. Aerosol optical depths at 500 nm increased from 0.05 to 0.8 on average, reaching a value of 2 during the dry season. Scattering and absorption coefficients, measured at 550 nm, showed a concomitant increase from average values of 6.8 and 0.4 Mm-1 to values of 91 and 10 Mm-1, respectively, corresponding to an estimated decrease in single-scattering albedo from ca. 0.97 to 0.91. The roughly tenfold increase in many of the measured parameters attests to the dramatic effect that extensive seasonal biomass burning (deforestation, pasture cleaning) is having on the composition and properties of aerosols over Amazonia. The potential exists for these changes to impact on regional and global climate through changes to the extinction of solar radiation as well as the alteration of cloud properties.

Background The clinical significance of moderate coronary stenosis is a fundamental to the choice of treatment. The gold standard is invasive fractional flow reserve (FFR) studying by quantitative coronary angiography (QCA). The role of 256 slices coronary computed tomography angiography (CCTA) one-beat acquisition is insufficiently studied and may be an important factor to predict the clinical significance of moderate coronary stenosis. Purpose To identify morphological CCTA predictors for the clinical significance of moderate coronary artery stenosis. Methods A total of 61 arteries (43 consecutive patients) underwent CCTA and QCA associated with a lesion-specific FFR measurement were retrospectively analyzed. CCTA was performed on a 256-slices CT one-beat acquisition, three-phase injection protocol by using smart shot dual injector. Stenosis from 50–69% were considered as moderate. FFR ≤ 0.80 was considered as functionally significant. Results The mean age was 67.9 ± 10.1, BMI 27.3 ± 4.4 kg/m2 and 75% were males. Twenty-nine percent patients (18 arteries) have clinically significant moderate stenosis with FFR ≤ 0.8; 23% (n = 14) have moderate but not clinically significant stenosis (FFR > 0.80) and 48% (n = 29) were presented by 30–49% stenosis. All of stenosis 0.8 (P Conclusion CCTA plays an important role for noninvasive assessment of clinical significance of moderate coronary stenosis. Moderate stenosis are clinically significant (FFR ≤ 0.8) if their length is more than 16 mm in calcified arteries, particularly in culprit arteries with multiple stenosis.

Resume La tuberculose neonatale ou congenitale est une manifestation meconnue de l'infection a Mycobacterium tuberculosis . Observations Cas 1. Un nouveau-ne premature et hypotrophique souffrait a j45 et en dehors de tout contact maternel d'une bronchopneumopathie bilaterale. Alors que la grossesse et l'accouchement s'etaient deroules sans incident notable, la mere a developpe une miliaire tuberculeuse. Sous rifampicine, isoniazide et pyrazinamide, elle decedait d'une insuffisance renale. Malgre le traitement, l'enfant decedait a j52 d'une defaillance multiviscerale. Apres quelques semaines, la culture des secretions tracheales a confirme le diagnostic de tuberculose. Cas 2. Un nouveau-ne premature et hypotrophique montrait a j22 une detresse respiratoire (miliaire), un ictere et une hepatosplenomegalie. Alors que la grossesse et l'accouchement s'etaient deroules sans incident, la mere avait 18 jours apres l'accouchement une miliaire et une pleuresie tuberculeuses. Malgre l'association de rifampicine, d'isoniazide et de pyrazinamide debutee a j22, l'enfant decedait a j27 dans un tableau de defaillance multiviscerale. Les biopsies hepatiques post mortem confirmaient le diagnostic de tuberculose. Cas 3. Un nouveau-ne a terme est hospitalise a j4 pour un ictere. Grossesse et accouchement s'etaient deroules sans incident. La mere developpait a j 10 une pleuresie tuberculeuse. L'allaitement etait interrompu. Devant la presence d'opacites pulmonaires, un traitement par rifampicine, isoniazide et pyrazinamide etait debute chez l'enfant. Une hepatomegalie et une mauvaise prise ponderale etaient observees jusqu'a j25, suivies d'une amelioration secondaire. Conclusion La tuberculose congenitale est une pathologie probablement sous-estimee. Un diagnostic precoce est indispensable, mais souvent delicat car les premiers signes sont retardes. Un meilleur depistage des femmes a risques ainsi qu'une sensibilisation du corps medical sont necessaires.

Resume La neurocysticercose est la parasitose du systeme nerveux central (SNC) la plus frequente dans le monde. Son extension, l'importance des flux migratoires depuis les pays d'endemie et la proximite de certains foyers font qu'il n'est plus exceptionnel d'avoir a envisager ce diagnostic en France metropolitaine. L'epilepsie en est la forme de revelation habituelle. Le diagnostic repose sur l'imagerie (tomodensitometrie et resonance magnetique) et la serologie (Elisa et Western Blot) qui doivent etre demandees devant tout signe clinique evocateur d'une atteinte du SNC chez un sujet ayant sejourne en region d'endemie cysticerquienne. L'evolution est tres variable, de la latence clinique complete a l'encephalopathie convulsivante avec regression psychomotrice. Le traitement specifique repose sur deux antiparasitaires de classe differente: le praziquantel (Biltricide®) et l'albendazole (Zentel®). Les indications de la corticotherapie sont encore discutees mais les symptomes de la neurocysticercose sont tres corticosensibles a la phase aigue de la maladie. Les formes racemeuses et les localisations intraventriculaires peuvent necessiter le recours a la neurochirurgie. Les espoirs therapeutiques dans les pays d'endemie reposent principalement sur les campagnes de prevention et les progres de la vaccination.

Summary In order to improve elm resistance to dutch elm disease by genetic engineering, woody internodes of field grown elms Commelin were tested for regeneration capacity and susceptibility to Agrobacterium tumefaciens . After a drastic surface disinfection (especially burning), the explants were introduced in vitro on a medium containing cef otaxime (500 mg - L ∔1 ). Budding took place within 2 weeks on the cambial part of the explants. After 1-2 months, the number of rootable shoots per explant was 3 -6, increasing up to 13 by shoot excision. Shoot rooting (70 %) and acclimatization (survival 80 %) were easy. Agrobacterium tumefaciens wild strains (Ach5, T37, C58, 82-139) were either inoculated on shoots or cocultivated on internodes. Octopine/agropine type Ach5 induced tumors (> 50 %) where agropine was often detected. Efficiency of 82-139 was lower. However, it was very effective in improving budding ability of internodes up to 11. A strategy to obtain transgenic elm based on these results is now in progress.

The percutaneous aortic valve replacement (TAVI) is the most recent and promising procedure in the area of interventional cardiology with a rapidly growing number of interventions worldwide. The transfemoral approach being less invasive, it has become the predominant access for the device delivery. The prevention of vascular complications by an optimal risk stratification using appropriate imaging techniques (vascular CT scan and angiography), optimised techniques for femoral puncture (active control of the arterial punction, crossover...) and skilled teams for peripheral angioplasty and percutaneous arterial closure devices (Prostar) has become mandatory given the fragile target population for TAVI. Vascular complications remain indeed one of the most frequent complication although the trend toward reduced sheeths size led to significant reduction This is mandatory regarding the needed size of the vascular arterial access - itself with constant improvement by minimising the initial 24 French with mandatory real chirurgical closure to the actual 18-19 French and soon 16 French. The improvement of the implanted devices is due to the recent evidence of the promising future of this technique and the important technological effort realised by the industry not only on the implanted aortic prosthesis but also on their delivering catheters.

The objective of the study was to determine the concordance of emergency physicians' and cardiologists' interpretations of emergency department (ED) electrocardiograms (ECG), to evaluate the impact of ECG misinterpretation on patient management, and to determine error rates as a function of the level of physician training and the specific ECG diagnoses. ECG interpretations were registered prospectively using a programmed-response data sheet. A second blinded interpretation by a staff cardiologist was assumed to be correct. Only ECG discrepancies with potential or probable clinical importance were considered as errors. The ED management of patients with ECG misinterpretations was reviewed by the investigators. The study was performed at an urban university hospital using 300 consecutive ED ECGs. The analysis found 154 errors of interpretation of which nine had probable clinical significance, and 56 had indeterminant significance. The concordance was weak at 0.69 (Kappa = 0.32, weighted Kappa = 0.30) with a significant discordance (McNemar Chi 2:P < 0.05). Error rates did not differ significantly between the diverse categories of physicians. In two cases, interpretation errors impacted patient management decisions but not patient outcomes. The most frequent errors involved repolarization abnormalities, ventricular hypertrophy and hemi-blocks. While discordance was significant, errors in ECG interpretation rarely impacted patient management. Prospective evaluation of ECG interpretation may be a useful means of gauging physician skills. It can also serve to focus educational activities on problem areas in electrocardiography.

Multilayer RF printed circuits boards with embedded passives are complex structures to manufacture and to package while keeping good RF performances. In this paper, technological solutions aimed at simplifying these issues are proposed: the use of thermoset materials instead of thermoplastic laminates and an original interconnection technique based on "RF openings" machined in the edges of the boards. Two breadboards based on these solutions have been developed and demonstrate very good RF performances between 5 and 15 GHz.

The impact of accidental injury on childhood morbidity and mortality in Africa is underestimated. The frequency and severity of accidents is high. This retrospective study includes 381 children (3% of admission) between the ages of 0 and 15 years hospitalized for accidental injury at the Principal Hospital in Dakar, Senegal, between January 1, 1997 and December 31, 2000. The annual incidence of childhood injury doubled over the 4-year study period. Mean age was 48 months and the M/F sex ratio was 1.7. The causes were trauma (n = 184) due to domestic accidents (n = 109 including 91 falls) or road accidents (n = 75), poisoning (n = 129 including 38 caustic soda burns), foreign body aspiration or ingestion (n = 30), burns (n = 18), and miscellaneous accidents (n = 20). Most fatalities (9%) were due to road accidents and falls. Rapid uncontrolled urbanization and problems of displaced rural populations in adapting to city living may account for the high frequency of falls from high buildings and road accidents. As in industrialized countries road accidents, though not the most frequent, are the most lethal. Lack of emergency services accounts for severity. Vigorous information campaigns and prevention action will be needed to lower the high morbidity and mortality of childhood injury in developing countries.

Childhood cancer has often been considered as a problem mainly affecting industrialized countries. In reality more than half of cases occur in developing countries where management and diagnosis are major issues. This retrospective study includes 130 children (0.3% of admissions) between the ages of 0 and 15 years hospitalized for malignant disease at the Principal Hospital in Dakar, Senegal between January 1, 1990 and December 31, 2000. Mean age was 97 months and M/F sex ratio was 1.2. Mean delay for admission was 3 months. The five most frequent cancers, accounting for 75% of cases, were leukemia (n = 28), lymphoma (n = 21), nephroblastoma (n = 21), retinoblastoma (n = 16) and osteochondrosarcoma (n = 10). Treatment was completed in 18% of cases. Half of patient were lost from follow-up. The cure rate was 10% overall and 50% for patients receiving complete treatment. The highest cure rate was achieved for nephroblastoma, i.e., 58% of cases treated. Management of childhood cancer in Africa is confronted with numerous problems, namely, paucity of specialized staff, absence of expert centers, shortage of anticancer drugs, lack of financial resources, and delay in treatment. These factors associated with frequent malnutrition and recurrent infectious diseases, greatly lower cure rates in comparison with industrialized countries.

We introduce an automated and accurate system for registering pre-operative 3D MR and CT images with intraoperative 3D ultrasound images based on the vessels visible in both. The clinical goal is to guide the radio-frequency ablation (RFA) of liver lesions using percutaneous ultrasound even when the lesions are not directly visible using ultrasound. The lesions locations and desired RFA sites are indicated on pre-operative images, and those markings are made to appear within the intra-operative 3D ultrasound images. We present our current implementation, provide analyses of its components, and demonstrate its performance.

We studied thrombocytopenia during acute Plasmodium falciparum malaria in 64 traveller children from Paris (France), 85 children from Dakar (Senegal) with an intermittent exposure (69 with severe attack or cerebral malaria), and 81 children from Libreville (Gabon) with a perennial exposure (43 with severe attack or cerebral malaria). Initial thrombocytopenia was present in 43-58% of children with P falciparum malaria but was not more frequent in severe outcome or cerebral malaria. Low parasitaemia may lead to the misdiagnosis of malaria and delayed treatment when there is associated thrombocytopenia

The relevance of WHO criteria for severe and complicated malaria has been debated for a while, especially as regards children. Recent data led WHO experts to modify the definition of severe malaria. The objective of this study was to evaluate retrospectively the significance of the new definition on severity, lethality and intensive care distribution in children admitted with falciparum malaria (in 1997-99) to Hopital Principal de Dakar, Senegal. We used the paediatric risk of mortality score (PRISM) to compare the 2 definitions, WHO 2000 and WHO 1990. Finally, we evaluated the impact of the new definition in terms of major therapeutic interventions (MTIs): mechanical ventilation, haemodynamic support, transfusion, haemodialysis, and the use of sedatives. Among 311 patients, the frequencies of severe malaria cases and case-fatality rates thereof were 52% (n = 161) and 17% (n = 28) respectively using the 1990 WHO criteria, and 75% (n = 233) and 12% (n = 28) using the 2000 WHO criteria. Mean PRISM score among severe cases decreased with the new definition (6.5 versus 8.6). Both definitions predicted neurological sequelae and deaths with 100% sensitivity. One or more MTIs were required in severe malaria cases in 86% (n = 139) under the 1990 criteria and 73% (n = 170) under the 2000 criteria. In this area of low and seasonal transmission, the 2000 WHO definition of severe malaria proved broader and less specific, but was easier to apply and retained the high sensitivity of the earlier definition in identifying life-threatening infections.

Three unknown di- and tricarboxylic acids were characterized in the fine size fraction of aerosols which were collected during the wet season in the Amazon basin (Rondonia, Brazil). For the structural characterization of the methyl esters of these unknown compounds, mass spectrometry with electron ionization (EI) and tandem mass spectral techniques combined with gas chromatographic (GC) separation were employed. Fragment and parent ion spectra were recorded during elution of the GC peaks by linked scanning of the B and E sectors in combination with high-energy collision-induced dissociation. The fragmentation patterns of significant ions in the first-order EI spectra were also obtained for nonanedioic acid, which was examined as a model compound. The compounds were tentatively identified as 4-acetyloxyheptanedioic acid and cis and trans isomers of 5-hexene-1,1,6-tricarboxylic acid. Since there were indications of biomass burning during the aerosol sampling the di- and tricarboxylic acids characterized in the present work could be markers for biomass burning. Furthermore, the characterization of di- and tricarboxylic acids in the fine size fraction of atmospheric aerosols may be important for assessing the effects of organic aerosols in cloud formation.

The authors report a new case of isolated spontaneous nephrocutaneous fistula revealed by a persisting draining sinus in the left groin. Their present causative factors are identified. The computed tomography and magnetic resonance imaging actually may resolve the diagnostic dilemma and are helpful in the surgical treatment.

Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to fibrinolysis in the treatment of acute myocardial infarction (AMI). However, after balloon PTCA, the rate of early re-occlusion, of re-infarctus and of restenosis remains high. Stent implantation with antiplatelet drug regimen (aspirin, ticlid) limits these risks. Abciximab (new GPIIb/IIIa receptors inhibitor) reduces PTCA complications rate in the acute coronary syndromes. Intravenous administration of abciximab can restore a normal flow in the infarcted related coronary artery (IRA) after few minutes. A monocentric, non randomized, prospective pilot study was iniated to assess the feasibility of pre-hospital treatment with abciximab in preparation to primary PTCA stenting in AMI (primary endpoint) and to appreciate potential benefits in initial IRA patency as well as prevention of PTCA thrombotic complications (secondary endpoint). Between April 1997 and January 1998, 38 AMI were treated with abciximab in pre-hospital phase (group A). Mobil Intensive Care Unit (MICU) team implemented the treatment and guaranteed immediate transport to the cathlab (abciximab bolus-coronary angiography time = 37 +/- 17 min). Immediate results were compared to those of 198 paired patients who were treated for AMI during the same period (Group T). Initial IRA flow TIMI grade 3 was significantly higher in group A, 24%, than in group T, 9% (p0.017). The rates of per-procedural complications (no flow, distal embolism), of local complications, of transfusions were not significantly different. During 1 month follow-up, there was no significant difference between group A and group T concerning death, re-MI, stent thrombosis and new revascularization. To conclude, the pre-hospital treatment with abciximab in AMI is feasible by MICU medical team without any delay of the cathlab admission. It is associated with no increased hemorrhagic complications rate. The abciximab pre-hospital treatment improves the initial IRA patency. These encouraging preliminary results expect to be confirmed by larger, multicentric, randomized and prospective studies.

Congenital syphilis is responsible for a variety of clinical symptoms, from subclinical attacks to septicemic forms that may be fatal. The most frequently encountered forms typically involve low birth weight, heptosplenomegaly and jaundice. Premature birth, anemia, cutaneous lesions, coryza, anasarca and pseudoparalysis may also occur. Neonatal X rays generally show characteristic but nonspecific osteochondrocyte lesions and periosteous dystrophy. A clinical form partly associated with growing tissues may be detected late. Diagnosis of fetal syphilis depends on the detection by immunofluorescence of specific IgM immunoglobulins in the newborn. Parenteral antibiotic treatment with 100,000 IU penicillin/kg.day for 15 days is given to newborns with symptoms. The classification and treatment of asymptomatic forms is unclear. A single injection of benzathine-penicillin is a good compromise between simple surveillance and admission to hospital for 10 days of intravenous treatment. In any case, serological surveillance is required to check that IgM disappears from the blood or that the titer of IgG decreases. Reinfection is always possible, even in a newborn treated correctly. In developing countries, pediatricians must be aware of the various clinical forms of congenital syphilis. In addition, national programs to combat sexually transmitted diseases should be supported and developed by international aid agencies. In economically advanced countries, attention is currently focused on the restricted nature of medical treatment. Improvements in the management of congenital syphilis depend above all on dealing with the social and cultural problems of populations affected by syphilis.

The object of this study was to assess the value of CK in the evaluation of left ventricular wall motion. Fifteen coronary patients aged 56 +/- 12 years were included: 8 patients were examined after acute myocardial infarction and 7 after unstable angina with a history of myocardial information. The left ventricle was divided into 7 segments after a modified Heger model, excluding the basal septal and basal lateral segments not seen on angiography. The left ventricular wall motion was assessed in two-dimensional echocardiography (2DE) and colour kinesis (CK) by two observers and compared with the results of left ventriculography, considered the reference method. Over all the 105 segments studied (7 segments for each of the 15 patients), CK was significantly better than 2DE (80% of segments correctly evaluated by CK vs 68% by 2DE, p0.05). Colour kinesis significantly improved the study of all segments except the interventricular septum (67% vs 60%, p = NS). The inter-observer variability in 2DE and CK evaluated over 135 segments (9 per patient) by the kappa was improved by colour kinesis (0.57 in 2DE, 0.7 in CK). The authors conclude that CK enables evaluation of left ventricular wall motion with greater precision and less inter-observer variability.

The authors report the case of a 34 year old woman, admitted to hospital because of myocardial infarction two months after delivery of her fifth child. The infarction was caused by spontaneous dissection of the left main coronary and left anterior descending arteries. Twenty-three months later, the patient was well with medical therapy. This case is an example of spontaneous post-partum coronary dissection which is the commonest cause of infarction occurring in that period. The physiopathology of this complication is not fully understood. The prognosis is poor, lethal in two thirds of cases. However, it must be emphasised that coronary dissection may regress spontaneously. Patients were previously referred systematically for surgery, but now it is usually reserved for cases with persistent myocardial ischaemia despite medical therapy. Angioplasty may be preferred despite the risks and may be successful in some cases.

Dynamic simulation solver codes are now extensively used by industry for the design verification of vehicle crashworthiness and for the process simulation of sheet metal forming. The logical next step is to use these by now proven codes for the optimization of the vehicle crash design and of metal forming processes. A step towards this goal has been taken by PSI, and an optimization code, PAM-OPT™, has been written for calling dynamic FE codes of the PAM-SOLID™ family in design and process optimization loops. The code interacts with the user via input, signalling and output files and it calls an interface that interacts with the FE solvers. The paper briefly outlines the properties and various flow charts of the optimizer, depending on single or multiple solvers used in the loop, single or parallel calls and fast solvers. Then the paper reports various applications of PAM-OPT™ in conjunction with the PAM-SFE™, PAM-CRASH™, PAM-SAFE™ and PAM-STAMP™ solvers. An outlook on how to replace the user-written interface with a general keyword-driven interface concludes the paper.

The authors report the case of a 31 year old woman at 30 weeks' gestation who developed a non-Q wave postero-lateral myocardial infarction during treatment with salbutamol. There were no complications and delivery took place at term normally. Coronary angiography was performed 3 months post-partum and was normal: the Methergin test was negative. Myocardial ischaemia occurring during treatment with a beta-2 mimetic in pregnancy is rare and hardly ever progresses to myocardial infarction. The usual mechanism of ischaemia is an imbalance of myocardial oxygen demand and supply. Myocardial oxygen consumption is naturally increased during pregnancy and excess intracellular calcium secondary to the beta-1 stimulation occurring with the use of beta-2 mimetic drugs further aggravates matters. This hypothesis raises the question of the value of calcium inhibitors in these forms of myocardial ischaemia.

One case of repeated incisional hernia is reported. This hernia was initially repaired but repeated infection occurred. This hernia was then successfully treated with a fasciocutaneous tensor fasciae latae island flap. The patient was reexamined two years after surgery and presented a functional abdominal wall. Other different reconstructive possibilities of regional myocutaneous flaps are described.

BETTER THAN ANGIOPLASTY: Prolonging inflation with a perfusion balloon decreases the risk of acute coronary occlusion after angioplasty. The longer the artery remains patent, the greater the chances of 0% residual stenosis. This is what the sent allows. Stent act on both mechanisms of stenosis: elastic recoil and fibrous remodeling of the arterial plaque. TARGETTED ACTION: Stents improve angioplasty prevention of acute stenosis. They have a real action on preventing degeneration of the saphenous graft and lead to a significant reduction in the rate of restenosis of the dilated site. There are however two specific complications: subacute occlusion and greater incidence of vascular events. Stents are particularly indicated for the treatment of restenosis and chronic occlusions. TWO IMPROVEMENTS: Risks related to the implantation of a foreign body in the vascular system have been reduced with the use of ticlopidine and high-pressure stent implantation. POSITIVE RESULTS: Stents have produced better angiographic results. They limit restenosis and the number of revascularizations required in treated patients. Several questions concerning indications remain open.

GENERAL CHARACTERISTICS: Several criteria are used for coronary stent design: biocompatibility, i.e. the capacity to resist thrombotic events and corrosion, flexibility, radial force sufficient to resist elastic recoil, percentage of the lesion covered, radio-opacity, minimal shortening at opening, absence of effect on collateral branches, possibility to use small calibre probe guides, and cost. TWO CATEGORIES: Both tubular stents (self-expanding stents and balloon stents) and filamentary stents (made of stainless steel or tantalum) are used, THE IDEAL STENT: There is no one ideal stent. Choice is dictated by the characteristics of the lesion and by the status of the artery to treat.

RATIONALE FOR ANTITHROMBOSIS THERAPY: Introducing a foreign body into the coronaries raises the risk of thrombosis in the acute phase and for the 4 following weeks. The objective of antithrombotic therapy is to inhibit platelet adhesion and aggregation or to induce hypocoagulability. AT IMPLANTATION: High-dose heparin is given in a bolus following pretreatment with aspirin. ASPIRIN-TICLOPIDINE COMBINATION: The risk of subacute thrombosis is low, about 1%, and the rate of vascular complications is minimal. Treatment is simple and compatible with short hospitalization.

Right ventricular involvement during inferior wall myocardial infarction does not seem to alter long-term clinical prognosis but its specific outcome has not been clearly studied. We have previously demonstrated that pulmonary regurgitant (PR) flow tracings doppler analysis allows the accurate diagnosis of RV involvement, especially when the pressure half-time of PR wasor = 150 ms and the ratio of the minimal velocity to the maximal velocity wasor = 0.5. We studied 40 patients with acute inferior wall myocardial infarction and with PR flow. Doppler echocardiography was obtained during the first day, before discharge (early control) and between 12 and 24 months follow-up (late control). Among 22 patients with RV involvement defined with PR-derived doppler parameters (RVIPR). 8 had right ventricular enlargement and/or wall motion abnormalities, observed in 6 cases at early control and in 4 at late control. Doppler analysis showed remnant RVIPR parameters in 9 patients at early control and 8 among these at late contorl, with no relation with pulmonary artery pressure or other echocardiographic parameters. No clinical, angiographic or therapeutic data predicted these distinct echocardiographic and doppler patterns and the long-term prognosis was not different. At late control, among 12 RVIPR patients which PR-derived doppler parameters were normal at early control, two patients had still RVIPR pattern at late control and described ischemic recurrence. PR flow doppler analysis is a useful tool for diagnosis and outcome evaluation of RV involvement and shows a remnant diastolic dysfunction in half of the patients with acute RV involvement.

Neurocysticercosis (i.e. cerebral localization of the metacestode larvae of Taenia solium) is believed to be a major cause of late onset epilepsy in non-Muslim developing countries. To define its role in childhood epilepsy in Madagascar, analysis of serological markers of cysticercosis was performed in 256 children with unexplained epilepsy and in 113 controls. Sera were considered positive when high titres in ELISA were present together with at least one of the bands 13, 14, 18, 21, 24 or 32 kD on Western blot. Altogether, 17.6% of the patients versus none of the controls were seropositive using these criteria. When analysing the bands of the Western blot, those of 13, 14 and 18 were significantly more frequently detected in sera of epileptic children than in sera of controls. Neurocysticercosis can be considered the main cause of secondary childhood epilepsy in our country, Madagascar being one of the most important foci in the world.

Neurocysticercosis is the most frequent parasitosis of the central nervous system in the world. Due to the extension of the pandemy, and the importance of the migrations from endemic countries, this parasitosis is being diagnosed with increasing frequency in France. Epilepsy is the main revealing symptom. However, in endemic countries, neurocysticercosis should be suspected in patients with any neurological sign. Diagnosis is based upon imaging procedures (computed tomography and magnetic resonance imaging) and serology (Elisa and Western blot). The evolution is highly variable, from complete latency to severe encephalopathy with psychomotor regression. Praziquantel and albendazole are the main therapeutic agents. Although corticosteroids are usually very effective on symptoms of the acute phase of the disease, their place in the treatment remains to be clarified. Racemic and ventricular forms of the disease usually need neurosurgery. In endemic regions, the diminution of the frequency of the disease relies upon prevention through health education compaigns, pending the achievement of an efficient vaccine.

The authors report the case of a patient undergoing coronary angiography for angina who had an anomalous origin of the septal perforator artery from a separate ostium. Anomalies of the coronary arteries may consist not only of anomalous trajectories and coronary fistulae but also of anomalous origins of the main coronary arteries. The anomalous origin of a septal artery from a separate ostium is very rare accounting for 0.5% of cases in the medical literature. In some cases, this artery provides a collateral circulation for occluded main coronary vessels, thereby preserving left ventricular contractility.

Rarely seen in industrialised countries, ileo-caecal tuberculosis does not require surgery unless complications or diagnosis uncertainly occur. When laparotomy is contre indicated in presence of chronical respiratory disease, laparo-assisted ileo-caecal resection is an interesting alternative to classical surgery as it has less effect on ventilation. This laparo-assisted ileo-caecal resection appears to the first reported in presence of intestinal tuberculosis.

The CPLEAR collaboration has constructed a detector at CERN for an extensive programme of CP-, T- and CPT-symmetry studies using K-0 and produced by the annihilation of in a hydrogen gas target. The K-0 and are identified by their companion products of the annihilation K(+/-)pi(-/+) which are tracked with multiwire proportional chambers, drift chambers and streamer tubes. Particle identification is carried out with a liquid Cherenkov detector for fast separation of pions and kaons and with scintillators which allow the measurement of time of flight and energy loss. Photons are measured with a lead/gas sampling electromagnetic calorimeter. The required antiproton annihilation modes are selected by fast online processors using the tracking chamber and particle identification information. All the detectors are mounted in a 0.44 T uniform field of an axial solenoid of diameter 2 m and length 3.6 m to form a magnetic spectrometer capable of full on-line reconstruction and selection of events. The design, operating parameters and performance of the subdetectors are described.