Search

En réadaptation visuelle, l’évaluation du champ visuel au sol (ECVS) permet de mesurer la taille des scotomes en lien avec la locomotion, et de restituer au patient l’étendue de son champ visuel (CV). Les informations obtenues par l’ECVS n’ont jamais été comparées avec le test de Goldmann. L’objectif de cette étude est d’évaluer la reproductibilité de la mesure du CV dans différentes conditions (test Goldmann, ECVS manuelle et automatisée). Dix patients (51,4±14,0 ans, 4 hommes et 6 femmes) présentant un CV tubulaire, inférieur ou égal à 25° centraux, ont réalisé trois versions d’une évaluation du CV binoculaire : le test de Goldmann, l’ECVS manuelle et l’ECVS automatisée. Les deux versions de l’ECVS ont été réalisées à 1m au sol, à 5m au sol et à 5m verticalement, face au patient. Le critère de jugement principal était la surface totale perçue pour chaque test. La reproductibilité de la mesure était moyenne ou bonne pour la condition à 1m au sol (ICC=0,685 à 0,866). À l’inverse, elle était très faible entre les conditions à 5m, excepté pour les conditions ECVS automatisée et manuelle à 5m au sol (ICC=0,888). Cette étude montre une bonne reproductibilité des mesures de l’ECVS à 1m, et une reproductibilité moins bonne dans les conditions à 5m, qui peuvent s’expliquer par les difficultés dans les conditions de passation de l’ECVS. Parmi les tests, l’ECVS automatisée semble être plus fiable que l’ECVS manuelle, et reçoit la préférence des patients.

L'effet de la canicule de l'été 2003 en France sur quatre espèces de poissons migrateurs diadromes (le saumon Atlantique - Salmo salar, l'alose - Alosa alosa, l'anguille - Anguilla anguillaet la lamproie marine - Petromyzon marinus) de la Garonne et de la Dordogne est analysé à partir des données de passage des migrateurs dans deux stations de comptage et à partir de diverses observations réalisées lors de cette épisode caniculaire. La station de comptage de la Garonne (Golfech) est située à proximité immédiate des rejets d'une centrale nucléaire alors que celle de la Dordogne est indemne de rejets thermiques. L'épisode caniculaire s'est traduit par des modifications des rythmes saisonniers de migrations, des modifications des migrations annuelles et par des mortalités variables selon les espèces considérées. La similarité des phénomènes sur la Garonne et la Dordogne laisse à penser que l'effet des rejets thermiques de la centrale nucléaire a été faible, voire inexistant.

Un programme conséquent d’amélioration du franchissement des barrages par les poissons migrateurs a été entrepris en France depuis une vingtaine d’années dans le cadre d’une nouvelle législation. EDF en tant que principal exploitant de centrales hydrauliques en France a effectué un certain nombre de réalisations et de recherches pour améliorer le franchissement des barrages et usines tant à la montée qu’à la dévalaison.

Une expérimentation a été conduite en 1996 au niveau de l'aménagement hydroélectrique de St. Cricq (gave d'Ossau) dans le but de tester deux dispositifs de dévalaison destinés à éviter le passage dans les turbines des smolts de saumon atlantique (Salmo sala L.). Le premier, localisé au barrage, consiste en une barrière acoustique répulsive destinée à détourner les smolts vers un clapet de décharge. Le champ sonore, généré par 16 émetteurs immergés, est dans la gamme de fréquence 100-600 Hz avec un niveau sonore maximal de 120-130 dB. Le deuxième dispositif, localisé à l'usine, consiste en un exutoire de surface situé en rive, à proximité immédiate de la grille de prise d'eau. L'efficacité des deux dispositifs a été évaluée par marquage-recapture et le comportement des smolts a été suivi par radiotélémétrie. Les passages de smolts par le clapet du barrage varient de 20 % à 60 % ; cette efficacité résulte essentiellement du débit élevé transitant par le clapet. Les tests effectués avec et sans barrière acoustique n'ont mis en évidence aucun effet significatif du champ sonore. L'efficacité de l'exutoire du bassin de mise en charge est d'environ 80 %. La faible largeur de la prise d'eau (11 m), le faible espacement des barreaux de la grille de prise d'eau (2,5 cm), les conditions hydrauliques devant la grille qui guident rapidement les poissons vers l'entrée de l'exutoire, et la configuration de l'entrée de l'exutoire qui crée un écoulement à faible gradient de vitesse peuvent expliquer l'efficacité élevée de ce dispositif.

Deux expérimentations ont été conduites en 1995 et 1998 au niveau de la prise d'eau de l'aménagement hydroélectrique de Bedous sur le Gave d'Aspe afin de tester l'efficacité d'un exutoire de dévalaison pour smolts de saumon atlantique (Salmo salar L.). Le dispositif de dévalaison est situé en rive droite à proximité immédiate du plan des grilles. Le débit moyen alimentant l'exutoire a varié au cours de l'étude de 0,4 m3/s à 1,2 m3/s ce qui correspond à 1,6 % à 4,3 % du débit turbiné. Lefficacité du dispositif a été évaluée grâce à la technique de marquage-recapture. Le comportement des smolts dans le canal d'amenée a été suivi par radiotélémétrie. L'efficacité de l'exutoire (moyenne : 17 %) s'est révélée très faible en 1995 â cause de conditions hydrauliques défavorables. Un mur déflecteur a été mis en place en 1997 afin de modifier l'écoulement dans le canal et améliorer le guidage des poissons vers l'entrée du dispositif de dévalaison. L'efficacité de l'exutoire est passée à 55 %. Le comportement des poissons à l'amont immédiat des grilles de prise d'eau est très dépendant des conditions hydrodynamiques dans le canal d'amenée. L'efficacité de l'exutoire semble croître avec la longueur des poissons, la proportion des classes de taille inférieures à 19 cm étant plus faible sur les poissons piégés que sur les poissons lâchés. Cette sélection est très certainement liée à l'espacement relativement important des barreaux des grilles de la prise d'eau (30 mm) qui malgré le courant tangentiel au plan de grilles demeurent plus perméables aux individus les plus petits. L'éclairage de l'entrée de l'exutoire ne paraît pas avoir d'influence sur les déplacements des poissons radiomarqués dans le canal d'amenée, le facteur hydraulique étant prépondérant. Il modifie cependant les rythmes de passage des poissons par l'exutoire.

Cet article, qui actualise le chapitre 13 du n°326-327 du Bulletin Français de la Pêche et de la Pisciculture des mêmes auteurs, fait le bilan des connaissances actuelles sur la migration de dévalaison au niveau des centrales hydroélectriques, que ce soit sur les dommages induits par le transit des poissons à travers les turbines et par les évacuateurs de crues ou sur la conception des dispositifs spécifiques destinés à éviter l'entraînement dans les prises d'eau. Les divers types de solutions opérationnelles ou prometteuses pour limiter les mortalités (barrières physiques ou comportementales) sont abordés essentiellement vis-à-vis des salmonidés migrateurs pour lesquels on dispose d'un retour d'expérience conséquent. On insiste sur la conception et l'utilisation des exutoires de surface associés aux grilles de prises d'eau, qui représentent la solution la plus immédiatement utilisable sur la plupart des microcentrales en France. La problématique relative aux autres espèces est abordée.

Depuis 1982, conformément aux dispositions de la Convention EDF - Ministère de l'Environnement - Secrétariat d'État à l'Énergie, EDF s'associe à l'effort national entrepris en matière de restauration des populations de poissons migrateurs, en mettant en place des dispositions destinées à faciliter le franchissement d'un certain nombre de barrages. A l'heure actuelle, plusieurs réalisations ont vu le jour. Parmi les principales, nous citerons Belleville sur la Loire, Bergerac sur la Dordogne, Poutès sur le Haut-Allier et l'ascenseur à poissons de Golfech sur la Garonne dont la partie aval est actuellement en fonctionnement. Un certain nombre d'actions de recherche et de suivi d'efficacité de ces ouvrages est parallèlement en cours.

Les ouvrages hydroélectriques qui constituent un obstacle à la migration de montée sont aussi susceptibles de perturber la dévalaison. En particulier, en cas de transit par les turbines, les migrateurs peuvent subir des dommages. Des études in situ visant à estimer les risques potentiels de mortalité ont été conduites par EDF en collaboration avec le CEMAGREF sur trois barrages de caractéristiques différentes : barrages de Poutès sur l'Allier, Mauzac et Tuilière sur la Dordogne. Les résultats sont étroitement dépendants des caractéristiques de la turbine. A Mauzac et Tuilière, les mortalités sont limitées. A Poutès, où les risques potentiels sont élevés, il a été procédé à la mise au point d'un dispositif permettant d'éviter l'entraînement dans les turbines.

Des organismes aquatiques sont aspirés aux prises d'eau des centrales thermiques, principalement sur les sites en bord de mer et en estuaire. Cet article présente les études réalisées et en cours à la Direction des Etudes et Recherches d'EDF en vue de prévenir les risques de colmatage des prises d'eau et de minimiser l'impact des captures de poissons et crustacés sur les populations exploitées par la pêche.

Radiotracking studies have been carried out since 1985 on three species of migratory fish - Atlantic salmon (Salmo salar, sea trout (Salmo trutta trutta), shad (Alosa alosa)- in relation to surveys carried out before and after the construction of fishways on Electricité de France dams. Three sites were investigated: — Poutes-Monistrol hydropower project on the Allier river: determination of the possibility for Salmon to reach the new fishlift entry located at the Poutes dam; the effect of Monistrol powerhouse discharge on migration was particularly analysed, — st-Laurent-des-eaux weir on the Loire river: determination of the projected fishway's characteristics for shad, — Mauzac.dam on the Dordogne river: determination of the attractivity, for shad and sea trout, of a new fishway located close to the powerhouse. American radiotracking equipment was used (Advanced Telemetry System and Smith Root) with frequency ranges 40-41 MHz and 48-49 MHz. Fishes were tagged with transmitters of various sizes implanted in the stomach. A total of 28 shad, 43 salmon and 18 sea trout were tagged. Various techniques of tracking have been employed according to each site and fish species: — for manual tracking (by foot, car, boat or plane), we employed various antennas: loop, adcock, whip or underwater. Precise location was made by biangulation or trian-gulation with receivers or by use of underwater antennas; — automatic tracking with graphic recorders was used for continuous observations.Transports upstream by truck have been tested. They give good results only under specifc conditions. The duration of studies varied from 2 months to 8 months. The accuracy of results is directly dependent on the number of personnel assigned to the study. Use of radiotracking to survey or to design fishways appears to be a lumbersome but irreplaceable technique for the obtention of results concerning fish behaviour.

Depuis 1971, année de mise en service de l'aménagement hydroélectrique de Golfech sur la Garonne, le passage de l'alose (alosa alosa) et des autres espèces migratrices à l'amont de I'ouvrage était très limité voire impossible. Dans cet article, les auteurs rapportent les principaux critères utilisés pour le dimensionnement d'un ascenseur à poissons implanté au droit de l'usine de Golfech. Sa conception est directement inspirée de celle de I'ascenseur à poissons du barrage de Holyoke sur la rivière Connecticut (USA). Deux modèles hydrauliques ont été utilisés pour choisir la situation des entrées et optimiser I'attractivité de I'ouvrage et les conditions hydrodynamiques dans la partie basse du dispositif. L'ascenseur a été construit en 1986-1987. Les poissons migrateurs sont attirés dans un grand bassin de stabulation par un débit d'attrait et piégés à I'aide d'une grille articulée jouant e rôle de nasse anti-retour. Cette grille, mécanisée et montée sur un chariot, sert également à pousser les poissons au-dessus d'une cuve située à l'extrémité amont du bassin de stabulation. Le débit d'attrait est injecté au travers de grilles verticales situées à l'amont de la cuve et sur les parois latérales du bassin de stabulation. Les poissons, remontés dans la cuve, sont déversés dans un canal de transfert qui leur permet de rejoindre le canal d'amenée de I'usine. L'ascenseur à poissons a été contrôlé en 1987 et 1988 à l'aide d'un dispositif de comptage vidéo automatisé de façon à en tester l'efficacité, à valider certains critères utilisés pour sa conception et à acquérir des informations sur les caractéristiques migratoires des différents espèces. Au cours des premières années de contrôle, 25 espèces ont emprunté le dispositif et de 14 000 à 66 000 aloses par an ont été comptabilisées.

Alors qu'avec la nouvelle loi sur I'eau du 3 janvier 1992, le cadre législatif oriente les différents acteurs de I'eau vers des procédures de concertation, on constate le manque d'outils opérationnels pour la mise en place localement de telles démarches. Ce n'est pourtant pas une tâche aisée dans la mesure où les relations entre les usagers sont souvent conflictuelles, notamment en situation de pénurie. La sensibilisation de ces acteurs aux besoins des uns et des autres, étape indispensable pour mener à bien le dialogue, requiert donc un effort en matière de communication. Dans ce contexte, la Direction des Etudes et Recherches (DER) d'EDF développe depuis 1991 un outil informatique d'aide à la gestion intégrée de la ressource en eau : le logiciel AGIRE. La première version de ce logiciel (version 1 .O) est aujourd'hui achevée : il s'agit d'une version monodimensionnelle, en mode permanent et à pas mensuel. Cet outil se présente sous la forme d'un logiciel interactif, facilement utilisable pour un non initié, et qui permet au gestionnaire de visualiser les conséquences, à la fois sur le milieu aquatique et sur la satisfaction des usagers, de différents scénarios d'aménagement et de gestion du bassin. Ces scénarios peuvent porter sur le niveau de développement ou d'équipement des usages agricoles, industriels ou domestiques, sur les schémas de circulation d'eau (lâchers de barrages amont, transfert d'eau entre rivières,..), sur les contraintes environnementales (débit de salubrité par exemple), sur les aléas climatiques ... Cet outil informatique, qui fonctionne sur station de travail, est bâti autour : – d'un outil de simulation reposant sur une bibliothèque de modèles numériques; – d'un outil de visualisation développé à partir du système d'information géographique ARC INFO. Une première application sur deux rivières du Sud-Ouest de la France (Gave de Pau et Echez), réalisée dans le cadre d'une convention entre EDF-DER, l'Agence de I'Eau Adour-Garonne, le Ministère de l'Environnement et l'Institution Interdépartementale pour l'Aménagement Hydraulique du Bassin de l'Adour, est opérationnelle à l'Agence de I'Eau Adour-Garonne. Quelques exemples de résultats de scénarios (augmentation des surfaces irriguées, amélioration du rendement des stations d'épuration existantes, hypothèse d'un transfert d'eau entre rivières en période estivale) permettent d'illustrer l'utilisation possible de la version 1.0 du logiciel AGIRE.

Worldwide, obstructions on watercourses have interfered with migratory pathways of fish species, reducing life‐cycle success and often eliminating diadromous fish species altogether from river basins. Over the last century, efforts to mitigate these effects were initially directed at developing fishways for upstream, high‐value migrant adult salmon. In more recent years, efforts have turned to developing fishways for other species. Results of past research suggest that the development of effective fishways requires biological knowledge of fish behaviour when encountering variable flows, velocity and turbulence, combined with hydraulic and civil engineering knowledge and expertise to develop facilities that provide appropriate hydraulic conditions that fish will exploit. Further, it often requires substantial financial resources for biological and hydraulic testing as well as engineering design, particularly where prior knowledge of the behaviour of target fish species does not exist. Where biological or engineering knowledge (or both) is absent, development of effective passage facilities must take on a trial and error approach that will almost certainly require years to attain success. Evaluations of existing adult and juvenile fish passage facilities, where they have been carried out, suggest that migrant fish reject areas with hydraulic conditions they determine unsuitable. Even well designed fish ladders or nature‐like bypass channels for upstream migrants, even those with good attraction flows, will fail if incorrectly sited. Although progress has been made, developing successful installations for downstream migrants remains much more difficult, probably because downstream fish move with the flow and have less time to assess cues at entrances to any bypasses that they encounter. Copyright © 2011 John Wiley & Sons, Ltd.

The effect of the summer 2003 heat wave in France on four species of migratory diadromous fish (Atlantic salmon - Salmo salar, shad - Alosa alosa, eel - Anguilla anguilla and sea lamprey - Petromyzon marinus) of the river Garonne and the river Dordogne is analyzed from data of migratory fish passage in two fish counting stations and various observations made during this heat wave period. The counting station of the Garonne (Golfech) is located near the discharge of a nuclear power plant while that of the Dordogne is exempt of thermal discharges. The heat wave event has resulted in changes in seasonal migration patterns, changes in annual migration and in mortality depending on fish species. The similarity of phenomena on the Garonne and the Dordogne suggests that the effect of the nuclear power station thermal discharge is low or nonexistent. L'effet de la canicule de l'?t? 2003 en France sur quatre esp?ces de poissons migrateurs diadromes (le saumon Atlantique - Salmo salar, l'alose - Alosa alosa, l'anguille - Anguilla anguilla et la lamproie marine - Petromyzon marinus) de la Garonne et de la Dordogne est analys? ? partir des donn?es de passage des migrateurs dans deux stations de comptage et ? partir de diverses observations r?alis?es lors de cette ?pisode caniculaire. La station de comptage de la Garonne (Golfech) est situ?e ? proximit? imm?diate des rejets d'une centrale nucl?aire alors que celle de la Dordogne est indemne de rejets thermiques. L'?pisode caniculaire s'est traduit par des modifications des rythmes saisonniers de migrations, des modifications des migrations annuelles et par des mortalit?s variables selon les esp?ces consid?r?es. La similarit? des ph?nom?nes sur la Garonne et la Dordogne laisse ? penser que l'effet des rejets thermiques de la centrale nucl?aire a ?t? faible, voire inexistant.

Efficiencies of two types of bypass, a surface and a bottom sluice, were tested for the natural downstream migration of silver eels Anguilla anguillaat a small hydroelectric power plant at Halsou, on the River Nive in France. Naturally migrating eels were caught after their passage through either bypass. A total of 637 eels were trapped during the three‐year study. Total efficiency for both bypasses, evaluated on the basis of downstream movement of radiotagged eels, ranged from 56% to 64%. Given a bias due to hydrological conditions at the time of the runs, the precise efficiency of each separate bypass was not calculated. However, preferred passage through the bottom bypass for both tagged and untagged eels was confirmed by telemetry, as three to four times as many eels transited through the bottom bypass compared to the surface one. The behaviour of 74 individuals released in the forebay was observed by radiotelemetry. Close to half of the radiotagged eels returned up the headrace after their release, and most eventually migrated downstream over the dam with appropriate environmental conditions. Upon arrival at the power plant, eels displayed foraging behaviour in the forebay with frequent displacement interrupted by long resting periods in zones with low current. The repulsive effect of the trashrack located in front of the turbine intake increased with increasing turbined discharge. The study indicated that a trashrack with a smaller bar‐spacing (around 20 mm), associated with an appropriate bypass, could deflect a large proportion of the female eels from the turbines. However, this solution needs to be tested on site to quantify the risk of mortality due to impingement on the trashrack. Copyright © 2005 John Wiley & Sons, Ltd.

Doxorubicin-based immunochemotherapy, with interferon, has been shown to improve survival in patients with advanced follicular lymphoma. High-dose chemotherapy with stem-cell support is effective in follicular lymphoma in relapse but remains controversial as a first-line therapy. In a randomized study using a purged autologous stem-cell support, we compared these 2 approaches in patients with advanced follicular lymphoma. Newly diagnosed advanced follicular lymphoma patients (172 patients) were randomly assigned either to an immunochemotherapy regimen (cyclophosphamide, doxorubicin, teniposide, prednisone, and interferon) or to a high-dose therapy followed by purged autologous stem-cell transplantation. Compared with the patients who received chemotherapy and interferon, patients treated with high-dose therapy had a higher response rate (69% vs 81%, P = .045) and a longer median event-free survival (not reached vs 45 months). This did not translate into a better survival rate due to an excess of secondary malignancies after transplantation. The Follicular Lymphoma Prognostic Index identified a subgroup of patients with a significantly higher event-free survival rate after high-dose therapy. Autologous stem-cell transplantation cannot be considered as the standard first-line treatment of follicular lymphoma for patients younger than 60 years old with a high tumor burden.

Doxorubicin-based immunochemotherapy, with interferon, has been shown to improve survival in patients with advanced follicular lymphoma. High-dose chemotherapy with stem-cell support is effective in follicular lymphoma in relapse but remains controversial as a first-line therapy. In a randomized study using a purged autologous stem-cell support, we compared these 2 approaches in patients with advanced follicular lymphoma. Newly diagnosed advanced follicular lymphoma patients (172 patients) were randomly assigned either to an immunochemotherapy regimen (cyclophosphamide, doxorubicin, teniposide, prednisone, and interferon) or to a high-dose therapy followed by purged autologous stem-cell transplantation. Compared with the patients who received chemotherapy and interferon, patients treated with high-dose therapy had a higher response rate (69% vs 81%, P= .045) and a longer median event-free survival (not reached vs 45 months). This did not translate into a better survival rate due to an excess of secondary malignancies after transplantation. The Follicular Lymphoma Prognostic Index identified a subgroup of patients with a significantly higher event-free survival rate after high-dose therapy. Autologous stem-cell transplantation cannot be considered as the standard first-line treatment of follicular lymphoma for patients younger than 60 years old with a high tumor burden.

Un programme conséquent d’amélioration du franchissement des barrages par les poissons migrateurs a été entrepris en France depuis une vingtaine d’années dans le cadre d’une nouvelle législation. EDF en tant que principal exploitant de centrales hydrauliques en France a effectué un certain nombre de réalisations et de recherches pour améliorer le franchissement des barrages et usines tant à la montée qu’à la dévalaison.Cet exposé synthétise les actions réalisées et le retour d’expérience sur les divers types de passes à poissons pour la montée : plus de soixante dix ouvrages ont été construits sur des cours d’eau de taille variable et pour diverses espèces de migrateurs (saumon, alose, anguille…). Les travaux de recherches concernent essentiellement la mise au point de dispositifs de dévalaison permettant d’éviter la mortalité des poissons dans les turbines. Des dispositifs spécifiques aux salmonidés (exutoires associés aux grilles de prises d’eau) sont d’ores et déjà opérationnels pour des usines de petite taille (débit turbiné inférieur à 100 m3/s). Les recherches se poursuivent pour l’adaptation de ces dispositifs aux usines de taille plus importante et à d’autres espèces de migrateurs tels que l’anguille.

ABSTRACTEnteroviral meningoencephalitis was diagnosed in a patient with an immunodeficiency syndrome acquired after treatment with rituximab for a relapsed primary B-cell lymphoma. A second meningoencephalitic episode was diagnosed 6 months later and was successfully treated with a combination of immunoglobulins and pleconaril. The infection was persistent since the enterovirus genome was detected in five sequential specimens of cerebrospinal fluid collected over 9 months. An echovirus 13 isolate was isolated in the first three samples. The viral sequence encoding the VP1 capsid protein of the three isolates was determined and was compared with that of four control viruses. The virus isolates recovered from the patient shared >99% nucleotide sequence similarity with one another. In a phylogenetic tree, they were directly related to a control virus obtained from a patient hospitalized in 2000 during an outbreak of enterovirus meningitis. The epidemiological origin of a chronic echovirus infection in a patient with immune deficiency suggests that the echovirus had been continuously circulating in the general population after the outbreak that had revealed its emergence.

Published data on transplantation in Waldenstrom's macroglobulinemia (WM) are still limited. We present a retrospective multicentric study of 27 WM patients who underwent 19 autologous (median age, 54 years) and 10 allogeneic (median age, 46 years) transplantations. Median time between diagnosis and transplantation was 36 months; 66% of patients had received three or more treatment lines and 72 % had chemosensitive disease. High-dose therapy (HDT) and autologous transplantation induced a 95% response rate (RR), including 10 major responses. With a median follow-up of 18 months, 12 patients are alive at 10 to 81 months and eight are free of disease progression at 10 to 34 months. The toxic mortality rate (TRM) was 6%. Allogeneic transplantation was preceded by HDT in nine patients and by a nonmyeloablative regimen in one patient. The RR was 80%, including seven major responses. With a median follow-up of 20.5 months, six patients are alive and free of progression at 3 to 76 months. Four patients died, all from toxicity, resulting in a TRM of 40%. HDT followed by autologous transplantation is feasible in WM, even in heavily pretreated patients, with some prolonged responses but a high relapse rate. Conversely, allogeneic transplantation is more toxic, but likely induces a graft-versus-WM effect and may, for some patients, result in long-term disease control. Semin Oncol 30:291-296. © 2003 Elsevier Inc. All rights reserved.

To comparatively assess first-line treatment with fludarabine and 2 anthracycline-containing regimens, namely CAP (cyclophosphamide, doxorubicin plus prednisone) and ChOP (cyclophosphamide, vincristine, prednisone plus doxorubicin), in advanced stages of chronic lymphocytic leukemia (CLL), previously untreated patients with stage B or C CLL were randomly allocated to receive 6 monthly courses of either ChOP, CAP, or fludarabine (FAMP), stratified based on the Binet stages. End points were overall survival, treatment response, and tolerance. From June 1, 1990 to April 15, 1998, 938 patients (651 stage B and 287 stage C) were randomized in 73 centers. Compared to ChOP and FAMP, CAP induced lower overall remission rates (58.2%; ChOP, 71.5%; FAMP; 71.1%; P < .0001 for each), including lower clinical remission rates (CAP, 15.2%; ChOP, 29.6%; FAMP, 40.1%;P = .003). By contrast, median survival time did not differ significantly according to randomization (67, 70, and 69 months in the ChOP, CAP, and FAMP groups, respectively). Incidences of infections (< 5%) and autoimmune hemolytic anemia (< 2%) during the 6 courses were similar in the randomized groups, whereas fludarabine induced, compared to ChOP and CAP, more frequent protracted thrombocytopenia (P = .003) and less frequent nausea-vomiting (P = .003) and hair loss (P < .0001). For patients with stage B and C CLL first-line fludarabine and ChOP regimens both provided similar overall survival and close response rates, and better results than CAP. However, there was an increase in clinical remission rate and a trend toward a better tolerance of fludarabine over ChOP that may influence the choice between these regimens as front-line treatments in patients with CLL.

To comparatively assess first-line treatment with fludarabine and 2 anthracycline-containing regimens, namely CAP (cyclophosphamide, doxorubicin plus prednisone) and ChOP (cyclophosphamide, vincristine, prednisone plus doxorubicin), in advanced stages of chronic lymphocytic leukemia (CLL), previously untreated patients with stage B or C CLL were randomly allocated to receive 6 monthly courses of either ChOP, CAP, or fludarabine (FAMP), stratified based on the Binet stages. End points were overall survival, treatment response, and tolerance. From June 1, 1990 to April 15, 1998, 938 patients (651 stage B and 287 stage C) were randomized in 73 centers. Compared to ChOP and FAMP, CAP induced lower overall remission rates (58.2%; ChOP, 71.5%; FAMP; 71.1%; P< .0001 for each), including lower clinical remission rates (CAP, 15.2%; ChOP, 29.6%; FAMP, 40.1%;P= .003). By contrast, median survival time did not differ significantly according to randomization (67, 70, and 69 months in the ChOP, CAP, and FAMP groups, respectively). Incidences of infections (< 5%) and autoimmune hemolytic anemia (< 2%) during the 6 courses were similar in the randomized groups, whereas fludarabine induced, compared to ChOP and CAP, more frequent protracted thrombocytopenia (P= .003) and less frequent nausea-vomiting (P= .003) and hair loss (P< .0001). For patients with stage B and C CLL first-line fludarabine and ChOP regimens both provided similar overall survival and close response rates, and better results than CAP. However, there was an increase in clinical remission rate and a trend toward a better tolerance of fludarabine over ChOP that may influence the choice between these regimens as front-line treatments in patients with CLL.

Immunoselected CD34+ peripheral blood progenitor cell (PBPC) transplantation is now frequently used to support autologous hematopoiesis after myeloablative therapy, its feasability having been proved by several groups. However, we and others observed delayed platelet recovery. We hypothesized that immunoselection processing might induce selective loss of megakaryocyte progenitors, or a decrease in their proliferation. We used a colony-forming units megakaryocyte (CFU-Mk) assay to evaluate these consequences and predict platelet recovery in patients. In CD34+ PBPCs from 10 children with solid tumors, we observed no selective loss in CFU-Mk numbers during immunoselection processing and no impairment of clonogenicity. The CFU-Mk yield (59.2 plusmn; 11.3%) was at least similar to the CD34+ yield (44.2 ± 3.8%). We assessed the predictive value of CFU-Mk numbers infused for recovery of platelet lineage. We found an inverse correlation between the time taken to reach a platelet count greater than 50 X 109/L and only the CFU-Mk dose (r = -0.71; p = 0.022) among the different type of progenitors, including colony-forming units granulocytemacrophage (CFU-GM), burst-forming units erythrocyte (BFU-E) and colony-forming units-mixed (CFU-Mix). These findings suggest that CFU-Mk number could be used as sole predictive functional parameter for platelet reconstitution in children after immunoselection of CD34+ cells, in particular for low CD34+ cell dose, and thus as an indicator for initial quality of hematopoietic cells before in vitro expansion.

All transretinoic acid (ATRA) followed by daunorubicin (DNR)-AraC chemotherapy (CT) has improved the outcome of acute promyelocytic leukemia (APL) by comparison to CT alone. In a randomized trial, (1) we compared 2 induction schedules (ATRA followed by CT [ATRA?CT] and ATRA plus CT [ATRA+CT, with CT added on day 3 of ATRA treatment]) and (2) we assessed the role of maintenance treatment. Four hundred thirteen patients =75 years of age and with newly diagnosed APL were included. Induction treatment was stratified on white blood cell (WBC) count and age: patients =65 years of age and with an initial WBC count of =5,000/µL (n = 208) were randomized between ATRA?CT and ATRA+CT (initially randomized patients); patients with a WBC count greater than (high WBC count group, n = 163) and patients 66 to 75 years of age with a WBC count greater than 5,000/µL (elderly group, n = 42) were not initially randomized and received ATRA+CT from day 1 and ATRA ?CT, respectively. All patients achieving CR received 2 additional DNR-AraC courses (only 1 in patients 66 to 75 years of age) and were then randomized for maintenance between no treatment, intermittent ATRA (15 days every 3 months) for 2 years, continuous low-dose CT (6 mercaptopurine + methotrexate) for 2 years, or both, using a 2-by-2 factorial design. Overall, 381 (92%) of the patients achieved complete remission (CR), 31 (7%) suffered an early death, and only 1 patient had leukemic resistance. ATRA syndrome occurred in 64 patients (15%) and was fatal in 5 cases. The CR rate was similar in all induction treatment groups. Event-free survival (EFS) was significantly lower in the high WBC group (P = .0002) and close to significance in the elderly group (P = .086) as compared with initially randomized patients. Relapse at 2 years was estimated at 6% in the ATRA+CT group, versus 16% in the ATRA?CT group (P = .04, relative risk [RR] = .41). EFS at 2 years was estimated at 84% in the ATRA+CT group, versus 77% in the ATRA?CT group (P = .1, RR = .62). Two hundred eighty-nine patients were randomized for maintenance. The 2-year relapse rate was 11% in patients randomized to continuous maintenance CT and 27% in patients randomized to no CT (P = .0002) and 13% in patients randomized to intermittent ATRA and 25% in patients randomized to no ATRA (P= .02). An additive effect of continuous maintenance CT and intermittent ATRA was seen, and only 6 of the 74 patients who received both maintenance treatments had relapsed. Overall survival was improved in patients who received maintenance CT (P = .01), and there was a trend for better survival in patients who received maintenance ATRA (P = .22). Our findings strongly suggest that early addition of chemotherapy to ATRA and maintenance therapy combining continuous CT and intermittent ATRA can reduce the incidence of relapse in APL. This effect already translates into significantly better survival for maintenance treatment with continuous CT.

All transretinoic acid (ATRA) followed by daunorubicin (DNR)-AraC chemotherapy (CT) has improved the outcome of acute promyelocytic leukemia (APL) by comparison to CT alone. In a randomized trial, (1) we compared 2 induction schedules (ATRA followed by CT [ATRA→CT] and ATRA plus CT [ATRA+CT, with CT added on day 3 of ATRA treatment]) and (2) we assessed the role of maintenance treatment. Four hundred thirteen patients ≤75 years of age and with newly diagnosed APL were included. Induction treatment was stratified on white blood cell (WBC) count and age: patients ≤65 years of age and with an initial WBC count of ≤5,000/μL (n = 208) were randomized between ATRA→CT and ATRA+CT (initially randomized patients); patients with a WBC count greater than (high WBC count group, n = 163) and patients 66 to 75 years of age with a WBC count greater than 5,000/μL (elderly group, n = 42) were not initially randomized and received ATRA+CT from day 1 and ATRA →CT, respectively. All patients achieving CR received 2 additional DNR-AraC courses (only 1 in patients 66 to 75 years of age) and were then randomized for maintenance between no treatment, intermittent ATRA (15 days every 3 months) for 2 years, continuous low-dose CT (6 mercaptopurine + methotrexate) for 2 years, or both, using a 2-by-2 factorial design. Overall, 381 (92%) of the patients achieved complete remission (CR), 31 (7%) suffered an early death, and only 1 patient had leukemic resistance. ATRA syndrome occurred in 64 patients (15%) and was fatal in 5 cases. The CR rate was similar in all induction treatment groups. Event-free survival (EFS) was significantly lower in the high WBC group (P= .0002) and close to significance in the elderly group (P= .086) as compared with initially randomized patients. Relapse at 2 years was estimated at 6% in the ATRA+CT group, versus 16% in the ATRA→CT group (P= .04, relative risk [RR] = .41). EFS at 2 years was estimated at 84% in the ATRA+CT group, versus 77% in the ATRA→CT group (P= .1, RR = .62). Two hundred eighty-nine patients were randomized for maintenance. The 2-year relapse rate was 11% in patients randomized to continuous maintenance CT and 27% in patients randomized to no CT (P= .0002) and 13% in patients randomized to intermittent ATRA and 25% in patients randomized to no ATRA (P= .02). An additive effect of continuous maintenance CT and intermittent ATRA was seen, and only 6 of the 74 patients who received both maintenance treatments had relapsed. Overall survival was improved in patients who received maintenance CT (P= .01), and there was a trend for better survival in patients who received maintenance ATRA (P= .22). Our findings strongly suggest that early addition of chemotherapy to ATRA and maintenance therapy combining continuous CT and intermittent ATRA can reduce the incidence of relapse in APL. This effect already translates into significantly better survival for maintenance treatment with continuous CT.

After a brief reminder of the reasons why migrating fish need to move freely up and down rivers, this article describes current techniques in the area of upstream fish passage facilities, emphasising the value and limitations of each type: poll-type fishways, fish locks and lifts, by pass channels and preliminary weirs. The authors then define what is meant by efficiency in this context, before going on to describe fishway monitoring methods. The second part of the article reviews current knowledge on dowstream fish migration through hydropower stations, focusing on damage caused by fish passing through turbines or by spillways, and on the design of facilities (physical and behavioural barriers) used to prevent fish from entering water intakes. The study highlights surface bypasses which have been used successfully to guide migrating fish safely past existing water intakes. The authors conclude by emphasising that whatever the facilities used, small-scale hydropower stations virtually always have some impact on migratory fish populations, especially when a series of installations along their migratory route causes the impact to become cumulative.

Intensive sequential chemotherapy with mitoxantrone, 12 mg/m2/d on days 1 through 3, etoposide, 200 mg/m2/d as a continuous infusion on days 8 through 10, and cytarabine, 500 mg/m2/d as a continuous infusion on days 1 through 3 and 8 through 10 was administered to 72 patients aged less than 60 years with previously treated acute myelogenous leukemia (AML). Forty patients had refractory AML (nonresponse to prior therapy, early first relapse, or multiple relapse) and 32 had late first relapse. Sixty-one percent of patients, with a 95% confidence interval (CI) ranging from 49% to 72%, achieved complete remission (CR), including 45% (CI: 30% to 62%) of refractory patients and 81% (CI: 64% to 93%) of late first relapse patients. Twenty-nine percent of patients (CI: 19% to 41%) did not respond to therapy and 10% (CI: 4% to 19%) died from therapy-related toxicity. Median duration of aplasia was 30 days. Nonhematologic WHO grade 3 or more toxicity included sepsis (57% of patients), vomiting (10%), mucositis (35%), diarrhea (7%), skin rash (6%), and hyperbilirubinemia (11%). Postinduction therapy was attempted in 36 of 44 CR patients: 16 of them received a second course of the same regimen, 7 received maintenance chemotherapy, 4 underwent autologous bone marrow transplantation (BMT), and 9 allogeneic BMT. At a median follow-up of 20 months, 23 of the 44 complete remitters have relapsed, 1 to 14 months after achievement of CR, including 19 of 31 patients not undergoing BMT. Median survival is 7 months with 16% (CI: 4% to 28%) projected survival at 47 months. Median disease-free survival is 6 months with 21% (CI: 3% to 39%) of CR patients projected to remain disease-free at 46 months. Twenty-six percent (CI: 13% to 43%) of the evaluable patients who did not receive transplantation had inversion of CR duration. Among patients younger than 50 years, there was no significant difference in disease-free survival between patients receiving postinduction chemotherapy and those receiving BMT. We conclude that this chemotherapy regimen is highly efficient and could be used as first-line therapy in young patients with AML.

Intensive sequential chemotherapy with mitoxantrone, 12 mg/m2/d on days 1 through 3, etoposide, 200 mg/m2/d as a continuous infusion on days 8 through 10, and cytarabine, 500 mg/m2/d as a continuous infusion on days 1 through 3 and 8 through 10 was administered to 72 patients aged less than 60 years with previously treated acute myelogenous leukemia (AML). Forty patients had refractory AML (nonresponse to prior therapy, early first relapse, or multiple relapse) and 32 had late first relapse. Sixty-one percent of patients, with a 95% confidence interval (CI) ranging from 49% to 72%, achieved complete remission (CR), including 45% (CI: 30% to 62%) of refractory patients and 81% (CI: 64% to 93%) of late first relapse patients. Twenty-nine percent of patients (CI: 19% to 41%) did not respond to therapy and 10% (CI: 4% to 19%) died from therapy-related toxicity. Median duration of aplasia was 30 days. Nonhematologic WHO grade 3 or more toxicity included sepsis (57% of patients), vomiting (10%), mucositis (35%), diarrhea (7%), skin rash (6%), and hyperbilirubinemia (11%). Postinduction therapy was attempted in 36 of 44 CR patients: 16 of them received a second course of the same regimen, 7 received maintenance chemotherapy, 4 underwent autologous bone marrow transplantation (BMT), and 9 allogeneic BMT. At a median follow-up of 20 months, 23 of the 44 complete remitters have relapsed, 1 to 14 months after achievement of CR, including 19 of 31 patients not undergoing BMT. Median survival is 7 months with 16% (CI: 4% to 28%) projected survival at 47 months. Median disease-free survival is 6 months with 21% (CI: 3% to 39%) of CR patients projected to remain disease-free at 46 months. Twenty-six percent (CI: 13% to 43%) of the evaluable patients who did not receive transplantation had inversion of CR duration. Among patients younger than 50 years, there was no significant difference in disease-free survival between patients receiving postinduction chemotherapy and those receiving BMT. We conclude that this chemotherapy regimen is highly efficient and could be used as first-line therapy in young patients with AML.

We undertook a study to determine the specificity of the monoclonal antibody, B-ly-7, for hairy cell leukemia (HCL) by examining the expression in 150 samples from B-cell lymphoproliferative diseases as well as screening for reactivity in a number of other hematologic malignancies. Within the B-cell lineage we found that the expression of B-ly-7 was highly specific for HCL and reacted with all 28 cases examined, as well as with 3 of 9 cases of a variant form of HCL. Cells of other closely related B-cell disorders, prolymphocytic leukemia, and splenic lymphoma with villous lymphocytes were negative. Investigation of the peripheral blood and bone marrow of patients with HCL before and after treatment with alpha-interferon or deoxycoformycin suggests that B-ly-7 may be useful in the assessment of minimal disease after therapy. In addition to HCL, we found that B-ly-7 was positive with cells of three mature, CD4+ T-cell malignancies. In view of the reactivity with malignancies of activated B and T cells, we searched for the expression of B-ly-7 on activated, normal B and T cells and found that B-ly-7 reacted specifically with activated normal peripheral blood CD8+ T cells. B-ly-7 has a number of applications, including the precise classification of mature B-cell neoplasia and the diagnosis HCL and its assessment after treatment. In addition, B-ly-7 recognizes a small subset of T-cell disorders. Its expression on these malignancies and on in vitro activated peripheral blood CD8+ T cells suggests that B- ly-7 detects a lymphocyte activation antigen.

Hydroelectric works, which constitute an obstacle to upward migration, are also likely to disturb going down. Particularly when this involves transit through turbines, the migrating fish can be physically affected. In situ studies aiming at estimating the potential mortality risks have been conducted by EDF in collaboration with CEMAGREF and they involve the three following dams : Pout?s in the Allier, Mauzac and Tuili?re in the Dordogne. The results strictly depend on the characteristics of the turbine. In Mauzac and Tuili?re, mortalities are restricted. In Poutes where there is a high percentage of potential risks, a device has been made available to avoid risks in the turbines.Les ouvrages hydro?lectriques qui constituent un obstacle ? la migration de mont?e sont aussi susceptibles de perturber la d?valaison. En particulier, en cas de transit par les turbines, les migrateurs peuvent subir des dommages. Des ?tudes in situ visant ? estimer les risques potentiels de mortalit? ont ?t? conduites par EDF en collaboration avec le CEMAGREF sur trois barrages de caract?ristiques diff?rentes : barrages de Pout?s sur l'Allier, Mauzac et Tuili?re sur la Dordogne. Les r?sultats sont ?troitement d?pendants des caract?ristiques de la turbine. A Mauzac et Tuili?re, les mortalit?s sont limit?es. A Pout?s, o? les risques potentiels sont ?lev?s, il a ?t? proc?d? ? la mise au point d'un dispositif permettant d'?viter l'entra?nement dans les turbines.

Since 1982, and in accordance with the provisions of the EDF/Environment Ministry/Energy State Secretariat agreement, EDF contributed to the national effort made to re-establish migrating fish populations, by providing measures intended to facilitate the crossing of a certain number of dikes. Currently, many undertakings have been completed. Amongst the main ones are those at Belleville in the Loire, at Bergerac in the Dordogne, at Pout?s in the Haut-Allier and the fish lift in the Garonne and whose downstream part is currently in operation. Some research and follow-up activities concerning the effectiveness of these works, are also being carried out.Depuis 1982, conform?ment aux dispositions de la Convention EDF - Minist?re de l'Environnement - Secr?tariat d'?tat ? l'?nergie, EDF s'associe ? l'effort national entrepris en mati?re de restauration des populations de poissons migrateurs, en mettant en place des dispositions destin?es ? faciliter le franchissement d'un certain nombre de barrages. A l'heure actuelle, plusieurs r?alisations ont vu le jour. Parmi les principales, nous citerons Belleville sur la Loire, Bergerac sur la Dordogne, Pout?s sur le Haut-Allier et l'ascenseur ? poissons de Golfech sur la Garonne dont la partie aval est actuellement en fonctionnement. Un certain nombre d'actions de recherche et de suivi d'efficacit? de ces ouvrages est parall?lement en cours.

In the first part of this paper, the present state of design of fishways is reviewed, focusing on the interest and the limits of each type of fish facility. The second part deals with downstream migration problems at hydroelectric powerplants: fish damage in spillways and hydraulic turbines and design of fish screening and other diversionary techniques used to prevent entry of downstream migrant into intakes.

It has been shown that all-transretinoic acid (ATRA) at doses of 45 to 100 mg/m2/d induces complete remission (CR) of acute promyelocytic leukemia (APL) by a differentiation process. To date, ATRA dose-ranging studies have not yet been evaluated. Thus, we initiated in May 1990 a multicenter study with ATRA at a lower dose of 25 mg/m2/d until CR. Thirty patients with APL were treated with ATRA, of whom 12 were previously untreated, 14 were in first relapse, and 4 had failed after conventional first induction chemotherapy. Twenty-four of 30 achieved CR, 3 failed, and 3 died before day 30. Median time to CR was 45 days. Hyperleucocytosis (14 to 43 × 109white blood cells per liter) was observed in 9 patients between days 10 and 23. Clinical complications that may have been related to the retinoic acid syndrome were observed in 8 patients, of whom 3 died. Pharmacokinetics studies were performed in 5 patients. Peak plasma concentrations and mean area under the concentration-time curve were not lower than previous levels obtained under the 45 mg/m2dose. Overall, our study shows that there is no difference in terms of therapeutic efficacy, triggering of hyperleukocytosis, or retinoic acid syndrome and pharmacokinetic results with ATRA at 25 or 45 mg/m2/d.