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This paper summarizes the latest studies on lithic raw material raising that are currently undertaken within the Sierra de Atapuerca research project. During the past two years, several works have provided new petrographical and technological data, contributing to the knowledge of the kinds of materials exploited by the Atapuerca hominids, as well as the areas where those materials were raised. The sites yielding this information are Gran Dolina (Lower and Middle Pleistocene) and Galeria (Middle Pleistocene), both located in the Trinchera del Ferrocarril archeopaleontological complex. [Copyright &y& Elsevier]

The efficacy of drug therapy in asthma varies widely between patients. Inter-subject variability may be due to environmental factors, differences in patient compliance, biological variations involved in the mechanisms of the disease or in the mode of action of drugs, some of which may be genetic in origin. The study of genetic factors determining treatment response to a given drug defines pharmacogenetics, a science in its infancy at the dawn of this new millennium. In asthma, a comprehensive screen of genes likely to be important in determining treatment response has not yet been performed. This paper will review the recent data regarding two good examples of polymorphisms apparently determining treatment response to two classes of drugs, the β2-agonists and the anti-leukotrienes. [Copyright &y& Elsevier]

The paper describes the modelling of coriander essential oil extraction by steam distillation. Two models are applied: the first one takes only diffusion into account, in the second the solution of the transferred species is additionally modelled. The model is formulated as the system of partial differential equations. It is space discretized and than solved using Runge–Kutta method. The comparison of the simulation results with experimental data shows that the more complex model gives good agreement with experimental data. [Copyright &y& Elsevier]

Matching of relationships between structures during epileptic seizures.The general context of this paper is the study of stereoelectroencephalographic signals (depth EEG) recorded during epileptic seizurs. A matching method is presented. It is aimed at quantifying (from seizure to seizure) the reproducibility of relations between channels estimated with the coherence function. On two recordings, we choose with the expert the signals on which the coherence functions are computed. A bias-correcting algorithm is then applied, and the corrected coherence is averaged on a set of frequencies to get an estimator with a lower variance and easy to interpret. The coherences are quantified and matched by extracting the least cost trace, from which we look for the vectors of coherence having a minimum number of identical coordinates. The method is applied on simulated signals built from scenarios that describe a subtype of temporal lobe epilepsy and then tested on real SEEG signals. Issues of this work are linked to: i) the automatic extraction of similarities in the evolution of relationships that take place between cerebral structures during seizures, and ii) the pointing out of recurrent scenarios in the organization of these seizures. [Copyright &y& Elsevier]

Dense motion field estimation on a echocardiographic sequence.The estimation of the dense motion field is a first stage treatment often encountered in echocardiographic sequence diagnosis systems. Due to the low time sampling rate and the significant noise of such images, the usual methods based on the first order approximation of the optical flow constraint are inefficient. In this paper we propose a new method capable of dealing with these two problems by using the discrete form of this constraint. However, with this approach we are confronted with a non-convex minimization problem, dealt with by means of a continuation process. Finally, we present the results obtained on different echocardiographic sequences. [Copyright &y& Elsevier]

A book published in 1999 hypothesized that the scientists who worked with the CHAT type 1 attenuated polio strain tested in the former Belgian Congo in the late 1950s had covertly prepared the vaccine in chimpanzee kidney cells contaminated with a simian immunodeficiency virus which evolved into HIV-1, group M. This paper summarizes the results of the investigation conducted by the author to determine the legitimacy of the accusation. Testimony by eye witnesses, documents of the time, epidemiological analysis, and ancillary phylogenetic, virologic and PCR data all concur to reject the hypothesis as false and without factual foundation. [Copyright &y& Elsevier]

In a clinical research studying juvenile sexual delinquents, we noted that close to 40% of these teenagers had a parent or a grandparent having been, not abuser, but rather victim of sexual abuse in his own infantile or juvenile history. This astonishing statistic brought us to analyse the family relations that can exist between parents and young authors of sexual abuse. To present different models of transmission we are inspired by six groups of studies: American empirical studies of the family environment of young authors of sexual abuse; papers on sibling incest; research on traumatism and identification to the aggressor; investigations on the failings of the paternal function; studies on «sociopathy», a notion that designates delinquency as a sub-culture, and more recent hypotheses on secrets, silences and their attractive strength on the adolescent via a so-called «unconscious» psychic transmission. [ABSTRACT FROM AUTHOR]

Introduction. – Treatment of malignant tumors can delay some opportunistic infections. In this paper, we report three cases of alveolo-interstitial pneumonia among HIV negative patients who received chemotherapy.Exegesis. – All three patients received corticotherapy for a long time. In two cases, it was pneumocystis-tuberculosis coinfection. Evolution was favourable for two patients with sulfame´thoxazole-trime´thoprime (one with corticotherapy).Conclusion. – The possible role of chemotherapy, corticotherapy and malignant tumor in the pathogenesis of opportunistic infections will be discussed. [ABSTRACT FROM AUTHOR]

Several prognostic scores have been developed for cardiac surgery. The Euroscore, published in 1999, is one of these tools. It was then disseminated and widely studied. However, before being used in a given context (i.e., in a particular country or population of patients), the prognostic scores must be validated, perhaps even adapted. If an existing model cannot be sufficiently adapted, a new model must be developed. Continuing improvement is necessary. Our paper aimed to verify that the Euroscore responds to current methodological standards. The main publications on the Euroscore are summarized to present the score. The methodological aspects of its development and validation are then discussed using the « Agence nationale d'accre´ditation et d'e´valuation en sante´ a˚ (French National Agency for Accreditation and Evaluation in Health Care) critical evaluation grid to bring out the score's strengths and weaknesses. The Euroscore allows an objective evaluation of the risk factors of early mortality. It may be recommended as a component which is preliminary but essential for managing patients with indications of cardiac surgery. As a validated prognostic scoring index, the Euroscore may be used by physicians and researchers for any evaluation purpose in groups of patients, either for results of surgical procedures or clinical trials. The work that led to developing the Euroscore should be highlighted and shown as an example to follow, reproduce, and complete by following up cohorts, with the aim of modeling survival time, the risk of disability, and quality of life. [Copyright &y& Elsevier]

The official way of taking care of the mentally disabled is by its principles, procedures and techniques a two-fold treatment. It will appear in this paper that our preference goes to the most traditional of the two options, the combined-therapies, in other words the “multisided therapies”, also called the “focus-shifting” strategies. The issue concerning combined therapies with two or three focuses being applied to severely disabeled patients is raised. This involves simultaneously an analytic investigation as well as behavioral psychotherapy, together with medication and support. Concerning the other more popular technique – the “integrating psychotherapies” – also known as the “psychotherapeutic movement for integration”, it will be critically examined. Our aim is to show that this integrative approach in psychotherapy is an offshoot from the eclectic and pragmatic american school of thought.It is not compatible with a psychoanlytical approach even when it tries to use its clinical and theoretical contribution. [Copyright &y& Elsevier]

Scho¨nlein-Henoch purpura is a systemic vasculitis involving primarily the skin, musculoskeletal system, gastro-intestinal tract, and kidneys. The purpose of this paper was to report the first described pediatric case, to our knowledge, of adrenal hemorrhage occurring in Scho¨nlein-Henoch purpura.Case report. – Our patient was a 12 year-old girl who presented a right adrenal hematoma diagnosed following an episode of acute right flank pain, ten days prior to the appearance of the clinical symptoms of Scho¨nlein-Henoch purpura.Conclusion. – We think that Scho¨nlein-Henoch purpura should be included in the diagnosis of adrenal hematomas. [ABSTRACT FROM AUTHOR]

Juvenile aponeurotic fibroma is a rare benign tumour which occurs mainly in young patients under 20 years of age and especially during childhood. Clinical presentation is a unique, hard and painless tumour of the palm or sole. The treatment commonly accepted for this locally recurrent tumour is complete excision with function preservation. In this paper, we report on a case of juvenile aponeurotic fibroma of the thenar area with a thickening of the first metacarpal bone shaft. Bone involvement in juvenile aponeurotic fibroma is a very rare condition. We only found one report of a comparable case in literature. [Copyright &y& Elsevier]

Many papers in the literature focused on cholecystokinin for some years. It is a group of small peptides which act at several levels in the organism. Cholecystokinin plays an important role in nutrition, food regulation and satiety signaling. This article presents the biosynthesis and structure of this family of peptides, the cholecystokinin receptors and the digestive, nutritional, metabolic and satiety control exerted by these regulatory peptides. The psychobehavioral aspects of cholecystokinin are not described here in details. [Copyright &y& Elsevier]

For the last two decades, neural networks have been progressively used in the field of biomedical research. Among them, electroencephalography largely benefited from these tools. In this paper, we are presenting the main characteristics of neural networks. Those networks are tools which are nicely suitable to the electroencephalogram processing. A large bibliography provides the reader a broad view of the works performed in this field and can be used to begin new studies. [Copyright &y& Elsevier]

The first aim of this paper is to present a critical review of the existing literature on neurogenic ectopic ossification. The second aim is to introduce the two papers published in this issue of the journal. In addition, etiopathogenic aspects are described as well as some insights in classical therapies and new therapeutic options which could prove to be useful in the near future. [Copyright &y& Elsevier]

On 1859 October 31, in a paper presented to the Socie´te´ me´dico-psychologique, L.V. Marce´ has described the cases of two girls suffering from what Lase`gue and Gull would name, a few years later, anorexia nervosa. Isolation therapy is required for the treatment of these patients.Since the most clinicians have endorsed the therapeutic role of isolation.For instance Charcot have emphazided the need of an “absolute isolation” and nowadays a few teams still believe in isolation or at least a strict separation from family.But at the same time, new therapies have been developped and alternative therapeutic models to full time classical hospitalisation have appeared. In this new programs parents are now integrated (instead of being move away) in a therapeutic alliance, even considered as cotherapists. [Copyright &y& Elsevier]

This paper written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie is specially devoted to the nutritional treatment of infant and child acute diarrhea, ie oral rehydration with salts solution and feeding. It complements an article on drug therapy of child acute diarrhea written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, and published in this same issue of the Archives de pe´diatrie. [ABSTRACT FROM AUTHOR]

In this paper written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, recommandations are given on the indications of drugs in infant and child infectious acute diarrhea, based upon the current scientific knowledge on their effectiveness and tolerance. This paper complements an article on nutritional treatment of acute diarrhea written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie, and published in the same issue of the Archives de Pe´diatrie. [ABSTRACT FROM AUTHOR]

Two kinds of methods are available in order to assess the functional relationships between different cerebral structures from the analysis of EEG signals: linear and non-linear methods. In this paper, we describe didactically the methodological bases of signal processing. After recalling the significance of the fundamental parameters of a sine wave: frequency, amplitude and phase, we show, from a first example about an epileptic seizure propagation, how a linear variation between phase and frequency can be interpreted as a small time difference between two EEG channels. This linear method hypothesises that these two signals are respectively the input and the output of a linear system. Then, we point out the limits of this method and we introduce non-linear methods. Among the latter, a recent approach introduces a realistic model of EEG which try to relate signal measured quantities to relations between underlying structures which produce them. [ABSTRACT FROM AUTHOR]

This paper examines the phonological status of nasal vowels in Haitian Creole. We propose to represent these elements in the lexicon by a sequence oral vowel/floating nasal consonant. The postulating of such a floating segment allows us to evaluate two rules of nasalization: a regressive rule of nasalization that takes place within a morpheme and a progressive rule that occurs across a morpheme boundary. It is shown that these rules apply in very few cases and processes of nasalization/free variation/non-nasalization occur in the speech of the same speaker. We assume that the unstable nature of the phenomenon of nasalization is due to a phenomenon of linguistic change toward nasalization. The floating nature of the nasal element accounts, from a theoretical standpoint, for both the process of linguistic change and the unpredictible nature of nasal assimilation. The description proceeds within the framework of Principles and Parameters. [Copyright &y& Elsevier]

This paper gives an account of recently completed research on the effects of violent TV images on early adolescents. This work deals with the question of the influence of the (small) screen on early adolescents presented differentially with violent and non-violent images using both group and individual clinical approaches. In particular, the work has tried to deal with one particular question : in what ways might groups and images interfere with each other and lead to violent behaviours ? (Even though violent images are usually held responsible for violent behaviours). Violent pictures increase childrens’ vulnerability to the group violence : children who have seen such images experience sensations, emotions and bodily states which are hard to control and are therefore disturbing. These children are tempted to adopt the reference points of their peer group or even those of the group leader. It can therefore be said that the violence preparation for group violence, in turn further intensifies the violence of the (original) images. Certain proposals have been abstracted from this research for the use in establishing media- and image-education programs. The authors believe this could lead to a return towards the real purpose of the school: the teaching of the symbolisation of life’s experiences using all possible means. [ABSTRACT FROM AUTHOR]

Palaeoenvironmental distribution of Messinian oysters in the Sorbas Basin (Andalucia, SE Spain). According to their abundance in the Cainozoic deposits and their good preservation, the oysters constitute good indexes for the Neogene palaeoenvironmental reconstructions. So, in this paper, oysters are used to propose palaeoenvironmental reconstructions of the Sorbas Basin (Andalucia, SE Spain) during the Messinian, both before and during the deposit of evaporites. Four sections have been studied. The three first ones are located in the pre-evaporitic Messinian (La Mela, Cerro de Los Lobos and Cerro Mandras) and have provided four species of oysters: Neopycnodonte navicularis (Brocchi, 1814), Crassostrea gryphoides (Schlotheim, 1913), Ostrea lamellosa offreti Kilian, 1889, et Hyotissa hyotis (Linne´, 1758). The sequential distribution of these species in the sections and the ecological affinities of Recent related species are used to propose a pattern of distribution of oysters during the Messinian in the western Mediterranean: (1) N. navicularis seems to be mainly a species of deep inner shelf and outer shelf (circalittoral sensu . (2) C. gryphoides et O. lamellosa offreti are distributed in the inner shelf (infralittoral sensu mainly on fine substrates for C. gryphoides and mainly on coarse substrate for O. lamellosa offreti (3) H. hyotis is restricted to shallow inner shelf and near the coral reefs.The fourth section (Los Yesos) contains mainly evaporitic facies and has been interpreted with the palaeoenvironmental pattern of oysters distribution established with the previous study of pre-evaporitic series. This section comprises a serie of 75 metres of gypsum, but shows two intercalations of fossiliferous sands (at 10 and 30 metres from the base of the gypsum, respectively) in its lower midpart and a third fossiliferous intercalation of marls and limestones in its upper midpart (at 70 metres from the base of the gypsum). So, the section presents a cyclic succession of evaporitic deposits and non evaporitic facies with oysters. The three fossiliferous intercalations are interpreted as clear marine facies: (1)-the two first ones are closely similar (black sands with H. hyotis and N. navicularis) and characterize inner shelf; (2)-the marls and the fine limestones with N. navicularis of the third intercalation characterize outer shelf. [Copyright &y& Elsevier]

The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months.Seventy-five cases only are described in the literature. The surgery is the basic treatment.whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank. [ABSTRACT FROM AUTHOR]

This paper concerns a numerical and analytical investigation of the self-similarity of the turbulent plumes evolving in a stratified medium. The analytical investigation allows us to bring out the self-similarity conditions of the flow. The laws obtained are as valid for the case of a plume of warm air as for light gas and are verified experimentally in the case of a helium plume. The axial evolution of the mean velocity and concentration does not follow the classical laws, but follows new self-similarity laws that depend on the stratification of the medium. The self-similarity is even observed for the turbulent field, especially for the vertical velocity component while it is reached more slowly by the radial component. A simple numerical model is proposed for the prediction of the mean fields. The influence of the different coefficients of the model on the progressing of the flow is investigated. The results we obtain are compared to the experimental data and good agreement between theory and experiments is observed. [Copyright &y& Elsevier]

In this paper, we study the monodromy of the ramified Cauchy problem for operators with multiple characteristics of constant multiplicity. More precisely, we give an estimation of the eigenvalues of the solution''s monodromy, first with the assumptions of the theorem of Hamada–Leray–Wagschal, then with the assumptions of the theorem of Leichtnam. [Copyright &y& Elsevier]

We show the methodology we followed in order to reliably estimate a factor that, to our judgement, is fundamental for the assessment of the characteristics of a prehistoric settlement: the conditions of exposure to the sun. This methodology is applied to the study of Mesolithic shell middens in the North of Spain, with the aim to introduce a new kind of information in the debate about the meaning of shell middens. Throughout this century, different ways to understand the behaviour these remains conceal have been proposed. Our thesis with regard to it, presented in this paper, is based on the observation of a series of variables, among which we can find the exposure to the sun the settlements undergo. We therefore show in the last part of the paper, how to join the information from the proposed analysis with the other data subsequent from the study of other variables such as the environmental conditions prevailing during the period of formation of the sites; the situation of the settlements; the location of the remains in the caves; the entity of the occupations; and the energy spent on the transportation of the aquatic resources from the coast towards the places where their rests are found nowadays. In short, we propound a methodology for the study of one of the variables that falls upon the habitability of a prehistoric settlement and we point out the contribution that the incorporation of an analysis of this kind means for the research of Mesolithic shell middens in the North of Spain. [ABSTRACT FROM AUTHOR]

Escherichia coli (E. coli) is the most frequent bacterium implicated in community-acquired infection as well as in nosocomial infections. This bacterium is characterised by numerous possibilities to acquire resistance mechanisms, even during antibiotic treatment. The main mechanism of resistance is the production of beta-lactamines, enzymes hydrolysing beta-lactam ring. This paper describes enzymatic mechanisms of resistance of E. coli to beta-lactam and indicates the necessity of a good knowledge of the risk factors for resistance to have an adapted good clinical practice in using antibiotics. [Copyright &y& Elsevier]

Purpose. – Treatment of non-Hodgkin’s lymphoma (NHL) in the elderly is difficult because of an increased risk of toxicity and frequent chronic or debilitating diseases. The aim of this paper is to describe the main studies in this field.Current knowledge and key points. – Most recent clinical trials deal with anthracyclin or assimilated drugs regimens. Potential interest of chemotherapy and associated immunotherapy is on study. Without any influence on survival duration, haematopoietic growth factors seem to improve the tolerance of the treatment.Future prospects and projects. – For elderly patients with good performance status and without severe co morbidity, curative strategy with anthracyclin-containing regimen like CHOP is still the standard chemotherapy. Association with rituximab improves the prognosis. For patients with poor performance status and/or associated disease, optimal strategy remains to be defined with quality of life evaluation. [ABSTRACT FROM AUTHOR]

This paper deals with segmentation of retinal angiographic images and especially drusen images (yellowish deposits). Those images are very complex because of noise, low contrast, insufficient gray level dynamic and non-homogeneous representation of objects. We introduce a segmentation method, which proceeds in two steps. The first step deals with contrast enhancement thanks to an image optimal partition into three classes : the first class (highest gray level values) corresponds to drusen, the second class corresponds to the image background and the intermediate class, clusters all the ambiguous pixels, defining fuzzy region. In the second step, we apply a fuzzy classification. It first consists in giving membership value for each gray level. Then, an iterative method, taking to account the pixel spatial context, allows to determine whether a fuzzy pixel belongs to the drusen class or to the background class. Quantitative results deduced from our automatic segmentation of drusen are well correlated with those derived from manual delineation of a clinician. The proposed quantification both allows to a reliable assessment of the number and the size of drusen and we shows that it could be applied to control the evolution of over the time. [Copyright &y& Elsevier]

The relationship between volume and surgical outcome seems logical, but needs to be demonstrated in the real world. A qualitative systematic review has been conducted to verify this hypothesis. Five systematic reviews and hundred original papers have been retreived and analysed. Most of the studies were retrospective and used administrative data instead of medical charts. Moreover few studies involved a good case mix adjustment when comparing surgical units or individual surgeons. These methodological flaws do not allow any evidence based conclusions. Even though a positive relationship is suggested for surgical units, the relationship between volume and outcome was however less obvious for an individual surgeon. There is some evidence that the relationship varied greatly according to the specialty or the procedure evaluated. A new approach based on predictive scores comparing expected versus observed outcomes is mandatory and seems to be the best way to assess objectively the relationship between surgical volume and outcomes. [ABSTRACT FROM AUTHOR]

Since January 2001, radiotherapy treatments with modulated intensity beams (IMRT) have started at the Centre Oscar-Lambret. This paper presents the tests and measurements made before the clinical implementation as well the quality control performed before each routine treatment. We use the treatment planning system Helax-TMS (MDS-Nordion) and the Primus accelerator (Siemens) linked to the Lantis network with Primeview© and Simtec© modules (Siemens) allowing to deliver intensity modulated beams with Step-and-Shoot technique. A prostate case and a head and neck case have been studied and have permitted to evaluate the benefit of IMRT compared to a “classical” conformal radiotherapy. In a second time, we have tested the accelerator''s capabilities to deliver these intensity modulated beams, id-est. the accuracy of the leaf positions and the linearity of the monitor chamber. The third step has been the verification of the dose distributions calculated by Helax-TMS, id-est, the dose for different segment sizes, the dose profiles for an intensity modulated beam and the dose distribution for all the traitment beams. The used phantom has been especially developed at the Centre Oscar-Lambret for IMRT. The results have allowed to start clinical treatments and to establish a quality control set for this technique. The next step is the real time dosimetry with a portal imager. [Copyright &y& Elsevier]

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Herpesviridae are ubiquitous, and are commonly involved in well identified diseases as genital herpes, chickenpox and herpes zoster, infectious monucleosis, exanthem subitum… They are responsible for latent and chronic infections after primo infestation. Atherosclerosis, multiple sclerosis, Alzheimer’s disease are diseases which are very different, and for which pathogenesis remains unknown. Several authors have hypothesized that Herpesviridae could play a role in such diseases. The present paper reviews arguments not only in favour but also against such hypothesis. Any formal conclusion is impossible, and more extensive studies are warranted. [Copyright &y& Elsevier]

Genital herpes is a frequent chronic, sexually-transmitted disease among adults. Besides its physical consequences that largely depend on the frequency and intensity of recurrences, genital herpes frequently induces a psychological morbidity. This paper discusses the instruments of measure that can be used in the evaluation of health-related quality of life among infected patients and states the results of a French study that confirmed the substantial psychological morbidity caused by genital herpes. [Copyright &y& Elsevier]

Because it symbolizes henceforth the sanitary risk and fears which are linked to it, the blood transfusion must master the potential or real risks associated to its practice. The analysis of these risks leads to confirm the initial selection phase of candidates for blood donation as an always original stage of the blood transfusion safety towards the identified infectious risks, but also mainly towards the emergent or modelled risks. The evaluation of the current system of prevention leads to consider two potential dangers: the ineffectiveness of the selection because of the lack of meaning given to this stage, and the donors'' disaffection caused by badly accepted or badly justified deferrals. The deficit of meaning can be due to an insufficient information of the population as for the policy of collective prevention of transfusion-transmitted infectious diseases. It can be worsened by the construction of the pre-donation interview which can appear as a succession of questions without visible links. This paper suggests risk analysis to blood transfusion, and a reflection to improve this important stage of blood product safety approach represente by the selection of candidates to a blood donation. [Copyright &y& Elsevier]

Cardiac pacing has been proposed for patients with advanced heart failure refractory to optimal drug treatment and having conduction disorders to resynchronize mechanical activity of the heart. Activation asynchronism as caused by bundle branch block results in alteration of systolic function and arrythmias. A too short or too long atrio-ventricular delay can also affect diastolic ventricular filling. Early clinical studies showed a benefit of very long atrioventricular delays shortening, not confirmed by further studies. Direct stimulation of the left ventricle was beneficial in acute hemodynamic studies. Three controlled clinical studies now completed, PATH-CHF, MUSTIC and MIRACLE have showed a functional benefit. Other studies (COMPANION, CARE-HF) are currently in process to evaluate the effect on survival and the interest to associate an automatic defibrillator. Technical aspects are also under investigation: optimal lead placement in the coronary venous system, types of leads, special pacing devices. This paper reports the experience of the first 50 patients treated with multisite pacing in Aix-en-Provence general hospital, 33 men and 17 women, 71 years of mean age, on NYHA class III or IV, and showing QRS width above 120 ms. During the follow-up (mean duration 16 months) 15 deaths (30%) happened. The benefit on NYHA class was 1,34 ; rehospitalization rate was low. Coronary sinus access was successful in 100% of cases. Sixteen per cent had a reintervention for lead displacement or threshold elevation. Left atrioventricular crosstalk, observed in six patients, supports the use of devices with three independant channels. Echocardiography is of interest for responders identification, optimal device programming and follow-up. [ABSTRACT FROM AUTHOR]

Objective: The starting point of the French conference of consensus concerning arousal after coma was to answer the following question: “How can we define the ways of going from coma to arousal and their clinical levels?”Materials and method: A team of readers have picked up in the literature one hundred and fifty papers, out of which fifty six have been analysed.Results: From this analysis, three points emerged: The concepts of coma and arousal; The conditions of evolution from coma to arousal; Various groups of patients depending on their expressing arousal. One could not find any consensual model concerning the different ways of going from coma to arousal. The variability of the technics and the changing validity of all scores did not allow the conditions of arousal to reach a satisfactory level of proof. The Glasgow Coma Scale (GCS) is the recognised standard for severe wakefulness’ impairment, but it is not sensitive enough while patients’ arousing. The Glasgow Outcome Scale (GOS) takes into account the patients’ situations far later and does not include situations such as Minimally Conscious States (MCS). That’s why we face multiple scores, either ordinal, or categorial, all tending to evaluate the slow levels of arousal.Conclusion: Clinical findings concerning arousal are to be completed by non-clinical data. This would be greatly helpful to define appropriate management concerning individualized groups of patients. At this stage, another challenge for clinicians is to make the difference between emerging wakefulness and growing conscious activity. [Copyright &y& Elsevier]

Objective: To analyse relevant literature and to express an expert point of view concerning the interest of electroencephalography and evoked potentials recordings in the evaluation of severe head trauma in adults in the context of a consensus conference.Material and methods: Scientific databases have been checked on the Internet using key-words.The summaries of 340 papers have checked out. Consequently 94 papers have been thoroughly analysed. Fifty-nine of them are cited in the text of this paper.Results: Electroencephalography (EEG) and evoked potentials (Eps) evaluate the functional status of the brain. They augment the clinical examination. They are non invasive and easy to perform at patient''s bedside. The EEG evaluate globally the functional status of the brain but it is very sensitive to sedative and anaesthetic drugs. It can disclose subclinical or electroclinical epileptic seizures. When reactivity to sensory stimulations can be elicited, this can be considered a prognostic indicator for a good outcome. Evoked potentials are less influenced by sedative drugs. There are several types of evoked potentials, each one with a different localizing value. Brainstem auditory evoked potentials (or short-latency Eps) evaluate the auditory nerve and brainstem. When normal they have no specificity. When abnormal they are an indicator of a poor or bad outcome. Somatosensory and auditory middle-latency Eps evaluate the primary cortex. In coma due to traumatic brain injury the presence of primary cortex components is an indicator of a good outcome and its absence is an indicator of a poor outcome at least when there is no focal brain lesion as to have the primary cortex component to be absent. Event-related potentials evaluate associative brain areas. When they are present in a comatose patient they favor the idea that some cognitive processes are active and they have a high positive predictive value for a return to consciousness. The electrophysiological evaluation can help to identify atypical situations and pathologies close to coma, disclose nonconvulsive seizures and localize certain complications or dysfunctions in atypical cases. [Copyright &y& Elsevier]

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience of several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation. [Copyright &y& Elsevier]

The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3D treatment planning systems, sophisticated immobilization devices and demanding quality assurance and treatment verification. The main goal of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of healthy tissues. These techniques would then allow a further dose escalation increasing local control and survival. Non-small cell lung cancer (NSCLC) is one of the most difficult malignant tumors to be treated. It combines geometrical difficulties due to respiratory motion, and number of low tolerance neighboring organs, and dosimetric difficulties because of the presence of huge inhomogeneities. This localization is an attractive and ambitious example for the evaluation of new techniques. However, the published clinical reports in the last years described very heterogeneous techniques and, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from those conformal radiotherapy techniques. After reviewing the rationale for 3DCRT for NSCLC, this paper will describe the main studies of 3DCRT, in order to evaluate its impact on lung cancer treatment. Then, the current state-of-the-art of IMRT and the last technical and therapeutic innovations in NSCLC will be discussed. [Copyright &y& Elsevier]

This paper reports the patient care experience during the trajectory of the radiotherapy. Plights are multiple. Patients are confronted with a complex and unknown distressing space, an irrelevant information, a banalisation of side effects, an isolation with a frequent inadequate support of their family or the caregivers team, with the fear of a definitive abandonment at the end of the treatment without conforting follow-up. It is imperative to state a real policy in order to improve the patient support. Sensibilisation and training of the caregivers, in spite of a frequent overbooking technical work, is required in a pluridisciplinary approach to provide a relevant reception with the collaboration of psychologists, social workers and self care groups and associations. The personal implication of the physicians and technologists is also essential. The simple smile is the intangible proof of the reliable emotional support. [Copyright &y& Elsevier]

Introduction: Split-thickness nail bed graft have been proposed for treatment of post-traumatic nail bed dystrophies. Only three papers reported good results in 60 to 90% of cases. We report our experience.Material and methods: We reviewed 18 cases of split-thickness nail bed grafts from operative and consultation files and photographs. Evaluation was made using criteria as the nail plate shape, its adhesion on the nail bed, patient satisfaction and possible sequelae on the donor finger.Resultats: Thirteen patients have been reviewed with a sufficient follow-up to assess the results. In 13 cases, the graft was taken from the hallux. The nail-bed graft was used for hallux recontruction two times, the thumb six times, index six times, middle and ring finger one each, and the little finger two times. In every patient the graft was molded using either the patient nail or the nail plate from the donor finger. Clinical results were excellent in five cases, good in three and poor in five cases. Five failures were due to wrong indications in three cases in which matrix problem has been underestimated, and infectious failures in two cases. Fifteen per cent of our patients had some sequelae on the donor finger. [ABSTRACT FROM AUTHOR]

Numerical simulation methods permit the control of most parameters in surface heat treatment by Laser and constitute tools for treatment conditions prediction and optimisation. This paper deals with a transient numerical model which enables the simulation of all thermal history for three-dimensional space with any boundary conditions till the return to the thermal equilibrium at cooling. The problem formulation integrates a standard FEM code to solve the heat equation in non-linear transient behaviour. The numerical scheme proposed authorises the resolution with moving boundary condition in consideration of suitable space and time meshing. This model takes into account the non-linearities in relation with the variation of thermophysics properties with temperature and the loss by radiation and convection. The heat of solid phase changing is introduced as conditional source into the thermal affected zone. Compared with several contributions in this subject, this model should give a more subtle approach which gets free from classical simplifying assumptions. [Copyright &y& Elsevier]

Skeletal metastases are common in patients with breast and prostate cancer and cause considerable morbidity and aversely affects the quality of life (bone pain, pathological fractures, hypercalcaemia and nerve compression syndromes). In this paper emerging new concepts of breast cancer-bone interactions, in particular the involvement of angiogenesis and the role of cancer-induced bone resorption in skeletal metastasis are discussed.Because of the progress made in early detection and surgical treatment of the primary tumor, mortality in cancer patients is increasingly linked to metastatic disease. Bone is the second most common site of metastasis. and the frequency of bone metastases at autopsy of cancer patients varies between 60 % and 85 %, depending on the cancer type. Clinical and experimental observations indicate that the hematopoietic marrow, rather than the bone tissue, is the initial site of cancer cell seeding. Micrometastases in bone marow represent the pathophysiological basis of minimal residual disease that will eventually lead to cancer relapse as overt metastases. Understanding of the molecular events in bone metastasis is, therefore, a prerequisite for the evaluation of novel therapies aiming at repressing initial stages of metastatic growth. [ABSTRACT FROM AUTHOR]

This paper reviews literature about oocyte donation for patients with Turner’s syndrome and reports the experience of our center. Before contemplating pregnancy, it is essential to perform a careful evaluation of the cardiovascular system, the renal system, the thyroid status and the glucose tolerance. Different studies have reported a suboptimal response of the endometrium of women with Turner’s syndrome to oestrogen therapy, and suggested that higher doses of estrogens may be necessary to achieve appropriate endometrial preparation. Pregnancy rate per transfer following oocyte donation is around 30% for patients with Turner’s syndrome, comparable to the one observed for patients with other conditions requiring oocyte donation. Miscarriage rate is however higher (40–50%) after oocyte donation in Turner''s syndrome, and could be related to the presence of a hypoplastic uterus along with hypovascularization. During pregnancy, cardiovascular complications are potentially the most severe, such as the exacerbation of a preexisting hypertension and the dissection of aortic aneurysms. There is a high rate of Caesarean section among Turner’s syndrome patients, the main reason being fetopelvic disproportion. Regarding the increased obstetrical risks in Turner’s syndrome patients, the selective transfer of one embryo should ideally be performed in order to avoid additional risks associated with multiple pregnancies. In our center, 9 patients with a Turner’s syndrome had 15 cycles of oocyte donation. Five pregnancies were obtained among which three were evolutive. The outcome of oocyte donation cycles were comparable for patients with a Turner’s syndrome and for patients with other indications of oocyte donation. [Copyright &y& Elsevier]

Trigeneration is defined as the production of three useful forms of energy—heat, cold and power—from a primary source of energy such as natural gas or oil. For instance, trigeneration systems typically produce electrical power via a reciprocating engine or gas turbine and recover a large percentage of the heat energy retained in the lubricating oil, exhaust gas and coolant water systems to maximize the utilization of the primary fuel. The heat produced can be totally or partially used to fuel absorption refrigerators. Therefore, trigeneration systems enjoy an inherently high efficiency and have the potential to significantly reduce the energy-related operation costs of facilities. In this paper, we describe a model of characterization of trigeneration systems trough the condition of primary energy saving and the quality index, compared to the separate production of heat, cold and power. The study highlights the importance of the choice of the separate production reference system on the level of primary energy saving and emissions reduction. [Copyright &y& Elsevier]

Let M be a CR manifold. The main results of this paper are the following:(A)When M is real analytic, a semi-global Hartogs extension phenomenon occurs for real analytic CR functions if and only if M is nowhere strictly pseudoconvex and dimRM⩾3.(B)When M is a standard manifold, the Hartogs–Bochner extension phenomenon occurs for non-CR-confined domains if and only if M is nowhere strictly pseudoconvex and dimCRM⩾2.(C)If M is a smooth submanifold of Cn foliated by complex curves, a semi-global Hartogs–Bochner extension phenomenon occurs for smooth non-CR-confined domains if and only if dimCRM⩾2.(D)If M is a real analytic nowhere strictly pseudoconvex manifold and if Ω is a sufficiently small domain in M, a hyperfunction which is real analytic in a neighborhood of bΩ and CR in a neighborhood of Ω is in fact real analytic on Ω. [Copyright &y& Elsevier]

This paper describes the human remains and other evidence of human presence (lithic artifacts) located in the early Pleistocene deposits of Orce and Cueva Victoria (SE Spain). We also discuss the age of those sites. [Copyright &y& Elsevier]

This paper presents preliminary archaeological and chronostratigraphical data obtained during pilot excavations of one of the northernmost European Early Upper Palaeolithic sites, Zaozer''e, situated on the western slope of the Middle Urals. [Copyright &y& Elsevier]

HIV-infected patients are at greater risk for drug hypersensitivity than non-HIV-infected patients. Sulfonamides and anti-retroviral drugs are most often the responsible agents. We detail in this paper our 5-year experience with this problem. Ninety-three HIV-positive patients with a clear history of hypersensitivity to cotrimoxazole, nevirapine, nelfinavir or efavirenz were included in a tolerance-induction protocol. The clinical manifestations were as follows: 68 patients had had pruriginous maculo-papular eruptions including 17 with fever and 12 with other symptoms (conjunctivitis, asthenia, digestive symptoms, etc). Fourteen patients presented with urticaria, with fever in 4 of them. Twelve doses of the responsible drug, prepared the day of the challenge, were given orally at 30-minute intervals. We were successful in 90% of the cases. Therefore, tolerance induction may be an alternative for such patients. [Copyright &y& Elsevier]