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Demaille Julien. Introduction. Pour une histoire sociale, politique et culturelle des associations cultuelles en Grèce et en Asie Mineure (époques hellénistique et impériale). In: Les associations cultuelles en Grèce et en Asie Mineure aux époques hellénistique et impériale. Compositions sociales, fonctions civiques et manifestations identitaires (époques hellénistique et romaine) Besançon : Institut des Sciences et Techniques de l'Antiquité, 2021. pp. 9-15. (Collection « ISTA », 1523)

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The cultural association devoted to Zeus Hypsistos at Pydna is known by a large stele both dated by the Macedonian era and the Augustan era. By enumerating the names of the dignitaries and of the worshippers, the inscription gives some information concerning the functions of the officials and allows us to study the social characteristics of an association located at the periphery of the colonial territory of Dion by the middle of the 3rd century A. D. Put into perspective with other inscriptions in the territory, the study of this stele will try to help us understand the peculiarities of the worship dedicated to Zeus Hypsistos in Pydna. But many questions remain unanswered, in particular how to determine to which sanctuary this association is connected., L’association cultuelle à Zeus Hypsistos de Pydna est connue par une grande stèle datée conjointement par l’ère macédonienne et l’ère d’Auguste. En énumérant les noms des dignitaires et des fidèles, cette inscription présente les fonctions des responsables de la confrérie et permet d’appréhender le faciès social d’ une association située en périphérie du territoire colonial de Dion au milieu du IIIe siècle apr. J.-C. Mise en perspective avec les autres inscriptions du territoire, l’étude cette stèle tentera de comprendre les particularités du culte voué à Zeus Hypsistos à Pydna. Mais bien des questions restent en suspens, notamment celle de déterminer à quel sanctuaire cette association est liée., Demaille Julien. L’association des fidèles de Zeus Hypsistos à Pydna, reflet d’une société périphérique sur le territoire colonial de Dion (Piérie, Macédoine). In: Les associations cultuelles en Grèce et en Asie Mineure aux époques hellénistique et impériale. Compositions sociales, fonctions civiques et manifestations identitaires (époques hellénistique et romaine) Besançon : Institut des Sciences et Techniques de l'Antiquité, 2021. pp. 65-88. (Collection « ISTA », 1523)

À partir de tous les types de textes disponibles, les actes de ce colloque international invitent à s’interroger sur les mots et les discours relatifs à la ville dans les territoires où l’on a parlé grec au cours de l’Antiquité et du Moyen Âge. L’étude du vocabulaire et du langage vise à mieux comprendre le sens des mots eux-mêmes, leur évolution dans le temps, leur variation selon les régions et la diversité de leurs usages dans des écrits de nature différente. Elle a aussi pour but d’expliciter les représentations mentales qui tout à la fois sous‑tendent l’usage de ces mots et en résultent. Comment les mots de la ville se façonnent-ils ? Comment les mots façonnent-ils la ville ? Les articles, consacrés à un terme pris isolément, à une famille lexicale, à un champ sémantique ou à une œuvre concernant des mondes urbains réels ou fictifs, examinent la ville dans son ensemble, ses édifices, les activités conçues comme proprement urbaines, ou les personnes qui y vivent. Ils sont répartis en quatre chapitres intitulés « Des hommes et des villes », « Composantes et composition de l’espace urbain », « Nommer et classer les villes » et « Des villes dans un empire ». Based upon all sorts of available texts, the proceedings of this colloquium are an invitation to question the words and the discourses concerning the city in the territories in which the Greek language was spoken during Antiquity and the Middle Ages. The study of vocabulary and language seeks to better understand the meaning of the words themselves, their evolution over time, and their variations according to region, as well as the diversity of their usage in various types of texts. This study aims at clarifying the mental images both underlying the usage of these words and resulting from it. How are the words of the city formed? How do words shape the city? The articles focus on one term in isolation, on a semantic field, or on a work related to urban worlds, real or fictitious. They treat the city as a whole: its edifices, its activities considered as strictly urban, or its inhabitants. The articles are organized into four categories entitled “People and cities”, “Components and composition of urban spaces”, “Naming and classifying cities”, and “Cities in an empire”.

Dion et Philippes sont deux villes macédoniennes qui possèdent de nombreux points communs et pour lesquelles une histoire comparative peut apparaître, à bien des aspects, particulièrement intéressante. Suite à l’article que Cédric Brélaz et moi-même avons écrit sur l’héritage grec des deux colonies, il m’a semblé pertinent de poursuivre l’analyse comparative des deux cités, au travers des noms par lesquels elles étaient désignées depuis l’Antiquité. Les similitudes entre ces deux villes sont ...

We wanted to assess the awareness of the nursing staff to therapeutic communications on improving the welcoming experience of patients in the operating room for outpatient surgery.This was a single centre prospective impact study performed in an outpatient surgery clinic. In a first phase, a questionnaire was administered by the anesthetist nurse upon arrival of the patient to assess the patient's comfort (NRSc) and satisfaction on a simple numeric scale, and calculate a negative communication score ('NC'). In the second phase, the awareness of the nursing staff on therapeutic communication was emphasized on listening, empathy and the use of positive wording, using educational videos. In the third phase, after the staff awareness-raising period, the questionnaire was repeated. Quantitative variables (primary outcome criterion made of the number of patients with a NC score ≥ 5, NRSc, satisfaction), and qualitative variables before and after the awareness raising phase to therapeutic communications were compared.A total of 234 patients were included (109 before and 125 after). Following the staff awareness session to therapeutic communication, the NC score ≥ 5 decreased significantly from 20% to 6% as well as the median NRSc [PThis preliminary study shows a mild improvement of the patients' comfort and satisfaction after therapeutic communication. A controlled randomized trial is needed to confirm those results.

The Territory of the Roman Colony of Dion. Extension and Cadastration. The territory of Dion was considerably enlarged when the Macedonian city became a Roman colony in 44-43 B. C. The epigraphic texts allow us to partly know its extension, which coincided more or less with the Pierian plain. But a Roman colonial territory is not made of a single block : some autonomous Pierian areas probably still existed., Le territoire de Dion a connu un agrandissement considérable quand la cité macédonienne est devenue colonie romaine en 44-43 av. J.-C. Les textes épigraphiques permettent d’avoir une idée de son extension qui devait coïncider plus ou moins avec l’extension de la plaine de Piérie. Mais un territoire colonial romain n’est pas d’un seul tenant : il subsistait probablement, en Piérie, des enclaves restées autonomes., Demaille Julien. Le territoire de la colonie romaine de Dion : extension et cadastration. In: Espaces et territoires des colonies romaines d'Orient. Journée d'étude de Besançon. 3 octobre 2013. Besançon : Institut des Sciences et Techniques de l'Antiquité, 2016. pp. 93-117. (Collection « ISTA », 1355)

There must have been many slaves and freedmen on the territory of the Roman colonia of Dion (Pieria, Greek Macedonia) as the inscriptions discovered reveal more than forty of them. However it is difficult to recognize their names as most of the time their status was not written. Their level of wealth, generally low, is also a reason of their poor representation in the corpus of the inscriptions of the colonia. In comparison with the number of ingenui, there are more slaves in the territory than in the city of Dion whereas the distribution of freedmen does not look different., Los esclavos y los libertos debían de ser numerosos en el territorio de la colonia romana de Díon (Pierría, Macedonia griega). Las inscripciones halladas en Pierría permiten distinguir más de cuarenta personas dependientes, pero su reconocimiento onomástico es difícil ya que muchas veces no aparece el estatuto social. Su infravaloración en el corpus de inscripciones de la colonia también proviene del bajo nivel de riqueza de la población en general. Sin embargo resulta que, proporcionalmente y con respecto a los ingenui, los esclavos están más presentes en el territorio que en la ciudad de Díon, mientras que la repartición de los libertos no parece ser diferente de la de los ingenui., Demaille Julien. Esclaves et affranchis sur le territoire de la colonie romaine de Dion (Piérie, Macédoine). In: Los espacios de la esclavitud y la dependecia desde la antigüedad. Madrid, 28-30 novembre 2012. Actats del XXXV coloquio del GIREA. Homenaje a Domingo Placido. Besançon : Presses Universitaires de Franche-Comté, 2015. pp. 537-559. (Actes des colloques du Groupe de recherche sur l'esclavage dans l'antiquité, 35)

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Objective To clarify the therapeutic education program impact with multiple sclerosis patients, literature review. Highlight contents and efficacy. Method A non-systematic review on Medline, PubMed and Cochrane library databases from 1966 to 2010 using the following keywords: “multiple sclerosis”, “self-care”, “self-management” and specific symptoms keywords. Clinical trials and randomized clinical trials, as well as literature reviews published in English, French and German will be analyzed. Results Counseling is a part of the non-pharmacological management of chronic illnesses such as multiple sclerosis. Symptoms’ diversity and the different clinical forms limit standardized programs of self-care management, applicable to patients. In the literature review, counseling programs have often low metrology. A behavior change with patients and medical staff could exist. To empower the patient, to reduce symptoms’ impact and to improve treatment access are the aims of educational therapy. Conclusion Therapeutic education program for multiple sclerosis patients could progress with their standardization and assessment, for each sign. To promote the educational therapy of multiple sclerosis patients, a specific training for medical staff, as specific financing are necessary.

Demaille Julien. Les P. Anthestii : une famille d'affranchis dans l'élite municipale de la colonie romaine de Dion. In: La fin du statut servile ? Affranchissement, libération, abolition. Volume I. Besançon 15-17 décembre 2005. Besançon : Presses Universitaires de Franche-Comté, 2008. pp. 185-202. (Actes des colloques du Groupe de recherche sur l'esclavage dans l'antiquité, 30-1)

Could a simple educational intervention modify beliefs about whiplash? A preliminary study among professionals working in a rehabilitation ward.Whiplash and its consequences remain an alarming clinical and social problem, and psychosocial factors could play a role. We aimed to translate and assess the effects on beliefs of an evidence-based educational booklet on whiplash-associated disorders among professionals who work in a rehabilitation ward.After translation/back-translation of the English version of The Whiplash Book, we undertook a before-and-after prospective study. The main outcome assessment was final score on the whiplash belief questionnaire (WBQ) involving nine questions assessing beliefs and attitudes about the consequences of whiplash rated on a 5-point Likert scale ranging from "completely agree" to "complete disagree." Final scores range from 9 to 45, low scores indicating positive beliefs. Demographic, educational and professional data, as well as personal medical history of neck pain, were recorded. Acceptability of the booklet was rated on a 10-point scale and by open questions.Among the 50 professionals included in the study, 48 completed the questionnaire. Whiplash beliefs tended to be positive at first assessment (WBQ score 23.37+/-6.45). Reading the whiplash booklet significantly improved beliefs (14.27+/-4.39; P0.05). Global evaluation of the booklet on a 10-point scale was good (8.13+/-1.05) as was acceptability (8.13+/-1.05).After reading a booklet about whiplash translated into French, beliefs about the consequences of whiplash were changed for the better in this sample of French-speaking healthy professionals working in a rehabilitation ward. This simple educational intervention translated into French could be used for education and for ameliorating beliefs about the consequences of whiplash among health care professionals and the public.

Kiratisin Amonmat, Demaille Dominique. XIX. Les perles en variscite d’Er Grah. In: Gallia préhistoire. Suppléments, supplément 38, 2006. Monuments mégalithiques à Locmariaquer (Morbihan). Le long tumulus d’Er Grah dans son environnement. pp. 205-223.

Réunion du Groupement De Recherche SESAMEIPCMS Strasbourg 22-23 novembre 2004; National audience; La qualité cristalline de cristaux de ZnO de type SCVT (Seeded Chemical Vapour Transport) ethydrothermal a été analysée par topographie aux rayons X et diffraction des rayons X.Les cristaux de ZnO hydrothermal sont mieux appropriés que ceux de SCVT, en tant que substrats pourl’homoépitaxie de films Zn 1-x M x O (M=Co, Mn).

To investigate complications (calcification and/or disc collapse) as seen on radiography and patient-assessed effectiveness after intradiscal injections of acetate of prednisolone (Hydrocortancyl).A retrospective study of medical records of 67 patients (68 injected discs) given an intradiscal injection of acetate of prednisolone for low back pain with endplate signal changes on magnetic resonance imaging and/or evidence of fast destructive discopathy, as well as records of 85 patients (55 women, mean age 49 +/-9 years) to assess the effectiveness of intradiscal injection: the global appreciation of the patient (excellent, good, mild, none, worse) concerning the result of the intradiscal injection at one, three and six months. Two physicians were blinded during analysis of images.The mean period of follow up for radiographics was 10.25 +/-5.99 months. A total of 44.8% of the patients had control at six months and 38.8% at 12 months or more. No calcification was found, but two discs showed a collapse of 20 and 25% at six and 12 months, respectively, after the injection. For effectiveness of intradiscal injection, 71.8% the patients considered the result good or excellent at one month, 55.3% at three months and 43.5 % at six months.The benefit-to-risk ratio of use of acetate of prednisolone intradiscal injection seems good in selected patients with low back pain.

To determine the common risk factors of recurrence, chronicity and non return to work in low back pain.A systematic review of the literature was done by searches of Medline, Embase, Pascal, the Cochrane database and also in the unindexed literature. Keywords used were low back pain, chronic, risk factors, recurrence, predictive value of tests, prognosis, confounding factors. Studies were assessed by two readers using the ANAES (French Agency for Health Assessment) scale allowing classification into high-, moderate- and low-quality trials. The scientific evidence level of the identified risk factors depend on the methodological quality of the studies, the number of studies in agreement, the coherence of their results and their clinical relevance.Fifty-four high quality studies were included. Several prognostic factors are common to the three described clinical situations. A history of low back pain (including the concept of pain severity, duration, disability, leg pain, related sickness leave and a history of spinal surgery), low level of job satisfaction and poor general health are highlighted with a strong level of evidence. Socioprofessionel and psychological factors including employment status, amount of wage, workers' compensation, and depression were found but with moderate level of evidence. Physical factors including lifting time per day and work postures were also found with moderate level of evidence.This study confirm that several prognostic factors are commun to recurrence, chronicity and non return to work in low back pain. Early identification of these factors is important in understanding, and hopefully preventing, the recurrence or the progression to chronicity and disability in low back trouble.

Ewing's sarcoma is the second most common malignant bone tumor of childhood, yet it is a rare tumor. Primary maxillary localization is unusual and occur in only 1-2% of cases, mostly in the mandible. The prognosis of Ewing's sarcoma has been improving considerably since the introduction of combined modality treatment. The estimated overall survival at 4 years is 75%. It is widely accepted that prompt chemotherapy is necessary to treat occult micrometastasis, present in over 80% of cases at time of diagnosis, and to reduce the tumor size. Prognostic factors correlated with a poor overall survival are large tumor size and poor histologic response to initial chemotherapy. Adequate local control of Ewing's sarcoma can be achieved after chemotherapy, with radical or conservative surgery and radiotherapy. Surgery was recommended whenever possible. Radiation dosage and fields are based upon the quality of surgery and histological response to chemotherapy. Concern has been raised, however, regarding deleterious late effects of radiation in this young population. Conservative surgery and reconstruction are often used to improve functional outcome. We report four cases of Ewing's sarcoma localized to jaw bone and mandible, successfully treated by combined modality treatment.

Duchenne (DMD) and Becker (BMD) are allelic forms of a X-linked neuromuscular disorder. Both are caused by mutations arising in the gene encoding dystrophin, a cytoskeletal protein. Two-thirds of DMD/BMD patients have large deletions localised in two hot spots, and the remaining cases are presumed to be caused by point mutations. Since Duchenne muscular dystrophy is a serious disorder for which at present there is no effective treatment, much emphasis has been given to prevention. This involves the ascertainment of women likely to have an affected son, and the provision of genetic counselling and prenatal diagnosis for such women. Accurate carrier detection and genetic counselling depend upon identifying the mutation itself in the proband. Large deletions are easily identified using multiplex polymerase chain reaction (PCR) whereas detection of point mutations is restricted to a few number of specialized laboratories. Hence carrier and prenatal diagnosis in 40% of families rely heavily on indirect approaches which presents major drawbacks and are not applicable in sporadic cases of DMD or BMD. We developped a strategy for searching small alterations in the dystrophin gene. As most of the non-deletion mutations cause a premature termination of translation, we have used the Protein Truncation Test to scan specifically the dystrophin transcripts isolated from muscle biopsies. This approach allowed to detect the disease-causing mutations in more than 90% of the patients who have been investigated; his efficiency is thus significantly higher than DNA-based strategies. The identification of the mutation in non deleted sporadic cases allows the at-risks females to benefit from an accurate diagnosis. Also, the characterization of the molecular defects provides a better understanding of the molecular pathology of the dystrophin gene.

Ifosfamide is one of the most efficient antimitotic in soft tissue sarcoma. To try to find a possible dose-effect, 10 patients with advanced pretraited relapsed soft tissue sarcoma received 15 g/m2/cycle ifosfamide in continuous infusion during 5 days. A pharmacokinetic study was done for 2 patients. All patients received growth factors, ondansetron and 8 clonazepam. Renal toxicity was evaluated after the first and the second cycle. Twenty two cycles were delivered to patients who have been already treated with ifosfamid (10 patients with 15 g/m2 to 54 g/m2, median 27 g/m2) or cis platinum (2 patients). No major renal or neurologic toxicity was observed; only subclinical modifications of urinary enzymes excretion were found. Two patients had visual hallucinations at the end of a cycle and just in the 2 following days; another presented a neuropathy of inferior limbs. Hematological toxicity was very limited. Pharmacokinetic study did not show induction mechanism at this dosage and with this type of administration. So ifosfamide 3 g/m2 during 5 days is feasible. The few level of complications observed is perhaps linked to the daily dose of 3 g/m2 instead of 4 g/m2 or more used in the other studies.

By using the single strand conformation analysis to search for point mutations in the choroideremia gene, we had previously identified the first truncative mutation responsible for CHM in France. The aim of the present study was to perform a simple and nonisotopic routine test to identify carriers and non carriers in the relevant family.We used a PCR-based restriction analysis to detect the presence or absence of the mutation in the family members, as the mutation creates a restriction site in the coding sequence of the CHM gene.We could follow the segregation of the mutation in the pedigree, and unambiguously determine the genetic status of the females.When a mutation responsible for choroideremia modifies a restriction site, the PCR-restriction provides an efficient and unexpensive one-day test to detect heterozygosity in the family.

Atypical decubital fibroplasia (FAD) occurs especially in elderly and physically debilited or immobilized patients. We report one observation which is peculiar due to the patient's young age and its circumstances. The painless mass is situated in hyperpressure areas (shoulder, posterior or lateral chest wall, sacrum). The lesion is situated in the deep subcutis and has ill defined limits; it is characterized by zones of fibrinoid necrosis and fibrosis and a prominent myxoid stroma. The differential diagnoses includes mesenchymatous malignant tumors and non neoplastic fibroblastic proliferations such as proliferative fasciitis and decubitus ulcer. The prominent underlying factor and the initial event contributing to its pathogenesis seems to be ischemia. Although some recurrent cases have been reported, FAD is a benign lesion whose treatment is surgical removal.

The aim of this study was to know the wishes of our patients for information and to compare them with the point of view of our colleagues in a cancer center.We gave 100 consecutive new patients with breast cancer a questionnaire about their needs. The same questionnaire was given in duplicate to all our colleagues in the cancer center (n = 53) asking: 1) their own needs of information if they had breast cancer 2) how they thought the patients would answer.Seventy-five percent of the patients and 81% of the doctors returned the questionnaire (28 were men and 15 women; 81% were involved in the management of breast cancer). On one hand, concerning information about the disease and about the treatment, there was no difference between the needs expressed by patients of doctors (as patients). As expected, the two groups wanted to be well informed. On the other hand, there was always a statistically significant difference between the needs expressed by patients and the opinion of doctors who systematically underestimated them. Concerning information to the family, 21% of doctors and only 4% of patients didn't want any information to be given to their family. Interestingly, 67% of the patients thought the decision had to be taken together with the doctor and 56% of the doctors (as patients) wished the decision to be taken by the doctor.Patients and physicians if they were patients, expressed the same high level need of information, but the patients needs seemed underestimated by the majority of doctors.

A prospective study about the development of the mandibular second right molar, has been performed with 17 chemotherapy treated children in the Paediatric Oncology department of the Centre Oscar-Lambret (Lille). Our method is based upon the measure of the crown or root length for different periods: periods with or without chemotherapy. These measurements have been performed every 6 months for 18 months with orthopantomograms. We notice for both the crown and the root: a significant difference in growing speed between periods with an without chemotherapy; a speeding up of the mineralization at the end of the treatment rejoining the average figures of a healthy test population.

Dystrophin, the Duchenne muscular Dystrophy gene product, is a large cytoskeletal protein associated with a complex of membrane proteins, the Dystrophin Glycoprotein Complex (DGC). Dystrophin is localized to the sarcolemmal membrane of all normal muscle types, but is absent from muscles of DMD patients. Using monoclonal antibodies raised against distinct regions of the dystrophin, we studied its expression and subcellular localization during human skeletal, cardiac and smooth muscle development. We have shown that the expression and the association of dystrophin with the plasma membrane take place earlier in cardiac and smooth muscles (8 weeks of gestation) than in skeletal muscles. In skeletal muscles, dystrophin is first observed in the cytoplasm, and is progressively localized to the plasma membrane from 10 weeks onwards. We obtained differences in staining when using antibodies against either the central part of the protein or the carboxy-terminal domain, and we suggested that isoforms of dystrophin, probably differing in their carboxy-terminal end and their capacity to associate with the plasma membrane were differentially expressed during development and in different tissue-types (7). These findings are discussed in the context of the pathology of Duchenne Muscular Dystrophy.

First described in 1975 by Köhler and Milstein, monoclonal antibodies (Mabs) result from the fusion of a B lymphocyte and a myeloma cell. Among the many uses of Mabs, oncology constitute a privileged, but difficult, field of investigation: the antigen heterogeneity and difficulty of access to tumors are major obstacles. In diagnosis, the Mabs allow the identification and the quantification of tumor specific or tumor-associated antigens: the assay of circulating tumor markers is one of the largest applications. In situ localization of tumors is also possible, using radiolabelled Mabs. In therapeutics, Mabs are used alone or linked to radionuclides, toxins, anticancer drugs or enzymes. Ex vivo treatment of bone marrow is used in autologous and allergenic grafts. The use of mono (Fab,Fv) or bivalents (F(ab)'2) antibody fragments, chimeric or human Mabs, cocktails of Mabs, intended to improve sensitivity and specificity of the tests, are the main prospects of this research area.

A prospective comparative study of the alveolar bone resorption after teeth extraction was achieved in a series of 79 patients in order to analyze macroscopically the possible consequences of radiotherapy and chemotherapy on the toothless edges. After quarterly coronal and sagittal X-rays for two years, this study enhances quite a similar vertical resorption for the radiation and chemotherapy-treated patients as well as for the witness patients. The alveolar bone resorption progression also appears unaltered by anti cancerous treatments. In both cases, a resorption stabilisation can be clearly seen after 6 months according to dental extractions. The vertical alveolar bone resorption is more important in incisor and canine regions. The anti cancerous treatments may not have significant disastrous consequences as far as available bone amount is concerned, on a post prosthetic restoration.

The SI/Col mouse is carrier of the i.v. mutation which expresses itself in an autosomal recessive mode. Fifty per cent of mice born of homozygotic i.v./i.v. parents are normal and 50% present an abnormality of lateralisation of the thoracic and abdominal organs with cardiac malformations involving the venous, atrial, ventricular and arterial segments. Identifying the i.v. mutation may improve our understanding of the genesis of the heterotaxic syndrome in man. With the help of return crossing with wild mice, the authors studied segregation of 10 makers of the murine, chromosome 12 of the situs inversus mice. The genetic map constructed from this data places the i.v. mutation near the telomeric extremity of the murine chromosome 12. Given the inter-species conservation between this region and the telomeric region of the human chromosome 14, it is a candidate region for the search of a homologous human gene in syndromes of heterotaxis.

Malignant germinal tumours of the thyroid gland are exceptional. Two cases are reported here. The first case concerned an 8-year old girl who had a teratoma; she was treated by surgery and adjuvant chemotherapy; 4 years after the diagnosis she is still alive and in complete remission. The second case is that of a 21-year old woman with a vitelline sac tumour treated by surgery and radiotherapy; she soon had lung metastases and died. The diagnostic, prognostic and therapeutic aspects of malignant germinal tumours of the thyroid gland are presented, together with data from a review of the literature. The authors insist on the importance of marker assays for all thyroid tumours with suspicious cytology. These tumours should be treated by surgery and initial chemotherapy combined, just as malignant germinal tumours located in other organs.

An outbreak of streptococcal pharyngitis due to a group A beta-hemolytic streptococcus has occurred in a French Army unit based in Djibouti during the month of september 1991. Out of 304 sick soldiers, 73% were seen by a physician in the initial 48 hours of the outbreak. All the patients showed a sore throat, associated with myalgia and rachialgia (85%), headache (26%) and digestive signs (24%). They were given a systematic antibiotic therapy by a penicillin or a macrolide, so no post-streptococcal complication was observed. From 23 throat swabs, 10 Streptococcus pyogenes strains were recovered with identical chimiotype, antibiotype and serotype (T:11, M non typable). Five serological assays were performed on 33 paired (early and 15 days later) samples of serum: ASLO (latex agglutination and microtitration), ASH, ASD and ASK. ASLO microtitration with ASD appear to be the most profitable association. The cost of such an outbreak is very heavy. More, the operational capacity of this unit was seriously compromised as long as 6 days. Measures to be applied are those used for the prevention of foodborne diseases, including medical surveillance of the cooking staff and strict observance of cool conservation of cooked meals and foods.

One hundred and three patients previously treated with chemotherapy including an anthracycline were entered in a VMMC protocol study: vindesine (Eldisine), mitoxantrone (Novantrone) and mitomycin C (Ametycine). Group A consisted of 41 women who received the protocol published by Belpomme: vindesine (2.5 mg/m2 day 1 and 8) and mitoxantrone (12 mg/m2/day) every 4 weeks, and mitomycin C (8 mg/m2) every 8 weeks. Group B consisted of 62 patients who were treated with a modified protocol: vindesine (2.5 mg/m2) and mitoxantrone (12 mg/m2) every 3 weeks on day 1, and mitomycin C (8 mg/m2) every 6 weeks. Tolerance was acceptable with 79% of patients complaining of weakness. There was a 66% incidence of gastro-intestinal toxicity, a 10.7%-incidence of neurotoxicity (reversible dysethesias), and a 5.8% incidence of cardiotoxicity. There was considerable hematotoxicity of grade 2, 3 and 4: neutropenia 16.6%, thrombocytopenia 7.7%, anemia 21.4%. There was a 19.2% overall objective response rate (CR and PR) (95% confidence interval: 12-30) (CR: 3.2%). The median duration of the response was 39 weeks. There was no significant difference in response rates whether or not the patients (19 cases) were undergoing simultaneous hormonal therapy and no difference according to the protocol used. Similarly, neither menopause nor a previous response to anthracyclines had any effect on the response rate. The 19.2% response in this protocol is similar to other breast cancer salvage chemotherapy protocols for patients who have failed to respond to anthracyclines (20%).

Between the 1st of January 1974 and the 30th of June 1989, we saw 9 cases of primary lymphoma of the breast at the Oscar Lambret Centre, all occurring in women. This comprised 0.27% of the malignant tumours of the breast and 3.2% of all non-Hodgkin lymphomas. 8 occurred on the right side and 1 on the left. There were multiple tumours in 5 cases. The clinical findings were always suggestive of a malignant condition and so were the mammography findings in 6 cases. Two patients had total mastectomy. In the other cases, the diagnosis was made (twice) by biopsy or by lumpectomy (5 cases). Using Kiel-Lennert's classification: 5 were highly malignant and 4 of low grade malignancy (using the Working Formulation, three were moderate and 4 were intermediate; 1 was very high grade and 1 intermediate or high). Treatment changed a lot during the period under consideration. Five patients are still alive without any recurrence. One died of lymphoma and two died of intercurrent causes and one died of unknown causes.

895 axillary clearances were carried out in 3 years between 1986 and 1988 on 878 patients with primary breast cancer. Two procedures were used: either direct total axillary clearance (in stages 1, 2 and 3 of Berg) or inferior axillary clearance (stages 1 and 2 of Berg). This was carried out in association with frozen section diagnosis of the lymph node followed by clearance in Berg stage 3 if the diagnosis on frozen section was positive. The authors found a higher frequency of late complications, particularly of arm lymphoedema in patients who had complete axillary clearance than in patients who only had an inferior axillary clearance. The survival rate actuarilly calculated was not significantly different in the two groups of patients. The carrying out of total axillary clearance was "beneficial" for only 3 patients who had negative inferior axillary clearance and positive sub-clavicular clearance. Finally the frozen section diagnosis of the state of the axillary nodes shown to be correct (specificity -99% and sensitivity -76%) but it was difficult to carry out routinely.

After Leksell and Steiner's pioneering experience with the use of the gamma units, another technically different system has been developed, using a linear accelerator. It's a very precise stereotactic radiosurgical approach which allows to deliver the necessary dose of radiation to the target volume while sparing the surrounding structures from potentially dangerous levels of radiation. This hyperselective irradiation is a new and complementary method of treatment of arteriovenous malformations located in central or functionally critical areas of the brain. The aim is to obtain a progressive and total obliteration of the lesion. The place of radiosurgery is obviously reserved for the patients who do not seem able to profit from the benefits of open surgery and/or embolization techniques.