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Objective: To analyse the doctor-patient relationship from the patient's point of view and from the doctor's point of view., Material and Methods: Experience of a chairman of a chronic pelvic and perineal pain patient association (AFAP-NP) and experience of doctors specialized in chronic pelvic and perineal pain., Results: Management of a patient with chronic pelvic and perineal pain requires knowledge and understanding of the patient's trajectory disease, the history of the disease and the patient's hopes and disappointments, and evaluation of the patient's personality and family, social and work environment., Conclusion: As pain is an emotional experience, the type of doctor-patient relationship determines the quality of subsequent management. A number of basic principles should be applied: believe the patient, avoid making the patient feel responsible for failure, avoid overestimating the secondary benefits, avoid making the patient passive and dependent, learn to reinterpret the patient's symptoms, ask "how" does the pain persist rather than "why", clearly define the patient's demand and adapt management to realistic and accessible objectives., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The permeability of aortic endothelium and myocardial capillaries was examined in 72 Sprague-Dawley rats (approximately 350 g) using the diffusion tracer peroxidase. Animals were subjected to cigarette smoke for periods of 1 day (acute effects), 2 weeks (sub-acute effects) and 15 weeks (chronic effects) and were sacrificed 5 minutes or 8 hours after smoking. Peroxidase was not generally present at the sub-endothelial level in the aortic endothelium of control animals and sham-smokers. However, in smokers, the increase in peroxidase permeability is proportional to the smoking period. Moreover, in these smokers we observed junctional and subendothelial vacuolar dilatations which correspond to degenerative morphologic changes. Cigarette smoke has a different effect on the right ventricle. Endothelial permeability of the myocardial capillaries increases in animals subjected to cigarette smoke for 1 day and those who smoked for 2 weeks sacrificed 5 minutes after smoking. This increase in permeability is not related to the significant morphologic changes observed in the myocardium and endothelial capillaries. However, the myocardial endothelial capillaries, the sub-endothelial space and the adjacent interstitial space were generally free of peroxidase in animals subjected to cigarette smoke for 15 weeks and in those smoking for 2 weeks sacrificed 8 hours later. An adaptive phenomenon to the effects of cigarette smoke appear to exist in the myocardial endothelium capillaries contrary to that which is observed in the thoracic aorta.

Congestive cardiomyopathies represent a group of diseases having in common an intrinsic abnormality of the myocardial contraction, of which the cause often remains unknown. In children, there is a more marked incidence during the first year of life. At the Cardiology Institute of Quebec, 25 patients have been diagnosed with a congestive cardiomyopathy since January 1967. The mortality remains high at 48 per cent, and the morbidity at 28 per cent. Thus, the chance of total survival at 16 years was 33 percent. The evaluation and the treatment of the cardiac function as well as the search for a specific etiology must be carried out because the etiological treatment is sometimes possible. Biopsy of the skeletal muscle as the study of fatty acids metabolism have become very important since the identification of a carnitine deficiency. On the other hand, biopsy of the endomyocardium remains the only means to make a pathological diagnosis. Since the treatment of persisting myocarditis is feasible, the histological diagnosis is a pre-requisite in children. So, in four patients with congestive cardiomyopathy, biopsy of the endocardium has enabled to demonstrate a chronic inflammation of the myocardium in one patient. In three other cases, two had non specific lesions on histological examination an one had an extensive fibro-elastosis. As the symptomatic treatment is often deceiving, an in-depth investigation is mandatory in a child suffering from a congestive cardiomyopathy in order to identify an etiology. Such an approach will enable to apply a specific treatment, to achieve a better understanding and perhaps modify its natural history.

Report of a histochemical and ultrastructural study of the Hamasaki-Wesenberg Bodies in ganglionic sarcoidosis. These peculiar bodies have variable form and size and are located in the ganglionic sinuses as free elements or in the histiocytes; they are found most often in cases with sarcoidosis but are not specific of this disease. The results of this study suggest that their origin is probably lysosomial and that their nature is not unlike that of ceroid or lipofuscinic pigments. The exact signification of the presence of these bodies in the lymph nodes would need deeper investigation.

From 1971 to 1980, 86 patients with polycythaemia (vera 69, undetermined 15 and respiratory 2) were treated with pipobroman (N,N' bis bromopropionyl piperazine). The initial treatment in doses of 75 mg/day resulted, within 45 days, in complete remission in 46/49 new patients (93.9%), and in 17/20 previously treated patients with polycythaemia vera (85%) and in 14/15 patients with apparently primary polycythaemia. The main duration of the first remission was 17.5 months. Relapses occurred in 30% of the cases but responded to pipobroman at the initial high dosage level. Low-dose maintenance treatment appears to be necessary. Adverse effects on the blood were rare; they included leucopenia (8%) and moderate thrombocytopenia (7%); macrocytosis was noted in 20% of the patients. Acute leukaemia (3 cases) and osteomyelofibrosis (3 cases) were only observed in patients previously treated with 32 P or busulfan. Pipobroman therefore appears to be much less toxic than other alkylating agents. Its is as effective as 32 P but acts more rapidly. It seems to have little oncogenic power, but a more prolonged study is required to ascertain this point.