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International audience; La politique publique de protection du patrimoine français a commencé à se structurer à partir du deuxième quart du XIXe siècle, donnant ainsi naissance au service des Monuments historiques. Si les bases d’une politique patrimoniale sont posées sous la monarchie de Juillet, c’est la Troisième République qui en crée les fondements juridiques, notamment avec la promulgation de la loi du 31 décembre 1913. Dès lors et jusqu’aux années 1970, les mesures législatives promulguées sont marquées par une grande centralisation des dispositifs. Les réformes opérées ensuite, surtout depuis le début des années 1980, traduisent au contraire un désengagement progressif de l’État au profit des collectivités territoriales, témoignant des liens étroits qui unissent désormais le patrimoine et l’aménagement du territoire.En près de deux siècles d’existence, la politique patrimoniale française a ainsi connu des inflexions majeures qui offrent à voir l’action de l’État comme un processus en constante transformation, reflétant avec force les évolutions sociales et politiques.

International audience; From the end of the 18th century and especially in the 19th century, the Pyrenees were a privileged area for the development of thermal baths. However, as in other territories, thermal activity did not develop homogeneously throughout the massif. The central part, for example, is characterised by a large number of small spas. The six sites mobilized in the study (Cadéac and Ferrère in the Hautes-Pyrénées, Couret and Ganties in Haute-Garonne, Audinac and Sentein in Ariège) show that the evolution of these resorts has been conditioned by multiple factors : economic, sociological, geographical, and political. The comparative analysis of the trajectories of these health resorts then makes it possible to identify the common features in the development of this type of resort.; Los Pirineos constituyen desde finales del siglo xviii y sobre todo en el siglo xix un espacio privilegiado para el desarrollo del termalismo. Sin embargo, como en otros territorios, la actividad termal no se desarrolla de forma homogénea en todo el macizo. La parte central, por ejemplo, se caracteriza por un gran número de pequeños balnearios. Los seis lugares movilizados en el estudio (Cadéac y Ferrère en los Altos Pirineos, Couret y Ganties en el Alto Garona, Audinac y Sentein en el Ariège) muestran que la evolución de estas estaciones ha estado condicionada por factores múltiples, a la vez económicos, sociológicos, geográficos y políticos. El análisis comparativo de las trayectorias de estos balnearios permite entonces identificar los rasgos comunes en el desarrollo de este tipo de balnearios.; Les Pyrénées constituent dès la fin du xviiie siècle et surtout au xixe siècle un espace privilégié pour le développement du thermalisme. Toutefois, comme dans d’autres territoires, l’activité thermale ne s’épanouit pas de manière homogène sur l’ensemble du massif. La partie centrale par exemple se caractérise par un nombre important de petites stations thermales. Les six sites mobilisés dans l’étude (Cadéac et Ferrère dans les Hautes-Pyrénées, Couret et Ganties en Haute-Garonne, Audinac et Sentein en Ariège) montrent que l’évolution de ces stations a été conditionnée par des facteurs multiples, à la fois économiques, sociologiques, géographiques et politiques. L’analyse comparative des trajectoires de ces lieux de cure permet alors de dégager les traits communs au développement de ce type de station.

International audience; Ce dossier a pour ambition de réhabiliter les stations thermales secondaires et de mettre au jour leur histoire économique, sociale et architecturale. Par ce biais, il vise à affiner les connaissances du phénomène thermal et de son développement, et à éclairer la variété des modèles et des formes du thermalisme. Il s’agit non seulement de comprendre les conditions de création et d’évolution de cette catégorie de stations thermales mais aussi de déterminer s’il existe un modèle architectural qui leur est propre et de mesurer l’impact qu’elles ont eu sur l’épanouissement de leur territoire, notamment dans les domaines urbain et touristique.Les six articles composant ce dossier se répartissent en trois entités : la première correspond à trois études de cas du bassin midi-pyrénéen, la seconde propose une approche comparative à partir d’exemples issus de deux autres régions françaises (Bourgogne-Franche-Comté, Grand-Est), enfin, la dernière démontre, à partir des études menées notamment dans le cadre du programme européen Thermalisme, Culture, Villégiature dans les Pyrénées, la pertinence scientifique d’analyser conjointement les patrimoines culturels matériel et immatériel.

National audience

Sinonasal carcinomas account for 3% of ENT cancers. They are subdivided into squamous cell carcinomas (50%), adenocarcinomas [20%, mostly of intestinal type (ITAC)], and more rarely, adenoid cystic carcinomas, olfactory neuroblastomas (=esthesioneuroblastomas), neuroendocrine carcinomas or undifferentiated sinonasal carcinomas (SNUC). The 5-year survival rates are, in descending order, 72% for neuroblastomas, 63% for adenocarcinomas, 50-60% for large-cell neuroendocrine carcinomas, 53% for squamous cell carcinomas, 25-50% for adenoid cystic, 35% for small-cell neuroendocrine carcinomas and 35% for SNUC and newly discovered histologies. Surgery is the main treatment; endoscopic approaches reduce the morbidity with equivalent tumour control. Intensity-modulated radiation therapy (IMRT) is almost systematic. Nodal involvement is rare in ethmoidal adenocarcinomas and adenoid cystic carcinomas; it is intermediate and may justify prophylactic radiotherapy for N0 necks in SNUC, neuroblastoma, squamous cell carcinomas and sinonasal neuroendocrine carcinomas. IMRT or proton therapy is the mainstay of treatment of unresectable disease. Radiotherapy optimization by carbon ion therapy for adenoid cystic carcinomas, or by chemotherapy for all carcinomas with IMRT or proton therapy, is investigated within clinical trials in France. Neoadjuvant chemotherapy is reserved for rapidly progressive disease or histologies with a high metastatic potential such as neuroendocrine carcinomas or SNUC. Given their histologic and molecular specificities and different relapse patterns, an expertise of the REFCOR network, with REFCORpath review, is likely to correct diagnoses, rectify treatments, with an impact on survival.

Figure 1: A Tribute to Arlette by her longtime friend Annie Baglin 1. Conference rationale Eighty years ago, Paul Ledoux, then in Chicago, published with Chaim Leib Pekeris the now famous work entitled Radial Pulsations of Stars. Stellar evolution was still in its infancy, numerical model were not computed on a massive scale as today. With the advent of computers and the improvement of observational data, the study of stellar structure and evolution has now become a central field of astrophysics, and pulsations have become the prime method to learn about the internal structure of stars. In the last fifteen years space telescopes provided us a tremendous amount of data, opening the way to test stellar models with unprecedented thoroughness. It is now up to theoretical stellar physi-cists to use these observations to improve stellar models and provide accurate stellar properties to fields such as exoplanetary science and Galactic archeology. The last decades were also marked by the achievements of a remarkable scientist, an inspiring col-league, a patient teacher and a friend, who devoted herself to our field of research and who celebrated her 75th birthday in August 2018, Arlette Grotsch-Noels. This conference is a tribute to Arlette. The aim of this workshop was to bring together experts of theoretical stellar physics and Galactic archeology to discuss the current issues connected to stellar structure and evolution. Topics ranged from microphysical ingredients such as atomic

National audience

The safeguarded sectors plan, created by the "Malraux Law" in 1962, aimed not only to ensure historical architecture sets preservation but also to give them back an active place within the contemporary city. Considered for a long time as monuments in their own right, the safeguarded sectors have been tending over the past ten years to become innovation places in terms of architectural rehabilitation. These old districts which are today representing only a tiny portion of the french urbanized areas are distinguishable by the durability of their buildings and the cleverness of their morphology. The historic core of Vitré, whose the transformations are regulated by a safeguarded sector since 1976, testify the economic, political, and social richness of the city history from the 13th century. Spared from the brutal city planning which has spread in the first half of the 20th century thanks to the will of the Historic Monuments Department, it has been subject of numerous restoration and rehabilitation since the creation of the safeguarded sector.From the study of the Vitré city, this research looks at the housing heritage before the creation of the safeguarded sector, what has been achieved with it and what it tends to become. The study is composed of five volumes: the text (volume I), the maps, plans, tables and iconographic documents (volume II) and the inventory studies catalogue (volume III to V).; Le dispositif des secteurs sauvegardés, créé par la « Loi Malraux » en 1962, avait pour ambition non seulement d’assurer la conservation des ensembles architecturaux historiques mais aussi de leur redonner une place active au sein de la ville contemporaine. Considérés pendant longtemps comme des monuments à part entière, les secteurs sauvegardés tendent depuis une dizaine d’années à s’affirmer comme des lieux d’innovation en matière de réhabilitation architecturale. Ces quartiers anciens, qui ne représentent plus aujourd’hui qu’une infime partie de l’espace urbanisé français, se distinguent par la durabilité des constructions qui les composent et par l’intelligence de leur morphologie. Le cœur historique de Vitré, dont les transformations sont encadrées par un secteur sauvegardé depuis 1976, témoigne de la richesse de l’histoire économique, politique et sociale de la ville depuis le 13e siècle. Épargné de l’urbanisme brutal qui se généralise dans la première moitié du 20e siècle grâce à la volonté du service des Monuments historiques, il fait l’objet depuis la création du secteur sauvegardé de nombreuses interventions de restauration et de réhabilitation.À partir de l’étude de la ville de Vitré, cette recherche analyse ce qu’était le patrimoine logement avant la création du secteur sauvegardé, ce qu’on en a fait, et ce qu’il tend à devenir. L’étude est présentée en cinq volumes associant le texte (volume I), les cartes, plans, tableaux et documents iconographiques (volume II), ainsi que les notices se rapportant aux études d’inventaire (volumes III à V).

International audience; Parmi les 20 000 nouveaux cas de cancers ORL, tête et cou et des voies aérodigestives (VADS) enFrance, les carcinomes épidermoïdes des VADS représentent environ 90 % des cas. Parmi ceux-ci,les variants des carcinomes épidermoïdes dits conventionnels représentent entre 5 % et 10 % descas. Un recensement précis est difficile car ils ne sont pas actuellement colligés de façonsystématique. L'anamnèse et le terrain sont rarement différents de ceux des carcinomes épi-dermoïdes conventionnels. Ces variants des carcinomes épidermoïdes peuvent pourtant êtresujets à des erreurs diagnostiques, voire à des erreurs thérapeutiques, du fait de confusions avecdes sarcomes, des tumeurs glandulaires, voire des tumeurs bénignes. Certaines précautionsd'analyse (par biopsies profondes par exemple) doivent être connues pour ne pas omettre leurcomposante la plus agressive en cas de tumeurs avec contingents variés. L'immunohistochimie et certaines analyses moléculaires spécialisées peuvent, de plus, aider au diagnostic. Une relecturediagnostique paraît indispensable pour certains de ces variants. Par ailleurs, certains variants sontradiorésistants et à l'inverse, d'autres radiosensibles. Dans les autres cas, des compléments d'analysesmoléculaires peuvent redresser certaines erreurs diagnostiques et permettre des traitements adé-quats. Une actualisation des référentiels REFCOR 2008 a été réalisée au vu de la littérature inter-nationale et de la nouvelle classification OMS/IARC (Organisation mondiale de la santé/Internationalagency for research on cancer) 2017 pour les sept principaux variants de carcinomes épidermoïdesdes VADS, les carcinomes verruqueux, acantholytiques (ou adénoïdes), basaloïdes, papillaires, à cel-lules fusiformes (improprement nommés sarcomatoïdes, adénosquameux et lymphoépithéliaux). Leséléments diagnostiques et thérapeutiques différenciants y sont rapportés.

Among the 20,000 new cases of head and neck neoplasms in France each year, squamous cell carcinomas (HNSCC) represent about 90 % of the cases. Among these, variants of conventional squamous cell carcinomas represent between 5% and 10% of cases. Patient history and risk factors are often similar from those of conventional HSNCC. Variants may, however, be misdiagnosed, which can lead to therapeutic mismanagement due to confusion with sarcomas, glandular tumors or even benign tumors. Diagnostic workup needs to be more cautionary or to include additional exams not to omit their most aggressive component in the case of composite tumors or to under stage the tumor. Immunohistochemistry and specific molecular analyses may be required for proper diagnosis. Central pathological review may also be essential for some of these variants. In addition, some variants are radioresistant and, conversely, others are radiosensitive. An update of the REFCOR 2008 standards was carried out in the light of the international literature and the 2017 WHO/IARC classification for the seven main variants of HNSCC, verrucous, acantholytic (to be named adenoid carcinomas), basaloid, papillary, spindle cell (incorrectly named sarcomatoid), adenosquamous and lymphoepithelial carcinomas.

International audience; The CoRoT mission developped since 1993 was dedicated to the observation of ultra high precision measurements of the variations of stellar fluxed on long and continuous durations. His two major objectives were the detection of stellar oscillations and of extrasolar planets. A a pionnier mission, it had to invent several methods and to built the successive steps of the data treatment. They are rapidly described. The low cost 'CNES Petites Missions" programme imposed severe contraints on the instrument concept (Organisation and management, choice of the detectors, of the orbit, reduction of all parasite lights) which have been and will be guides for new generation projects. Some scientific highlights are then presented on both programmes, as for instance the use of the seismic tool as an indicator of the structure and evolution of the Galaxy, the first detection of a super-Earth, and the first precise characterisation of a brown dwarf . CoRoT has opened several avenues in instrumentation as well as science. It is shown how some aspects of this heritage have been used in the design and development of its two major heiress: CHEOPS to be launched in 2018 and the more ambitious PLATO, to be launched in 2025.

National audience; Les progiciels de gestion intégrés (PGI) ou ERP (Enterprise Resource Planning en anglais) sont des applications informatiques complexes dont le but est de coordonner l'ensemble des activités d'une organisation autour d'un système d'information unifié. Cet ouvrage se donne comme objectif de démythifier les fonctions de traitement de l’information des entreprises, de présenter les principaux processus de gestion et de planification et de démontrer l’importance de l’intégration des fonctions et des métiers.Ce livre s’adresse d’abord aux étudiants qui, même familiers avec l’informatique, n’ont qu’une vague idée de ce qu’est un système d’information, ensuite à tous les formateurs, enseignants, professeurs qui doivent transmettre les notions de base sur les systèmes d’information et les illustrer par des exemples concrets, en particulier dans le domaine de la gestion des opérations, enfin au personnel des entreprises qui ne maîtrisent souvent qu’une partie du système d’information sans comprendre d’où viennent les informations qu’ils reçoivent et ne mesurent pas nécessairement l’usage qui est fait de celles qu’ils communiquent.La lecture de cet ouvrage donnera à l’actuel ou au futur utilisateur une vue d’ensemble et une bonne compréhension de la logique et des processus d’un ERP.L’organisation de ce livre est inspirée de la plateforme pédagogique e-Prelude qui est utilisée comme outil de formation par de nombreux établissements d'enseignement en France et à l’étranger. Elle apporte un ensemble d’outils pédagogiques destinés à un apprentissage approfondi des ERP, de la gestion industrielle et des mécanismes de la Supply Chain.

Mucosal melanomas of the head and neck (sinonasal and oral cavity) account for 1% of neoplasms, 4% of all melanomas and over 50% of all mucosal melanomas. They have a high metastatic potential. Five-year overall survival does not exceed 30%. Diagnosis may be difficult and includes adequate immunohistochemical staining. Risk factors, presentation and molecular biology are different from those of cutaneous melanomas. The mainstay of treatment is surgery and postoperative radiotherapy. Endoscopic surgery should be evaluated prospectively. Neck dissection is recommended for N0 oral cavity melanomas, while it can generally be omitted for sinonasal melanomas. Inoperable tumors can be treated with exclusive radiotherapy. Molecular guidance for metastatic cases is a relevant option despite low level of evidence, based on the rarity of disease and low response rates to chemotherapy. c-KIT inhibitors and immunotherapy appear promising.

Malignant tumors of the upper aerodigestive tract may be rare by their histology (sarcoma, variants of conventional squamous cell carcinomas) and/or location (sinuses, salivary glands, ear, of various histologies themselves). They represent less than 10% of head and neck neoplasms. The confirmation of their diagnosis often requires a medical expertise and sometimes biomolecular techniques complementary to classical histology and immunohistochemistry. Due to their location, their treatment often requires a specific surgical technique. Radiation therapy is indicated based on histoclinical characteristics common to other head and neck neoplasms but also incorporate grade. Further, the technique must often be adapted to take into account the proximity of organs at risk. For most histologies, chemotherapy is relatively inefficient but current molecular advances may allow to consider pharmaceutical developments in the coming years. The REFCOR, the French Network of head and neck cancers aims to organize and promote the optimal management of these rare and heterogeneous diseases, to promote research and clinical trials.

Aerodigestive tract tumors are very diverse, either in terms of location, or histologically. Also, this heterogeneity poses particular problems for the histological diagnosis but also for the establishment of the most appropriate treatment. Thus, the network REFCOR (réseau d'expertise français sur les cancers ORL rares/French expert network on rare ENT cancers) was created to better understand these issues, by proposing an epidemiological and diagnostic approach with research collaborations. This network is dedicated to all primary malignant tumors of the salivary glands, ear, nasal cavity and sinuses and all head and neck malignancies other than conventional squamous cell carcinoma. The REFCORpath network consists of expert pathologists and offers, through a network of scanned images, a second opinion or even a third.

The treatment of carcinomas of unknown primary revealed by cervical lymphadenopathy is based on neck dissection and nodal and pan-mucosal irradiation to control the neck and avoid the emergence of a metachronous primary. The aim of this review was to assess diagnostic and therapeutic approaches and criteria that may be used for a customized selective approach to avoid severe toxicities of pan-mucosal irradiation. A literature search was performed with the following keywords: cervical lymphadenopathy, unknown primary, upper aerodigestive tract, cancer, radiotherapy, squamous cell carcinoma, variants. The diagnostic workup includes a head and neck scanner or MRI, ((18)F)-FDG PET CT, a panendoscopy and tonsillectomy. Squamous cell carcinoma represents over two thirds of cases. The number of metastatic cervical nodes, nodal level, and histological variant (associated with HPV/EBV status) may determine the primary site origin and might be weighted for the determination of radiation target volumes on a multidisciplinary basis. A selective customized approach is relevant to decrease radiation toxicity only if neck and mucosal control is not impaired. Although no recommendation can yet be made in the absence of sufficient level of evidence, the relevance of systematic pan-mucosal irradiation appears questionable in a number of clinical situations. Accordingly, a customized selective redefinition of target volumes may be discussed and be prospectively evaluated in relation to the therapeutic index obtained.

National audience

The occurrence of mural nodules in serous or mucinous ovarian tumours is not frequent. Mural nodule can be developed in benign, borderline or malignant tumours. They can be benign, malignant or mixed type. Thus the prognosis of the ovarian tumour can be dramatically modified by the presence if these nodules. Eighty-two cases of mural nodules were reported in the literature, among which we account four cases of mixed nodules type. We report an additional case of mixed type mural nodules of anaplastic carcinoma and sarcoma-like developed in an ovarian mucinous borderline tumour at a 60-year-old woman.We give details about the classification, the differential diagnosis and prognosis of theses nodules.

The importance of fibroblast growth factor 23 (FGF 23) has been highlighted in the mechanism of urinary leakage of phosphate in the oncogenic osteomalacia (OO). It is now a component of diagnosis of this disease. We report a 58-year-old man who presented with osteomalacia and hypophosphatemia secondary to urinary leakage of phosphorus. Although serum FGF 23 was normal, the diagnosis of OO was obtained after another cause of acquired prolonged hypophosphatemia has been excluded (hyperparathyroidism and Fanconi syndrome in particular). The search for a deep tumor was performed, allowing the detection of a 12 mm hemangiopericytoma in the upper thigh. Its removal allowed the rapid resolution of clinical symptoms and laboratory abnormalities. The importance of functional sequelae in OO depends on prompt diagnosis. Tumorectomy remains the optimal treatment. Thus, the search for a secreting tumor is essential even in the absence of elevated serum FGF 23.

The presence of metastases in cervical lymph nodes (except distant metastasis) is the most significant independent prognostic factor in carcinoma of the head and neck. The purpose of this article is firstly to review the anatomy of the neck compartments, the types of neck dissection and secondly to describe recommendations for the technical procedures required and thus to provide a full informative report to optimise management by the clinician.

We report the case of a 48-year-old female patient who had a Crohn's disease treated by corticosteroids. The patient developed severe cardiac failure, which was refractory to treatment with inotropic agents. At necropsy, examination of the heart revealed myocardial abscesses. On microscopic study, we diagnosed an aspergillar myocarditis. Aspergillar myocarditis is a rare and fatal localisation in disseminated aspergillosis. Diagnosis is difficult and treatment, usually initiated late, is ineffective.

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies. We present a case report and a review of the literature.We report the case of a 31-year-old man who neglected bitemporal visual loss (less than 1/10 OD and 2/10 OS). Emergency cerebral tomodensitometry found a pituitary apoplexy. Visual field loss was nearly complete at OD and temporal hemianopia was present at OS. These ocular complications led to a neurosurgical transsphenoidal resection of the necrotic adenoma. Follow-up was satisfactory with complete recovery of visual acuity and visual field.In the literature, headaches are present in 76% of the patients, visual loss in 62%, and ocular motor nerve palsy in 40%. Third cranial nerve palsies are predominant.The clinical picture of pituitary apoplexy is characterized by the sudden onset of oculomotor palsy or blindness with acute headaches and even consciousness impairment. A functional and vital risk is present because of acute hypopituitarism. This emergency diagnosis is confirmed by tomodensitometry or magnetic resonance imaging. The association of hormone substitution and tumor transsphenoidal resection commonly leads to a positive outcome and visual improvement.

For patients with chronic inflammatory disease treated by immunosuppressive agents (for example: rheumatoid arthritis or systemic lupus erythematosus), there are no available guidelines in medical literature on the use of antiviral agents for the management of symptomatic cytomegalovirus (CMV) infection.A patient treated by methotrexate for a spondylarthritis presented a CMV infection manifested with persistent fever and pneumonia. CMV pp65 antigenemia was of 120 positive nuclei for 100,000 cells. Treatment with valganciclovir allowed a prompt recovery, while treatment by methotrexate was maintained.Symptomatic CMV infection evolution is unpredictable and potentially severe in patients with chronic inflammatory diseases receiving immunosuppressive agents. Although there is no data issued from clinical trials, the observation reported in this article and the publications of similar cases in the medical literature indicate that treatment with valganciclovir seems worth to be used in this context. Stopping immunosuppressive therapy does not seem mandatory.

Erythropoietin is the treatment of the anaemia in chronic kidney disease. A target rate of haemoglobin higher than 11 g/dl was usually proposed, but recent recommendations stated that higher limit of haemoglobin was to be reached, with the aim to improve the quality of life of the patients and to reduce their risks of cardiovascular diseases. These objectives are to be revised, according to the results of recently published clinical trials.Patients treated to reach a high rate of haemoglobin (between 13 and 14,5 g/dl) have an improved quality of life, but a 30% higher mortality rate, compared to patients treated with a lower objective of haemoglobin rate (10-12 g/dl). Hypertension and vascular access thromboses were also more frequent in the patients with the highest haemoglobin rate. Two to three times more erythropoietin was necessary to reach the higher rate of haemoglobin. These results favour a target rate of haemoglobin not higher than 12 g/dl. A polemic followed the results of these clinical trials, mostly in the United States, questioning the way in which the higher limit had been fixed whereas precise data were unavailable. The role of pharmaceutical industry and of for profit dialysis centres was underlined.The next step is now to explain if the excess in cardiovascular morbimortality is related to the haemoglobin rate or to a direct effect of the erythropoietin. Such an understanding is important, the more so as new erythropoiesis-stimulating agents are being developed.

Periodic hypokalemic paralysis can be of genetic origin or secondary to other causes of hypokalaemia. The thyreotoxic hypokalemic periodic paralysis (THPP) usually occurs among asian subjects. It is a diagnostic and therapeutic emergency which may lead to life-threatening complications due to hypokalaemia and muscle weakness. The potassium supplementation is followed by a complete recovery after a few hours. We underlined the interest of thyroid assays in patients having an acute muscular paralysis associated with hypokalaemia.

3e éd. , 2001; Le Management Industriel et Logistique est une approche globale où les meilleures entreprises - World Class Manufacturers - cherchent à exceller dans tous les domaines opérationnels depuis les achats jusqu'à la distribution physique des produits. Cette recherche de l'excellence passe par une optimisation tic l'ensemble de la Supply Chairs, grâce à des système d'information et de pilotage des flux physiques et financiers de type ERP, des processus de conception et de développement de produits nouveau optimisés, des montages de. partenariats avec les fournisseurs et/ou les distributeurs, une optimisation économique à tous les niveaux, une approche globale de qualité totale; l'utilisation des nouvelles technologies comme l'e-procurement. Cette nouvelle édition propose une approche synthétique d Management Industriel et Logistique sur les plans conceptuel et méthodologique. Elle couvre l'ensemble de la chaîne de valeur de toute entreprise e reflète une vision intégrée de la fonction. En particulier, elle fait ressortir le évolutions les plus récentes, et détaille les avancées sur le plan opérationnel. Destiné aux professionnels et aux formateurs, ce livre comprend des à questions de réflexion et une soixantaine d'exercices qui permettront au lecteur une mise en application immédiate des concepts exposés. Il s'adresse aux étudiants d'université, aux élèves des grandes écoles d'ingénieurs et de gestion, aux participants de programmes MBA, ainsi qu'aux cadres supérieur rieurs et dirigeants de l'industrie recherchant une réflexion globale et synthétique.

Nowadays it is quite easy to diagnose idiopathic retroperitoneal fibrosis (IRF), particularly with the help of medical imaging. However there is no guideline about the treatment.Looking for data about an evidence-based management.Screening of the database Medline. Titles and abstracts of articles published between 01/01/1985 and 31/12/2004 have been read to identify clinical trials and series about more than ten patients.No record of any therapeutic trials has been found. Eight series in total, which included 177 patients, were identified. Two of the patients have been treated by an ureteral desobstruction only (endoscopy or nephrostomy), 45 by surgery (ureterolysis), 65 by corticotherapy and 64 both by surgery and steroids. For 38 patients, immunosuppressive drugs were combined with corticotherapy (azathioprine, cyclophosphamide or D-penicillamine). According to the authors, doses and duration of corticotherapy varied. Median follow-up lasted 56 months. The outcome is satisfactory in 73% for surgery alone, 86% for medical treatment alone and 73% for both. The association between steroids therapy and immunosuppressive drugs is efficient in 97% of the cases. No clear data about side effects was mentioned.Treatment of the IRF is still empirical, based on surgery and corticotherapy. There is no guideline about the treatment strategy. Although tamoxifen has been proposed, efficacy evidence is lacking. Prospective multicenter studies will help us to progress in the management of the IRF.

Nitrates are frequently prescribed drugs, although their indications are limited. We studied nitrates' prescription in elderly patients hospitalised in the internal medicine ward of a French teaching hospital.Hospitalised patients aged 65 years and more and receiving nitrates in their usual treatment were identified prospectively. A standardised questionnaire was used during a structured medical interview conducted by the same physician for all patients. Informations regarding nitrates' prescription were studied according to the actual recommendations for their use: angina in patients with contraindication to betablockers, acute myocardial infarction and acute pulmonary oedema.Among 256 hospitalised elderly patients, 49 (19% [IC95%: 15-25]) were under nitrates therapy, because of either angina pectoris, heart failure or unknown reason. Cardiologists prescribed nitrates in accordance with guidelines significantly more frequently than non-cardiologists. Transdermal treatment was used in 69% of patients.In hospitalised patients aged 65 years and more who are prescribed nitrates in their usual treatment, at least one quarter have no recommended indication for its use. As almost one fifth of patients are receiving nitrates in their usual treatment, the medicoeconomic impact of these useless prescriptions could be significant. Nitrates prescribing can be optimized by following guidelines for their use, and restraining from prescribing the transdermal treatment which is more costly and without evidence-based clinical benefit compared to the oral route.

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Numerous lesions of the prostate, such as atrophy, adenomatous atypical hyperplasia (adenosis) or PIN can be misdiagnosed with prostatic cancer, and confused with ASAP, leading to perform additional biopsies. In such lesions, the pathologist can perform an immunohistochemical study with the anti-high molecular weight cytokeratin antibody CK903 (34bE12), which confirms the absence of basal cells and supports the diagnosis of prostatic cancer.To compare markers of basal cells (cytokeratin 5/6, p63) and the marker of prostatic carcinomatous glands (p504s) or alpha methylacyl-CoA racemase (AMACR).Retrospective study of 44 cases of paraffin-embedded prostatic specimens (36 biopsies, 4 PER, 1 adenomectomy and 3 radical prostatectomies), consisting in 20 cases of prostatic carcinomas (2 intraductal, 12 Gleason 6 (3+3), 4 Gleason 7 (4+3), 2 Gleason 8 (4+4)), 11 ASAP, 9 PIN (2 low grade, 7 high grade (2 isolated)), and 10 benign lesions (8 atrophy, 1 atypical adenomatous hyperplasia and 1 case of clear cell cribriform hyperplasia). All cases were tested with antibodies to CK 5/6, and with a cocktail to p63 and p504s, after heat antigenic retrieval on NEXES Ventana processor.Basal cells of normal prostatic glands stained with CK5/6 and p63 in 91,3% and 100% of cases, independently from the fixation procedure (Bouin or Formalin). Carcinomas had a p63-/p504s+ profile, PIN were p63+/p504s+, and benign lesions were p63+/p504s-. We observed an increase in sensitivity: p63/p504s (100%), CK5/6 (80%), p63 (90%), p504s (95%), and specificity: p53/p504s (90%), CK5/6 (87.5%), p63 (90.5%), p504s (90.9%).Our results show that the use of a cocktail to p63/p504s is more specific than the use of CK5/6 alone this technique supports a diagnosis of prostatic cancer in 40% of cases previously considered as ASAP.

Cahier de Recherche du Groupe HEC nº 800; Le développement des services apparaît comme une tendance majeure des économies développées au XXème siècle, à la fois en terme macro-économique (domination du secteur tertiaire) qu¿en termes micro-économiques, du fait de la nature des tâches assurées au sein des entreprises ou de la nature des produits/services offerts par ces dernières. En même temps, le développement d¿offres de services est souvent présenté comme une stratégie de différenciation, susceptible d¿éviter aux entreprises une confrontation directe sur les prix de produits banalisés. Consciente de ces enjeux, l¿Union Européenne a financé un programme de recherche sur le développement d¿offres de services dans les PMI de l¿Union. Ce programme de recherche avait les objectifs suivants : ¿ Faire un état des lieux des pratiques existantes en matière de développement d¿offres de service dans les PMI. ¿ Recenser les difficultés rencontrées par ces entreprises lors du développement de services. ¿ Proposer des dispositifs favorisant la prise de conscience de l¿importance des services chez les acteurs concernés, encourageant le développement des services au sein de ces PMI et facilitant les nécessaires adaptations de ces entreprises aux exigences liées à la production et à la vente de services. Dans ce cahier de recherche, nous rendons compte des résultats de la première phase du programme de recherche, phase qui avait pour objectif de réaliser une étude des pratiques existantes, tant sur le plan théorique que sur le plan pratique. En particulier, nous avons cherché à répondre aux questions suivantes : de quels services parle-t'on ? ces services sont-ils largement commercialisés par les entreprises ? pourquoi et comment les délivrent-elles ? quelles difficultés rencontrent-elles quand elles souhaitent passer de la production/commercialisation de biens à la production/commercialisation de services ? La première partie du document présente les principaux travaux existants autour du thème des « services dans l¿industrie ». Elle définit par ailleurs les concepts qui seront utilisés dans la recherche empirique, et débouche sur la constitution d¿une liste nominative de services. La seconde partie du cahier de recherche est consacrée à l¿étude empirique (méthode et résultats) qui a été réalisée dans quatre pays européens pour connaître l¿état de développement de l¿offre de services.

IgG-secreting lymphoplasmocytoid leukemia is a rare disease associating splenomegaly and B cell proliferation. Lymphoid phenotype is usually different from chronic lymphocytic leukemia. We report a case disclosed by hyperviscosity syndrome. Diagnosis was confirmed at routine ophthalmologic study.

To evaluate the role of endoscopic versus external surgery in the treatment of inverted papillomas, the clinical courses of 35 patients over a period of 10 years were reviewed. 13 patients were treated endoscopically whereas 15 were treated with an external approach. 7 patients with a post operative follow up of less than 12 months were excluded from the study. Recurrences occurred in 4 patients, 2 patients had been treated by endoscopic surgery and 2 by medial maxillectomy by lateral rhinotomy. 3 patients were diagnosed with squamous cell carcinoma. Salvage surgery was performed by an external procedure or endoscopically depending on the extension of the recurrence. Late complications occurred in both groups: cosmetic complaints and epiphora were more frequently encountered after external treatment. Functional complaints were noted after endoscopic treatment. If there is no evidence of associated malignancy, if complete exposure of the tumor is possible and long term follow up is feasible, the authors propose endoscopic surgery as first line treatment to excise the body of the tumor, assess it's extension, and remove the root of the tumor. If this is not the case, medial maxillectomy by external approach should be performed.