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Introduction Les patients hemodialyses sont a risque de forme severe d’infection a SARS-CoV2. Les facteurs cliniques et biologiques correles a la severite ne sont pas connus et aideraient a l’orientation precoce des patients. Description Il s’agit d’une etude retrospective sur la cohorte des hemodialyses en secteur COVID du centre, comprenant nos patients prevalents atteints et ceux ayant eu au moins une seance en repli. Methodes Les donnees sont recueillies depuis les informations du dossier medical, du logiciel de biologie et des compte-rendus d’hospitalisation. On definit les formes graves par une oxygenorequerance ≥ 6 L/min. Les caracteristiques des patients, leur biologie a l’entree et lors de l’evolution, les traitements entrepris sont analyses. Resultats Trente et un patients ont ete inclus du 12 mars au 17 avril 2020, deux tiers provenant de l’exterieur : âge median 59 ans, 69 % d’hommes, IMC median 25,6 kg/m2, anciennete mediane en dialyse 28 mois. Treize (42 %) ont recu de l’azithromycine, 10 (32 %) un traitement specifique (1 tocilizumab, 3 oseltamivir, 5 hemisuccinate d’hydrocortisone ou 1 hydroxychloroquine), 12 (39 %) ont presente une forme grave, avec une mortalite totale de 20 % (6/31). Les facteurs de gravite identifies ont ete l’IMC eleve (p = 0,025), les elevations de la CRP (p = 0,0024), des LDH (p = 0,037) et des polynucleaires neutrophiles (p = 0,013) des le diagnostic. L’âge, l’IL-6 et le diabete n’ont pas ete pronostiques dans cette etude. Conclusion Cette serie de 31 patients permet d’identifier des facteurs de gravite simples (IMC, CRP, LDH, polynucleaires neutrophiles) d’infection SARS-CoV2 frequemment severe chez les hemodialyses et compliquee d’une mortalite elevee. En complement de la clinique, le profil du malade et sa biologie initiale doivent conduire a une hospitalisation chez des patients ambulatoires.

Introduction L’impact de la modalite du traitement de suppleance renale sur l’evolution de l’infection a SARS-CoV2 est indetermine. Les patients transplantes developpent une immunodepression secondaire a leur traitement tandis que les patients dialyses sont generalement plus âges et fragiles. Le but de notre etude est de determiner l’impact de la modalite du traitement de suppleance sur le pronostic de l’infection a SARS-CoV2. Description Nous avons mene une etude de cohorte retrospective utilisant l’entrepot de donnees de sante de notre institution. Une recherche automatique sur les dossiers des patients ayant eu au moins un contact medical dans notre service de Nephrologie a ete effectuee sur la base de codes CIM-10. Ont ete inclus les patients hospitalises pour une infection a SARS-CoV2 dans un des hopitaux de notre institution (criteres « Sante Publique France »). Methodes Un modele de Cox stratifie sur l’âge et la presence d’un antecedent de coronaropathie a ete utilise pour determiner des Hazard Ratios (HR) ajustes estimant le risque de deces ou d’hospitalisation en reanimation. Resultats Nous avons inclus 72 patients : 47 dans le groupe « transplantation » et 25 dans le groupe « dialyse ». Vingt-et-un deces ou hospitalisations en reanimation sont survenus au cours du suivi (15 (32 %) dans le groupe « transplantation », 6 (24 %) dans le groupe « dialyse » ; p = 0,45). En analyse multivariee, le HR ajuste de deces ou admission en reanimation etait de 1,70 [IC95 % : 0,59-4,86] pour les transplantes en comparaison aux dialyses (p = 0,32). Conclusion Dans notre etude, chez des patients hospitalises pour une infection a SARS-CoV2, nous n’avons pas mis en evidence de difference significative de risque de deces ou d’hospitalisation en reanimation entre les patients transplantes et dialyses. Des etudes supplementaires sont necessaires pour confirmer ou infirmer ces resultats.

The ongoing COVID-19 pandemic comprises a total of more than 2,350,000 cases and 160,000 deaths. The interest in anti-coronavirus drug development has been limited so far and effective methods to prevent or treat coronavirus infections in humans are still lacking. Urgent action is needed to fight this fatal coronavirus infection by reducing the number of infected people along with the infection contagiousness and severity. Since the beginning of the COVID-19 outbreak several weeks ago, we observe in GHU PARIS PsychiatrieNeurosciences (Sainte-Anne hospital, Paris, France) a lower prevalence of symptomatic and severe forms of COVID-19 infections in psychiatric patients (∼4%) compared to health care professionals (∼14%). Similar observations have been noted in other psychiatric units in France and abroad. Our hypothesis is that psychiatric patients could be protected from severe forms of COVID-19 by their psychotropic treatments. Chlorpromazine (CPZ) is a phenothiazine derivative widely used in clinical routine in the treatment of acute and chronic psychoses. This first antipsychotic medication has been discovered in 1952 by Jean Delay and Pierre Deniker at Sainte-Anne hospital. In addition, to its antipsychotic effects, several in vitro studies have also demonstrated a CPZ antiviral activity via the inhibition of clathrin-mediated endocytosis. Recently, independent studies revealed that CPZ is an anti-MERS-CoV and an anti-SARS-CoV-1 drug. In comparison to other antiviral drugs, the main advantages of CPZ lie in its biodistribution: (i) preclinical and clinical studies have reported a high CPZ concentration in the lungs (20-200 times higher than in plasma), which is critical because of the respiratory tropism of SARS-CoV-2; (ii) CPZ is highly concentrated in saliva (30-100 times higher than in plasma) and could therefore reduce the contagiousness of COVID-19; (iii) CPZ can cross the blood-brain barrier and could therefore prevent the neurological forms of COVID-19.Our hypothesis is that CPZ could decrease the unfavorable evolution of COVID-19 infection in oxygen-requiring patients without the need for intensive care, but also reduce the contagiousness of SARS-CoV-2. At this end, we designed a pilot, phase III, multicenter, single blind, randomized controlled clinical trial. Efficacy of CPZ will be assessed according to clinical, biological and radiological criteria. The main objective is to demonstrate a shorter time to response (TTR) to treatment in the CPZ+standard-of-care (CPZ+SOC) group, compared to the SOC group. Response to treatment is defined by a reduction of at least one level of severity on the WHO-Ordinal Scale for Clinical Improvement (WHO-OSCI). The secondary objectives are to demonstrate in the CPZ+SOC group, compared to the SOC group: (A) superior clinical improvement; (B) a greater decrease in the biological markers of viral attack by SARS-CoV-2 (PCR, viral load); (C) a greater decrease in inflammatory markers (e.g. CRP and lymphopenia); (D) a greater decrease in parenchymal involvement (chest CT) on the seventh day post-randomization; (E) to define the optimal dosage of CPZ and its tolerance; (F) to evaluate the biological parameters of response to treatment, in particular the involvement of inflammatory cytokines. Patient recruitment along with the main and secondary objectives are in line with WHO 2020 COVID-19 guidelines.This repositioning of CPZ as an anti-SARS-CoV-2 drug offers an alternative and rapid strategy to alleviate the virus propagation and the infection severity and lethality. This CPZ repositioning strategy also avoids numerous developmental and experimental steps and can save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easy to manage side effects. Indeed, CPZ is an FDA-approved drug with an excellent tolerance profile, prescribed for around 70 years in psychiatry but also in clinical routine in nausea and vomiting of pregnancy, in advanced cancer and also to treat headaches in various neurological conditions. The broad spectrum of CPZ treatment - including antipsychotic, anxiolytic, antiemetic, antiviral, immunomodulatory effects along with inhibition of clathrin-mediated endocytosis and modulation of blood-brain barrier - is in line with the historical French commercial name for CPZ, i.e. LARGACTIL, chosen as a reference to its "LARGe ACTion" properties. The discovery of those CPZ properties, as for many other molecules in psychiatry, is both the result of serendipity and careful clinical observations. Using this approach, the field of mental illness could provide innovative therapeutic approaches to fight SARS-CoV-2.

International audience; The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly.Methods: The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated.Results: Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P

Nous présentons ici une méthode originale et sécurisée pour l'élaboration en une seule étape de films nanostructurés composés de nanoparticules enrobées dans une matrice. Ce procédé polyvalent combine sous vide la technologie des jets de nanoparticules avec la pulvérisation magnétron classique. Le principal avantage de la technique est la possibilité de choisir indépendamment la nature chimique des nanoparticules et celle de la matrice. La capacité à réaliser la synthèse sur de grandes surfaces est fournie par l'utilisation d'une série de plusieurs lentilles aérodynamiques placées en parallèle entre la source des nanoparticules et la chambre de dépôt sur une machine prototype., We present here an original safe-by-design method for the elaboration of nanostructured films composed of nanoparticles embedded in a matrix. This versatile single step process operates under vacuum by combining the jet of nanoparticles technology with classical magnetron sputtering. The main advantage of the technique is based on the possibility to choose independently the chemical nature of nanoparticles and matrix. The ability to achieve synthesis on large surfaces is provided by the use of a series of several aerodynamic lenses implemented on a prototype set up between the source of nanoparticles and the deposition chamber.

Obesity is a major public health problem. Pregnant women are also affected by this epidemic. In pregnant women, obesity increases obstetric and neonatal complications, and is associated with alterations in the quality of labor that could be explained by reduced myometrial contractility. This leads to an increase in the rate of caesarean sections and postpartum haemorrhages in this population at risk. Adipokines, hormones secreted by adipose tissue, may have a role in altering the myometrial contractility. Weight loss in these patients is based on dietary management and on physical activity, which could be a way to improve adipokines action and uterine contractility. The objective of this literature review was to review current knowledge about the role of adipokines on uterine contractility in obese pregnant women and to assess the interest of sport in improving contractility and in reducing obstetric complications in these women.

The aim of this study was to review the evidence regarding the pathophysiology of detrusor underactivity in the elderly.A literature review was conducted in July 2016 using the Medline/Pubmed database limiting the search to works in English or French.The prevalence of detrusor underactivity has been reported to range from 8% to 48% depending on the definition used and the age of the population studied. Current data suggest that aging may itself be a causative factor of detrusor underactivity through myogenic dysfunctions (ultrastructural degeneration of the detrusor muscle) and neurogenic dysfunctions (by degeneration of efferent but mostly afferent innervation mechanisms). Beyond these inherently age-related mechanisms, many comorbidities whose prevalence increase with age (diabetes, bladder outlet obstruction, estrogen deficiency, atherosclerosis, etc.) may be implicated in the development of detrusor underactivity in the elderly. The role played by detrusor overactivity in the appearance of detrusor underactivity must be considered separately as both seem to be the expression of the same condition of the lower urinary tract responding to different stages and secondary to numerous etiopathogenic factors which modulate its progression and clinical expressions.Pathophysiology of detrusor underactivity remains poorly understood but seems to imply myogenic and neurogenic factors which are favored, besides the aging per se, by various and numerous comorbidities which prevalence increase with age (diabetes, bladder outlet obstruction…).

To assess the overall treatment time of radiotherapy delivered with curative intent in a cohort of 185 consecutive patients and the causes of this possible delay. If delay, to propose corrective actions.We report a single-center prospective study including all consecutive patients receiving a radiation therapy with curative intent, from 1st December 2013 to 28th February 2014, on the three linear accelerators of the radiotherapy department. For each fraction missed, the causes of non-completion were prospectively collected. This analysis took into account the following parameters: age, sex, occupation, transport type and duration, tumour localization, radiation dose, concomitant chemotherapy, hospitalization, type of linear accelerator.One hundred and fifty-five patients were included in the study (183 evaluable, two did not complete treatment). The overall treatment time was respected for 31 patients (17%). It was lengthened on 4.6 days (d) (0-29 d; median: 3d). The mean number of delayed fractions was 3.4 (0-17; median: 2). The reasons of delay were: breakdown 32.2%; maintenance 29.3%; holiday 11%; treatment toxicity 9.4%; inadequate planning 8.6%; other disease 3.9%; treatment refusal 2.1%; unspecified personal reasons 1.5%; refusal to wait 0.8%; transportation 0.3%; error of communication 0.3%; other 0.6%. Two parameters had a significant impact on the overall treatment time: the type of linear accelerator in relation to breakdown occurrence (P0.001) and transportation duration (more or less than 40 min, P=0.022). One hundred and thirty-eight patients (75%) and 79 patients (43%) were treated on one or more than two Saturdays. Treatment on Saturday significantly reduced the overall treatment time (median, 1.9 d; P0.001).The overall treatment time was globally respected excluding break down and maintenance. Their impact on the overall treatment time is minimized by the systematic opening of the department on Saturdays.

Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly.Relevant data from the literature were identified primarily through a Medline search of articles published through December 2013. The search terms included overactive bladder, central nervous system, elderly, anticholinergic, and antimuscarinic. Articles were chosen for inclusion based on their pertinence to the focus on treatment of OAB in the elderly.Several anticholinergic drugs are available for the treatment of OAB, including oxybutinin, tolterodine, trospium chloride, solifenacine, fesoterodine. Among the agents reviewed, penetration of the blood-brain barrier (as predicted by lipophilicity, polarity, and molecular size and structure) is highest for oxybutinin, lower for tolterodine, solifenacine, and darifenacine, and lowest for fesoterodine and trospium chloride. Unwanted CNS adverse effects depend in part on patient specific variability in pharmacokinetic parameters, blood-brain barrier permeability, degree of cholinergic neuronal degeneration, total anticholinergic drug burden and patient's baseline cognitive status. The spectrum of anticholinergic CNS adverse effects ranges from drowsiness to hallucinations, severe cognitive impairment, and coma. Among the different anticholinergic agents, oxybutinin has been associated with cognitive impairment and trospium chloride and fesoterodine have shown favorable CNS tolerability.Anticholinergic drugs improve significatively overactive bladder symptoms in older adults. However, potential CNS adverse effects of anticholinergic agents used in OAB must lead to a full evaluation before and during the treatment in order to evaluate benefice, risks and central side effects in this frail population.

Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly.Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation).By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used.Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.

4 pages; International audience; Hepatic alveolar echinococcosis is a rare parasitic zoonosis, potentially lethal in childhood. It is due to Echinococcosis multilocularis whose larva insidiously develops in the liver. We report the case of a 13-year-old girl, living in the Vosges Mountains, followed for recurrent abdominal pain, with recent worsening. Diagnosis of alveolar echinococcosis was immediately suspected based on the liver ultrasound scan and then confirmed by imaging (CT scan, NMR) and serology. A curative surgical treatment (segmentectomy) was performed 3 months after diagnosis, under oral albendazole treatment, maintained for at least 2 years. Hepatic alveolar echinococcosis usually has a negative prognosis, except if diagnosed early, which allows rapid surgical treatment, as in our patient.

Afin de caractériser le signal de chargement quelconque d’une chaussée bitumineuse, une modélisation numérique de structure de chaussée a été faite à l’aide du code de calcul aux éléments finis Cast3M. Le modèle de Kelvin Voigt généralisé implanté dans ce code a été utilisé pour prendre en compte le comportement viscoélastique des couches bitumineuses. Les résultats obtenus montrent que le signal de chargement dépend de la structure de chaussée (matériaux, épaisseur, température, interfaces, etc.), de la vitesse de chargement et de la configuration de la charge. Le niveau de déformation, la durée et le nombre de pics en extension sont des propriétés du signal de chargement qui influent sur la durée de vie en fatigue.

Cet article présente un modèle numérique 2D capable de prédire le comportement viscoélastique des enrobés bitumineux. Le matériau a été modélisé en tant qu’un milieu biphasé contenant des inclusions (granulats) à propriétés élastiques linéaires et une matrice (le mastic) ayant un comportement viscoélastique linéaire limité aux petites déformations. Le modèle rhéologique de Maxwell généralisé a été utilisé pour exprimer le comportement viscoélastique du mastic. Dans ce modèle, nous avons généré d'une façon aléatoire des inclusions de différentes tailles et différentes formes qui représentent le squelette granulaire des enrobés bitumineux. La taille et la forme des granulats sont choisies de façon à s'approcher du cas réel. Le modèle est soumis à un déplacement constant dans le domaine temporel. 29ème rencontre de l’AUGC Tlemcen (29-31 Mai 2011).

Sub-Saharan Africa remains the most affected region in the global AIDS epidemic. Côte d'Ivoire is one of the most affected countries by this epidemic. The collective search for deleterious determinants of the evolution of immunological markers (CD4 cells count) may help to optimize the therapeutic efficiency in this resource-limited country.We are interested in studying the antiretroviral response of efavirenz-based regimen (treatment of choice in first line) by the nonhierarchical-descendant model by taxonomy of CD4 cells count trajectories. From 87 CD4 cells count trajectories of symptomatic naive patients, classes of similar profiles grouped by the model have formed typical profiles of evolution as meta-trajectories. The analysis of these meta-trajectories was used to study the determinants of CD4 cells count evolution by classes of patients.Four classes have been determined for an optimal taxonomy with a partition score of 0.72: P1 (n=27), P2 (n=15), P3 (n=24), P4 (n=21). Our model showed a variation between groups of CD4 cells count trajectories linked to explanatory factors by highlighting the predictive role of certain characteristics on antiretroviral response in Côte d'Ivoire (CD4 cells count baseline [P0.01], CD4 percentage baseline [P0.05], adherence [P0.05]). The multiple correspondence analysis revealed other characteristics that influence the immune response such as the presence of opportunistic infections, bloodless status and weight at the initiation of treatment.The factors influencing the profile of meta-trajectories of CD4 cells count during efavirenz-based antiretroviral regimen should be considered at the initiation of treatment to optimize performance in the therapeutic monitoring of patients in Abidjan. The model of biomedical indicators meta-trajectories provides a therapeutic decision support provided prior to capitalize sufficient expertise for a better interpretation.

International audience; OBJECTIVES: To illustrate the value of diffusion tensor imaging and tractography in the diagnosis and follow-up of central pontine myelinolysis. CASE REPORT: We report a case of central pontine myelinolysis in a 29 year old woman, also anorexic, studied using MR Diffusion Tensor Imaging (DTI) and Fibre Tracking (FT) focused on the pons, and compared with the studies of 5 normal volunteers. Tractography showed a swollen aspect of the right corticospinal fiber tract correlating with mild left lower extremity deficit at clinical evaluation. The pontine fibers were posteriorly displaced but intact. The sensory tracts were also intact. Apparent Diffusion Coefficient values were increased and Fractional Anisotropy was decreased in the lesions. Follow up imaging showed persistent abnormal ADC and FA values in the pons although the left cortico-spinal tract returned to normal, consistent with the clinical outcome. CONCLUSION: Diffusion Tensor Imaging MR and Fiber tractography are a new method to analyse white matter tracts. It can be used to prospectively evaluate the location of white matter tract lesions at the acute phase of central pontine myelinolysis and follow up.

Magnetic resonance imaging is the method of choice for the evaluation of brachial plexopathy. Knowledge of the anatomy and normal imaging appearance is required. High-resolution imaging technique is necessary with the use of adequate coils. Evaluation of the brachial plexus requires T1 weighted sequences in three plans, T2 weighted sequences with fat suppression and if necessary the study is completed with gadolinium injection sequences with fat suppression. A CISS sequence is used if a nerve root avulsion is suspected. The spatial resolution must be optimized with the use of adapted parameters. We illustrate a variety of pathologies that can involve the brachial plexus. The pathology includes trauma, primary (neurogenic tumors, lymphomatosis) or secondary tumors, radiation plexopathy or inflammatory polyneuropathy.

Totally implantable venous access ports (TIVAP) are valuable medical devices for long-term intravenous treatment such as parenteral nutrition, cancer chemotherapy or antiviral therapy. Implantation and use of these devices are each associated with infectious or mechanical complications.To determine the frequency of complications and to analyze bacterial contamination of different parts of TIVAP (tip, septum, internal lumen of the port).Clinical charts of patients, which TIVAP was removed between April 20th to December 31st 2003, were retrospectively reviewed. Infectious complications (local and septicemic) and non-infectious complications (i.e. obstruction, thrombosis, drug extravasation...) were defined using clinical and/or microbiological criteria. Quantitative culture from different parts of the TIVAP was performed.One hundred and ten patients (age 57 +/- 14-years-old, 94.3% cancers) were included, corresponding to 57,018 catheter-days: 39.1% had one or more non-infectious complications (density incidence: 0.86 for 1000 catheter-days). Among the 49 complications, obstruction, thrombosis, extravasations and malposition accounted for 30.6%, 30.6% 4.1% and 6% of cases. Twenty-one patients (19.1%) had an infectious complication: 11 were local and 14 were systemic (density incidence 0.43 for 1000 catheter-days). Bacteria responsible for TIVAP-associated bacteraemia were coagulase negative staphylococci (N = 2), Staphylococcus aureus susceptible to methicilline (N = 3), micrococci (N = 1), corynebacteria (N = 1) or Gram-negative bacilli (N = 8). Comparison of quantitative culture of the different parts of TIVAP with a threshold at 10(3) CFU/ml showed that culture of tip, septum and port has a sensitivity of 47.6% 57.1% and 61.9 %, respectively and a specificity of 100% 92.1% and 92.1%, respectively for the diagnosis of TIVAP infection.Complications associated to TIVAP are frequent but incidence that we have reported is comparable with previous studies. Analysis of internal lumen of the port is the most sensitive method for the diagnosis of TIVAP-associated infections.

Peripheral venous catheter (PVC)-associated complications were prospectively evaluated in a 2 month-study performed in 3 different wards.For each inserted PVC, the following complications were observed daily by an external investigator: tenderness, erythema, swelling or induration, palpable cord and purulence. PVC that were removed were systematically sent to the Microbiology department and analysed according to the semi-quantitative method described by Brun-Buisson et al.A total of 525 PVC (corresponding to 1,036 catheterisation-days) were included. Main clinical complications were erythema (22.1%), tenderness (21.9%), swelling or induration (20.9%), palpable cord (2.7%) and purulence (0.2%). Phlebitis, defined by 2 or more of the following signs: tenderness, erythema, swelling or induration and palpable cord, was observed in 22%. Catheter colonization (or = 103 CFU/ml) occurred in 13%. Bacteria isolated from colonized catheters were coagulase-negative staphylococci (88.1%), Staphylococcus aureus (7.1%) and Candida sp. (4.8%). Multivariate risk factor analysis showed that ageor = 55 y. (OR = 3.16, p = 0.003), insertion on articulation site (OR = 2.94, p = 0.01) or in jugular vein (OR = 8.18, p = 0.01) and72 hour-catheterisation (OR = 4.74, p = 0.0003) were significantly associated with PVC colonization. Risk factors for phlebitis were skin lesions (OR = 1.88, p0.016), active infection unrelated to PVC (OR = 2.8, p = 0.001), "poor quality" peripheral vein (OR = 2.46, p0.02) and72 hour-catherisation (OR = 2.38, p = 0.009).Complications associated with peripheral venous catheters are frequent but remain benign. They could probably be reduced by a systematic change every 72-96 hours as recommended by different guidelines.

Founded in 1997 at the initiative of Charles Mérieux, the European Center for Humanitarian Health Care (French acronym, CESH) is a Public Interest Organization comprising 7 members, i.e., Lyon 1 Claude Bernard University, Aix-Marseille II University of the Mediterranean, the Public Hospital System of Lyon, the Public Hospital System of Marseille, the French Army Health Corps, the Mérieux Foundation, and the National School of Veterinary Medicine in Lyon. The CESH is a multifunctional resource dedicated to providing education, information, and research in the field of humanitarian action. The objectives of the CESH's Educational Program are to increase awareness of the complexity of humanitarian action and teach the principles and methods necessary to integrate experienced teams already in the field. Courses including a three-week study program sanctioned by an Interuniversity Degree in Public Health and several 2-to-3-day training modules are open to all humanitarian actors including field workers and decision-makers, health-care professionals, and governmental or other administrative agents. Thanks to a diverse faculty with academic, humanitarian, training, civilian and military backgrounds and to a wide-ranging curriculum, the CESH helps to promote communication and to open up closed pathways of cooperation between the different groups involved in humanitarian action. The module entitled "Humanitarian Assistance and Civilian and Military Cooperation" exemplifies the effort of the CESH to generate collaborative behavior among civilian and military actors. The CESH's Research Program is aimed at providing practical tools for decision-making in the field. The web site of the CESH [http://cesh.univ-lyon1.fr] presents the mission and activities of the Center as well as information on course enrolment and humanitarian action.

As in the other animal species, human senses are adapted to their environment. The energy of photonic, mechanical, thermic or chemical, stimulus is perceived by sensory cells, either dispersed or packed in a sensory end organ. Fifteen years ago, our knowledge of the molecular bases of the function of the various modes of sensory perception was rudimentary with the noticeable exception of that of the phototransduction cascade. Since then, several causative genes for human sensory defects have been isolated. We will examine the outcome of this research in fundamental and medical terms, and bring up the vast yet unexplored fields of the sensory perception. Human genetics should contribute to enlighten the molecular aspects of the latter.

Diarrhea that occurs in hospitalized patients is frequent and may be due to infectious or noninfectious causes. In adults with nosocomial diarrhea, the most commonly detected agent is Clostridium difficile; in children, rotaviruses are predominant. Various studies have shown that bacterial enteric pathogens (e.g. Salmonella spp., Shigella spp., Campylobacter spp...) or parasites are common causes of community-acquired diarrhea but rarely cause nosocomial enteritis. Stool cultures for these pathogens and ova and parasite examination should not be performed in patients hospitalized for more than three days unless there are plausible clinical or epidemiological reasons to do so. In contrast, C. difficile toxins assay (and rotavirus screening in children) should be primarily requested. The detection of C. difficile toxin B by stool cytotoxicity assay remains the 'gold standard'. Identification of toxin A (or A + B) can also be performed by immuno-enzymatic (ELISA) tests: results may be obtained in three hours. Electronic microscopy is the standard method for rotavirus diagnosis but tests using latex agglutination or immuno-enzymatic assay are now available. Various typing methods have been developed and may be routinely used in epidemiological investigations.

Clostridium difficile is responsible for 10-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudo-membranous colitis (PMC). This anaerobic spore-forming bacterium has been identified as the leading cause of nosocomial infectious diarrhea in adults. Pathogenesis relies on a disruption of the normal bacterial flora of the colon, a colonization by C. difficile and the release of toxins A and B that cause mucosal damage and inflammation. Incidence of C. difficile intestinal disorders usually varies from one to 40 per thousand patient admissions. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (65 years), antineoplastic chemotherapy, and length of hospital stay. Nosocomial transmission of C. difficile via oro-fecal route occurs in 3-30% of total patient admissions but it remains asymptomatic in more than 66% of cases. Persistent environmental contamination and carrying of the organism on the hands of hospital staff are common. Measures that are effective in reducing cross-infection consist of an accurate and rapid diagnosis, an appropriate treatment, an implementation of enteric precautions for symptomatic patients, a reinforcement of hand-washing and a daily environmental disinfection. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

Deafness is the most common sensory defect. The investigation of the cause of deafness is critical for genetic counselling, and sometimes for appropriate management of associated pathologies. About two thirds of cases of congenital deafness are genetic forms, and the proportion is probably similar concerning the forms of deafness that appears during childhood. Some of the genetic forms are syndromic and the associated signs are sometimes inapparent or may appear during childhood. Consequently, a systematic search for the most frequent syndromes is necessary in each deaf individual. In the majority of genetic cases, deafness is the sole defect (non-syndromic deafness) and the major mode of transmission is autosomal recessive. The DFNB1 form of deafness, due to connexin 26 gene mutations, underlies half of the cases of non syndromic congenital deafness cases. The hearing loss has a prelingual onset, and it is most frequently severe or profound. There is no associated pathologies or radiological anomalies of the inner ear, and the vestibular tests are normal. The possibility of offering molecular diagnosis of connexin 26 gene defects is profoundly modifying daily medical practice in the investigation of the cause of deafness.

From February 1996 to January 1997, 74 patients from 53 sibships underwent genetic counselling for sensorineural deafness at the Pasteur Hospital, Paris, France. Genetic counselling was based on the etiological diagnosis of the hearing impairment, by an audiological and non-audiological examination program. At the first examination, 31 families presented with a familial deafness and 22 families with apparently one affected individual. However, familial audiological examinations revealed familial deafness in 5 of these 22 families. Consequently, a total of 36 families had hereditary hearing impairment and the etiological groups showed the following distribution: non-syndromic deafness (14 families), syndromic deafness (12 families), probable syndromic deafness (5 families), and incomplete assessment (5 families). Out of the remaining 17 families in which affected individuals were sporadic cases, the etiological groups were as follows: acquired deafness (2 families), probable syndromic deafness (5 families), unknown cause (5 families), and incomplete assessment (5 families). Etiological assessment is discussed, with reference to the cost-effectiveness of this examination program. In light of this preliminary report, we present a model of assessment for the etiological diagnosis of sensorineural deafness in children and young adults.

Determine the frequency of enteropathogenic agents isolated in diarrheic feces of patients with HIV infection and to compare findings with a control group (HIV + without diarrhea) in order to identify risk factors.All HIV seropositive inpatients and outpatients seropositive for HIV, with or without diarrhea, seen between 1 November 1994 and 30 April 1995 were included. Samples of feces were obtained for culture, virology examination, parasite examination and search for Clostridium difficile. The same samples were obtained in case of diarrhea during the course of hospitalization.There were 113 samples. Analyses demonstrated a pathogenic agent in 73.6% of the samples in patients with diarrhea and in 31.6% of those without diarrhea. Clostridium difficile and parasites were the most frequently identified agents. An infectious agent was identified in one-fourth of the patients without clinical signs of diarrhea, and in one-fourth of those with diarrhea no pathogen could be demonstrated. No factor of risk for finding a particular microorganism in feces of patients with diarrhea could be identified.The exact pathogenic roles of Pseudomonas aeuriginosa, yeast, and adenovirus remain to be determined. It is hypothesized that the HIV has a direct effect on the host digestive tract.

Meropenem is a new dehydropeptidase stable carbapenem which has an in vitro bacteriostatic activity superior to imipenem against Pseudomonas aeruginosa. Minimal inhibitory concentrations of meropenem (MEM) and imipenem (IPM) were determined on twelve strains: two were genetically characterized reference strains and ten isolated from patients. Killing curves were performed for MEM used at 1,2 and 4 fold the MIC and 32 mg/l; survivors were counted at baseline and after 5 and 24 hours of incubation by spiral plating. Five strains were susceptible to MEM and IPM; five were intermediate and two resistant to MEM; these seven strains were resistant to IPM. A weak bactericidal effect was obtained after 5 h at each concentration. Only one strain achieved a 3 log 10 reduction after 5 h at 2 x MIC. A regrowth of all the strains tested was observed after 24 h.

Clostridium difficile accounts for 15-25% of cases of antibiotic-associated diarrhea (AAD) and for virtually all cases of antibiotic-associated pseudo-membranous colitis (PMC). This anaerobic bacterium is also carried in the gastro-intestinal tract of less than 3% of the normal adult population and can be isolated from the feces of 50-70% asymptomatic neonates. Since recent years, C. difficile has been identified as the leading cause of nosocomial diarrhea in adults. Pathogenesis relies on a disruption of the normal bacteria flora of the colon, a colonization with C. difficile and the release of toxins that cause mucosal damage and inflammation. Incidence of C. difficile intestinal disorders varies between 1 to 30 per thousand patient admissions. Risk factors for C. difficile-associated diarrhea include antimicrobial therapy, older age (65 years), intensive care, nasogastric tube, anti-acid use, and length of hospital stay. Nosocomial transmission of C. difficile via orofecal route occurs in 3-30% of total patient admissions but it often remains asymptomatic. Environmental contamination and carriage of the organism on the hands of hospital staff are common. Measures that are recommended to reduce cross-infection rely on an accurate and rapid diagnosis, implementation of enteric isolation, use of disposable gloves, hand washing with a suitable disinfectant (e.g. chlorhexidine) and daily environmental disinfection. C. difficile is a common cause of infectious diarrhea and should be therefore systematically investigated in patients with nosocomial diarrhea.

The incidence of atypical mycobacterial infections has increased with the AIDS epidemic. To present, microscopic examinations of airway specimens positive for acid-fast bacteria were highly suggestive of tuberculosis. However, since the AIDS epidemic, certain authors have reported an increase in Mycobacterium avium intracellulare found in respiratory specimens. The aim of this work was to determine what factors might distinguish between these two infections revealed discovery of an acid-fact bacilli.Hospital files of all HIV seropositive patients seen between November 1992 and March 1995 and with at least one airway specimen positive for acid-fast bacilli were studied retrospectively.Mycobacterium tuberculosis was isolated in 19 patients, Mycobacterium avium intracellulare in 8 and culosis and M. avium intracellulare. There was no difference for age, sex, geographical origin, transmission mode, antigen positivity, radiologic findings or clinical signs between patients with the different types of mycobacterium. The CD4 count was however significantly lower in patients with an atypical mycobacteriosis (14.5/mm3) than in patients with tuberculosis (91.7 +/- 83.7) (p = 0.004).These findings show that in HIV-infected patients with a CD4 count under 100/mm3, the presence of acid-fact bacilli can indicate either M. tuberculosis or M. avium intracellulare. Combined anti-tuberculosis and antimycobacteriosis therapy thus would appear to be justified until the germ can be identified.

Our study is based on a puppet theatre performed with a group of children aged from six to eight who were experiencing a neurotic context. Guignol's playing reveals anguishes and defensive mechanisms as well as, regarding the actors, the ability to experience the comedy with authenticity without forgetting it is imaginary. The puppet theatre has allowed us to progress in a therapeutic process while continuing diagnostic exploration.

A 72 year-old right handed woman had a right sided anterior choroidal artery infarction. She presented the triad of hemiplegia, hemianaesthesia, and homonymous hemianopsia, as well as complete non-determinant hemisphere syndrome that combined: disorientation for place and time, anosognosia, hemiasomatognosia, left spatial neglect, constructional apraxia and spatial fabulation concerning both the present time and the weeks that preceded the vascular event. Language and verbal memory were normal. Spatial memory could not be studied because of the severity of the neglect. The clinical course was poor: when tested one and a half year post-onset, the hemiplegia, the hemianaesthesia, and the hemianopsia as well as left spatial neglect remained severe. Vestibular caloric stimulation, carried out with left ear cold water irrigation, resulted in brief but clear-cut alleviation of the spatial neglect. An MRI with both axial and coronal slices showed a right-sided infarct affecting the whole posterior limb of the internal capsule including the genu, the posterior part of the globus pallidus, the anterior third of the cerebral peduncle and the amygdala but sparing the thalamus and the corona radiata. This crescent-shaped lesion transected entirely the thalamo-cortical connection fibers which resulted in a "thalamic exclusion". The measurement of brain glucose utilisation with (18F)-Fluoro-2-Deoxy-D-Glucose and positron emission tomography performed in the chronic phase (3 months post-onset) showed an exceptionally severe and widespread hypometabolism of the right hemisphere, relative to the left hemisphere, which correlated with both the unusual, severe and protracted non-dominant hemisphere syndrome. All the brain regions on the right side were hypometabolic relative to the left including the temporal region (mostly medial temporal), the left cerebellar lobe, the frontal lobe (mostly prefrontal region), the occipital region and the thalamus. The hypometabolism of the basal ganglia, the sensorimotor area and the parietal cortex was less severe. This most uncommon clinical-metabolic presentation presumably reflects a global thalamo-cortical disconnection inducing a diffuse dysfunction of the whole hemisphere.

Tamoxifen is the anti-estrogen the most widely used in breast cancer. The duration of its prescription, as adjuvant treatment, tends to increase (5 years, and even more) and now it is used in chemoprevention. A slight increase of thromboembolic complications was noted in some studies. This article evaluates the frequency of thromboembolic accidents (TEA) in 441 postmenopausal patients treated by an association of conservative radiosurgery, tamoxifen +/- chemotherapy, for a breast carcinoma T0, T1T24 cm. Nineteen patients (4.3%), all in remission, presented a TEA, between 1 and 44 months after the beginning of the tamoxifen treatment. We observed seven pulmonary embolisms (PE), 11 deep venous thromboses (DVT) and an acute arterial ischemia. Two patients aged 74 and 80 years died, the others had a favourable evolution under anticoagulant treatment. Among these 19 patients, six presented known risks factors (phlebitis, cardiovascular disorders) and ten had a "favouring circumstance" aggravating the risk of TEA (surgical operation, severe infection, fracture). Their median age was 65 years (61 for all the 441 patients). We noted eight cases of breast lobular cancer (42%) among these 19 patients (11% for all the patients). Among postmenopausal patients, the indication of tamoxifen must be evaluated according to the benefits expected in those with high risk factors of TEA (history of heart failure, obesity, spread varix, age65 years). In case of DVT and/or PE, this treatment seems contra-indicated. In case of "favouring circumstances", a hypocoagulant or systematic anticoagulant treatment must be proposed. In case of combined chemotherapy, it is better to start tamoxifen at the end of the treatment. These simple prophylactic measures should allow to reduce significantly the risk of TEA in postmenopausal patients with adjuvant anti-estrogenotherapy.

Increasing resistance to multiple antimicrobial agents including penicillins is a current problem with Streptococcus pneumoniae. Seven cases of severe infection due to penicillin G-resistant pneumococci were seen in two teaching hospitals in Paris (France) during the first half of 1991; six of the strains were recovered from pulmonary secretions (protected brush specimens) and one from cerebrospinal fluid (CSF). The bacteriostatic activity and killing curves of eight antimicrobials against these seven strains were studied. Antimicrobial agents tested included penicillin G (PEN), amoxicillin (AMX), cefotaxime (CTX), imipenem (IPM), rifampin (RIF), vancomycin (VAN), fosfomycin (FOS), and erythromycin (ERO). MICs were determined using the agar dilution method. Killing curves were obtained using a liquid medium inoculated with 10(5) to 10(6) CFU/ml and subjected to continuous agitation; survivors were counted at baseline and after 1, 3 and 5 hours incubation. MICs of each antimicrobial (mg/l) for the seven strains were in the following ranges: PEN: 0.5-2, AMX: 0.5-2; CTX: 0.125-1; IPM: 0.03-0.25; RIF: 0.12-0.25; VAN: 0.25-1; FOS: 16; ERO: 0.06 greater than 4. Overall, bactericidal activity was greatest with vancomycin, followed by imipenem, then amoxicillin. The cefotaxime-fosfomycin combination proved synergistic and exhibited bactericidal activity (2MIC + 2MIC) for three of the seven strains. This study demonstrated the value of the cefotaxime-fosfomycin combination. Both these antimicrobials seem appropriate for the treatment of meningitis caused by penicillin G-resistant pneumococci provided their dosage is adjusted to achieve adequate drug levels in the cerebrospinal fluid.

Currently, the method of choice in diagnosis of Clostridium difficile-associated intestinal diseases is the detection of toxin B in fecal specimens. This method is long (72 h) and can be realized in laboratories which have tissue culture facilities. Commercial agglutination test have been evaluated but they lack in specificity. An immunoenzymatic test has been recently commercialized for detection of toxin A. We have compared the results of this assay on 275 fecal specimens from patients suspected of having Clostridium difficile-associated intestinal diseases with the results obtained with the cytotoxicity test and the culture. Of the 275 fecal specimens, 58 were positive in cytotoxicity and 53 in Elisa. The overall sensitivity and specificity of the Elisa compared with cytotoxicity were 89.5% and 99.0% respectively. The immunoenzymatic test detecting Clostridium difficile toxin A is an easy test to perform in 2 h 15; it displays a good correlation with detection of toxin B and can be very useful in daily laboratory diagnosis.

The purpose of this study was to observe the change of the meniscal lesions, which are conservable by suture or simply by leaving-in-place within the frame of operated anterior instability. Forty-six knees which had been operated by the free transplant of bone-patellar tendon-bone, presented the associated lesions of conservable meniscus. These lesions were treated by suture of the meniscus in 15 cases and left in place in 31 cases. The programme of rehabilitation was the same in the two groups. All the patients have been followed-up for 26 months in average (12-40 months). In the group of meniscal suture, only one secondary meniscectomy was carried out. 8 patients presented moderate pain on the corresponding femorotibial joint line and 5/13 of the sportive patients recovered to the same level of activity. In the group of leaving-in-place, no meniscectomy has been carried out. Only 4 patients complained of pain and 23/27 recovered to the same activity level. The arthrographic and arthroscopic observations have been carried out in 23 cases. They confirmed the cicatrization of the sutured meniscus but also showed the possibility of total or partial cicatrization of the lesions left in place (12 on 13). The authors conclude that the peripheral meniscal lesions associated with the operation of the chronic anterior instability do not always require suture. The abstention on the meniscal lesion is possible if it is limited on the posterior segment: Then the functional results seem better.

In vivo covalent binding of trenbolone and estradiol was assayed using either radiolabeled compounds or 32P-post labeling. The covalent binding index, as measured with tritiated molecules, was 2.4 for the alpha isomer of trenbolone, 5.4 for its beta isomer and 5.4 for 17-beta estradiol. Using 32P-post labeling at repeated medium doses or a single high dose did not allow any of the 3 compounds to reveal specific adducts in the background of adducts spontaneously formed in control animals. It can therefore be concluded that these steroids most probably do not have a direct genotoxic action.

This is a case of a 38 year old woman in whom a small basophil cell tumour occurred with inguinal and iliac lymph node metastases followed by pulmonary metastases and extension of the tumour into the vagina and the bladder. The patient died eight months after having started multiple chemotherapy and radiotherapy with telecobalt. Extra studies were carried out ten years later on the cells. This made it possible to diagnose the condition as a neuro-endocrine carcinoma rich in serotonin.

Within the scope of a physical examination, more than 147,000 patients from the Eastern part of France, were examined and had a chest X-ray, between 1982 and 1987. Seven physicians read those radiographs and reported their findings. After discussion of an interindividual variation noted between the seven physicians, the authors present the major findings of this study: relation between a cardiovascular anomaly discovered on the radiographs and a high blood pressure; relation between a cardiovascular anomaly discovered on the radiographs and one or several electrocardiographic anomalies; relation between anomaly of the cardiovascular silhouette as seen on the radiographs and increased levels of triglycerides and cholesterol in young adults.

The occurrence of circulating immune complexes (CIC) was investigated in serum samples from 139 patients with breast cancer, using the 125I-C1q binding test. In the 85 cases of regional forms, the level of Clq binding activity did not appear to be correlated with the clinical TN stage, nor with the local treatment of the tumor. Conversely it was clearly elevated in the 13 cases of inflammatory breast tumors, and the decrease of CIC at the post-chemotherapy, but pre-surgical stage may involve the inflammatory signs in this augmentation of CIC. Frequency of occurrence and levels of CIC were slightly increased in the 41 metastatic breast cancer patients when compared to the cases of local breast carcinoma. In the disseminated forms, increase, no change, or decrease of CIC levels showed a poor correlation to progression, stabilisation, or improvement of the disease. CIC seems to be of slight prognostic value in breast cancer with local forms, but regarding progression of the disease, metastatic breast cancer patients with elevated CIC did not prove to be unfavorable group. So far, CIC did not appear to be a tumor marker or an evident prognostic factor of clinical relevance in breast cancer. Assays for antigen-specific CIC might be of greater clinical significance, in breast cancer, than the antigen non specific assays available at present.

The definition of oral leukoplakia is presently under revision. Most authors do not include anymore the clinical conditions known as cheek and lip biting, frictional keratosis, actinic cheilitis, smoker's palate and other lesions attributed to tobacco, e.g., snuff dipper's lesion. An epidemiological review reveals a prevalence ranging from 0.2 to 11.7% among various population groups. As malignant transformation rate of leukoplakia increases up to 17.5% with time, there is a need for continued observations no matter how long the lesions have been present. Among the aetiological factors, smoking is probably the most important, but industrial hazards in certain factories are responsible for a high prevalence of oral leukoplakia. The tongue and the floor of the mouth are predilection sites for carcinomatous transformation. A histological examination is essential to the diagnosis or confirmation of this premalignant lesion.