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Teenagers admitted to the emergency room for a violent attacks episode are increasingly numerous. The source of agitation is multifactorial for these teenagers, often with a complex course. They jeopardize hospital wards, which are often ill-suited for and overwhelmed during these outbursts. This study aims to identify and describe all the teenagers admitted to the hospital over 1 year for a violent outburst and discuss their management.Retrospective and descriptive study of teenagers admitted to the pediatric emergency department of the Nantes University Hospital for a violent outburst in 2015.During this 1-year study, 99 teenagers out of a total of 182 consultations were admitted for a violent outburst. We noted that 85% of them had a previous history of a violent outburst, 70% of them were seeing a psychologist, and 56% were followed by the child welfare services. Most of the outbursts took place at home and were hetero-aggressive. Upon arrival at the pediatric emergency ward, 90% of the teenagers had calmed down. The mean time spent in the emergency ward was 3h42min. Finally, 31% of the teenagers were hospitalized in the general pediatric unit, 14% in the children's psychiatric department, and 8% in the adult psychiatry ward.We observed a high proportion of complex cases in the teenagers admitted to our emergency department for a violent outburst. These teenagers in distress, with a complex previous history, illustrated the relation between violence against themselves and their own violent behavior toward others. Developing short-stay units for a temporary isolation could be an advantageous multidisciplinary approach to allow somatic, psychological, and social evaluation of these vulnerable patients.

Reading is at the core of most current cultural achievements, including literature and science. Cognitive neurosciences now allow us to understand how this crucial cultural construct, its operation, development and breakdown, is rooted in the biological constraints of brain function.

The report of cases of pure alexia suggests that some regions of the neural system are dedicated to reading-specific visual processing abilities. Pure alexia results from the disruption or the disconnection of the visual word form area, a region reproducibly located within the left occipito-temporal sulcus and encoding the abstract identity of strings of visual letters. The functional specialization of this area suggests that it is initially plastic and becomes attuned to the orthographic regularities that constrain letter combination during the acquisition of literacy. The visual word form area further belongs to the network of areas that are consistently implicated in studies of people with developmental dyslexia. Developmental dyslexia is typically interpreted as resulting from a core phonological disorder and most neuroimaging studies showed reduced activity in the left perisylvian regions which have a role in phonological processes. Although low level visual and/or visual attentional disorders have been consistently reported suggesting a visual basis of developmental dyslexia, these disorders typically co-occurred with phonological problems so that the phonological deficit was viewed as the most plausible cause of the poor reading outcome of dyslexic children. In the last years however, dissociations have been reported in developmental dyslexia between phonological processing deficits and a particular kind of visual disorder, a visual attention span deficit characterised by a reduction in the number of distinct orthographic units which can be processed simultaneously in a single fixation. Large sample studies revealed that a non trivial number of dyslexic children exhibit a visual attention span disorder and that this disorder typically dissociates from phonological impairments in the dyslexic population. Neuroimaging studies suggest involvement of the parietal lobes - in particular the superior parietal lobules - in visual attention span and these brain regions are less active in people with developmental dyslexia. A visual attention span disorder thus appears as a second core disorder related to a parietal dysfunction in developmental dyslexia. Further studies are required to determine whether the phonological disorder or the visual attention span disorder independently contribute to the development of the visual word form area during literacy acquisition. These neurobiological dysfunctions are further modulated by environmental factors such as language characteristics, remedial interventions or socio-economic status. Future studies would help better understanding the interactions between neurobiological and environmental factors and the potential influence of the later on the development of the visual word form area.

Fetuses and infants of women with anti-SSA/Ro and anti-SSB/La antibodies are at risk of neonatal lupus syndrome, featuring skin lesions, hematological and hepatic disorders, and congenital heart block (CHB) in the absence of severe cardiac malformation. The prevalence of CHB in newborns of anti-SSA/Ro positive women with known connective tissue disease is 1 to 2% and the risk of recurrence ranges from 10 to 17%. CHB is definitive and is associated with significant morbidity (pacemaker must be implanted in 2/3 of cases) and mortality (16 to 19%). Myocardial involvement may either be associated or appear subsequently. Other manifestations are discussed. For anti-SSA/Ro positive pregnant women, echocardiograms should be performed every 2 weeks from 16 to 24 weeks of gestation, and every week in case of past history of CHB. Electrocardiogram should be performed in the first days of life for all children to detect incomplete CHB. Therapy for CHB detected in utero is based on fluorinated steroids, especially betamethasone. Its efficiency is variable.

An increasing number of studies are focusing on the anatomo-functional organisation of number processing and some cognitive models have been recently developed. Nevertheless, relationships between areas implicated in number processing, and language areas and circuits remain unclear. Recently, Dehaene and Cohen, in their "triple-code model of number processing", (Dehaene and Cohen, 1995) distinguished two alternative number representation and processing systems: one depending on verbal processes, the other representing a quantity manipulation. According to this model, the retrieval of "arithmetical facts" (AF), learned by rote at school and memorised in a verbal form (such as the multiplication table or simple addition problems) can be considered as a verbal automatism; conversely, subtraction problems, which require mental manipulation of the quantities, represent an abstract, semantic elaboration: "Actual Calculation" (AC). The anatomical correlate of the retrieval of AF (depending on automatic verbal associations) seems to correspond to the left-hemispheric perisylvian areas, while impairment of the actual calculation (AC) depends on the intraparietal region, particularly in the left dominant hemisphere. The present study describes the neuropsychological assessment of three patients, tested after surgery for left parieto-occipital tumors. Two of them were affected by an anaplasic glioma, the third by a low-grade glioma. The cognitive evaluation included: words of Rey, numeral (directed and reversed) span, reading of "simple" numbers (from 1 to 10) and of "complex" numbers (many decimals), writing (dictation) and reading a standard text, finger denomination and right-left distinction. All patients showed language disturbances, dysgraphia and severe dyslexia. In reading numbers, we identified two types of errors: lexical and syntactic. "Lexical errors" consisted in a wrong choice among words in the number's lexicon. For instance, all patients made errors in reading "complex" numbers composed by many decimals, switching single numbers but respecting the decimal size and the structure of the whole number (such as 69107 instead of 68107). On the other hand, only one patient committed syntactic errors, misunderstanding the decimal size and the structure of the number. We considered lexical errors as verbal errors, and syntactic errors as semantic errors, affecting the notion of quantity. We tried to explain verbal disturbances as well as lexical errors as a consequence of lesion of the left-hemispheric perisylvian areas, while syntactic errors as a consequence of impairment of the intraparietal region.

Volvulus of the mobile spleen is a rare condition generally manifested by acute sudden onset abdominal pain localized in the left flank. Ultrasound or computed tomographic imaging generally provides the diagnosis.An 18-year-old patient was hospitalized for acute pain of the left flank that had begun 48 hours earlier. The abdominal scan visualized a volvulus of a mobile spleen. Laparoscopic distortion was successful, allowing normal recoloration of the spleen.Rapid intervention is crucial for conservative treatment. Laparoscopic treatment allows distortion manoeuvres and splenopexia using a mesh. This is the first reported case of successful conservative laparoscopic treatment of volvulus of a mobile spleen.

Cystic dystrophy of aberrant pancreas, characterized by cystic formations in ectopic pancreatic tissue, produces variable signs. Treatment is difficult.Our patient presented signs of acute pancreatitis and angiocholitis due to cystic dystrophy of an aberrant pancreas situated in the duodenal wall associated with chronic alcoholic pancreatitis. Prolonged medical treatment was unsuccessful. Duodenopancreatectomy with preservation of the tail led to complete regression of the clinical signs.Signs of cystic dystrophy of an aberrant pancreas vary greatly. Diagnosis is generally established on the basis of echoendoscopic findings. After failure of medical treatment, duodenopancreatectomy with preservation of the tail could be the most appropriate surgical treatment, hypothesizing that the disorders result from obstruction of the Wirsung and the lower main bile ducts.

Pre-ejectional left ventricular wall motion has been demonstrated clinically by angiography. Intramyocardial wall velocities generated by cardiac contraction may be measured by Doppler tissue imaging. The aim of this study was to detect pre-ejectional wall motion and to analyse its sequencer. A long axis M Mode with simultaneous septal and posterior wall imaging was performed in 11 normal subjects (age 37 +/- 15 years) with velocity analysis between the electrocardiographic Q wave and the onset of ejection by digitised analysis between the electrocardiographic Q wave and the onset of ejection by digitised images with automatic velocity extraction (3.8 ms) along a horizontal subendocardial line. The total duration of the pre-ejectional periods in conventional and Doppler tissue imaging are compared. Oscillatory velocimetric appearances with alternate colours of adjacent bands in each wall and a mirror image between walls was observed. The mean and peak velocities of the first four bands were significantly different between the walls (p0.001) as were the absolute values between bands 2 (p0.02) and 3 (p0.006). The duration of band 2, related to motion mainly towards the center of the ventricular chamber exceeded that of the adjacent bands (septum p0.02, posterior wall p0.001). The correlation coefficient for total duration of the pre-ejectional period between Doppler tissue imaging and conventional Doppler was 0.83, p0.05 for the interventricular septum and 0.76, p0.04 for the posterior was. The authors conclude that regional pre-ejectional wall motion can be recorded. During isovolumic contraction, there is motion predominantly towards the center of the left ventricular chamber of the two walls, confirming previous angiographic findings. Its timing suggests that wall motion proceeds the increase in ventricular pressure.

Spinal tape syndrome requires rapid diagnosis and adapted treatment. A relatively small diameter needle inserted parallel to the dura mata fibers is the best preventive measure. The ventral supine position for a few hours followed by a short walk is sufficient. Caffeine may also be prescribed and has been shown to be as effective orally or intravenously. For severe or persistent syndromes, the blood-patch is remarkably effective and simple to use.

Two patient with familial cavernous angiomatosis presenting with long lasting variable epilepsy with a poor therapeutic response and variable neurologic impairments are presented here. One of the numerous cavernous angiomas was resected in one case. This last patient remains asymptomatic. Familial cerebral cavernous angiomas are often numerous and disseminated in the brain, therefore clinical manifestations are very polymorphous. Moreover the course of these lesions is variable. Therefore MRI should be performed to every patient presenting with poorly understood neurological symptoms, focal or generalized epileptic seizures or absence in order to look for potentially imputable brain lesions. A reliable genetic marker might be helpful for diagnosis of this disease with a variable penetrance and autosomal dominant inheritance. Then a neurosurgical treatment should be carefully discussed if lesions are accessible and medications are poorly efficient with recurrent neurologic impairments or epilepsy.

The advent of extra-corporal shock-wave lithotripsy in the eighties totally changed management strategies for renal and ureteral lithiasis of the upper urinary tract. Currently, approximately 80% of all patients can benefit from lithotripsy with an overall success rate of about 75%. Although classical surgery has a higher success rate of about 90%, extra-corporal shock-wave lithotripsy has many advantages. First there is a very low risk of morbidity (pain, immobilization, complications) for this outpatient treatment. Second, the overall cost, including that of preventive treatment, is low as illustrated by the major reduction in the number of cases of pyonephritis on stones and of corraliform lithiasis. The apparent safety of shock-wave therapy should not mask the risk of unacceptable indications: small stones which may resolve spontaneously or inversely very large stones carrying the risk of residual fragments and renal damage. Long-term morbidity remains to be evaluated, but the management of upper urinary tract lithiasis now relies heavily on shock-wave therapy alongside conventional surgery and percutaneous or endoscopic methods.

Selective conservation of the ability to read Arabic numbers in patients unable to read words or even letters is a classical characteristic of pure alexia described by Dejerine (1982). We report our work on the capacity of two patients with pure typical alexia to process numbers. Our main finding was that these patients could count pairs of Arabic numbers correctly when the reading task was simple (example 2 4--"two four") or when the task involved comparing sizes (example 2 4--"four is bigger than two"). Inversely, these patients often made mistakes when asked to perform arithmetic operations (example 2 4--"two plus four equals six"). Using these two numbers, there was a similar dissociation between excellent performance on comparison tests and severe deficiency in reading out loud. We interpret these findings with the hypothesis that both of the hemispheres can identify Arabic numbers, but that the visual systems on the right and left play a different role during different tasks. In pure alexia, a lesion in the left identification system leads to selective deficiency in linguistic tasks such as reading numbers out loud, recognizing numbers with several figures or mental arithmetic. The right identification system in intact and is sufficient for comparison or reading isolated Arabic numbers.

This study was undertaken to assess the value of percutaneous dilatation of the right ventricular outflow tract as a substitute for surgical systemic pulmonary anastomosis in varieties of tetralogy of Fallot with severe irregularity or major pulmonary arterial hypoplasia unsuitable for complete repair of first intention. Fifteen neonates aged 3 to 23 days with severe desaturation (SaO2 = 73 +/- 11%) and twenty five children aged 1.2 to 174 months with anoxic crises or severe desaturation (SaO2 = 67 +/- 15%) fulfilled these criteria. They underwent right heart catheterisation completed by an attempted pulmonary dilatation. This manoeuvre failed in 6 cases, all neonates, because it was not possible to cross the annulus or maintain the balloon in position, or because of infundibular perforation. There were complications in 5 cases, all neonates: 2 tamponades with 1 death, one dissecting aneurysms of the annulus, 1 gastroenteritis and 1 caval thrombosis. Of the 34 patients dilated, 8 were poor results, mainly in the older age group (7 cases) and 26 were successful as judged by a significant improvement in arterial saturation. However, 7 patients rapidly deteriorated due to anoxic crises (6 infants and children) or fatal secondary tamponade (1 neonate). Therefore, there remained 19 stable successful procedures, 49% of attempts, representing 56% of successful attempts and 73% of primary successes. In neonates, these proportions were respectively: 47%, 78% and 87%, and in the older children: 48%, 48% and 63%.(ABSTRACT TRUNCATED AT 250 WORDS)

It is of great importance to be able to distinguish hyperamylasemia linked to a pathological condition of the pancreas from one due to the presence of the macroamylase in the serum of the patient. We have evaluated both gel filtration chromatography and precipitation by PEG-6000 for the detection of serum macroamylase. Our study has enabled us to define a simple detection protocol, suitable for routine laboratory use. In this protocol, macroamylasemia is detected initially by precipitation with PEG-6000; if less than 60% of amylase activity is precipitated, there is no macroamylasemia. If more than 60% of amylase activity can be precipitated by PEG-6000, macroamylasemia is confirmed by gel filtration chromatography. The incidence of macroamylasemia in hospitalized patients was studied; it was 1.3% in cases where amylasemia was normal, and 4.5% in hyperamylasemic patients.

In Diabetes Mellitus, type IV collagen biosynthesis is increased: the alpha 1(IV) procollagen specific mRNA concentration is elevated, particularly in the kidney, and the type IV collagen protein is accumulating is the thickened basement membranes. Aldose reductase inhibitors like sorbinil do prevent basement membrane thickening and type IV collagen overproduction. The latter seems related to intracellular sorbitol accumulation and also to protein kinase C activation. Autocrine or paracrine TGF beta may be involved in the type IV collagen oversecretion. The secreted type IV collagen is subject to posttranslational alterations, especially glycation which leads to advanced glycation end-products and covalent crosslinks. This decreases collagen extractability and susceptibility to collagenases and favours basement membrane thickening. Disaccharide unit-specific alpha-glucosidase activity is inhibited by glucose (Kp = 7.5 mM). Type IV collagenase activity secreted by endothelial cells cultured at high glucose concentrations appears to be diminished. Therefore type IV collagen catabolism may be decreased in Diabetes Mellitus.

A case of crossed cerebellar atrophy after cranial trauma, with a 12-year neuroradiological follow-up is reported. This uncommon cerebellar degeneration has previously been reported only as an autopsic finding. It results from a lesion affecting the contralateral cerebral hemisphere. The role of different cerebro-cerebellar pathways is discussed.

A case of neurocysticercosis in a Zaïrian patient with clinical and neuro-radiological follow-up is reported. Treatment with praziquantel resulted in the regression of only some of the cysts. Subsequent treatment with albendazole was effective, eliminating most of the remaining lesions. This case illustrates a selective sensitivity of cysts to praziquantel and albendazole in a single patient.

Four right-handed patients (69, 58 and 68 year-old men; 85 year-old woman) complained of motor difficulties with their left hand (3 cases), or both hands predominant on the left side (1 case). Continuous (1 case) or intermittent (2 cases) myoclonus was noted in the left arm. These disorders gradually progressed for 3 to 10 years. Clinical examination disclosed absence of motor, sensory (except in 1 case), or visual deficit. There were no cerebellar signs, no parkinsonian features (except for mild rigidity in 1 case), and no oculomotor abnormality. On the other hand, neuropsychological examination showed evidence of visuo-constructive apraxia in all cases, dressing apraxia in 3/4 cases and writing impairment in 3/4 cases. There was no amnesia, no aphasia and no intellectual impairment. MRI showed atrophy of the parietal areas, predominant on the right side. A positron emission tomography study was performed in all cases, and twice in 1 case. Cortical energy metabolism was measured using either 18 F-fluorodeoxyglucose or 15 O-Oxygen, to calculate the cerebral metabolic rate of glucose (CMRglu) or oxygen (CMRO2) respectively. Cortical metabolism was significantly decreased in the whole cortex of the right hemisphere in 3 cases, and was also reduced in the cortex of the left hemisphere, significantly in 1/3 studied planes. Moreover, regional metabolic indices (CMRO2 or CMRglu/cortex) showed a significant decrease in both the right and left posterior associative areas (temporo-parieto-occipital cortex), predominantly marked on the right side in 3 cases, indicating bilateral cortical dysfunction. At follow-up, one patient became progressively demented, another had visuo-spatial disorders indicating a lesion of both parietal areas. The relationships of our cases with the slowly progressive apraxia syndrome and with corticobasal degeneration are discussed.

Cranial pachymeningitis is a rare manifestation of sarcoidosis, corresponding to a pseudo-tumoral thickening of the meninges. We report the case of an African patient who presented with isolated headaches. CT-scan and MRI showed the topography of the lesions and their regression under corticosteroid therapy.

A 21-year-old man experienced sudden and intense rotational vertigo. A moment later, he was amazed to see the whole visual world rotate clockwise progressively by about 160 degrees. On the following day, the visual tilt was only 30 degrees, and it soon receded completely, while headache appeared. CT scan, magnetic resonance imaging, vertebral arteriography, and cerebrospinal fluid analysis were normal, and the aetiology could not be ascertained. Illusions of visual tilt are an unusual consequence of disorders affecting the vestibular system. The locus of the impairment is usually in the brainstem, particularly in association with Wallenberg's syndrome. However, the peripheral vestibular pathways or the vestibular projections into the cerebral cortex may occasionally be involved. In the latter case, the visual tilt is part of a vestibular epileptic seizure.

This paper reports a retrospective study of 21 children with atrioventricular and ventriculo-arterial discordance, or double discordance, associated with a large ventricular septal defect responsible for pulmonary hypertension. Other associated congenital defects were: atrioventricular block (5 cases), coarctation of the aorta with neonatal cardiac failure (6 cases), tricuspid valve malformations responsible for significant tricuspid regurgitation (11 cases) and right ventricular hypoplasia (1 case). Two children died before any therapeutic intervention, one from syncope related to atrioventricular block and the other after a decision of therapeutic abstention. Three children underwent total correction with one good result (the only case of situs inversus), one late death and one lost to follow-up. The majority of patients (n = 16) underwent initial palliative surgery consisting in pulmonary artery banding occasionally associated with reconstruction of the aortic arch: there was no early mortality but there were 2 late deaths. Of the 14 survivors, 6 are well after a mean follow-up period of 31 months. Eight underwent open heart surgery with 1 operative death, 6 post-operative complete atrioventricular blocks requiring cardiac pacing and 5 poor results due to aggravation or secondary tricuspid regurgitation leading to 1 cardiac transplantation (death) and 2 reoperations for valvular surgery (1 plasty and 1 tricuspid valve replacement). The overall results of this series are poor: high mortality (33 per cent) and equally high morbidity when direct surgery is undertaken. Two major complications are observed: complete atrioventricular block (55 per cent) and regurgitation of the systemic atrioventricular valve (45 per cent), both of which often necessitate invalidating complementary procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Obstruction of total anomalous pulmonary venous drainage (TAPVD) is sometimes observed in neonates, usually at the site where the collector drains into the caval system. Stenosis of the pulmonary veins themselves before joining the collector is less common. This was observed in 6 cases of intra- and supracardiac TAPVD; the prognosis is usually very bad due to postoperative pulmonary hypertension (PHT) which is difficult to treat. Three of our cases had TAPVD into the coronary sinus with obstruction presenting at birth. Conventional surgery did not reduce the PHT of the first 2 children because the congenital stenosis of the pulmonary veins was not corrected. In the first case, the pulmonary veins resembled fibrous cords and in the second case, the collector was stenosed at its junction with the coronary sinus. These two children died despite surgery. The third child, however, was cured because the obstruction was diagnosed preoperatively and successfully treated when the TAPVD was corrected. In the other three cases, TAPVD to the superior vena caval system was not obstructed but the pulmonary veins retracted progressively after surgery causing PHT and right ventricular failure. After unsuccessful percutaneous dilatation, reoperation revealed obstruction due to exuberant scar tissue with retraction at the site of anastomosis and (or) reconstruction of the pulmonary veins by incision or enlargement with a pericardial patch. One of these children survived after pneumonectomy of the obstructed lung which relieved reflex PHT of the contralateral lung.(ABSTRACT TRUNCATED AT 250 WORDS)

The nature and extent of computerization in Canadian hospitals vary widely. Is this a reflection of the management style of CEOs? In a series of eight interviews, Lynne Cohen found that in most cases, the CEO played a key role in shaping the computerization process.

The scrotal skin is vascularized in part by means of the superficial perineal branch of the internal pudendal artery. This nutrient pedicle, together with the scrotal skin dependent on it, can be isolated. The urethra is approached via the perineum. The stricture is incised longitudinally right down to the healthy area. The scrotal flap and pedicle are mobilized, and then anastomosed along the edges of the urethra. From March 1983 through April 1987, sixteen patients have been operated. Postoperative results: the mean follow-up for the 16 patients is 60 months with extremes of 24 and 66 months. 13/16 patients show good results (81%). 3/16 patients show poor results with recurrence of the stricture localized at the junction of the flap and healthy urethra. Such recurrences have yielded to treatment, in two cases, by optical urethrotomy and, in the other case, by means of a new scrotal flap.

The most classical treatment of metastatic prostatic adenocarcinoma is hormone therapy. Most often, chemotherapy is proposed only when the tumor becomes hormonally unresponsive. But evaluation of its efficacy is impaired by the diversity of inclusion criteria used and by the different criteria of response assessment. Results of randomized, comparative studies show that all cytotoxic agents currently available have a similar response rate (about 30 to 40%). Use of combined chemotherapy does not seem to significantly improve these results. Several others ways have been proposed which attempt to improve the efficacy of chemotherapy (androgen stimulation, priming chemotherapy, adjuvant or neo-adjuvant chemotherapy...) but, most probably, progress will come from the discovery of more effective and selective cytotoxic agents, and not from the increase of clinical trials with the same agents.

Five patients with malignant hemopathies, including four treated by bone marrow transplantation, developed cyclophosphamide-induced hemorrhagic cystitis that failed to respond to the usual treatments. Each was treated by continuous irrigation of the bladder with potassium alum. Hematuria ceased in three patients followed up for 5 to 10 months. A review of the literature confirmed the 75% success rate of this treatment. No local side effects were recorded, but one patient had a single seizure.

Thirteen patients were operated for bladder carcinoma, from November 1987 to September 1988, using a Camey type II low pressure ileal bladder replacement. Clinical, radiological and urodynamic findings were studied. Diurnal continence was always acquired at three months. In terms of nocturnal continence, only 75 percent of the patients are comfortable, while two patients require oxybutinin to remain continent. Urodynamic exploration showed a low pressure in 8 patients, but a high pressure peak in 4 patients. Radiological study showed integrity of the urinary tract. This work confirmed the improvement obtained with the Camey II procedure. Nevertheless, it also shows the failure of the method with occasional high pressure peaks. We think that a more anatomical bladder reconstruction, such as Hautmann Pouch, may improve the results for nocturnal continence. This needs to be confirmed by a comparative study.

Twenty-four patients with invasive bladder cancer underwent Hautmann enterocystoplasty. A study of the urinary continence revealed 100 per cent of good results during the day and 87.5 per cent of good results at night. Urodynamic investigation after 3 months revealed that only one patient presented with peristaltic waves and that the postmicturating residual urine volume was always less than 100 cc. There was no mortality in this series. The only uncertainty concerns the long-term outcome of these patients because of the risk of incomplete emptying and distension of the neobladder.

Radioimmunoassay (RIA) of prostatic acid phosphatases (PAP) using the Gammadab (R) PAP pack supplied by Clinical Assays in an effective method for determining extension of prostatic cancer. In patients with lymph node or metastatic invasion serum assay values are almost always elevated (sensitivity = 94%), especially with well differentiated cancer. Elevated levels of this variable are practically pathognomonic of external extension (specificity = 94%). This is of importance in therapy since the degree of invasion determines the choice between palliative and curative treatment. Strategy leading to this therapeutic choice can be greatly simplified and thus modified by RIA of PAP.

The authors report a case of sclerosing cholangitis following surgical treatment of a hydatid cyst of the liver. The review of the literature demonstrates the rarity of this serious complication. The authors speculate on the mechanism of this disease: postoperative infection of the common bile duct, or chemical trauma associated with a cysto-biliary fistula. No single hypothesis seems to be able to account for all of the signs of this condition.

The authors report six cases from six different families of lethal brittle bone disease with narrow diaphyses and thin ribs. This phenotype should be dissociated from the lethal forms of osteogenesis imperfecta and encompass two diseases. In the first, autosomal recessive, the metaphyses of long bones are narrow, with a membranous ossification, without cartilagenous residue. Cultured fibroblasts demonstrate a marked increase in type V collagen. In the second type, the metaphyses are enlarged and the babies have a facial dysmorphism with hypoplasia of the eyebrows, frontal bossing and a small mouth.

A retrospective study of 152 consecutive patients admitted for renal carcinoma between January, 1969 and August, 1987 showed that these patients could be divided into two groups, the dividing line being 1980, date of the advent of ultrasonography. Compared with the 68 patients treated between 1969 and 1980, the 84 patients treated between 1981 and 1987 had a significantly greater number of asymptomatic renal carcinomas. The asymptomatic tumours discovered incidentally by ultrasounds were less advanced than the symptomatic tumours, the difference between the 2 groups being highly significant. The diagnosis of asymptomatic renal carcinoma at an early stage suggests that these tumours might have a better prognosis. These data underline the usefulness of a systematic study of the kidney during all abdominal or vesicoprostatic ultrasonographic explorations.

Phosphoproteins of Chicken bone have been extracted by 0.5 M EDTA pH 7.5. Their amino acid composition was similar to that of phosphoproteins of other calcified tissues. The crude EDTA extract contained 80 to 90% proteins, only 70% of the total organic phosphorus was bound to the proteins. We have studied and identified two phosphorylated components. o-phosphoserine and o-phosphothreonine have been identified by amino acid analysis at pH 1.7 from a partial acid hydrolysate, and confirmed by the liberation of the parent amino acids after total hydrolysis. In addition, phosphorus was found equimolecular to both of them. The presence of these phosphorylated groups is important for an understanding of the role of these proteins in the mechanism of mineralization.

The lethal form of osteogenesis imperfecta must be more clearly defined than it is. Early death of the child is not a sufficient criteria since it is observed in other forms compatible with survival. The authors therefore insist on the innumerable fractures of the ribs giving the particular aspect described as "bamboo ribs". These are observed in practically all cases. Heterogeneity however is undoubtful and an X-ray film is reproduced showing thin ribs without fractures in another exceptional lethal form. Genetic and very recent biochemical investigations suggest a new heterogeneity of the lethal form, even well defined clinically and radiologically. Contrary to earlier and frequent statements, it results most often from a dominant mutation, while recessive inheritance is much rarer, therefore the overall risk of recurrence much below 25%.

Twenty-eight neonates aged 1 to 21 days with critical pulmonic stenosis were treated by percutaneous valvotomy consisting of balloon dilatation of the stenotic valve by percutaneous catheterization. The right ventricular systolic pressure (RVP) was either the same or higher than the systemic pressure in all cases but 3. In those it was somewhat lower (80%) than the left ventricular systolic pressure (LVP) so that, on the whole, the RVP/LVP ratio, here called rP ranged from 0.8 to 2 (m = 1.41 +/- 0.36). The procedure failed 5 times because of failure to introduce the balloon through the valve (4 cases) or because of an accident (1 case). All failures occurred during the initial phase of our experience with this procedure as the last 20 trials were successful. The procedure was inefficacious in 3 cases (13%) but immediately successful in the other 20 (87%) with a drop in the mean rP to 0.59 +/- 0.17. During the follow-up period, one neonate continued to present with an important degree of cyanosis, due to a poor right ventricular compliance. He had to be operated on. Pulmonic stenosis reappeared in 6 cases who underwent for a second time a percutaneous valvotomy. The procedure was successful in 3 and failed in 3 who eventually required surgery. Overall, the satisfactory results observed after the procedure persisted over time in 13 cases. In conclusion, interventional catheterization has become almost always possible in neonates with critical pulmonic stenosis. If performed under vigorously controlled conditions including an infusion of prostaglandin E1 in cases with severe cyanosis and the use of large diameter balloons, this method is relatively safe and generally efficacious since in 70% of cases it circumvents the need for surgery.

A classification of the different types of osteogenesis imperfecta is proposed. There are 3 main groups: the lethal type, the severe type and the so-called regressive type, with a more favorable course. This classification was established to allow for a more precise definition of the prognosis at the time of birth, or even in utero when diagnosis is made by ultrasonography. It should also allow for better classification of the data obtained by the study of the molecular collagen. This project is different from Sillence's one by the exclusion of type II B lethal types, which are often compatible with survival. In view of the frequent occurrence of a dominant mutation in the type II A, the more generally accepted recessive transmission is discussed.

According to us large retinal tears are between 20 degrees and 70 degrees in their largest dimension, which excludes true giant tears. Study of the data collected on 42 patients has shown us the following facts:--these retinal tears occur in phakic and often highly myopic eyes;--our global success rate is 73,8%;--tears smaller than 2 to 3 papillary diameters radially are on the whole easy to indent and failures are quite often related to a surgical fault;--tears wider than 3 papillary diameters radially are on the whole difficult to indent and failures are not always related to an obvious surgical fault, fishmouth phenomenon plays an important role;--in every case presence of blood in the vitreous seems to be unfavourable to the prognosis;--use of episcleral pockets solves must of times surgical problems related to fishmouth or tear dimension;--post operative intern limiting membrane retraction is frequent (10% vs 5,7% for all the retinal tears and detachments cured in the same period of time).