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Les marchés publics représentent un enjeu économique important (200 à 300 milliards de francs par an). En France, ces marchés sont encadrés par une ré-glementation complexe régie en particulier par le code des marchés publics. Le nombre des marchés (150 à 200 000 par an) ainsi que la diversité des documents et des procédures qui s'y rattachent, justifient le développement de logiciels spécifiques. Après une analyse du contexte particulier des marchés publics, l'auteur de ce dossier décrit les fonctionnalités des différents logiciels développés pour le compte des services du ministère de l'Equipement ; ces logiciels étant par ailleurs utilisés par différents services privés ou publics, des collectivités territoriales, des services de l'Etat et notamment des DDAF. Un chapitre particulier est consacré aux nouvelles perspectives ouvertes par le développement des systèmes d'échanges de données informatisées (EDI).

Presentamos una aproximación fitogeográfica de Abies alba Mill. en la vertiente española de la cordillera pirenaica, basada en “Modelos de Distribución de Especies” (MDEs) y una revisión del registro fósil paleopalinológico cuaternario más sobresaliente de los Pirineos. Articulando los resultados derivados del MDEs (perspectiva topoclimática), y una revisión del registro fósil palinológico cuaternario de los Pirineos (enfoque climático y antrópico), intentaremos realizar una interpretación histórica de la dinámica de estos bosques. El modelo presentado revela que los abetales españoles ocupan en la actualidad el 30% de su potencial geográfico óptimo y ofrece pruebas suficientes que demuestran que A. alba podría haber vivido en un gradiente altitudinal más amplio que el actual. Este trabajo sugiere el empleo de los MDEs para reforzar hipótesis acerca de la distribución cuaternaria de A. alba en la península Iberica, así como para ubicar geográficamente refugios que permitan la pervivencia a largo plazo de esta especie.

Objectives: Radical prostatectomy (RP) remains a standard for localized prostate cancer treatment. The objective of this study is to present this operating technique of the robot-assisted radical prostatectomy (PR-RA) and to evaluate oncological and functional results as well as on the surgical safety., Methods: A first series of 1679 patients consecutively operated in our institution with this technique from 2005 to 2010 and with a 5-year follow-up evaluated in 2014. The oncology monitoring is ensured with a PSA test every six months during the first three years and once a year the years after if the level remains undetectable., Results: The oncologic outcomes show 17.4% for pT2 stages and 36.9% for pT3 stages positive margins. The level of biological recurrence is 21.27% with an average delay of 88 months as the time needed for the recurrence to occur. At 12 months, urinary continence (0-1pad/day) returned at 94% of all patients and potency with successful penetration for all men is 61.1% and 88.8% for men with sexual activity before surgery., Conclusions: The technique PRRA seems to be a reliable technique whose functional results studied from meta-analysis seem to be superior in terms of rapidity of recovery of the continence and erection in comparison with classical surgical or laparoscopic approach., (Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: MINE chemotherapy is used to treat refractory Hodgkin's disease. Cutaneous adverse effects of MINE regimen are uncommon and chiefly consist of erythema and oedema of the extremities. More recently, a number of cases of panniculitis and subcutaneous inflammatory oedema have been described., Observation: We report the case of a 17-year-old girl developing acute and painful oedema of the limbs with panniculitis of the trunk. This incident was associated with inflammatory lesions of mucous membrane, in particularly in the genital area and on the tongue. These signs occurred 7 days after initiation of MINE chemotherapy, with no other drugs being introduced. A drug-induced reaction was suspected due to the absence of any other aetiology, particularly infectious disease. The condition gradually improved with symptomatic pain therapy. The patient's chemotherapy was subsequently modified., Discussion: The chronology of the symptoms, spontaneous improvement after the end of treatment, and the absence of other potential causative factors resulted in a hypothesis of a cutaneous adverse reaction to the MINE regimen. The signs could be due to capillary leak syndrome resulting from the toxicity of vinorelbine on endothelial cells. Dermatologists should be aware of these cutaneous adverse effects and of the inflammatory lesions of mucous membrane newly described herein., (Copyright © 2010. Published by Elsevier Masson SAS.)

Aim: To describe medium-term functional results of Transurethral Needle Ablation (TUNA) to treat symptomatic benign prostatic hyperplasia (BPH) refractory to medical treatment., Materials and Method: Patients who completed at least 2 years follow-up after TUNA were systematically offered a reevaluation including: Flowmetry, PSA, symptom score (IPSS), satisfaction index visual analogic scale (VAS) and a treatment impact evaluation with a Likert scale (ranging from much worse to much improved)., Results: From December 2002 to January 2007, 45 patients were treated with TUNA under local regional anaesthesia (prostatic block). Twenty-seven of them were followed-up longer than 24 months (median follow-up 44 months [26-52]). Changes in the selected outcomes were: increase in Qmax from 9.5 mL/s preoperatively to 9 mL/s at 6 month and 11.5 mL/s after 2 years; increase in IPSS from 19.3 before TUNA to 16.3 at 6 month and 16.5 after 2 years. About subjective evaluation, 58% of patient gave a satisfaction VAS>or=6, and the improvement index was greater or equal to +1 in 67% of case., Conclusion: In this initial monocentric experiment, despite a modest improvement of objective parameters and a 20% of retreatment rate, TUNA give contentment and improvement sensation for 60% of patients who were treated for non-efficiency of medical treatment for benign prostatic hyperplasia.

Background: Arndt-Gottron scleromyxedema is characterized by cutaneous mucinosis occasionally associated with systemic disorders, and it has a chronic and unpredictable course. The lesions are due to abnormal fibroblastic activity leading to acid mucopolysaccharide deposits in tissue. We report the case of a 50-year-old woman treated with intravenous immunoglobulin (IVIG), with excellent results in terms of her cutaneous lesions., Case Report: A 50-year-old woman presented with multifocal micropapular lesions and cutaneous sclerosis that progressively limited joint movement and mouth opening and which were associated with a circulating monoclonal IgG Kappa. Previous treatments, including steroids, PUVA therapy, interferon, acitretin, methotrexate, melphalan and D-penicillamin were either ineffective or were stopped because of adverse effects. IVIG resulted in a remarkable and durable response at decreased dosage (0.5 g/kg per day for 3 days) with a 2-month treatment interval., Discussion: IVIG at a dose of 2g/kg for 5 days constitutes a valuable alternative treatment because of its immunomodulatory effect. In scleromyxedema without systemic lesions, we propose a maintenance regimen at lower dosage, i.e. 0.5 g/kg per day for 3 days., Conclusion: Since Arndt-Gottron scleromyxedema is a rare disease, no standardized treatment has been yet established. The combination of minimal adverse effects and real efficacy makes IVIG an interesting alternative treatment for this disease.

The authors report a case of high-flow priapism in an adolescent due to rupture of the deep penile artery after falling astride, confirmed by Doppler ultrasound on the third day after the accident, and treated successfully by highly selective embolization with no harmful effects on erectile function.

Diagnosis of a vertebral artery loop in the transverse canal, suggested by a CT scan image, is dependent mainly on results of angiography (preferably computer assisted and by the venous route). This lesion is a differential diagnosis of a neuroma, when the cervical intervertebral foramen is enlarged.

The authors present 23 cases of pure dural spontaneous vascular malformations (DVM) between 1980 and 1983; among the 23 patients, presented with a sellar DVM, 10 with a torcular DVM and adjacent sinuses, 1 DVM was located at the lamina cribriformis. The history of the patients can be classified into 3 groups: - trauma history (9 patients); - vascular disease (15 patients); - infections history (1 patient). Certain remarkable associations were encountered: 2 cases of multifocal DVM, 3 cases with intracranial aneurysms, 1 case with a brain AVM in an other territory, 1 maxillo-facial AVM. Certain aspects of the symptomatology can be noted: 1 case was in a child of 3 years of age, 2 cases presented during pregnancy, 1 case with premenstrual changes, 2 cases with acute choroidal detachment. Of the 11 patients which had a DVM with cortical venous drainage, 9 were complaining of CNS symptoms and 3 were explored in emergency: 2 for SAH, 1 for acute spontaneous SDH. In this series, following a multidisciplinary decision, the treatment chosen was always endovascular a priori. However it was preceded in one case by surgery at the anterior base of the skull in order to develop a collateral circulation from a reachable artery (for embolization); in an other case, it was followed by surgery to evacuate a compressive SDH, and in an other it was completed by surgery to improve a too proximal embolization. Only once had the internal carotid artery to be occluded to obtain a satisfactory clinical result. One slowly regressive complication was noted following active heparin therapy. No patient has been excluded from this series during that period. With the exception of 1 spontaneous cure, following embolization (s) 13 cases are asymptomatic among which 9 have an anatomical "cure"; 4 cases have an incomplete but significant improvement; 1 patient after a initial good result had recurrent symptoms were stabilized with medical treatment; 2 cases were not embolized for technical reasons, but are asymptomatic. Finally, one died a few days after surgery for evacuation of his SDH. Details of embolic agents and vessels embolized are specified. 5 observations can be made: - The angiographic screening must be complete and must not overlook dangerous vessels which could limit the embolization. - All the vascular compartments of the lesion must be visualized, as all of them do not have to be embolized; the embolic agent has to be radio-opaque and the nidus of the malformation must be reached.(ABSTRACT TRUNCATED AT 400 WORDS)

This paper concerns the tomodensitometric (TDM) study, with the same clinical and radiological criteria, of 78 schizophrenic patients (age: less than 60 years) from psychiatric hospitals in Madrid and from Sainte-Anne hospital (Paris). The length of evolution and the severity of disturbances seemed to be the most important causal elements of cerebral atrophy. Some TDM peculiarities appeared correlated with some clinical forms (paranoid or hebephrenic). The review of previous works illustrates the importance of some etiological conditions for the production of cerebral atrophy: age, length of evolution and, more particularly, the severity of the disease. The confrontation of the anatomo-pathological and pneumoencephalographic studies with the TDM results suggests that, if the TDM is a good indicator of ventricular dilatation, appreciation of the widening of the cerebral sulci remains difficult.

The authors report 14 cases of vein of Galen dilatation explored and/or treated between 1983 and 1986. Three anatomic types have been individualized: the vein of Galen arterio-venous malformation (AVM) (7 cases); the cerebral AVM with vein of Galen ectasia (6 cases); the varix of the vein of Galen without AV shunt (1 case). When an AVM is present the shunt is located either in the venous wall (vein of Galen AVM) or in the brain parenchyma; in the latter the AVM drains into a tributary of the vein of Galen (cerebral AVM with vein of Galen ectasia). However in all the 14 cases downstream to the draining vein, a venous (dural) anomaly could be demonstrated. This anomaly suggests the secondary nature of the dilatation proximal to a developmental obstacle. Clinically the vein of Galen AVM reveals early in neonates by cardiac complications; the other types are usually seen later following hydrocephalic or bleeding episodes. As far as therapeutic aspect, we can technically stabilize the hemodynamic problem, by occluding most if not all the shunts by endovascular approach, and make most of the neonates survive. However the quality of survivance and the future neurological development is impossible to predict yet. Nevertheless the short term follow-up is very encouraging. The combined per operative embolization through the vein must be exclusively reserved to vein of Galen AVM. The torcular approach is contraindicated in brain AVM with Vein of Galen ectasia. The vein of Galen varix do not require any type of morphological correction.