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La gestion patrimoniale de tous types de reseaux urbains repose sur une politique de rehabilitation coherente fondee sur une analyse de la pathologie des ouvrages et des equipements. Dans le domaine de l’assainissement, la direction de l’eau et de l’assainissement (DEA) du conseil general de Seine- Saint-Denis cherche a evaluer la perennite des travaux de rehabilitation des collecteurs visitables et non visitables. Une premiere etude commencee en 2010 porte sur les ouvrages visitables rehabilites par des techniques lourdes. La presente etude complete le travail en cours sur les reseaux visitables en analysant la durabilite des travaux de rehabilitation des canalisations non visitables. Ces techniques sans tranchees sont frequemment utilisees pour la renovation des reseaux d’assainissement. Cette analyse est basee sur des resultants collectes par des inspections televisees des canalizations rehabilitees. Finalement, elle vise a developer la connaissance sur la durabilite des rehabilitations en fonction des differents parameters tels que : les techniques employees, les ouvrages concernes et l’environnement.La methode consiste a comparer l’etat de la rehabilitation au moment de la pose a celui actuel afin de determiner les facteurs influencant la durabilite des travaux. Pour ce faire, un echantillon de 25 portions de 100 m est selectionne. Finalement, cette etude dresse un premier bilan des connaissances et un etat des lieux de l’evolution visible des chemisages. Aujourd’hui, aucune comparaison ne relie l’âge du chemisage et les defauts observes. Ces anomalies semblent provenir de causes intervenant lors des trois grandes etapes du chantier : lors du choix du type de travaux, lors de la mise en place du chemisage et entre la reception des travaux et aujourd’hui. Cinq des 25 portions inspectees sont classees comme ayant un etat mediocre et presentent un detachement de la renovation. Ainsi, plusieurs recommandations semblent necessaires pour garantir la durabilite des chemisages. Pour finir, cette etude pourrait etre complete par l’examen de nouveaux troncons pour poursuivre et confirmer l’analyse des causes de degradation des rehabilitations. Une analyse complementaire quantitative pourrait etre obtenue par la realization de tests d’etancheites et d’essais de flexion pour affiner les resultats en matiere d’evolution des desordres et caracteriser l’evolution des materiaux constituant la gaine.

Pour pallier les insuffisances structurelles de son reseau d’assainissement, le conseil general de Seine-Saint-Denis construit des bassins de retenue depuis les annees 1970 afin de delester les collecteurs satures lors des fortes pluies. Quarante annees d’exploitation ont conduit a bien connaitre les differents types de nuisances et risques qu’ils generent, et a mettre en place les moyens adaptes pour les maitriser. En premier lieu, le degazage des boues decantees en fond de bassin genere des gaz nauseabonds ou toxiques, voire mortels. La mise en oeuvre d’un nettoyage automatise immediatement apres la vidange et d’une ventilation « naturelle » efficace permet de s’en premunir. En second lieu existent les risques lies a l’ouverture des bassins paysagers au public. Ces risques ont conduit le conseil general a interdire systematiquement l’acces des bassins dont la conception n’integrait pas les profils de berges reglementaires contre le risque de noyade, et a autoriser l’ouverture de quatre d’entre eux. Enfin, le troisieme type de risque est lie a l’usage derive que l’on peut faire d’un bassin de retenue pour pieger une pollution accidentelle. Dans ce cas, la decision concernant le meilleur site d’extraction possible – bassin de retenue, ouvrage de depollution en ligne ou entree d’usine d’epuration – est essentielle pour limiter les nuisances aux usagers, voire les risques d’intoxication, d’incendie ou meme d’explosion.

IgA nephropathy is described in 11 cases out of a total of 177 renal biopsies examined representing an incidence of 6.2 per cent.Reference is made to comparable studies from other centres. Clinical and pathological findings are presented and discussed.

En Seine-Saint-Denis, le controle des ecoulements par temps de pluie dans le reseau d’assainissement passe par la gestion en temps reel des bassins de retenue. Leur bonne exploitation est primordiale pour garantir un fonctionnement operationnel a 100% pendant les evenements pluvieux. Conscient de cette necessite, le departement de Seine-Saint-Denis a travaille a la mise en oeuvre des moyens d’exploitation adaptes, en gardant la maitrise des couts.Apres avoir presente les objectifs de la demarche d’analyse des couts de construction et d’exploitation, l’etude decrit les caracteristiques des 29 bassins de retenue geres par le departement, puis la methode de repartition du cout de la gestion automatisee et du cout des astreintes du personnel. Elle presente ensuite une analyse des couts de construction pour les bassins enterres, puis des couts d’exploitation pour les bassins a ciel ouvert et pour les bassins enterres. A ce stade, les resultats presentes sont partiels et l’article decrit les pistes qui seront approfondies prochainement pour abaisser les couts d’exploitation des bassins departementaux.

Contrairement a certaines analyses sur la danse jatilan dans le centre de Java qui suggerent que cette pratique est devenue un spectacle integralement domestique, l'A. soutient que de nombreuses performances jatilan engagent les danseurs et l'audience dans des moments de possibilite, de relâchement emotionnel, et de communion spirituelle. Quand elle n'est pas executee comme partie de la culture officielle, la danse jatilan constitue un contre-discours local a la rhetorique dominante sur la retenue comportementale et affective et sur l'ordre culturel. Par l'incorporation des tensions entre deux tropes javanais : eling (conscience) et ngalamun (vide), ces performances refletent les luttes quotidiennes entre l'expression individuelle et la retenue sociale a Java. Par la violation des normes de la retenue et du controle emotionnel, et par la manifestation d'un pouvoir, la danse jatilan permet de participer a des moments d'incertitude parmi des forces sociales qui en temps normal cherchent a supprimer l'ambiguite. En tant que forme de connaissance, jatilan procure un contexte pour l'affirmation des identites personnelles et communautaires, et dans lequel les aspirations spirituelles et la dynamique de la performance se rejoignent dans un commentaire sur le monde socioeconomique et politique.

Researchers of ‘amuk’ behavior in Southeast Asia have normally adopted either a psychiatric or ethno-behavioral position, both of which impose an outside theoretical model. An ethnopsychological view of (ng)amuk in Java reveals it to be a poetic idiom of distress, reflecting cultural anxieties about mental illness, aggression, loss of control and vulnerability of the self. Ngamuk as mental/social suffering in Java occurs in a political context that promotes strong repression of emotion and dissent. A model of ngamuk as an exegesis of mental/social distress, reflecting everyday experiences of anxiety, vulnerability, danger and transgression, is proposed.

IgA nephropathy is a common glomerulonephritis for which there is no effective cure. It may recur after renal transplantation and cause graft loss. To determine the prevalence and predict recurrence of IgA disease in transplant recipients. A retrospective analysis was performed of all renal allografts in patients with IgA disease attending a National Renal Unit between 1984 and 1995. An immunopathological grading system was devised to assess the severity of disease at initial presentation and each patient was assigned a simple severity index. A total of 42 patients with IgA disease received 44 renal allografts. Biopsies were performed in 21 of the 44 transplants. Recurrence was diagnosed in five grafts (24%) and recurred only in the ‘moderate’ and ‘severe’ IgA groups. Recurrence was associated with younger age, glomerular crescents on the original renal biopsy, better donor/recipient HLA matching and greater number of rejections. The prevalence of recurrent IgA disease following transplantation in an Irish population is less than that reported at other centres (24% versus 60%). The severity of the original disease and transplant factors may predict recurrence post-transplantation.

The prevailing method of working with men who batter is through structured psychoeducational groups and cognitive-behavioral therapy. The authors contrast the assumptions of cognitive-behavioral with those of process-psychodynamic approaches in working with men who batter. They describe a process-psychodynamic treatment model that was implemented at an abuser-treatment program. The major phases of the group process are illustrated with excerpts of group dialogue.

The importance of the nuclear receptor peroxisome proliferator–activated receptor-γ (PPARγ) in regulating insulin resistance and blood pressure has been demonstrated in families with loss of function mutations. Gain of function mutations has been associated with severe obesity. However, previous population studies of the common variant Pro12Ala have produced conflicting results. As it is likely that the natural ligands for this receptor may include fatty acids, we hypothesized that the effect of this common variant may be altered by the character of the diet, particularly the ratio of dietary polyunsaturated fat to saturated fat (P:S ratio). We studied 592 nondiabetic participants in an ongoing population-based cohort study who were genotyped for the Pro12Ala polymorphism in the PPAR γ2 isoform. As the Ala homozygotes were uncommon (2.0%), all analyses were conducted comparing Pro homozygotes (79.1%) to Ala allele carriers. There was no difference in fasting insulin concentration or BMI between Ala allele carriers and Pro homozygotes. The fasting insulin concentration was negatively associated with the P:S ratio (P = 0.0119) after adjustment for age and sex, and a strong interaction was evident between the P:S ratio and the Pro12Ala polymorphism for both BMI (P = 0.0038) and fasting insulin (P = 0.0097). The data suggest that when the dietary P:S ratio is low, the BMI in Ala carriers is greater than that in Pro homozygotes, but when the dietary ratio is high, the opposite is seen. This gene-nutrient interaction emphasizes the difficulty of examining the effect of common polymorphisms in the absence of data on nongenetic exposures, and may explain the heterogeneity of findings in previous studies.

The nuclear receptor peroxisome proliferator-activated receptor gamma (PPARgamma) promotes adipocyte differentiation, exerts atherogenic and anti-inflammatory effects in monocyte/macrophages, and is believed to mediate the insulin-sensitizing action of antidiabetic thiazolidinedione ligands. As no complete PPARgamma antagonists have been described hitherto, we have constructed a dominant-negative mutant receptor to inhibit wild-type PPARgamma action. Highly conserved hydrophobic and charged residues (Leu(468) and Glu(471)) in helix 12 of the ligand-binding domain were mutated to alanine. This compound PPARgamma mutant retains ligand and DNA binding, but exhibits markedly reduced transactivation due to impaired coactivator (cAMP-response element-binding protein-binding protein and steroid receptor coactivator-1) recruitment. Unexpectedly, the mutant receptor silences basal gene transcription, recruits corepressors (the silencing mediator of retinoid and thyroid receptors and the nuclear corepressor) more avidly than wild-type PPARgamma, and exhibits delayed ligand-dependent corepressor release. It is a powerful dominant-negative inhibitor of cotransfected wild-type receptor action. Furthermore, when expressed in primary human preadipocytes using a recombinant adenovirus, this PPARgamma mutant blocks thiazolidinedione-induced differentiation, providing direct evidence that PPARgamma mediates adipogenesis. Our observations suggest that, as in other mutant nuclear receptor contexts (acute promyelocytic leukemia, resistance to thyroid hormone), dominant-negative inhibition by PPARgamma is linked to aberrant corepressor interaction. Adenoviral expression of this mutant receptor is a valuable means to antagonize PPARgamma signaling.

We describe five patients with glomerulonephritis (GN) associated with cerebrospinal fluid shunt insertion to relieve hydrocephalus. A ventriculo-atrial (V-A) shunt had been placed on average 12.5 years prior to the diagnosis of nephritis (range 0.5-21 years). Four patients developed membranoproliferative glomerulonephritis (MPGN) with associated hypocomplementaemia. A single patient developed focal proliferative glomerulonephritis. Coagulase-negative staphylococci were cultured in four patients, either from blood or from the shunt. Four patients had their shunts removed, two of whom also received antibiotics. The other patient received antibiotics alone for infective endocarditis due to staphylococcal bacteraemia which originated in the shunt. All patients had substantial renal impairment at the time of diagnosis (GFR, glomerular filtration rate, 20-45 ml/min). There was significant improvement in renal function after appropriate treatment; four of the five patients doubled their GFRs and two patients regained normal function.

We describe five patients with glomerulonephritis (GN) associated with cerebrospinal fluid shunt insertion to relieve hydrocephalus. A ventriculo-atrial (V-A) shunt had been placed on average 12.5 years prior to the diagnosis of nephritis (range 0.5-21 years). Four patients developed membranoproliferative glomerulonephritis (MPGN) with associated hypocomplementaemia. A single patient developed focal proliferative glomerulonephritis. Coagulase-negative staphylococci were cultured in four patients, either from blood or from the shunt. Four patients had their shunts removed, two of whom also received antibiotics. The other patient received antibiotics alone for infective endocarditis due to staphylococcal bacteraemia which originated in the shunt. All patients had substantial renal impairment at the time of diagnosis (GFR, glomerular filtration rate, 20-45 ml/min). There was significant improvement in renal function after appropriate treatment; four of the five patients doubled their GFRs and two patients regained normal function.

This paper describes the calibration of an automatic inspection system to size 5X reticle defects down to half-micron resolution, the defect printability limit of the stepper lens with which the 5X reticles are to be used. An enhanced technique using image analysis for defect sizing is also described. Whilst enabling more accurate defect sizing, this method is resolution limited in automatic operation.

The incidence of organ specific and non-organ specific auto-antibodies was assessed in the sera of 70 Irish patients with active rheumatoid arthritis and compared to with that in age and sex matched healthy controls and with a group of 39 patients who possessed rheumatoid factor in low titre in their sera but who did not satisfy the criteria for rheumatoid arthritis. Non-organ specific auto-antibodies were found to be significantly increased in the rheumatoid patients, organ specific autoantibodies were not significantly increased. The significance of the findings is discussed.

Immunofluorescent studies were performed on the clinically normal skin of 16 patients with systemic lupus erythematosus involving the kidney to detect the presence of immune deposits at the dermal-epidermal junction—positive lupus band test (L.B.T.). Our results suggest a significant correlation between L.B.T. positivity and degree of clinical activity, presence of active nephritis, and a more severe histological pattern of lupus nephritis.

Fifty-seven patients with spastic diplegia underwent one-stage bilateral proximal soft tissue release for correction of lower limb deformities. The indications for surgery were improvement of gait and posture and facilitation of toilet care. Significant improvement in ambulatory status followed operation, and most parents were pleased.

We report an incidence of IgA neph ropathy of 14.9% encountered in a total of 562 renal biopsies examined over a period of three years. Reference is made to the incidence reported in other countries. Details of light and fluorescence microscopical findings are correlated with clinical presentation and renal function in an effort to establish prognostic parameters. The results suggest that the presence of IgM deposits with extensions into capillary loops are associated with the more severe histological patterns. In contrast, the finding of classical IgA-IgG nephropathy and the occurrence of the lesion in younger patients is associated with less extensive structural damage.

Bilateral central dislocation of the hip is a rare injury. Most of the cases reported in the literature were the result of electroconvulsive therapy, one case following an eclamptic fit, and another following hyponatremic convulsions. An additional case, resulting from a grand mal epileptic fit, is reported.

Femoral stem failure in total hip replacement is uncommon. It tends to occur predominantly in males over 1.8 m in height and over 76 kg in weight. Poor or inadequate cementing technique may lead to cement failure, which may be seen as roentgenographic lucencies present by as much as 12 months prior to actual stem failure. This article reports on a case of double stem failure, together with a full metallurgical examination, which indicated loosening of the implant prior to eventual failure from overload. Although one of the fractures occurred across an area of relative weakness in the stem material, this was not felt to be the principal cause of failure.

The use of trochanteric osteotomy in lateral approach to the hip joint is a fundamental part of Charnley's low-friction arthroplasty. Its use allows adequate exposure and easy orientation of the hip. Reattachment using a single transverse and double vertical wires was evaluated in 500 consecutive hip arthroplasties. Of 500 patients, 466 (93.2%) showed complete bony union of their trochanteric osteotomy at three months. A further 20 (4%) patients united by 12 months, giving a union rate of 97.2%; 34 (6.8%) patients who showed incomplete or defective union at three months. There were five dislocations. Only one patient required removal of the wires, for bursitis. The patients with defective bony union had a relatively high rate of wire breakage at three months. Despite a 1.8% complete detachment and 1% fibrous union, the transtrochanteric approach allows easy access without fear of shaft fracture in very difficult cases, with surprisingly little ill effect or loss of function even in those failing to reunite.

Fifteen neonates with spina bifida were investigated prior to surgery for T and B lymphocytes subpopulations and mitogen responsiveness to PHA. Results were compared to similar studies in 30 normal healthy neonates. The mean percentage of T-lymphocyes in spina bifida patients was 44.6% compared to 48.9% in normal neonates. A normal dose response to PHA was obtained in all patients. These results suggest no impairment of lymphocyte function in neonates born with spina bifida.

The use of trochanteric osteotomy in lateral approach to the hip joint is a fundamental part of Charnley's low-friction arthroplasty. Its use allows adequate exposure and easy orientation of the hip. Reattachment using a single transverse and double vertical wires was evaluated in 500 consecutive hip arthroplasties. Of 500 patients, 466 (93.2%) showed complete bony union of their trochanteric osteotomy at three months. A further 20 (4%) patients united by 12 months, giving a union rate of 97.2%; 34 (6.8%) patients who showed incomplete or defective union at three months. There were five dislocations. Only one patient required removal of the wires, for bursitis. The patients with defective bony union had a relatively high rate of wire breakage at three months. Despite a 1.8% complete detachment and 1% fibrous union, the transtrochanteric approach allows easy access without fear of shaft fracture in very difficult cases, with surprisingly little ill effect or loss of function even in those failing to reunite.