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Resumen El embarazo constituye un periodo de riesgo para las mujeres con patologia cardiovascular. Las complicaciones cardiovasculares son la primera causa de mortalidad indirecta de las mujeres en la etapa del parto en los paises del hemisferio norte. Las cardiopatias preexistentes al embarazo son la primera causa de descompensacion cardiaca: las mas frecuentemente observadas en estas pacientes son las enfermedades valvulares y las cardiopatias congenitas. Las patologias de alto riesgo materno son las valvulopatias estenosantes, la hipertension pulmonar, las protesis mecanicas, la insuficiencia cardiaca, las cardiopatias congenitas cianogenas y los aneurismas de la aorta. El manejo y tratamiento de estas pacientes necesitan adaptarse durante el embarazo, y el parto debe ser programado por un equipo multidisciplinar preparado. No hay que olvidar el riesgo fetal y neonatal, en particular la prematuridad espontanea o inducida, el riesgo de retraso de crecimiento intrauterino, de abortos de repeticion o de teratogenicidad. Es frecuente detectar enfermedades cardiacas subyacentes, desconocidas hasta ese momento, en el periodo del parto, deteccion que se asocia a una importante morbimortalidad materna. En caso de sintomatologia sugerente, soplos, antecedentes familiares de cardiopatia o antecedentes personales de quimioterapia o radioterapia, se puede recomendar realizar una deteccion precoz clinica y ecocardiografica.

Resume Objectif Evaluer le bilan d’imagerie (echographie ± IRM) dans le diagnostic des malformations lymphatiques kystiques de localisations cervicales. Methodes Etude retrospective, descriptive des patientes ayant beneficie d’un depistage echographique de masses cervicales anterieures, confirmees en echographie de reference, au Centre pluridisciplinaire de diagnostic prenatal du Centre hospitalier regional universitaire de Lille de 1997 a 2014. Resultats Dix-sept lymphangiomes ont ete recenses. Douze (71 %) lymphangiomes etaient diagnostiques lors de l’echographie de reference et 88 % lors de l’IRM. On retrouvait une extension de la masse pour 10 (62 %) lymphangiomes en echographie et pour 11 (85 %) en IRM. Dans la plupart des cas, on objectivait respectivement en echographie et en IRM : une extension de la face (4, 23 %/6, 46 %), de la base de la langue (3, 18 %/2, 15 %) et du plancher buccal (3, 18 %/3, 15 %). Une atteinte pharyngee (5,38 %) et mandibulaire (4,31 %) etait depistee en IRM et non retrouvee en echographie. Deux (12 %) fœtus etaient porteurs de malformation urogenitale, 1 (6 %) de malformation cardiaque et 1 (6 %) de malformation faciale associee en echographie. Les lymphangiomes restaient stables dans 12 (71 %) des cas et disparaissaient dans 2 (12 %) des cas avant la naissance. Conclusion L’IRM et l’echographie paraissent indissociables pour permettre une evaluation et une prise en charge optimale des masses cervicales. Le bilan des lesions associees semble pouvoir nous aider dans l’orientation diagnostique. Enfin, les lymphangiomes semblent avoir une stabilite au cours de la grossesse et un bon pronostic en cas de masse cervicale lymphatique non compliquee et sans extension pejorative.

International audience; Aromatic characterization is a key element of enhancing one's knowledge of wine. While several studies have investigated the importance of wine expertise in the ability to perform odor-related sensory tasks, little attention has been paid to the influence of expertise on the semantic categorization of wine odors. To bridge this gap, this study aimed to explore the influence of a subject's expertise on the semantic representation of wine odors by means of a free sorting task. For this purpose, 156 subjects were recruited. Their level of expertise was measured using a questionnaire and the data analysis revealed four clusters of subjects with a gradual level of expertise. Subjects also performed a sorting task on 96 odor terms. From the number and the size of odor groups formed, as well as the additive tree representation and the consensus partition between the terms for each expertise level, we observed that all subjects, regardless of their experience, had largely the same semantic categorization of wine-odor attributes, which was mainly shaped by the sources of the odorants. It appeared that level of wine expertise played a minor role in creating the semantic representation of wine odors, affecting mainly the knowledge of specialized terms.

Resume But La decouverte d’une hyperechogenicite intestinale fœtale (HEI) entraine souvent la realisation d’un bilan etiologique invasif. Notre objectif est d’etudier les etiologies et le pronostic des HEI selon les constatations echographiques antenatales afin d’evaluer la pertinence de ce bilan. Materiels et methodes Etude retrospective monocentrique, menee de 2008 a 2012, incluant toutes les patientes adressees pour une suspicion d’HEI. Nous avons analyse les resultats des donnees antenatales et neonatales selon 4 groupes definis en echographie : HEI isolee, associee a des signes digestifs, des signes vasculaires ou d’autres signes echographiques. Resultats Cent quarante-neuf patientes ont ete suivies pour une HEI : 69 HEI isolees, 24 associees a des signes digestifs, 16 a des signes vasculaires, 40 a d’autres signes. Les issues etaient differentes entre ces groupes avec respectivement 92,8, 41,7, 0 et 45,0 % d’enfants sains. En cas d’HEI isolee, nous avons note 2,9 % de mucoviscidose, 2,9 % d’infection congenitale et aucune dyschromosomie. Conclusion L’HEI isolee semble avoir un meilleur pronostic que les formes associees. Toutefois, un bilan pour eliminer une mucoviscidose ou une infection congenitale doit etre propose et pourrait etre initialement non invasif, si l’absence de dyschromosomie etait verifiee sur une plus grande serie.

During pregnancy, the occurrence of aortic dissection is a rare event immediately threatening fetal and maternal prognosis. Its occurrence is more common in cases of connective tissue disease. But the absence risk factor shall not exclude or delay diagnosis. We must learn to think about it, because the prognosis is highly dependent on time management. The clinical presentation of this medical and surgical emergency varies, and pregnancy adds its own symptoms. We have to ask without hesitation that echocardiography or chest CT be performed since these diagnostic methods are both reliable and available.

Resume La hernie de coupole diaphragmatique congenitale, dont la physiopathologie est partiellement elucidee, est pourvoyeuse d’une morbi-mortalite importante. Nous rapportons le cas d’un fœtus atteint d’une hernie de coupole diaphragmatique associee a une triplication du gene EDNRA codant pour le recepteur ET-A de l’endotheline 1. Les techniques genetiques de haute resolution ont permis de retrouver la cause probable de la pathologie, et plaidaient en faveur d’une forme isolee de bon pronostic. La sur-expression du recepteur ET-A au niveau des vaisseaux pulmonaires serait responsable d’un remodelage vasculaire et d’une hypertension arterielle pulmonaire. Ces anomalies pulmonaires auraient precede la survenue d’une breche diaphragmatique.

Resume Objectif La tocolyse par inhibiteurs calciques est largement repandue en France. Neanmoins, ces molecules n’ont pas l’autorisation de mise sur le marche dans cette indication. L’objectif de ce travail est de faire une mise au point sur l’ensemble des effets indesirables des inhibiteurs calciques publies ou signales a la Banque nationale de pharmacovigilance. Materiel et methode Nous avons realise une revue de la litterature reprenant les donnees experimentales animales sur les inhibiteurs calciques, les etudes retrospectives et prospectives randomisees ou non comparant les differents tocolytiques, les cas cliniques publies et enfin nous avons fait une requete aupres de la Banque nationale de pharmacovigilance francaise sur les cas declares apres utilisation des inhibiteurs calciques en tant que tocolytique. Resultats Des effets indesirables sont retrouves chez 2 a 6 % des patientes tocolysees par nifedipine (Adalate®), dont 0,9 a 1,9 % d’effets indesirables severes. Il s’agit majoritairement de cephalees, de flushs et d’hypotensions arterielles. Les donnees concernant la nicardipine (Loxen®) sont plus limitees. Pour ce dernier, il existe des effets indesirables specifiquement lies a sa voie d’administration (veinites) mais il semble que les autres effets indesirables rapportes ne soient pas plus frequents. Plusieurs meta-analyses ont mis en evidence une diminution des effets indesirables maternels lorsqu’on utilise les inhibiteurs calciques par rapport aux β-mimetiques. La comparaison des inhibiteurs calciques a l’atosiban est moins documentee. Des effets indesirables plus rares sont rapportes sous forme de cas cliniques. Il s’agit presque exclusivement de complications cardio-vasculaires (dyspnee, œdeme aigu du poumon, infarctus du myocarde, hypotensions arterielles). Elles sont plus frequentes avec la nicardipine qu’avec la nifedipine. On retrouve des observations similaires en interrogeant la Banque nationale de pharmacovigilance. Conclusion La prescription des inhibiteurs calciques dans le cadre de la tocolyse expose a des effets indesirables maternels sans gravite la plupart du temps et moins frequemment qu’avec les β-mimetiques. Des complications severes maternelles ont neanmoins ete rapportees plus frequemment avec la nicardipine qu’avec la nifedipine, ce qui justifie de ne plus utiliser la nicardipine en tocolyse. La nifedipine est la molecule la plus etudiee. Les donnees de la litterature ne permettent pas de definir une posologie maximale. Il apparait raisonnable de ne pas associer differents tocolytiques, et de surveiller de facon rapprochee la tension arterielle maternelle, la survenue d’une reaction cutanee ou d’hypersensibilite, d’une dyspnee, ou d’une douleur thoracique.

Resume Objectifs Analyser les facteurs favorisants l’apparition de pieds bots isoles, identifier les pathologies associees aux pieds bots et discuter la realisation systematique d’un caryotype en cas de pieds bots isoles. Patientes et methodes Etude : ont ete incluses retrospectivement toutes les patientes dont le diagnostic de pied bot varus equin a ete confirme dans notre centre de diagnostic antenatal entre janvier 2007 et decembre 2011. Nous avons defini et analyse les pieds bots varus equin isoles (PBVEI) et les pieds bots associes a d’autres anomalies morphologiques ou syndromiques (PBVES). Resultats Cent vingt-quatre pieds bots ont ete analyses. Quarante-sept cas PBVEI pour lesquels un caryotype a ete realise dans 34 cas et dont le resultat etait normal. Les facteurs de risque retrouves par notre serie etaient le sexe masculin (p = 0,0017), l’existence d’un antecedent familial de pied bot (p = 0,001) et la primiparite (p = 0,04). Soixante-dix-sept cas de PBVES ont ete identifies parmi lesquels 14 anomalies chromosomiques, 18 spina bifida, 10 anomalies neuro-musculo-squelettiques. Parmi les 124 cas, 25 etaient unilateraux et 99 etaient bilateraux. Le caractere bilateral du pied bot ne constituait pas un facteur de risque de PBVES (p = 0,8). Discussion et conclusion Nous n’avons pas retrouve d’anomalies chromosomiques en cas de PBVEI. Les resultats de notre serie permettraient de surseoir a la realisation systematique d’une amniocentese en cas de PBVEI chez les patientes primipares presentant un antecedent familial de pied bot chez un fœtus de sexe masculin. La realisation systematique d’une echographie morphologique realisee par un echographiste referent en diagnostic antenatal devrait etre poursuivie.

Esophageal atresia (EA) is prenatally diagnosed in less than one third of the cases and is usually only suspected. Recently, magnetic resonance imaging (MRI) with dynamic sequence and biochemistry of the amniotic fluid have been proposed to enhance prenatal diagnosis of EA. We report the case of a triple negative screening (ultrasound, MRI with dynamic sequence and biochemistry of the amniotic fluid) with a postnatal diagnosis of EA type III with a small defect. Even using second line tests, prenatal diagnosis of EA remains a challenge.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 6 - p. 424-430

Resume Objectifs Repertorier les signes echographiques mis en evidence lors de la suspicion d’un placenta accreta. Les objectifs secondaires sont d’analyser la pertinence du diagnostic en echographie et en imagerie par resonance magnetique (IRM), et de connaitre les circonstances diagnostiques afin d’identifier une population a risque. Patientes et methodes Il s’agit d’une etude retrospective monocentrique. Les cas de placentas accreta pris en charge au centre hospitalo-universitaire de Lille entre 2005 et 2010, suspectes en antenatal ou decouverts per-partum, ont ete recenses. Resultats Vingt-sept patientes ont presente un placenta accreta sur cette periode. 22 cas etaient suspectes en antenatal, dont 21 confirmes a la naissance. Six cas etaient decouverts per-partum. Le diagnostic etait suspecte dans 41 % des cas suite a un episode de metrorragies. Cent pourcent des patientes suivies au diagnostic antenatal avaient un uterus au moins unicicatriciel et un placenta anterieur insere bas. Cinquante pourcent des patientes non depistees avaient un placenta posterieur non insere bas. Les signes echographiques les plus frequents etaient « lacune placentaire » (85,7 %), « vascularisation anormale » (71,4 %), « perte du lisere hypoechogene du myometre » (66,7 %), « irregularite de la paroi vesicale » (57,1 %). La sensibilite de l’echographie de depistage est de 78 %. Vingt et une IRM, realisees en deuxieme intention confirmaient le diagnostic dans 66,7 % des cas. Discussion et conclusion L’echographie est un examen pertinent pour le diagnostic de placenta accreta. Les placentas posterieurs, plus difficiles d’acces, ne doivent pas etre negliges. Les placentas anterieurs praevia chez les patientes multipares ayant un uterus cicatriciel doivent requerir toute l’attention de l’examinateur.

Resume But Etudier l’utilisation du misoprostol pour le declenchement du travail en cas de mort in utero ou d’interruption de la grossesse au deuxieme ou au troisieme trimestre et definir ses modalites d’administration. Materiel et methode Revue de la litterature a l’aide de PubMed, articles en anglais et en francais, mots cles utilises : misoprostol, termination of pregnancy, second and third trimester, scarred uterus, previous cesarean section, uterine rupture. Resultats Le misoprostol est efficace pour le declenchement du travail des patientes presentant une mort in utero ou souhaitant realiser une interruption de la grossesse aux deuxieme et troisieme trimestres. La voie vaginale reduit le delai induction-expulsion et le taux de patientes n’ayant pas accouche dans les 24 premieres heures du declenchement par rapport a la voie orale sans augmentation des effets secondaires. La voie orale est une alternative possible si la patiente le souhaite. La voie sublinguale semble interessante mais les donnees sont peu nombreuses. L’utilisation de doses moderees (800–2400 μg/j) en prises espacees de 3 a 6 heures semble presenter le meilleur compromis efficacite-tolerance mais il n’est pas possible de recommander un schema d’administration precis. Le risque de rupture uterine en cas d’uterus cicatriciel justifie l’utilisation des doses minimales efficaces. Il est alors conseille de ne pas depasser la dose de 100 μg par prise. Le delai induction-expulsion et les doses de misoprostol necessaires pour declencher le travail sont diminues lorsqu’il est associe a la prise de mifepristone 36 a 48 heures avant le debut du declenchement. Conclusion Le misoprostol est efficace et sur pour l’induction du travail en cas de mort in utero ou d’interruption de grossesse aux deuxieme et troisieme trimestres.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 1 - p. 5-11

Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. A small number of cases during pregnancy have been described in literature. We report one HPS case in a pregnant patient at 21 week's gestation with systemic lupus erythematosus. We discuss diagnostic difficulties, obstetrical complications and therapeutic options.

Resume Objectif L’objectif de notre etude etait d’identifier, dans une population de patientes ayant presente une preeclampsie et/ou un HELLP syndrome, l’incidence et les facteurs de risque de survenue d’une complication vasculaire lors de la grossesse suivante. Patientes et methodes Quatre cent quarante-cinq patientes prises en charge pour une preeclampsie et/ou un HELLP syndrome entre mars 1996 et decembre 2006 ont ete incluses. Les donnees de la grossesse index et de la grossesse suivante ont ete etudiees. Afin de laisser un temps suffisant pour etudier le devenir de la grossesse suivante, seules les patientes ayant accouche depuis plus de deux ans ont ete selectionnees. Resultats Cent cinquante et une patientes ont eu une grossesse dont 142 sont allees au-dela de 20 semaines d’amenorrhee (SA). La mediane de suivi etait de six ans (intervalle : deux a neuf ans). Trente-neuf d’entre elles (27,5 %) ont eu une complication vasculaire. Une preeclampsie recidivait dans 20 cas (51,3 %). Trois patientes (7,7 %) ont developpe un HELLP syndrome. Une hypertension arterielle est survenue pour 14 patientes (35,9 %) et un hematome retroplacentaire pour une d’entre elles (2,6 %). Quatre nouveau-nes (10,3 %) etaient petits pour l’âge gestationnel ( e percentile). Une obesite, un accouchement avant 32 SA et un poids de naissance e percentile lors de la grossesse index etaient les trois principaux facteurs associes a la survenue d’une complication vasculaire lors de la grossesse ulterieure. Discussion et conclusion Les patientes avec un antecedent de preeclampsie et/ou de HELLP syndrome ont un risque accru de developper une complication vasculaire lors de la grossesse ulterieure.

Resume Objectif Definir le lieu de suivi et d’accouchement des grossesses gemellaires en France. Materiel et methodes Recherche bibliographique a partie de la base de donnees Medline et de la Cochrane Database Library. Consultation des recommandations des societes savantes de gynecologie-obstetrique etrangeres. Resultats Il n’existe pas d’etudes de haut niveau de preuve permettant de repondre a la question. Le risque d’accouchement premature et la chorionicite sont les deux facteurs, principaux qui conditionnent la prise en charge des grossesses gemellaires. En cas de situation a risque d’accouchement premature, le transfert in utero est recommande. Le suivi doit etre assure par une equipe connaissant les particularites de prise en charge selon la chorionicite. La prise en charge en structure specialisee n’est pas recommandee. Le travail et l’accouchement necessitent la disponibilite permanente et immediate d’une equipe perinatale incluant un gynecologue obstetricien, un anesthesiste et un pediatre. Conclusion Le lieu de suivi et d’accouchement doit tenir compte des besoins specifiques des grossesses gemellaires et de la chorionicite. Plutot que de definir un lieu precis, il semble plus logique de definir les moyens necessaires a mettre en œuvre pour obtenir une prise en charge optimale de ces grossesses.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 398-404

During the Early Cretaceous, the Arperos basin was located between the Guerrero arc terrane and nuclear Mexico. Remnants of this basin now form an oceanic suture zone between the coeval carbonate platforms to the east and the accreted Guerrero terrane to the west. The geochemistry on the Arperos mafic hypabyssal and volcanic rocks, based on the incompatible and trace element distribution and the eNdOTa110 MaU values, shows that this basin was floored by basalts that likely were generated by the mixing of OIB and N-MORB sources. The submarine lavas are overlain by and/or interbedded with siliceous sediments that have the highest eNdOTa110 MaU and lowest Th levels. In contrast, the turbidites interlayered with the pelagic carbonates located at the top of the Arperos stratigraphic column show the lowest eNdOTa110 MaU values and the highest Th contents. This evolution with time in the chemistry of the Arperos sediments is interpreted as marking the approach of the Guerrero juvenile arc to nuclear Mexico. q 2000 Elsevier Science Ltd. All rights reserved.

Telemonitoring in dialysis, either in hospital centers or at home, poses a challenge for physicians due to the necessity of monitoring and centralizing various patients and equipment parameters. In the near future however, this technique should allow a decrease in the number of patients in medical centers. It should also allow physicians to keep track of the sessions of outpatients who have a consultation every two months only. The study presented here, carried out in the Centre Hospitalier de Saint-Brieuc during the spring and summer of 1998, reviews some of the aspects of this new technology. We first report on the results of a survey performed in 60 dialysis centers in order to confirm the interest of telemonitoring for physicians of nephrology. We then tested and evaluated one of the commercial software programmes during several months. We finally point out some legal linked to such devices use.

The title compound is prepared by adding aqueous ammonia to a solution of phosphoric acid containing a small amount of iron (III) ions (3%). It crystallizes in the monoclinic system, space groupC2/c,a=16.8450(9) A,b=9.6111(1) A,c=17.6470(7) A, andβ=90.91(2)°,R=0.031, and wR=0.078. The structure consists of a two-dimensional framework made of HPO4, H2PO4groups, and FeO6octahedra sharing corners. In one layer, the NH+4cations are located inside 12 membered windows, which are generated by the corner-sharing FeO6and H2PO4. Water molecules lay in the interlayer space. With regard to magnetic properties, carried out in the range 1.7–300 K, the polycrystalline sample follows a Curie–Weiss law down to 30 K. At lower temperatures is a magnetic phase transition, where a spontaneous magnetization appears. This behavior suggests either a ferrimagnetic or a weak ferromagnetic order.

Objectifs La diffusion des bacilles a gram negatif (BGN) multiresistants est une menace grandissante en France en particulier chez Escherichia coli. L’objectif de cette etude etait d’evaluer le profil de resistance des E. coli uropathogenes isoles en laboratoires d’analyse de biologie medicale (LABM) en Languedoc. Methodes Cette etude retrospective multicentrique incluait tous les patients ayant eu un ECBU positif a E. coli diagnostique par un LABM du Gard et de l’Herault durant l’annee 2013. Tous les doublons ont ete elimines. Pour chaque inclusion, un recueil epidemiologique (âge, sexe, origine communautaire ou etablissement de sante) etait effectue. Les donnees de la resistance (R) des souches d’E. coli aux principaux antibiotiques testes etait effectue selon les recommandations du CA-SFM. Resultats Un total de 50 287 souches d’E. coli ont ete incluses isoles chez 83 % de femmes d’âge median 62 ans (0–105). Quatre-vingt-neuf pour cent des prelevements etaient communautaires et 11 % en ES. Aucune souche n’etait resistante a l’imipeneme mais 0,3 % (n = 164) etaient resistantes a l’ertapeneme, provenant patients en institution. Aucune carbapenemase n’a ete detectee. 46,4 % des souches etaient resistantes a l’amoxicilline, 31,7 % a l’association amoxicilline/acide clavulanique, 7,2 % au cefixime, 4 % a la gentamicine, 0,6 % a l’amikacine et 1,3 % aux furanes. Les souches isolees des hommes etaient plus resistantes que celles des femmes. Les souches isolees en ES ou en maison de retraites etaient les plus resistantes. Plus l’âge etait eleve, plus les E. coli etaient resistantes aux antibiotiques en particulier aux quinolones et aux C3G. En revanche, la fosfomycine reste particulierement active quel que soit l’âge. Conclusion La diffusion des E. coli multiresistants est importante dans notre region (4,3 % de toutes les souches et 21,4 % chez les hommes en maison de retraite). Nos resultats confirment que les fluoroquinolones et le cotrimoxazole ne peuvent plus etre des antibiotiques de premier choix dans les infections urinaires. Ces donnees locales sont essentielles pour adapter les referentiels locaux.

The Guerrero suspect terrane, composed of Late Jurassic-Early Cretaceous sequences, extends from Baja California to Acapulco and is considered to be coeval with the late Mesozoic igneous and sedimentary arc sequences of the Greater Antilles, the West Indies, Venezuela and the Western Cordillera of Colombia. These sequences represent the remnants of an arc which accreted to the North American and northern South American cratons at the end of the Cretaceous. In western Mexico, the arc sequences built on continental crust consist of high-K calc-alkaline basalts, andesites and rhyolites enriched in LREE with abundant siliceous pyroclastic rocks interbedded either with Aptian-Albian reefal limestones or red beds. They do not show magmatic changes during the arc development. In contrast, the arc sequences built on oceanic crust show an evolution with time. Arc activity began with the development of depleted low K-tholeiitic mafic suite (Guanajuato igneous sequence), followed first by mature tholeiitic basalts and then by calc-alkaline olivine basalts interbedded with micritic limestones and radiolarian oozes of Early Cretaceous age. At the end of the arc growth, during Aptian-Albian times, calc-alkaline pillow basalts and and esites poured out in the volcanic front while shoshonitic olivine basalts extruded in the back arc. The tholeiitic and shoshonitic mafic rocks as well as the calc-alkaline lavas are mildly enriched in LREE, Y and Nb and show high ϵNd ratios, typical of oceanic arcs. In contrast, the calc-alkaline mafic suite enriched in LREE, Y and Nb exhibits lower ϵNd ratios suggesting that it was derived by the partial melting of a mantle source contaminated either by Paleozoic subducted sediments or old source enrichments (OIB). The Cretaceous arc rocks of the Greater Antilles, interbedded with and/or capped by Aptian-Albian limestones, the Cretaceous andesites of northern Colombia, the Cretaceous tholeiitic and calc-alkaline volcanic rocks of Venezuela, and the Cretaceous volcano-plutonic arc assemblage of Tobago share a similar magmatic evolution with the western Mexican oceanic arc. The tholeiitic plutono-volcanic assemblage of Tobago, depleted in LREE and characterized by high ϵNd values is similar to the Guanajuato volcano-plutonic sequence of Mexico, considered to represent the pristine stage of the arc. The mature tholeiitic sequences exposed in the proto-Caribbean arc show flat to moderately enriched LREE patterns like those of the Guerrero terrane. However, felsic plutonic and volcanic rocks prevail in the Caribbean. Calc-alkaline suites, accompanied locally by shoshonitic lavas, characterize the end of arc magmatic activity in both places. Thus, the geochemical features of the Late Jurassic-Cretaceous arc series of the Guerrero terrane and the proto-Caribbean are consistent with the following plate tectonic model. The Guerrero terrane and the proto-Caribbean probably belonged to the same intra-paleo-Pacific arc system the development of which was related to the subduction of oceanic basins fringing the North and northern South American cratons. This subduction zone was WSW dipping. While subduction was going on, these magmatic arcs drifted, moved closer to the North and South American cratons, and finally collided with the American borderlands at different periods during the Cretaceous. The late Mesozoic Guerrero and proto-Caribbean arc sequences show striking similarities with the Miocene calc-alkaline lavas dredged from the Banda Ridges, the North Marianas Seamount Province, and the Halmahera and Philippine arcs. We suggest that the diverse but mostly submarine segments of this late Mesozoic intra-Pacific arc rimmed the North and South American cratons as much as these Tertiary arcs rim Southeast Asia.

The Late Jurassic-Early Cretaceous Alisitos-Teloloapan intra-oceanic arc, which extends along the Pacific coast of Mexico, is overlain by the extensive thick calc-alkaline Tertiary volcanics of the Sierra Madre Occidental. In central-southern Mexico this arc can be divided in to two major units. Its base, which is mainly exposed in the Guanajuato-Leon area, consists of a volcano-plutonic assemblage refered to as the Guanajuato magmatic sequence. The top consists of pillowed calc-alkaline basalts and andesites overlain and/or interbedded with a thick volcaniclastic sedimentary pile in which lenses of reworked Albian-Aptian reefal limestones are interlayered. The Guanajuato magmatic sequence represents the crustal section of an intra-oceanic nascent island arc and from top to base is made up of: (1) volcaniclastic sedimentary cover, (2) a predominantly pillowed basaltic sequence, (3) a doleritic and basaltic dyke complex, (4) silicic plutonic rocks and salite diorite, (5) Mg-hornblende diorite, (6) layered cumulate gabbros and, (7) ultramafic-mafic cumulates. Plutonic rocks of intermediate to silicic composition are volumetrically abundant. All the rocks have suffered low-grade metamorphism with magmatic textures preserved. Metamorphic textures do not occur. Mg-rich olivine is restricted to the ultramafic cumulates, whereas Ca-rich clinopyroxene is present in all the rock types, although with the exception of the most differentiated silica rich plutonic rocks. The textural relationships and mineral chemistry of the clinopyroxenes and hornblende in the ultramafic cumulates and in the clinopyroxene gabbros point to an origin by igneous accumulation from a tholeiitic parent magma at shallow levels above the mantle-crust boundary. Al-rich basalts and dolerites belong to a low-K tholeiitic suite. The Nb contents, which are abnormaly high for arc tholeiites, are in the range of N-MORB. Such enrichments have been related to an immature stage of the arc development, the mantle wedge being still enriched. This is in agreement with the evidence that the Guanajuato tholeiitic magma represents the earliest products of the Alisitos-Teloloapan arc magmatic activity. The Guanajuato basic rocks and hornblende diorite show similar high eNd ratios which fall in the range of the values of oceanic arcs. The most siliceous plutonic rocks differ from the basic suite by virtue of their slightly lower eNd and higher eSr ratios, which may be explained by an assimilation-fractional crystallization (AFC) process. The siliceous melts differentiated by crystal fractionation from the tholeiitic mantle magma and assimilated material such as metamorphosed oceanic crust and sediments, which form the wall rocks of the magma chamber. The high eSr ratios of the basalts and their feeder dykes are probably related to the polyphase low-grade metamorphism (i.e. hydrothermal oceanic alteration and regional metamorphism) that has affected the uppermost levels of the arc.

Two examples of felsic-mafic association resulting from a magma mingling mechanism have been studied in Carboniferous calc-alkaline granitoids from Sardinia using mineralogical and geochemical techniques: (1) the centimetric to decimetric magmatic mafic enclaves from the reversely zoned tonalitic Santa Restituta pluton; this type of enclave, which is common in calc-alkaline granitoids, represents blobs of mafic magma incorporated into a silicic host magma; (2) the Osidda mafic complex, about one kilometre in diameter, enclosed in the Benettuti granodiorite. This study intends to compare these two types of felsic-mafic association in order: (1) to clarify the nature of the interaction processes which occurred between the two magmatic components; (2) to test the influence of the degree of fragmentation of the mafic component into the felsic matrix on the intensity of such processes. The Santa Restituta enclaves (SRE) and the Osidda mafic complex (OMC) exhibit the same general mineral assemblage: plagioclase + biotite ± hornblende ± quartz. This assemblage is similar to that of the corresponding host granitoids; however, the SRE and the OMC are characterized by a greater abundance of biotite and hornblende. The mineralogical study reveals the presence of two types of crystals. The first type corresponds to minerals typical of the mafic or the felsic component. In the mafic magma they are represented by remnants of An-rich plagioclase, by hornblende clots (presumably pyroxene relicts) and by orthopyroxene (observed only in one facies of the OMC). These crystals represent remnants of phenocrysts present in the mafic component prior to the mingling event. In the felsic component, the first type of crystals is represented by quartz “ocelli” which are sometimes incorporated in the mafic magma as xenocrysts surrounded by a reaction rim of biotite and hornblende. The second type comprises minerals which are found indiscriminantly in both magmatic components and which formed during the mingling event (“mingling minerals”). They include: plagioclase (An52-35), biotite ± hornblende ± quartz. Mineralogical data indicate that thermal equilibrium occurred between the mafic magma and the felsic matrix. That equilibration was reached in the SRE, is shown by the compositional similarity of the mingling minerals of the enclaves and their host rocks. However, due to a lesser degree of fragmentation, thermal equilibration was not reached in the OMC. Geochemical data, however, do reveal close relationships between the two magmas which appear therefore, to have both been hybridized by mutual chemical interaction. A chemical comparison between the SRE and the OMC shows that, in both cases, the same qualitative interaction mechanisms operated between the host granitoids and, either a voluminous mafic body (Osidda) or a highly fragmented mafic component (Santa Restituta enclaves). However, the intensity of hybridization is minor in the OMC as compared with the SRE. It is suggested that hybridization of the host granitoids involves: (1) mass-to-mass mixing due to disaggregation and dispersal of the mafic magma in the host granitoid, resulting from mechanical stirring during the pluton's genesis (from the initial meeting of the two magmas to the pluton's final emplacement); (2) loss of certain elements (Si, K, Rb, Ba, Li, Zr, P, Nb, REE) which migrated towards the mafic magma through diffusion (due to compositional gradients) ± fluid transfer. As a consequence, the composition of the host granitoids is linked to that of their magmatic enclaves: the enclaves with the lowest FeO tot MgO ratios are enclosed in the least felsic granitoids and vice versa. Hybridization of the mafic component involves: (1) mechanical transfer of crystals (quartz) from the host granitoid; (2) enrichment in numerous elements migrating from the felsic component; this is expressed mineralogically by the crystallization of numerous anhedral phases such as quartz (SiO2), biotite (K, Rb, H2O), hornblende (H2O), apatite (P), and zircon (Zr); (3) loss of Ca and Sr by the mafic component. The nature of the processes of chemical migration are discussed. The importance of the continuous renewal of the contact surface between the two components is emphasized. The original compositions of the interacting mafic and granitic components become, therefore, highly modified. This phenomenon can probably be generalized to apply to calc-alkaline granitoids as a whole, which are in fact characterized by the common occurrence of magma mingling.

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S33 Poster Session 11 – Environmental Issues: Water, Air, Cleaning P11.01 Resistance of Acanthamoeba spp. cysts to disinfection treatments C. Coulon, A. Collignon, G. McDonnell, V. Thomas. STERIS, France; Paris 11 University, France; STERIS, United Kingdom Amoebae are known to potentially harbour bacteria that can present a threat to humans and particularly hospitalized patients. These bacteria potentially survive in amoebal cysts, as demonstrated for mycobacteria. It is thus important to evaluate the effectiveness of chemical disinfectants used for surface disinfection against amoebal cysts and trophozoites. Nine different Acanthamoeba spp. strains were grown in PYG medium before encystment. Cysts were diluted in each disinfectant tested (see below), and incubated for 10 min at appropriate temperature. After neutralization cysts were serial-diluted on E. coli lawns on NNA agar to observe re-growth, and log reductions were calculated. Actively growing trophozoites directly taken from PYG medium were evaluated using the same method. The most effective treatments were bleach 2.5%, ethanol 70% and a peracetic acid-based formulation (STERIS-20), with a minimum 4-log10 reduction, except for one strain presenting limited resistance to ethanol. Ortho-phthalaldehyde (OPA) alone at 0.55%, peracetic acid alone at 0.2% and a hydrogen peroxidebased product (SporKlenz) presented good activity on all strains (4-log10 reduction) except for 1 of 9 strains with OPA (1-log10 reduction), and for 2 of 9 strains for PAA (0.2 and 0.9-log10 reduction) and SporKlenz (1.7 and 3.6-log10 reduction). Bleach 0.25%, a commercial OPA-based product and glutaraldehyde 2% presented a moderate to low activity. Products with the lowest activity were hydrogen peroxide alone at 7.5% and a commercial, 2% glutaraldehyde-based product. Importantly, glutaraldehyde had also limited efficacy against trophozoites whereas all other tested products were efficient. This study demonstrates that biocides efficacy against amoebae can vary, with known high level disinfectants that may be taken for granted as being effective presenting only limited efficacy. Further investigations are needed to better understand the activity of biocides against amoebal cysts. P11.02 Ingress and egress of pathogens from single isolation rooms M. Muzslay, G. Moore, A.P.R. Wilson. University College London Hospitals, United Kingdom Background: Source isolation can protect the isolated patient (or their roommates) against infection. Some institutions have reduced infection rates by using single isolation rooms. However, others have failed to demonstrate similar benefit. Aims: To investigate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) to and from single isolation rooms. Methods: Conventional microbiological methods were used to recover MRSA and enterococci from the air (n = 132) and from high contact sites (n = 4257) within isolation rooms and open bay areas. The similarity between clinical and environmental isolates was determined via PFGE. Results: MRSA was recovered from 83 environmental surfaces; 49 were within isolation rooms. The environment of one isolated patient accounted for 43% of all MRSA-positive sites, yet the infective strain was not recovered from outside the room. No patient was colonized with EMRSA-15 B1 yet this strain was recovered from the environment of non-isolated patients, staff communal areas and from an isolation room occupied by an MRSA-negative patient, (previous occupant had different MRSA strain). VRE was recovered from 63 surfaces; 52 were within an isolation room. Large numbers of VR E. faecalis were recovered from the near-patient environment and, despite immobility of the patient, the ensuite toilet area. The same clone was isolated from the inner and outer door handles but not from outside the room. VS E. faecium was recovered from surfaces and the air (120CFU/m) of a 4-bedded open bay. The same clone was recovered from surfaces and the air (5 CFU/m) of an adjacent isolation room. Conclusion: Source isolation contained the infective organism(s). However, heavy airborne contamination and the persistence of MRSA within the ward environment enabled potential pathogens to spread from open bay areas to single isolation rooms via the air and the hands of healthcare workers. P11.03 Identifying opportunities to improve environmental hygiene in multiple healthcare venues P. Carling, J. Po, J. Bartley, L. Herwalt. Boston University School of Medicine, United States; Banner Estrella Medical Center, United States; ESCI, United States; University of Iowa School of Medicine, United States Background: Despite improved hand hygiene compliance and the use of active surveillance cultures to facilitate isolation practice, the impact of such interventions in various types of healthcare settings has been incomplete. Over the past several years 8 studies have documented increased risk of acquisition MRSA, VRE, C. difficile and A. baumannii from prior room occupants. In the context of recent prospective studies which have shown decreased transmission of bacterial pathogens as a direct result of improved hygienic cleaning, a broader evaluation of thoroughness of hygienic cleaning was undertaken by Environmental Hygiene Study Group hospitals. Objective: To evaluate the thoroughness of hygienic cleaning of surfaces that have a significant potential for transmitting hospitalassociated pathogens in a range of healthcare facilities and venues. Methods: A novel fluorescent targeting system was covertly used to objectively evaluate if disinfection cleaning of standardized sets of high risk objects was being performed in a manner consistent with institutional policies in a range of healthcare settings. Results: Terminal thoroughness of disinfection cleaning (TDC) in 82 hospitals was 54% and was significantly better than 16 hospital’s ORs (32%), 7 hospital’s neonatal intensive care units (36%) and 7 EMS vehicles (28%). Daily TDC in ICU isolation rooms in 7 hospitals (31%), in 4 ambulatory chemotherapy suites (26%), in 4 MD clinics (24%), in 5 dialysis units (33%) and in 5 long-term care facilities (34%) was also suboptimal (Figure). Overall the mean TDC for all sites/settings was 34% (Range = 3 to 88, 95% CI 25.2–43.0). Conclusions: Nine studies of TDC, which included >65,400 hightouch surfaces in 106 institutions and 145 venues, identified substantial opportunities for improvement in all venues, suggesting that TDC needs to be improved across a broad range of U.S. healthcare venues as part of efforts to prevent transmission of pathogens. P11.04 Optimising the recovery of methicillin resistant Staphylococcus aureus from surfaces using direct contact plates P. Wolyniec, D.J. Malik, G. Shama. Loughborough University, United Kingdom The presence in health care environments of Methicillin Resistant Staphylococcus aureus (MRSA) continues virtually unabated and has attracted concern from a number of quarters. Reliable methods of assessing the extent of contamination of such environments by MRSA constitute the first step in mobilizing resources to manage and contain potential threats of infection. Among the different techniques available for contamination assessment, Replicate Organism Detection and Counting (RODAC) direct contact plates

Objectifs Connaitre les differents types de la maladie trophoblastique. Connaitre les elements cliniques, biologiques et echographiques essentiels pour faire le diagnostic de maladie trophoblastique et de leurs diagnostics differentiels. Connaitre le bilan d’extension en imagerie des maladies trophoblastiques et les principes de prise en charge de ces pathologies. Points cles Un taux anormalement eleve de BHCG chez une patiente presentant des metrorragies pendant ou a la suite d’une grossesse doit faire evoquer le diagnostic de maladie trophoblastique. L’echographie pelvienne est la modalite d’imagerie indispensable pour confirmer le diagnostic. L’IRM pelvienne peut etre utile dans le bilan d’extension loco-regional et la tomodensitometrie thoracoabdomino-pelvienne dans le bilan d’extension a distance. L’etude histologique est indispensable au diagnostic, elle sert a preciser la gravite de la maladie. La decroissance du taux de BHCG ± associee a l’imagerie est primordiale dans la surveillance.

The study of some Carboniferous orogenic granitoid plutons from northern Sardinia reveals the close relationship between their composition and the abundance of the enclosed mafic magmatic inclusions. The latter represent blobs of mingled basaltic magma. Most of the plutons are normally zoned with their felsic character increasing towards the core. This compositional trend parallels the decrease in the number of the mafic inclusions. The mentioned characteristics are found in most calc-alkaline plutons throughout the world. Moreover, in Sardinia, each studied pluton contains a population of mafic inclusions typified by a distinct range in FeOt/MgO ratio, suggesting that the emplacement of each intrusion is related to a single episode of mingling with a basaltic magma. On the other hand, the close chemical relationship existing between the mafic inclusions and their host rocks shows that the basaltic and the granitic components are compositionally modified and that the granitic matrices are more or less hybridized. Based on our observations, we suggest that in calc-alkaline plutons, zoning is the result of 1. (1) a compositional stratification developed in an early stage of the pluton's history, in a felsic magma chamber located deeper than the level of the intrusion; 2. (2) the mingling and partial hybridization with a basaltic magma injected into the felsic. The intensity of hybridization of the granite host depends, among other factors, on the amount of its enclosed mafic inclusions. A model for magma withdrawal from a deep, stratified, felsic magma chamber injected by a basaltic influx is proposed to explain the normal zoning. In this hypothesis, the basaltic magma flows more rapidly through the overlying more viscous acid one, entraining and mobilizing part of the bottom layers of the felsic magma. These are drawn up, carrying abundant blobs of mafic magma and are followed by progressively higher levels which are poorer in mafic inclusions. The continuous emptying of the reservoir feeds the pluton at its level of final emplacement. A ballooning of the pluton results through the successive magmatic injection into the intrusion's core, accompanied by the deformation of the outer zones which are still hot and viscous. Hybridization mechanisms (migration of fluids, diffusion, mechanical exchange of phenocrysts) are enhanced by mechanical stirring and probably occur at various stages of the pluton's history i.e., in the deeper reservoir, during ascent and during ballooning.

Orogenic volcanic rocks form a continuous spectrum between tholeiitic associations of island arcs and calc-alkaline associations of continental margins and collision zones. Although these settings show a wide variation in plate convergence rate, depth of scismic zone, nature and age of subducted and over-riding lithosphere, the compositional characteristics of the volcanic association is correlated most strongly with crustal thickness. Tholeiitic associations dominated by basaltic rocks and with high FeOTT/MgO, and low K2O for a given SiO2 content are restricted to island arcs with crustal thickness less than 20 km. More calc-alkaline associations, dominated by andesitic rocks with lower FeOT/ MgO and higher K2O for a given SiO2 content occur in areas where crustal thickness exceeds 20 km. These suggest that (1) fractional crystallization occurring within the continental crust may be the major mechanism responsible for variations within orogenic volcanic associations and (2) formation of calc-alkaline associations may require the presence of continental crust. These relationships suggest that calc-alkaline magmas may be derived from more tholeiitic magmas by fractional crystallization, possibly combined with crustal melting or contamination. The extension of these processes might be responsible for formation of silicic ignimbrites occurring in continental areas where the crustal thickness exceeds 30 km, in areas of crustal extension.

The chemical variations in the continental-margin andesitic suite from northwestern Sardinia are compatible with a mechanism involving both fractional crystallization and contamination. Contamination is probably related to interaction with ignimbrites formed by crustal anatexis, which are spatially and temporally associated with andesitic rocks. A similar process may have also affected other calc-alkaline andesitic suites such as those of New Zealand and southern Peru where the contents of lithophile elements and the Sr isotope ratios appear to be related to the composition of associated ignimbrites.

Initial isotopic ratios of strontium have been determined in some calc-alkali rocks of Sardinia. The values of these ratios are from 0.7044 and 0.7047 in two basalts, and from 0.7063 to 0.7081 in five andesites. A dacite and a rhyolite have intermediate values of 0.7056 and 0.7058. It is suggested that increase of radiogenic strontium in andesite is most likely related to a contamination process involving water expelled from an underthrusting plate. This water also contributes to the increase in the potassium and related trace element contents in andesites. In spite of the 87 Sr 86 Sr difference between basalt and andesite, a cogenetic relationship between these two kinds of rocks cannot be precluded

The K/Ar datings made on recent lavas of northwest Sardinia (Logudoro and Bosano districts) show that the calc-alkaline volcanism lasted about 11 m.y. It began at the Oligocene—Miocene limit and ended in the Middle Miocene. A Plio—Quaternary alkaline volcanic cycle followed the Middle Miocene sea transgression. These geochronological measurements complement a recent paleomagnetic study made on these Sardinian lavas. These data enable us to show that the northwest Sardinian volcanism is subsequent to the island drift. Thus, this movement would have ended in the Late Oligocene at the latest.

The mineralogical and chemical compositions of the magmas emplaced during the three successive stages of Mt. Pelee's activity (ca. 0.4-0.2 Ma; ca. 0.1 Ma-19,500 y.B.P.; < 13,500 y.B.P.) remained relatively constant. All magmas are cogenetic in a broad sense and result from the combination of two major petrogenetic processes: fractional crystallization witnessed by gabbroic and dioritic cumulates (Fichaut et al., 1989, this issue), and magma mixing evidenced by textural, mineralogical and chemical heterogeneities (Gourgaud et al., 1989, this issue). The study of heterogeneous eruptions, e.g. the ash-and-scoria flows (second stage) and the 1902–1929 block-and-ash flows, demonstrates that the basic and acid magmas involved have small but significant geochemical differences; the distribution of compatible (Mg, Sc, Co) and hygromagmaphile (Th, La, Ta, Hf) elements indicates that fractional crystallization played a dominant role in the genesis of the second stage products, whereas magma mixing was dominant in the 1902–1929 lavas. Geological, mineralogical and geochemical constraints are used to propose models of magma chambers. The second stage deposits are considered to be the result of the discharge of the magmas stored in a chemically stratified, ca. 2–3 km3 magma chamber, tentatively described as a cylinder or a parallelepiped of large vertical extent (tens of km) but small horizontal section (some hundreds of meters). By contrast, the young ( < 13,500 y.B.P.) deposits of Mt. Pelee are thought to originate from a small (< 1 km3) and shallow (ca. 10 km in depth) chamber filled with andesitic to dacitic magmas. The periodic intrusion of basic magmas, presumably from a deeper chamber, causes magma mixing which triggers the eruption of heterogeneous and hybrid products.

A paleomagnetic study has been made about the calc-alkaline lavas (Late Oligocene-Middle Miocene age) and the Plio-Quaternary basaltic alkaline lavas of the Logudoro and Bosano (North West Sardinia). This study is based on the chronological scale of the volcanic phases of this part of Sardinia; this scale was established on field observations and K/Ar datings. Hence, the authors propose a sketch of paleomagnetic stratigraphy and discuss the problem of the drifting of Sardinia in the course of Cenozoic time. They are lead to the conclusion that the move of Sardinia terminated at the moment when the calcalkaline lavas flowed into the Logudoro and the Bosano.

A north-south chemical zoning is observed in the Cenozoic andesitic lavas of Sardinia. This zoning expresses itself in a gradual increase in K, Li, Rb, Sr in the north and in an enrichment in Fe in the south. The lavas have tholeiitic tendencies in the southern part of the island, while the lavas in the northern part have calc-alkaline characters. The existence of this zonation lends support to the hypothesis that Sardinia was formerly underlain by a subduction zone, which was responsible for the Oligo-Miocene volcanism on the island.

Electronic paramagnetic resonance (EPR) measurements have been performed on various types of organic conductors above their antiferromagnetic critical point. For metallic like [(TMTSF) 2 PF 6 ], correlated [(DMCTSeF) 2 AsF 6 ] or strongly correlated [(BEDT-TTF) 2 ICl 2 ] organic compounds at ambient pressure, the EPR linewidth diverges just above the Neel temperature T N according to the critical profile Δ H=cst(T−T N /T N ) − μ with μ ≅1.5. From the kinetic equations of motion for the critical correlation function and dynamic scaling arguments, it is shown that the linewidth profile near T N result from non-diffusive critical fluctuations and the critical exponent μ is classical or mean-field like. These conclusions are found to be quite compatible with previous NMR relaxation measurements made on similar compounds.