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Aging process is characterized by difficulties in ensuring balance control, especially in conditions of reduced or conflicting sensory information, leading to an increased risk of falling. Conversely, the practise of physical activities (PA) has been recognized as a good approach to improve the quality of balance control. This study aimed to investigate the influence of current and/or past PA on balance-related neurosensorial organization in older adults on the maintenance of the upright stance, especially during sensory conflicting situations. Postural control was evaluated by means of the Sensory Organization Test on 130 healthy noninstitutionalized volunteers aged over 65, split into four groups according to the presence or absence of PA before or after retirement. Subjects who practised PA for a long time (Gr1) and subjects who started PA after retirement (Gr2) displayed the best postural performances and better managed sensory conflicting situations compared to subjects who had stopped PA for many years (Gr3) and subjects who had never practised PA (Gr4). Multiple regression analyses revealed that current PA was the major determinant for postural parameters during sensorial conflict compared to age, gender, body mass index and past PA. Regular PA, even when started late in life, allows appropriate reorganization of the different components of postural control during sensory conflicting situations. Indeed, active subjects were more able to compensate for suppressed or perturbed sensory information by an increased usage of another referential and so to correct their posture by adopting a more appropriate balance strategy. Thus, PA counteracts the age-related decline of postural control and could consequently reduce the risk of falling.

Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.4+/-5.0 years), who had a standard health check-up at the 'Centre de Medecine Preventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.39+/-2.64 m/s. Men showed higher PWV values than women (9.99+/-2.56 vs 8.66+/-2.56, P

BACKGROUND The aim of this prospective study was to determine the target concentration (CPRED) curves for laryngeal mask airway (LMA) insertion in children. METHODS The CPRED of propofol required for insertion of the LMA was determined in 72 unpremedicated children, aged 3-10 years, ASA physical status I. CPRED was reached in 2 min according to a sequential allocation. LMA insertion was then performed by an experienced anaesthetist who was unaware of the concentration. Insertion conditions were noted as satisfactory (jaw relaxed, no coughing, gagging, swallowing or laryngeal spasm, minimal limb movement), excellent (no movement at all) or unacceptable if otherwise. RESULTS The CPRED50 and CPRED90 were 7.86 microg.ml(-l)[95% confidence interval (CI) 6.46-9.26] and 10.71 microg.ml(-l) (95% CI 9.31-12.12), respectively, in the satisfactory group and 10.86 microg.ml(-l) (95% CI 10.14-11.57) and 13.71 microg.ml(-l) (95% CI 12.99-14.42) in the excellent group when calculations were based on Kataria's pharmacokinetics. These figures were increased 1.5-fold when calculations were based on Marsh's pharmacokinetics. With Schuttler's pharmacokinetics, CPRED50 were 4.62 microg.ml(-l) and 13.66 microg.ml(-l) for satisfactory and excellent groups, respectively. CONCLUSIONS The target-controlled infusion technique for anaesthesia induction and insertion of the LMA was a safe and effective technique in our study.

(1) To study the use and diagnostic value, as a complement to ultrasound, of helical computed tomography (helical CT) to differentiate normal fetuses from cases of skeletal dysplasia; (2) to define the most relevant indications for helical CT; and (3) to evaluate its diagnostic performance with respect to radiological criteria considered discriminatory.This was a retrospective study from 2005 to 2008 in 67 pregnant women who underwent helical CT after 26 weeks of gestation for suspected fetal skeletal dysplasia due to fetal shortened long bones on ultrasound (≤ 10(th) percentile), either alone or associated with other bone abnormalities. The results were compared with pediatric examinations in 41 cases and with fetal autopsy findings after elective termination of pregnancy in the others.Helical CT had a sensitivity of 82%, specificity of 91% and positive and negative predictive values of 90% and 83%, respectively, for diagnosis of fetal skeletal dysplasia. An etiological diagnosis that had not been suspected at ultrasound was specified in 15% of cases and diagnoses suspected at ultrasound were confirmed in 24% and discounted in 43% of cases. The prevalence of skeletal dysplasia was increased in cases of micromelia3(rd) percentile or if there was a combination of bone signs. Helical CT showed 69% sensitivity in identifying individual predefined pathological bone signs which were confirmed on fetal autopsy findings.Helical CT is a key examination, in combination with ultrasound, in the diagnosis of fetal skeletal dysplasia from 26 weeks of gestation. It should be reserved for cases with severe micromelia below the 3(rd) percentile and for those with micromelia ≤ 10(th) percentile associated with another bone sign. A checklist of discriminatory signs is proposed.

The purpose of this study was to evaluate the health impact of working conditions at the Ruashi mine in the Katanga Province in the Democratic Republic of Congo.A cross-sectional etiological study was conducted in two cohorts including 100 miners and 109 students. Data necessary to allow comparison disease symptoms in the two cohorts were collected using a questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. A secondary analysis was performed to compare different mine workstations, i.e., diggers (n=61) versus non-diggers (n=39). Two logistical regression models were used to estimate adjusted OR and 95% CI for the association between occupation/workstation and disease symptoms.In comparison with students, miners exhibited higher frequencies for all symptoms even after adjustment. The highest ORs were observed for musculoskeletal disorders, i.e., low back pain (OR=36.5) and upper (OR = 20.7) or lower (OR = 18.3)] extremity pain. They were followed by respiratory disorders (OR = 5.91) and headache (OR = 5.34).The high exposure frequencies and OR's observed in this study underline the negative health impact of mine working conditions. Further occupational study will be needed to obtain and compare more data.

To determine the accuracy and precision of prenatal three-dimensional (3D) ultrasound in estimating fetal lung volume using the rotational multiplanar technique (VOCAL) by comparing it to postmortem volume measurements.Fetal lung volume was measured during 3D ultrasound examination using a rotational multiplanar technique in eight cases of congenital diaphragmatic hernia (CDH) (six left and two right-sided) and in 25 controls without pulmonary malformation, immediately before termination. Prenatal 3D sonographic estimates of fetal lung volume were compared with postmortem measurement of fetal lung volume achieved by water displacement.The intraclass correlation coefficient of fetal lung volume estimated by 3D ultrasound and measured at postmortem examination was 0.95 in CDH cases and 0.99 in controls. Based on Bland-Altman analysis, the bias, precision and limits of agreement were, respectively, 0.35 cm(3), 1.46 cm(3) and between -2.51 and + 3.21 cm(3) in cases with CDH and 0.08 cm(3), 2.80 cm(3) and between -5.41 and + 5.57 cm(3) in controls. The mean relative error of 3D ultrasound fetal lung volume measurement was -7.19% (from -42.70% to + 18.11%) in CDH cases and -0.72% (from -30.25% to + 19.22%) in controls, while the mean absolute error of 3D ultrasound fetal lung volume measurement was 1.40 (range, 0.71-2.52) cm(3) and 2.12 (range, 0.05-4.98) cm(3), respectively. Accuracy of 3D ultrasound for measuring fetal lung volumes was 84.86 (range, 57.30-99.48)% in cases with CDH and 91.38 (range, 69.75-99.45)% in controls. The mean intraobserver variability for lung volume estimated by 3D ultrasound was 0.28 cm(3) in controls and 0.17 cm(3) in CDH cases.Prenatal 3D ultrasound can estimate accurately fetal lung volume using the rotational multiplanar technique for volume measurements (VOCAL), even in fetuses with very small lungs, such as cases with isolated CDH.

The prevalence or hypertension increases with aging, reaching more than 50% in people aged 60 years and older. The increase of systolic blood pressure is a major risk of cardiovascular event.With the aim of assessing risk factors in old people "in apparent good health", we analysed blood pressure and treatments in people aged 60 years and older who had a periodic check-up that was adapted to older people.This check-up concerned, between April and December 2003, 1638 people with a mean age of 68 years (SD 5.7): 815 men and 823 women. Fourty percent had a systolic blood pressure (SBP)or=140 mmHg (44% of men, 36% of women); 6% (8% of men, 4% of women) had a diastolic blood pressure (DBP)or=90 mmHg. A treatment for hypertension was followed by 473 people: 31% of men and 26% of women. Fifty percent were controlled for the SBP and the DBP. Fourty-two percent were not controlled for the SBP, but were controlled for the DBP. Seven percent were not controlled for the SBP nor the DBP. Only 3 subjects (1%) were not controlled for the DBP, whereas they were controlled for SBP.These results, combined with data of literature on the predominant role of SBP in cardio-vascular risk, as compared with DBP, underline the need for a better treatment of systolic hypertension in older people.

To improve the current understanding of the etiology and natural history of primary lung cancer, we need to study the dynamic changes of clinical presentation and prognosis among a large number of patients with newly diagnosed lung cancer. In this report, we present the clinical features and survival rates up to 5 years of a patient cohort.We identified 5,628 primary lung cancer patients between 1997 and 2002 and followed them through 2003 using multiple, complementary resources.Of the 5,628 patients, 58% were men with a mean age at lung cancer diagnosis of 66 years, and 42% were women with a mean age at diagnosis of 64 years. Ten percent were50 years, and 8% were80 years at diagnosis. A tobacco smoking history was present in 89% of patients, and 40% were smoking at the time of diagnosis. The estimated overall 5-year survival rates of patients with non-small cell lung cancer (NSCLC) by disease stage was as follows: IA, 66%; IB, 53%; IIA, 42%; IIB, 36%; IIIA, 10%; IIIB, 12%; and IV, 4%. The 5-year survival rate of patients with small cell lung cancer was 22% for limited disease and 1% for extensive disease. Approximately 50% of all patients are participants in one or more research studies, and nearly 75% of these patients have donated biological specimens for research.The survival rate of this cohort of lung cancer patients was slightly improved compared with earlier reports, particularly for patients with low-stage NSCLC. Our patient and biospecimen resource has enabled us to obtain timely results from clinical and translational research of lung cancer.

Self-image is a central problem in alcoholism. Most theories about the relationships between the self-image of alcoholics and their behaviour have been derived from -clinical observations rather than empirical research. Most observations have pointed out that alcoholics are prone to underevaluation of themselves and that low self-image is the basis of much of the problem drinker's behaviour. All the research on self-image has concluded that alcoholics have a lower self-image than non-alcoholics. Some empirical research has been conducted on the self-image of alcoholics; it has, however, been carried out only a few times, restricted to small samples, and concerned with a limited number of aspects of self-image. Moreover, most of these studies are not recent, and it seems that this area of research is not well covered. Even though the hypothesis of a bad self-image in alcoholics was validated by various older studies, the representation of alcoholism has since changed. Because of this evolution, the ways in which the disease has been viewed have changed. One can question to what extent changes in society can influence the self-image of alcoholics. This question seems all the more pertinent for alcoholic women, given the evolution of the female condition since the Seventies. The objectives of this study are to evaluate the self-image of alcoholics and non-alcoholics, and to compare the self-image of male and female alcoholics. Our hypotheses are that: 1) the self-image of an alcoholic is more negative than that of a non-alcoholic, and that: 2) female alcoholics have a more negative self-image than male alcoholics. Two groups of 30 subjects each were made up: a group of alcoholics recruited in an alcohol-dependency unit and a group of non-alcoholics recruited in a public place. The comparison of socio-demographic data between the alcoholic group and the control group does not show a significant difference except for age and level of schooling. The average age of the control group is younger than that of the alcoholic group. The level of schooling of the control group is higher than that of the alcoholic group. These differences can be explained by the mode of recruitment of the participants. The significant differences between the alcoholic men and women are at the level of the number of Years of alcoholism, the age at which the disorder began and the number of detoxification episodes. These differences are probably due to cultural background. Indeed, the age at which alcoholism begins is later in women and they consult more quickly than men. The two groups were assessed using the Tennessee Self Concept Scale and the Self Esteem Inventory. Other tests were used to control factors capable of influencing self-image (depression, socio-demographic data). The results show that the alcoholics have a more negative self-image than the control group. The alcoholics perceived themselves significantly less favourably on the identity (what I am), self-satisfaction (how I feel about myself), and behaviour (what I do) scores than did those in the control group. The alcoholics also saw themselves in a significantly more negative light than did those in the control group on the scores relating to physical self (body, health.), moral-ethical self (moral worth), personal self (evaluation of personality), family self (adequacy and value as a family member) and social self (adequacy and worth in interaction with others). The self-criticism subscale provided further evidence that the alcoholics were more open and self-critical than were those in the control group. Female alcoholics had a lower self-image than male alcoholics, but not in every aspect. There was a significant difference between the scores of alcoholic women and alcoholic men, for three of the subscales measured by the Tennessee Self Concept Scale: "general self-image", "personal self" and "self-criticism". The alcoholic women perceived themselves more negatively when it came to "self-satisfaction", "personal self" and "social self". They were however more positive than the men in the sectors of "identity", "behaviour", "physical self", "moral-ethical self", and "family self". The alcoholic men were more openly self-critical than the alcoholic women. Our results confirm the conclusions of empirical studies and of clinical observations. Alcoholics see themselves as generally inadequate and unworthy of respect. The changes in representations of this disease seem to have influenced the alcoholic's self-image, but it remains however very negative. The alcoholics'negative self-image is generalised and not specific to personality and behaviour. The -representation of alcoholism seems to have contributed to an improvement in the self-esteem and self-image of alcoholics, and in particular of female alcoholics. Even if the self-image of alcoholic women remains more negative than that of alcoholic men, it tends to bring back the self-image of alcoholic women to a level close to that of the men.

Pericardial teratoma is a potentially curable lesion that may become life threatening when it induces mediastinal compression and fetal hydrops. So far, cases with fetal hydrops have been managed by elective delivery or pericardial needle decompression. We report a case in which pericardial teratoma resulted in fetal hydrops. Following transpleural needling of the fetal pericardium at 29 weeks and 6 days, pericardial effusion decreased but hydrops persisted, while major unilateral pleural effusion appeared. A thoracoamniotic shunt was placed at 30 weeks and 5 days. Hydrops resolved, although incompletely. The baby was delivered at 32 weeks and was operated upon on day 3. This observation suggests that fetal hydrops associated with pericardial teratoma may improve following thoracoamniotic shunting. Fetal therapy may limit the risks of respiratory distress arising from the combined effect of airways compression and lung immaturity.

Congenital erythropoietic porphyria (CEP) or Günther's disease is the rarest form of the porphyrias. The disease is usually diagnosed at birth or during early infancy, but rarely in utero. We describe here the first two cases of very early prenatal expression of CEP with cystic hygroma diagnosed at 14 weeks in the first fetus and at 19 weeks in the second. Both fetuses presented with severe nonimmune hydrops fetalis as early as 19 and 22 weeks, associated with intrauterine growth retardation, hyperechogenic kidneys and bones. Amniotic fluid was dark brown and uro- and coproporphyrin I was dramatically increased. Molecular screening of the CEP gene detected heterozygous C73R mutation in both fetuses, the other parental mutation being as yet unknown.

Fetal ultrasound examination at 13 weeks of gestation demonstrated a homogeneously echogenic protrusion, or tail, 7 mm in length, in the sacral region. At 15 weeks, the ultrasound appearance was consistent with a regression of the tail and by 21 weeks it had completely disappeared. Severe intrauterine growth restriction with reduced uterine blood flow was diagnosed at 21 weeks and intrauterine death occurred at 24 weeks of gestation. Postmortem examination revealed a 4-mm caudal appendage which contained no vertebrae on radiography. The appendage was located under and behind the last sacral vertebra suggesting a true vestigial tail with a delayed process of regression.

Defective DNA mismatch repair (MMR) appears to be rare in nonsmall cell carcinomas of the lung. Defective DNA MMR results from genetic or epigenetic alterations that inactivate the DNA MMR genes hMLH1 or hMSH2, and rarely hMSH6. The loss of normal DNA MMR is thought to promote tumorigenesis by accelerating the accumulation of mutations in oncogenes and tumor suppressor genes. Inactivation of hMLH1, hMSH2, and hMSH6 is observed as a loss of expression of these proteins by immunohistochemistry. Bronchioloalveolar carcinoma is a subtype of adenocarcinoma with distinctive clinical and pathologic features.An immunohistochemical study was performed on paraffin embedded sections of 33 bronchioloalveolar carcinomas (20 nonmucinous and 13 mucinous) for hmlh1, hmsh2, and hmsh6 proteins. RESULTS All the tumors showed normal expression of hmlh1, hmsh2, and hmsh6.These findings suggest that defective DNA MMR due to inactivation of hMLH1, hMSH2, or hMSH6 does not play a significant role in the pathogenesis of bronchioloalveolar carcinomas.

Diffuse pulmonary hemorrhage is an uncommon presenting manifestation of angiosarcoma.To review the clinical, radiologic, and pathologic findings of patients with metastatic angiosarcoma who presented with diffuse pulmonary hemorrhage.Patients fulfilling inclusion criteria were identified from the consultation files. Clinical and radiologic data were obtained from referring pathologists. Histologic slides were reviewed in all patients.Our patients included 6 men and 1 woman, aged 31 to 73 years; 4 patients were younger than 40 years. Six patients presented with hemoptysis, and all had diffuse abnormalities on radiographic studies. Clinical considerations prior to biopsy included pulmonary hemorrhage syndrome (n = 2), acute respiratory failure (n = 1), and infection (n = 1). Metastatic disease was included in the differential diagnosis in only 1 patient. None had a diagnosis of malignancy prior to lung biopsy. All biopsies showed hemorrhage associated with atypical epithelioid and spindle cells, forming anastomosing vascular channels, distributed along and within lymphatics and arteries. Neoplastic cells were immunoreactive for factor VIII-related protein or CD31 in all cases for which special stains were available. Three patients with complete follow-up died of their disease. Primary sites were discovered in all 3 patients who underwent autopsy examination. Two tumors arose in the heart and 1 in the pelvic soft tissues. One additional patient had a likely primary site identified in the right atrium by cardiac ultrasound and was subsequently lost to follow-up.Angiosarcoma should be included in the differential diagnosis of diffuse pulmonary hemorrhage, especially in young adults.

We present an antenatal ultrasonographic diagnosis of the cerebro-costo-mandibular syndrome. This rare dysmorphic disorder (only 51 cases have been reported to date) mainly associates defective costal development with features of the Pierre-Robin syndrome. The diagnosis is very often made at birth and the prognosis is very poor. Antenatal ultrasound examination may show a combination of orofacial and chest maldevelopment. In our case the diagnosis was made at 20 weeks' gestation during a routine ultrasound examination and the patient chose to terminate the pregnancy at 24 weeks.

The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is usually established on the basis of clinical, serologic, and radiologic criteria, of which eight are commonly cited. Although histologic abnormalities are not usually considered, a study of lobectomy/lung biopsy specimens provided evidence that the combination of mucoid impaction of bronchi with "allergic" mucin and fungal hyphae is diagnostic of ABPA. We attempted to explore the use of surgical specimens in the diagnosis of ABPA by examining endobronchial biopsy specimens and washings. Bronchial biopsy specimens obtained from 1990 to 1995 that contained fungal hyphae were reviewed and assessed for the presence of "allergic" mucin and bronchial wall abnormalities. We also reviewed cytologic specimens and clinical, serologic, and radiologic findings of the corresponding patients. Five biopsy specimens had fungal hyphae and associated "allergic" mucin. In some patients, the mucin was small in amount and contained degenerated eosinophils that resembled macrophages. None of the patients was thought to have ABPA clinically. All of the five had bronchial mucoid impaction at bronchoscopy. After additional investigation, only one patient fulfilled all of the eight traditional criteria for ABPA; one other patient fulfilled six criteria. Although some tests were not completed in the remaining three patients, follow-up and/or response to steroids was consistent with ABPA in all of the three. Four patients had bronchial washing performed at the time of biopsy. Cytologic examination showed one to be normal except for inflammatory cells that did not include eosinophils; three others showed mucus containing eosinophils intermixed with Charcot-Leyden crystals and scattered hyphae. We conclude that patients with ABPA might have atypical manifestations of disease and not meet standard diagnostic criteria. Bronchoscopy with bronchial biopsy and washing plays a role in detecting these patients. The presence of "allergic" mucin might be overlooked in the small biopsy fragments obtained by bronchoscopy.

The aim of this study, based on data of the Centre for Preventive Medicine, is to compare the perceptions women have of their health within a population of pregnant women that was divided into two categories: one group of women who feel they are in a poor health, the others feel they are in good health. The study results seem to differentiate between both the psychological and physical profiles of the two groups of pregnant women. The women who are not followed by a doctor don't seem to have a more negative perception of their health status. It seems, in addition, that the negative perception of health status has not only psychological roots, but also behavioural and environmental ones.

Conjoined (siamese) twins represent a rare situation which may occur in 1 of every 50,000 births. A prenatal diagnosis usually leads to stopping pregnancy. We report a case with successful surgical separation at the age of 15 days.Ultrasonographic examination at 20 weeks of gestation showed omphalopagus siamese joined at the abdomen from the xiphoid process to the umbilicus. Conjoined structures included liver. There was a multicystic right kidney in one twin, without other malformation. Karyotype was normal, 46XX. The mother refused interruption of her pregnancy. Both girls were born by cesarean section. Angiography, magnetic resonance imaging and intravenous urography confirmed the ultrasound examination. There was no cross circulation into the liver and the gastrointestinal tract was not conjoined. The twins were separated at 15 days of age with right heminephrectomy of the multicystic kidney. The girls are now 16 months old and are in very good health.Prognosis of siamese twins depends on the nature of joined structures and presence of malformations. Ultrasonographic examination during pregnancy shows the possibility of surgical separation, which is performed by a double anesthetic and surgical pediatric team. Preoperative investigations must include MRI.

To investigate the ability of fetal urinalysis to predict in utero the renal function of children with bilateral uropathy who survive to the second year of life.This was a prospective cohort study of 100 consecutive patients with prenatal diagnosis of bilateral uropathy who underwent fetal urine sampling. Fetal urinary concentrations of sodium, chloride, calcium, phosphorus, ammonium, urea, creatinine, glucose, proteins, and beta 2 microglobulin were measured. Prenatal findings were matched with renal function of survivors at 1-2 years. The single end point was serum creatinine, which was considered abnormal when greater than 50 mumol/L (0.56 mg/dL) during the second year of life.Elevated serum creatinine was found in 17 of 42 children with isolated uropathy who survived more than 1 year. For prediction of elevated serum creatinine during the second year of life, the fetal urinary concentration of beta 2 microglobulin was both specific (0.83) and sensitive (0.80); sodium, chloride, and urea levels were sensitive (0.70 or greater) but lacked specificity (less than 0.65); and fetal urinary glucose, phosphorus, calcium, ammonium, and total proteins were specific (0.70 or greater) but lacked sensitivity (0.65 or less).Our results provide a new approach to prenatal management of congenital obstructive uropathies by identifying those fetuses at risk for survival with suboptimal renal function. These fetuses might benefit from intrauterine therapy. In contrast, no attempt at prenatal uro-amniotic shunting should be made when a spontaneously good outcome is predicted by fetal urinalysis.

Magnetic resonance imaging (MRI) of the hypothalamic hypophyseal area was performed in seven children with multiple hypophyseal deficiency including growth hormone deficiency. In all cases stalk transection syndrome was found. In four cases MRI showed cranial or cerebral malformations. Perinatal asphyxia was found in only one child, and congenital hypopituitarism was present in two cases. The discussion focuses on the mechanisms that might be responsible for this syndrome. The malformation theory, while not taking into account all situations, seems to be the most appropriate, the reasons being the MRI finding and the patients' case histories.

Knowledge, behavior and attitudes towards cancer were studied by submitting a questionnaire to 247 adolescents and young adults aged 16-24 yr who attended the Vandoeuvre-lès-Nancy Centre of Preventive Medicine. Results of this enquiry showed that these young people were aware of the significant mortality rate by cancer but that they had a poor knowledge of risk factors, early symptoms and screening methods. For 70.4 percent of subjects, cancer was a source of concern and the majority expected society or doctors to provide them with information. The role of the medical practitioner in this health education is discussed.

Having seen 87 cases we will now attempt to refine the management to be carried out when intra-abdominal hyperechogenic masses are found in the fetus. Before the 20th week of amenorrhoea (47 cases) amniocentesis can be used to study the digestive enzymes to determine the fetal karyotype. The normal results for intestinal enzymes makes it possible to rule out fetal cystic fibrosis. Three karyotype abnormalities were found in this series. After the 20th week (40 cases) intestinal enzymes cannot be interpreted. The diagnosis of cystic fibrosis then must rely on Delta F 508 mutation; but the absence of this mutation does not exclude cystic fibrosis. When ultrasound signs of intra-abdominal hyper-echogenicity are found the diagnosis of cystic fibrosis should not be thought of first, because in this series the majority of fetuses who had this sign were born without any malformation. Four cases of cystic fibrosis that were confirmed have been found but equally there were other serious malformations, three chromosome abnormalities, four intestinal atresias, ten unexplained intra-uterine deaths and one case of biliary duct atresia.

In populations at risk or, more often, fortuitously during routine examination, ultrasonography makes it possible to diagnose a fairly large number of facial abnormalities. The most frequent of these are microphtalmos, hypotelorism (often as part of holoprosencephaly), hypertelorism and cleft lip. It these abnormalities can be isolated, they may belong to various polymalformative syndromes. Cervicofacial tumours can also be detected, but in utero their histological type can only be suspected and the possibility of surgical treatment is difficult to evaluate.

Although breast cancer in women over 50 years of age can be detected by physical examination and mammography, in our region many women of that age do not benefit from a satisfactory breast surveillance: 52.4% of women who had a general check-up between February and May 1989 have their breast examined by a physician once a year or more often; only 30% had a mammography less than three years ago; 34.2% examine themselves at least once a month. Overall, only one out of four women aged over 50 is under satisfactory breast surveillance; this small group of women is characterized by a personal history of breast disease or a family history of breast cancer. Women aged between 50 and 59 years tend to have more regular breast examination than older women. Social or geographical particularities do not seem to provide a significant explanation.

Arterial blood pressure was determined by the method of Korotkoff in 394 men and 1647 women. The mean values for men were 139/88 and for women 131/83. Arterial hypertension was found in 17.68% of the cases. A direct relationship was found between obesity and hypertension in both sexes. However, no correlation was found between obesity or cigarette smoking and mean arterial pressure. A significant interaction between hypertension and other risk factors (obesity and cigarette smoking) was found.

Left percutaneous nephrostomy was performed in a 30-week foetus with bilateral hydronephrosis due to abnormal pyelo-ureteral junction. Puncture of the pelvis and insertion of a 5 cm long F8 Malecot catheter were carried out under ultrasonography. The end of the catheter was left free in the amniotic fluid. Drainage was perfect during 3 weeks, until the skin of the foetus grew over the end of the catheter. At 34 weeks, a much longer catheter was introduced, but it was dislodged from the kidney within 48 hours. Vaginal delivery was induced at 37 weeks, giving birth to a normal male child. On the 4th day after birth the catheter was removed and resection-anastomosis of the left pyelo-ureteral junction was performed.

The authors expose their results in the field of prenatal diagnosis of renal and urinary tract malformations. They describe normal and abnormal ultrasonographic aspects of kidneys, ureters and bladder with special reference to prognosis and therapeutic decisions.

The public's knowledge and attitude concerning cancer were studied in 1,422 subjects aged 16 to 65 who attended the Center of Preventive Medicine in Vandoeuvre-les-Nancy during the first months of 1988. There was an obvious lack of knowledge about predisposing factors and early symptoms of colorectal cancer with important differences between age groups and socio-educational levels. Only 40% of the population knew at least one risk factor for this cancer (food) or an early symptom (generally bleeding), one out of three subjects was able to quote a screening method (fecal occult blood test, radiology, endoscopy). The public's knowledge about early detection of colorectal cancer must be improved. Each practitioner should fell concerned and involve himself in health education in order to improve the prevention of this cancer, by modifying the public's attitude toward risk factors and early diagnosis of colorectal cancer.

Some multisystemic abnormalities associations which can be found by ultrasound examination are sometimes chromosome anomalies and amniocentesis must be performed for confirmation. By ultrasonography we can now reach a new objective element: the fetus extremities. Limbs anomalies, such as polydactily, club-feet and/or club-hands must lead to perform amniocentesis in order to assess or not a possible 13 or 18 trisomy.

Ventilatory function (forced vital capacity, forced expiratory volume in one second, forced expiratory flows), static lung volumes, phase III slope and closing volume (single-breath nitrogen washout test) were measured in 499 children and adolescents aged 10-16 yrs from a general population sample in North-East France. A history of whooping cough was given by 44 children (22 of each sex); their results were compared to those of the 455 children (215 girls) with a negative history. The only difference between the two groups was a minimal increase in the residual volume/total lung capacity ratio in cases (19.2 +/- 3.1 vs 18.0 +/- 2.9%). We conclude that uncomplicated whooping cough in early childhood did not lead to significant pulmonary function abnormality in this population of children born after 1967.

Since 1979, thanks to high level ultrasonography systematic ultrasonic examinations between the 18th and the 22nd week of pregnancy have permitted to prediagnose limb and extremity abnormalities. Embryoscopy and foetoscopy can be used as additional techniques. This paper reports the activity results of the Port Royal Maternity hospital, between 1979 and 1983. In this hospital's Prenatal diagnosis Center, ultrasonographists, obstetricians, geneticists, surgeons, pediatricians and foetopathologists work together fruitfully. 16 limb abnormalities and 14 extremity abnormalities were detected there. We describe the circumstances of their detection, the diagnostic methods used, and the obstetrical attitude chosen.

During the Summer of 1987, interviews were carried out with 33 pregnant adolescents followed at the Nancy regional maternity hospital, in order to improve the knowledge of the present determinants of pregnancy in teens. These adolescents were mostly French, born in unfavourable classes; virtually all had school failure and no professional qualification. In one third of them, pregnancy was accidental and could appear as a further social handicap for these isolated and unemployed adolescents. However, two thirds of these future mothers declared that they had desired their pregnancy, most often within a steady and gratifying couple relationship.

The antenatal diagnosis of holoprosencephaly seems to need study of the interhemispheric fissure which may or not be complete in lesser degrees of that disease, but also measuring of interorbital distance (I.O.D.) and I.O.D./B.P.D. (biparietal diameter) ratio. The two last parameters show the constant hypotelorism. These measures may be useful in all fetal congenital deformities which include facial dysmorphy with modification of the interorbital distance.

At the request of its inhabitants, an epidemiological survey was conducted among the children of Carling, a particularly polluted industrialized town in the department of the Moselle in North-East France. Contrary to all expectations, no major toxic effect of industrial pollution on the respiratory health of the children was found. There was some correlation between the fact of living in a polluted area and a claimed respiratory morbidity. However, the potentially harmful effect of atmospheric pollution could not be translated in terms of abnormalities of respiratory function. In contrast, a significant effect of the smoking habits of the parents, and particularly of the mothers, on respiratory symptoms and spirographic data of their children was observed.

The authors report four cases of Bonnevie-Ullrich's syndrome where the diagnosis was made by ultrasound. The typical picture is of a cystic retrocervical hygroma with generalised lymphoedema which is more marked in the lower limbs and on the backs of the hands and feet, together with ascites. This syndrome adds up to Turner's syndrome. The diagnosis was definite in one case because it was confirmed by amniocentesis with monosomy X caryotype. It is very likely that the three other cases were the same because the anatomo-pathological features of the external and internal genital organs showed that the baby was feminine. In two cases raised alpha-foetoprotein was found. The levels were 1000 micrograms/ml and 2100 micrograms/ml and the authors discuss the origin of the alpha-foetoprotein. It is advisable to terminate the pregnancies in these major forms of Turner's syndrome because they usually die in utero (in two cases) at different stages of the pregnancy.

The impact on the respiratory system of complex industrial pollution (dust, sulphur dioxide, nitrogen oxides, hydrocarbons) was assessed by an analytical epidemiological study in a population of school children in the northeast of France. The parents of 375 children aged from 9-12 (middle school course 1 and 2) from the polluted zone and 523 children of the same age in a neighboring zone which was not polluted have filled in standardised questionnaires (respiratory symptoms, previous infections and allergies, frequency of infection in infancy; tobacco habits, professional and educational attainments of the parents, domestic environment). In the exposed children the majority of respiratory symptoms were more frequent (e.g., respiratory sounds in the boys, 15.6% against 7.9% p less than 0.01) and the absenteeism from school was more numerous (66.9% against 59.1% p less than 0.01). However, the interpretation of the results had to take into account the existence of confusing factors: parental smoking habits and the use of coal fires increased the prevalence of symptoms in the polluted zone, whereas a less crowded population worked in the inverse direction; likewise the educational level of the parents was higher in the polluted zone. After adjusting for these confusing factors, the frequency of rhinitis and absenteeism from school was significantly higher in exposed children.

Respiratory function (forced vital capacity-FVC; forced expired volume in one second-FEV1; maximal mid-expiratory flow-DEMM; peak flow-DP; maximal expiratory flow at 75-50-25% of vital capacity CV-DEMx) was studied in children of comparable age, sex and height (9 to 12 years) in a polluted zone (the exposed group n = 223) and a neighboring non-polluted zone (the control group n = 211) in the north of Lorraine. There was no significant difference in ventilatory function between the two groups. Amongst other factors capable of influencing the ventilatory function in the children we found an influence of parental smoking habits (particularly the mothers) identifiable in the non-exposed zone, above all in boys. A sub-segment analysis identified that in the absence of parental smoking, there was a negative influence of open coal fires. The discordance between the results of the measures of respiratory function and the prevalence of different respiratory symptoms, of acute infections and absenteeism from school, is probably explained by the interference of other factors which were not controlled in this study (e.g., ethnic factors and physical activity) and by the moderate level of the pollution; an over-reporting of respiratory symptoms by parents in the exposed zone could not be excluded.

International audience; Some of the 12 criminal trials and sentences in France for HIV transmission in 1998-2011 attracted substantial public attention , with a possible negative impact on people living with HIV (PLWH) through reinforced stigma and discrimination. This analysis aimed to characterize PLWH enrolled in the representative ANRS-VESPA2 survey, aware of and concerned about convictions for HIV transmission. Being a migrant from Sub-Saharan Africa, having difficult socioeconomic conditions, having unprotected sex with one's main partner and concealing one's HIV status were all factors statistically associated with concern about the sentences. Participants tempted to press charges against someone for infecting them were more likely to be younger, women, not living in a couple, unemployed, and to report a major depressive disorder. Concern about HIV-related criminal proceedings among the most vulnerable PLWH do not reflect the actual risk of prosecution they are exposed to. Resumen En Francia, algunos de los 12 juicios y sentencias relacionados con la contaminación del VIH en 1998-2011 suscitaron con-siderablemente el interés público. Esto pudo impactar negativamente las personas viviendo con VIH (PVVIH) aumentando su estigmatización y discriminación. Este análisis busca caracterizar las PVVIH, de la encuesta ANRS-VESPA2, informadas acerca de esos juicios e inquietos por la posibilidad de implicación en uno de ellos. Ser inmigrante subsahariano, las con-diciones socio-económicas desfavorables, las relaciones sexuales no protegidas con la pareja principal, y ocultar el VIH, están asociados a la posibilidad de ser implicados en un juicio. Por otro lado, aquellos que han intentado presentar cargos por contaminación del VIH fueron mayoritariamente jóvenes, mujeres, personas viviendo solas, desempleados, y personas en depresión. Los juicios por contaminación del VIH entre las PVVIH más vulnerables no reflejan el riesgo de acusación al que están expuestos.