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cited By 56; International audience; An organotin speciation method was optimized for the simultaneous determination of mono-, di- and tri-butyltin compounds and mono-, di- and tri-phenyltin compounds in water. The procedure was based on a one-step simultaneous ethylation and extraction using the sodium tetraethylborate reagent directly in the aqueous phase in the presence of an isooctane layer. Direct extract analysis was performed using capillary gas chromatography and flame photometric detection (GC-FPD). This derivatization procedure reduces drastically the number of analytical steps, thus saving time and improving reliability. Relative detection limits range from 0.4 to 0.8 ng dm-3 for butyltin species and from 0.7 to 2.1 ng dm-3 for phenyltin species; the linearity ranges from 0 to 400 ng dm-3 Analysis of environmental aqueous samples and a Certified Reference Material (CRM) demonstrates the accuracy of the analytical method.

Mass treatment of onchocerciasis has changed radically in the last 20 years. With implementation of the Onchocerciasis Control Programme (OCP), use of insecticides to control vector larvae has been effective but has not been extended to all infected areas due to the cost. The consequences of this problem have been lessened thanks to ivermectin, an effective drug that can be administered in a single yearly dose. Although ivermectin does not appear to induce major side-effects, surveillance is necessary after administration in polyparasitized subjects living in zones where loaiasis is present and in hypermicrofilaremic subjects. To assist in the fight against onchocerciasis, ivermectin is distributed free of charge through the Mectizan Foundation by Merck Laboratories. Inexpensive community distribution programs with active participation of the populations at risk have demonstrated their usefulness. The results of mass treatment through the Mectizan Foundation have been excellent. Non-governmental organizations and in particular the Organization for the Prevention of Blindness (OPB) have become increasingly involved in the fight against onchocerciasis. The campaign conducted by the OPB in Mali, Senegal and Guinea illustrate this involvement. The role of non-governmental organizations expanded greatly with the implementation of the APOC programme supported by the World Bank.

Introduction Il est actuellement decrit de nombreux roles extra-osseux de la vitamine D. Elle pourrait notamment etre impliquee dans la physiopathologie du diabete de type 2. L’obesite, facteur de risque majeur d’insulinoresistance, est egalement associee a des deficits en vitamine D parfois tres severes. Cette etude a pour but d’etudier les liens entre statut vitaminique D et insulinoresistance chez le sujet obese. Patients et methodes Il s’agit d’une etude observationnelle retrospective portant sur 943 patients avec un IMC median de 38,9 kg/m2. L’insulinoresistance est evaluee par le HOMA-IR. L’exposition de la population aux UVB est egalement prise en compte. Les liens entre 25 (OH) D, IMC, exposition theorique aux UVB et insulinoresistance ont ete etudies en analyses categorielles et lineaires. Resultats L’IMC (r = − 0,38, p Le niveau d’insulinoresistance est inversement correle a l’exposition theorique aux UVB de la population. Il existe une relation lineaire inverse entre 25 (OH) D et insulinoresistance et cette relation est independante des parametres anthropometriques (IMC, leptine) et du niveau d’exposition aux UVB. Discussion Ces resultats, mis en perspectives avec les donnees physiopathologiques de la litterature retrouvant une action moleculaire de la vitamine D sur les voies de signalisation insulinique, nous permettent d’evoquer un role direct du deficit en vitamine D dans l’insulinoresistance des sujets obeses faisant de cette vitamine l’un des mediateurs potentiels des variations saisonnieres de l’insulinoresistance. Ainsi, le deficit en vitamine D est en theorie une cause reversible d’insulinoresistance chez le sujet obese. Une etude prospective d’intervention visant a evaluer l’efficacite d’une supplementation vitaminique D dans le traitement de l’insulinoresistance du sujet obese est en preparation.

OBJECTIVES--To determine whether beta carotene is therapeutically equivalent to retinyl palmitate in the formulation currently recommended by the World Health Organisation. DESIGN--Randomised blind equivalence trial. SETTING--Rural area in Senegal. SUBJECTS--Children aged 2-15 years suffering from vitamin A deficiency as defined by abnormal results on eye cytology were randomly allocated treatment with retinyl palmitate (n = 256) and beta carotene (n = 254). MAIN OUTCOME MEASURE--Reversion to normal results on eye cytology as defined by the reappearance of goblet cells and normalisation of the epithelial cells. RESULTS--Seven weeks after the supplement was given the percentages were 51.2% (124/242) children taking retinyl palmitate and 50.0% (123/246) of those taking beta carotene, who had reverted to normal eye cytology, a difference of 1.2% (95% confidence interval 6.2% to 8.6%) [corrected]. According to an equivalence testing procedure, the two treatments were statistically equivalent; the null hypothesis of non-equivalence was rejected (one tailed p value = 0.03). CONCLUSIONS--beta Carotene supplementation seems to be a promising candidate for the alleviation of vitamin A deficiency. It could be given either as high dose capsule or through increased dietary intake. The challenge now is to improve dietary intake of vitamin A in programmes that are effective and sustainable at the community level.

The historical background to angioscopy shows that the principal successes recorded by its use result from the miniaturization of fibroscopes and the progress in video imaging. The first tentative use of angioscopy was by surgeons during operations carried out at about 1970, that of percutaneous angioscopy dating from 1984. The material used for diagnostic (fibroscope, cinecamera, video system, flushing pump) and interventional (fibroscope, clamps, Dormia cage, endoprostheses ... ) angioscopy is such that the basic equipment requires an outlay of about 150 to 200,000 francs. Percutaneous angioscopy implies the insertion of a catheter allowing flushing of the arterial lumen by means of a pressurized perfusion pump which, when reversed, is transformed into an aspirating pump for removal of the clot and/or atheromatous debris. The procedure is simple and does not expose to more complications than conventional arteriography.

Since 1987, routine angioscopic examination has been performed in 191 patients undergoing angioplasty, with interventions (196) after a 2 year surveillance period (55). Angioscopy allowed follow up "de visu" of the performance of angioplasty, details of its mechanism to be precise and under dilatation to be carried out. For femoral artery occlusions it allowed treatment "à la carte": conventional dilatation of vegetating atheroma, specific treatment of established thrombi (5) and abstention from therapy of atheroma covered by endothelium (3). It also enabled fresh thrombi complicating a stenosis or at the origin of a thrombus to be detected. The extraction technique employed (15) is described. It facilitated catheterization by directing the probe, enabled avoidance of bypassing of stenosis and flaps and of dissection or false introduction into collaterals (10). Directed biopsy could be carried out in inflammatory arteritis (7). Vegetating atheromatous lesions could be opened and extracted, facilitating subsequent dilatation and allowing an approach to removal of iliac artery obstructions without major risks of complications (13). Finally, after an ineffective dilatation or the presence of a dissection, it assisted making the decision to introduce a stent (9), the tolerance and outcome of these stents are described. Or the 196 patients considered suitable for angioplasty, our therapeutic conduct was modified by angioscopy in 58 cases (29%). Not simply a new diagnostic tool, it plays a role in interventional vascular techniques.

Efficacy of percutaneous treatments of arterial affections requires the correct choice of indications, necessitating precise knowledge of elementary arterial lesions. Arterial endoscopy appears to be more specific than angiography for this use, since it allows direct vision in vivo of the lesion, a histopathologic approach compared with the non univocal images produced by angiography (for example, an arterial obstruction can result from varied causes). Different accidents to the endothelial surface can be observed: golden yellow atheromatous elevations on a straw yellow background, intimal flaps, mobile intra-luminal vegetations. Established atheromatous stenosis are smooth and regular, or on the contrary ulcerated and edged with irregular flaps capable of provoking an eccentric residual lumen. The vegetating atheromatous lesions may project into the lumen, often as calcified and thus pearly white scales adhering to the wall, or as larger occlusive lesions. When capable of being isolated, a thrombus often completes the stenosis: its recognition is therefore fundamental since its removal exposes the subjacent lesions to be treated. The fresh clot is coral shaped, bright red and mobile in the blood flow. Established clots are compact and greenish brown. At an advanced stage of atheroma the surface of the occluding clot is covered with a regular straw yellow endothelium. In the presence of a dissecting vessel the fibroscope may be introduced into the false channel, no longer showing typical endothelium but a coagulated mass interspersed with fibrous bands. Prosthetic stenosis result from either intimal hyperplasia or a suturing fault with plication.

The increasing importance of vitamin A deficiency in even its mild subclinical form underlines the need for a mass screening test. Clinical, biochemical and cytological methods of assessing vitamin A deficiency in a public health setting have been described and widely used. The cytological method shows promise because it enables early detection of vitamin A deficiency. However interpretation is problematic since histopathological changes are gradual with the progressive disappearance of goblet cells and appearance of enlarged epithelial cells. The reliability and validity of the impression cytology with transfer (ICT) test were assessed in order to produce a meaningful standard for this cytological method. The ICT test was performed in Senegal on 1451 children, in the course of two surveys conducted in 1989 and 1990 in rural areas. Reliability, estimated by Cohen's kappa test for evaluating intra-reader variability, and sensitivity were highest for the abnormal-normal classification (kappa = 0.91; 95% confidence interval (CI): 0.89-0.93; and sensitivity = 74%; 95% CI 66-82%). The ICT method is a cheap, noninvasive and easy test to perform in the field. This method is also reproducible and fairly sensitive according to the abnormal-normal classification. As illustrated by our proposed 50% cutoff of abnormal cytology calculated in relation to 5% of serum retinol values below 0.35 mumol/L criterion, ICT only requires a small sample for the assessment of the overall health of a community in contrast to xerophthalmia and blood vitamin A deficiency tests.In Senegal an ophthalmologist conducted eye examinations on 192 preschool children from 2 rural villages in Niakhar district in the Diourbel region in April 1989 and on 1259 preschool and school age children from 30 rural villages from Malicounda community in the Thies coastal region in February-March 1990 to assess the reliability and validity of the impression cytology with transfer (ICT) test as a field indicator of vitamin A status. Researchers also intended to standardize the cytological results. Cohen's kappa test revealed almost perfect agreement between the observed and expected interpretations of the conjuctival imprints for the classification abnormal-normal (kappa=0.91; 95% confidence interval [CI] for ICT=0.89-0.93). Thus the ICT test was reliable. Serum retinal concentrations indicated that the ICT test was specific for the deficient-nondeficient classification (serum retinal concentrations [SRC]=96%; 95% CI 93-97%) and fairly sensitive for the abnormal-normal classification (SRC=74%; 95% CI=66-82%). These serum retinal concentration results indicated that the ICT test was valid. The researchers proposed 2 classifications--normal and abnormal--to increase reproducibility of the ICT test. Since the ICT test can detect insufficient peripheral supply of vitamin A to the eye at an early stage and has only a 50% cut off, the ICT test can determine the public health of a community with only a small sample. Further the ICT test is a reproducible diagnostic test that is inexpensive, noninvasive, and easy to perform in the field.

In a countrywide survey, we assessed the prevalence of vitamin A deficiency by clinical examination and impression cytology with transfer method (ICT) in a randomized sample of 2445 subjects representative of the population of the Republic of Djibouti. A plasma retinol determination was made on a part of this sample. Results lead to believe that serious vitamin A deficiency may periodically occur in Republic of Djibouti when nutritional conditions become poor. Meanwhile a large number of children, mostly in the rural area, have a marginal vitamin A status and are exposed to a high level of risk.

The changes in the vitamin A and nutritional status of children from a rural area in Senegal were determined by the same team during two cross-sectional surveys distant from exactly one year. At baseline (T = 0 year) 1,259 children were chosen at random. One year later (T = 1 year), 1,008 children were re-examined. Vitamin A and nutritional status were assessed by clinical and cytological methods, and by anthropometrical indicators for the 1,008 participants, respectively. No signs of xerophthalmia were recorded at T = 0 and T = 1 year. The proportions of children deficient in vitamin A as defined by abnormal cytology and suffering from stunting were similar at these two measuring points. Even though these percentages remained similar at T = 0 and T = 1 year, there existed little movement between the abnormal and normal eye cytology group and the stunted and non-stunted group. Since vitamin A is required for normal growth, we calculated the mean linear gain in height according to the eye cytological changes assessed between the two examinations. We found that mean linear growth increments were higher in the groups of children who remained abnormal or reverted to abnormal cytology than in those who remained normal or reverted to normal cytology.

The increasing concern about vitamin A deficiency in even its mild subclinical form has created the need for a mass screening test. Various clinical, biochemical and cytological methods for assessing the vitamin A status have been widely used but all are unsatisfactory for technical, ethical or public health reasons. The two prevalence criteria defined by the World Health Organization (WHO) for a vitamin A deficiency problem of public health significance are xerophthalmia and serum retinol concentrations. Recently we proposed a prevalence criterion for impression cytology with transfer (ICT) at the level of 50% of ICT results being abnormal. We conducted a cross-sectional survey of the prevalence of vitamin A deficiency and also undernutrition during the dry season in a random sample of 1,259 children (n = 442 for the 2-6 years and n = 817 for the 7-14 years) from a rural area in Senegal. Prevalence was 0 times and 4.2 times the WHO criteria for xerophthalmia and deficient serum retinol levels, respectively in preschool children. Abnormal ICT results were more frequent in preschool than in school children (53.4% versus 21.0%). There was an association between abnormal ICT results and stunting. Vitamin A deficiency was a public health problem in preschool children as assessed by the biochemical criterion (20.9% of serum retinol values under 0.35 mumol/l) or the cytological cut-off (53.4% of abnormal ICT results) but was also found in school children (21.0% of abnormal ICT results).

The purpose of our study was to determine the prevalence of protein-calorie malnutrition (PCM), ocular diseases, and vitamin A deficiency in preschool children selected at random in a rural zone of the groundnut belt of Senegal. The prevalence of PCM was 37.1% (95% CI 33.8-40.2%) according to the Waterlow classification, with a majority of stunting, and prevalence of hypovitaminosis A was estimated to be 11.4% (95% CI 9.3-13.5%) by using impression cytology. Furthermore, 19.4% (95% CI 15.8-22.0%) of the children might be defined at risk of deficiency. The prevalence of Bitot's spots was equal to 0.2% (95% CI 0.03-0.9%). A problem of PCM associated with a health-endangering vitamin A deficiency existed.

Vitamin A is an essential nutrient for man and animals. The long-term lack of an adequate supply of vitamin A or its precursors leads to the appearance of disorders of increasing gravity. Ultimately, the subject becomes blind and then dies. Vitamin A deficiency is a major problem in public health. It is serious because it is the primary cause of blindness throughout the world; it is serious because partial or total blindness is a burden not only for the individual but also for the community; it is serious because it affects children first and foremost and is one factor increasing infant morbidity and mortality.

Two hundred and six Senegalese preschool children included in an epidemiological study were selected by their results from impression cytology with transfer (ICT) for assessment of their nutritional state by means of biological variables and for assessment of the diagnostic values of the ICT. A problem of protein-calorie malnutrition existed (transthyretin and retinol-binding protein concentrations were low) associated with vitamin A deficiency (retinol concentrations were low). The sensitivity and specificity of the ICT defined with respect to retinol (threshold fixed at 0.35 mumol/L) varied with the classification criteria of ICT and seemed to be fairly insensitive but specific.

Because of the poor specificity of the arteriography, the authors have performed a percutaneous angioscopy before every angioplasty of the arteries of lower limbs for nearly 3 years. They define the angioscopy and describe materials and technique. The percutaneous route without surgery and without anesthesia underlines the originality of the technique. The great difficulty is to counter-pulse the arterial inflow. The rate of saline irrigation and all the means of arterial blockade are described. In the second part, the "elementary images" are classified. The authors insist on the specificity of the angioscopy in the interpretation of arterial obstructions. Because of this specificity, the right treatment can be applied to any type of lesion. Angioscopy permits to foresee endoluminal surgery technique.

A well-mastered technique will cause percutaneous transluminal angioplasty of iliac arteries to achieve long-term results comparable to those obtained surgically. In isolated iliac stenosis, a 95% good result rate is attained (81% cured, 14% improved). More complex cases of iliac stenosis yield 90% good results (72% cure), with a mean Doppler ankle/arm pressure index gain of 0.5 point in a series including 673 patients at 5 years follow-up. Only the presence of combined distal femoral lesions may cause the good result score to drop to 85%, including merely 35% cure. General complications are practically lacking and local complications are minimal, which incites one to propose this technique as a first-line treatment of iliac stenosis whenever distal blood circulation is maintained.

A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.

Angioscopy is a technique of endoscopic investigation of the vascular lumen and its contents, which we have coupled with iliac and femoral angioplasty. The material comprises 3 main elements: the angioscope, the TV-monitoring assembly and the infusion system. No complication was recorded in a series of 94 angioscopies (47 iliac, 44 distal femoral and 3 grafts) performed over a period of 18 months. The technical quality of the images obtained was good in 90% of cases (85/94). Angioscopy revealed lesions that had either been nonvisualized or underrated by angiography, and played a determinant role in 16% of cases (15/94), whereby the therapeutical procedure could be modified accordingly.

To cover the need in paediatric organ transplantation, every potential donor should be considered as a multi-organ donor. Successful transplantation may be performed with kidneys retrieved from very young infants, even anencephalic neonates if the en-bloc technique using both kidneys is used. Regarding the liver, paediatric donors can be accepted from one month of age while livers harvested from older children and even young adults can be transplanted into small children after ex-vivo reduction of the size of the graft. Multi-organ procurement from the same donor provides valuable organs if the anaesthetic management of the donor is appropriate. Active transplant programs needs international cooperation which is made possible by the organ exchange organizations.

We have developed a vector strategy that allows transfer of plasmid DNA by conjugation from Escherichia coli to various Gram-positive bacteria in which transformation via natural competence has not been demonstrated. The prototype vector constructed, pAT187, contains the origins of replication of pBR322 and of the broad host range streptococcal plasmid pAMβ1, a kanamycin resistance gene known to be expressed in both Gram-negative and Gram-positive bacteria, and the origin of transfer of the IncP plasmid RK2. This shuttle plasmid can be mobilised efficiently by the self-transferable IncP plasmid pRK212.1 co-resident in the E. coli donors, and was successfully transferred by filter matings at frequencies of 2 × 10−8 to 5 × 10−7 to Enterococcus faecalis, Streptococcus lactis, Streptococcus agalactiae, Bacillus thuringiensis, Listeria monocytogenes and Staphylococcus aureus.

A molecular-dynamics study of clustering in systems of 400 and 900 hard parallel squares shows that in the high-density region the distributions $N(n)$ of clusters of size $n$ depend only upon one dimensionless variable. Results are slightly different in the intermediate-density fluid region. For all densities and values of the clustering distance parameter $l$, $N(n)$ is a monotonic decreasing function of $n$. A simple free-volume theory predicts relatively well the results in the high-density region. The clusters are relatively compact. From an exponential fit to the function $\frac{N(n)}{N(1)}$ obtained for densities near the phase-transition region, one estimates the values of the parameters of the exponential law given by the classical theory of nucleation.

A definition for the time lag L in the Zeldovich modified Becker‐Doring theory of nucleation is introduced which is in accord with the commonly used definition of L in diffusion theory. This L can be obtained exactly without solving for the transient concentration of embryos of the new phase. L is found to be the time required to set up the steady‐state distribution of embryos from a given initial distribution by means of the steady‐state flux of embryos. The numerical evaluation of L from various initial distributions, for at least vapor‐liquid transition, exhibits the importance of the homophase fluctuations in the initial embryo distribution in allowing us to observe the transition within the experimental observation time. The implications of this result for the general theory of phase transitions and for ``memory'' effects in nucleation are discussed.

Antigenic variants of the Italian strain of NDV were selected using monoclonal antibodies directed against the HN and F proteins of Italian virus. Antigenic mapping of the HN and F proteins using variant viruses in cross neutralization tests revealed the presence of at least two different epitopes on HN and four epitopes on F protein. Immunoselected variant viruses were demonstrated to have different intravenous pathogenicity index than the parental Italian virus.

Bacillus circulans NRRL B-3312 produces the aminoglycoside antibiotic butirosin and encodes an aminoglycoside 3'-phosphotransferase. We detected a 48 kilobase plasmid, pIP850, in this strain; this was analyzed by agarose gel electrophoresis following digestion with EcoRI restriction endonuclease and by nucleic acid hybridization. The results obtained indicate that plasmid pIP850 does not carry the structural gene for the aminoglycoside modifying enzyme.

282 children with portal hypertension (PHT) were studied. PHT was due to extra-hepatic portal venous obstruction in 40% of children, to intra-hepatic disease in 56% and to post-sinusoídal lesions in 4%. Presenting symptoms, and risk of gastro-intestinal bleeding were analyzed in each etiologic group, as well as the follow-up in children in whom a portal-systemic shunt was not carried out. In portal venous obstruction, gastro-intestinal bleeding occurred frequently and early in life; liver failure and portal systemic encephalopathy did not occur; none of these children died except those with severe congenital heart disease. In children with cirrhosis, gastro-intestinal bleeding occurred twice less frequently and its date depended upon the etiology of cirrhosis; in this group, death was due twice more often to the underlying liver disease than to gastro-intestinal bleeding. In supra-hepatic PHT, the risks of PHT proper are limited except for ascites.

We studied two outbreaks of calf salmonellosis caused by apramycin and gentamicin-resistant Salmonella typhimurium strains. In both cases, the responsible strains were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, tetracycline, and trimethoprim; one strain was also resistant to nalidixic acid in one outbreak. A systematic survey of the intestinal Escherichia coli strains of calves from the two affected flocks showed that 11 of 24 animals sampled were also colonized by apramycin- and gentamicin-resistant E. coli strains. These isolates belonged to four biotypes and were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, tetracycline, trimethoprim, and nalidixic acid. All of the strains were resistant to high levels of apramycin (MICs, 512 to 1,024 micrograms/ml) and to gentamicin (MICs, 8 to 32 micrograms/ml), and these resistances were always transferred en bloc. In S. typhimurium, this coresistance was borne by plasmids that were approximately 39 kilobases long (outbreak 1) or 90 kilobases long (outbreak 2), whereas in E. coli, the coresistance was due to plasmids that were approximately 110 kilobases long in both outbreaks. The two plasmids of Salmonella and four plasmids of E. coli encoded type IV aminoglycoside 3-N-acetyltransferases. The intensive use of curative and preventive treatments in calf production could be responsible for the emergence of enzymic resistance to apramycin and gentamicin.

Staphylococcus haemolyticus BM4610 was resistant to high levels of lincomycin and susceptible to macrolides, clindamycin, and streptogramins. This resistance phenotype, not previously reported for a human clinical isolate, was due to inactivation of the antibiotic. The gene conferring resistance to lincomycin in strain BM4610 was carried by a 2.5-kilobase plasmid, pIP855, which was cloned in Escherichia coli. Plasmid pIP855 caused inactivation of both lincomycin and clindamycin in S. haemolyticus and in E. coli but conferred detectable resistance to lincomycin only in S. haemolyticus and to clindamycin only in E. coli.

We described a new method to stain epithelial cells harvested by ocular impression. The cells are immediately transferred on a glass slide after the sampling; this transfer permits a very simple staining and easier reading by light microscopy. The results are compared with those obtained with the previous techniques and confirm ocular impression as a good help for vitamin A status determination.

The vitamin A status of 105 elderly French people was assessed by ocular impression cytology with transfer (ICT). 5 patients (4.8%) had a negative ICT defined by the absence of goblet cells and the enlargement of the epithelial cells (deficient vitamin A status). 100 patients had a positive ICT with goblet cells and small, numerous epithelial cells (sufficient vitamin A status). ICT results were compared to serum biochemical parameters. Mean serum levels of retinol, retinol-binding protein (RBP) and transthyretin (TTR) were significantly lower while C-reactive protein (CRP) and orosomucoid were significantly higher in negative ICT than in positive one. The etiology of vitamin A deficiency is difficult to conclude (malnutrition, vitamin A deficiency, inflammation). ICT is a good indicator of peripheral vitamin A deficiency in our experience.

From 1959 until 1981, 157 children were treated for portal hypertension by esophageal varices ligation in 13 cases and by portosystemic shunt in 144 cases. The age of the patients at operation was correlated with the cause of portal hypertension : mean age was six and a half years for cases with extra-hepatic blockage, and ten years for cases with cirrhosis. In 73% of cases, the shunt was undertaken following a bleeding episode from esophageal varices; at the present time, the decision to undertake a prophylactic type of shunt would be much more questionable. Central splenorenal shunt and mesocaval shunt were the operations most frequently performed by the different surgical teams in charge of these children (respectively 69 and 47 cases). Among the postoperative complications, three cases of venous stasis in lower limbs occurred after a mesocaval shunt; one child died two and a half years after a central splenorenal shunt from pneumococcal sepsis. During the last two years, there is a tendency in our group to perform a Warren shunt for intrahepatic portal hypertension, and a mesocaval shunt with jugular vein interposition in the case of extrahepatic portal hypertension. Recurrence of bleeding from esophageal varices after simple ligation has been observed in 64% of the cases; after portosystemic shunts, the anastomosis was a success in 89.3% of the cases. Whereas a significant fall in portal pressure after completion of the anastomosis is of good prognostic value, the fact that in some cases intraoperative measurement of pressure before and after shunting may show no difference does not imply a secondary thrombosis of the anastomosis, since this complication was seen in only 13% of the cases in these conditions.

Despite the progress in functional investigation procedures, phlebography remains the standard test in venous disease of the lower extremities. The development of better quality contrast media has significantly improved patients tolerance. After a review of the regular, routine procedure, the authors stress the technic's pitfalls. Uncomplicated pitfalls are air bubbles, Venturi's effect, venous malformations, and superimposed venous axes or gases. This type of problems is easily circumvented. Flow images caused by confluent axes of high-flow veins (internal iliac veins, renal veins) or layer courants (gutter effect) are presented as a reminder. Compression images are often more treacherous: related to normal veins: compression of left iliac vein by aortic junction; of inferior vena cava by enlarged aorta or by osteophyte; tourniquet too low, iliac vein compressed by a dilated bladder; or compression due to intramuscular hematoma,... related to pathological veins: to be mentioned are bridle-caused obstruction of the popliteal vein (Klippel-Trénaunay syndrome), and retroperitoneal fibrosis. Although the present description of phlebography-related pitfalls is neither new, nor exhaustive, it should be reconsidered, as phlebography of the lower limbs, while being currently better tolerated, is still an update technic that needs to be rendered more reliable.

Individual variations in serological response to avian influenza virus infection were demonstrated after experimental infection of specific-pathogen-free chickens with H6N2 influenza virus. Homologous antibodies were detected from the 6th to the 157th day after infection using hemagglutination-inhibition or enzyme-linked immunosorbent assay and from the 11th to the 157th day by agar gel precipitation test.

Streptococcus faecalis BM4100 was resistant to high levels of gentamicin, kanamycin, and structurally related antibiotics. The genes conferring resistance to aminocyclitols in this strain were carried by a plasmid, pIP800, self-transferable to other S. faecalis strains. The aminocyclitol resistance was mediated by constitutively synthesized phosphotransferase and acetyltransferase activities. It was inferred that phosphorylation occurred at the 2"-hydroxyl group and that acetylation occurred at the 6'-hydroxyl group of the aminocyclitols. The enzyme activities were not separable by gel filtration or by isoelectric focusing. Their apparent molecular weight was 31,000, and their isoelectric point was 5.3. With respect to substrate profile, size, and charge, the transferases from strain BM4100 resembled closely those with identical site specificity described in staphylococci. These results suggest that plasmid gene transfer may occur between the two pathogenic bacterial genera.

Very few papers about peripheral angioscopy are reported in literature. Percutaneous angioscopy (P.T.A.) of 25 peripheral arteries (21 iliac and 4 femoral arteries) have been performed by the authors without surgery and without anesthesia. Three observations are selected. The first one demonstrates an eccentric stenosis altering its diameter during pulsations; an irregular ulcerated atheroma is observed. The second case shows the signs of a centric atheroma with an intimal fragment. The last one is an intimal dissection due to PTA. The prospective aspects of this new technique are discussed.

The apparently chromosomally encoded 3',5"-aminoglycoside phosphotransferase (type III), from the high-level aminoglycoside-resistant Streptococcus pneumoniae BM4200, was compared with homologous enzymes coded for by the plasmids pJH1 and pSH2, originally isolated from Streptococcus faecalis and Staphylococcus aureus, respectively, and also found in a wild strain of S. aureus, BM4600. The enzymes appeared to be indistinguishable, and we conclude that the gene encoding 3',5"-aminoglycoside phosphotransferase (type III) can cross generic barriers within gram-positive cocci.