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New off-line instrumentation was developed to implement measurements of non-methane hydrocarbons (NMHC) on (French) research aircraft. NMHC are collected on multisorbent tubes by AMOVOC (Airborne Measurements Of Volatile Organic Compounds), a new automatic sampler. AMOVOC is a versatile and portable sampler targeting a wide range of NMHC at high frequency (sampling time of 10 min). Multisorbent tubes are analyzed on the ground by short-path thermal desorption coupled with gas chromatography and mass spectrometry. The development and optimization of both NMHC sampling and analysis are reported here. On the one hand, the paper points out technical choices that were made according to aircraft constraints and avoiding sample loss or contamination. On the other hand, it describes analytical optimization, tube storage stability, and moisture removal. The method shows high selectivity, sensitivity (limit of detection less than 10 ppt) and precision (less than 24%). Finally, NMHC data collected on French aircraft during the African Monsoon Multidisciplinary Analysis campaign are reported for the first time. The results highlight instrumentation validity and protocol efficiency for NMHC measurements in the lower and upper troposphere.

The development of environmental policies to reduce the ozone levels around large agglomerations requires a good understanding of the development of ozone episodes. In particular, it is necessary to know the location and photochemical activity of the plume where ozone is formed. Measurement campaigns make it possible not only to characterize the concentration fields of ozone and its precursors but also to identify the zones of strong ozone production, by means of specific measurements and kinetic calculations. The combination of the observation-based data with numerical simulations allows to better characterize photochemical pollution. This paper presents a study carried out within the ESCOMPTE program and based on the determination of ozone production rates by experimental and numerical methods: ground measurements of peroxy radicals, NOx at a rural site, airborne measurements of NOX and O3, Eulerian modeling. The reported case is of particular interest since it corresponds to an episode with very different photochemical situations. The diurnal variations of the peroxy radical concentration are analyzed in relation to those of ozone and its precursors. Ozone production rates—P(O3)–are studied over one particular day. The results show particularly high concentrations of RO2+HO2 at ground level (up to 200 pptv) under the influence of the urban and industrial plume, but also highlight very high production rates of ozone (60 to 80 ppbv h−1) a few tens of kilometers from the sources. The results show satisfactory agreement between the various approaches. Modeling provides a four-dimensional (4D) description of the plumes, in particular the relation between the ozone precursor concentrations and P(O3) on the ground.

The atmospheric concentrations of O3, NMHCs, PAN and NOx were measured at the TOR station in Porspoder (Brittany, France) from 1992 to 1995. The results from April 1992 to December 1994 are reported here. In order to study the behaviour of trace gases in the air masses coming from the Atlantic Ocean, the origin of these air masses was characterised by the analysis of the five-day back-trajectories reaching 950 mbar at Porspoder. Three kinds of oceanic air masses are considered, depending on their origin: North Atlantic northern and southern latitudes and North American continent. It appears that the oceanic high-latitude troposphere was strongly influenced by continental emissions, which in turn impacted the median latitude troposphere during polar outflow events. A greater accumulation of anthropogenic compounds in the Arctic sector was calculated and may be at the origin of the high oxidant levels measured in spring in this same sector. The influence of north American emissions on the European coast was also studied and seems to reach a maximum in spring. Long-range transport of long- lived species was observed throughout the year, but evidence for winter transport of more reactive species, such as ethene, is also shown. Meteorological parameters and local photochemistry appear to play an important role in the distribution of the pollutants over the North Atlantic Ocean throughout the year. Further investigations are needed to give more complete information about the origin, formation and destruction of the secondary pollutants.

Radioiodine is a safe and effective treatment for Graves' disease. Iatrogenic hypothyroidism is very common after treatment, but its onset is unpredictable. Even a short episode of hypothyroidism can result in significant morbidity and ideally should be avoided. In Newcastle a standard dose of radioiodine (400MBq) is used, but for historical reasons two different protocols are used after radioiodine: Regimen A: regular clinical and biochemical monitoring and initiation of levothyroxine when serum thyroid hormones have normalized, and Regimen B: block and replace with Carbimazole and levothyroxine starting 2 weeks post-radioiodine and continuing for 6 months, then withdrawing Carbimazole, but continuing with levothyroxine long-term.

[1] In situ measurements of formaldehyde (CH2O) onboard four European research aircraft in August 2006 as part of the African Monsoon Multidisciplinary Analysis (AMMA) experiment in West Africa are used (1) to examine the redistribution of CH2O by mesoscale convective systems (MCS) in the tropical upper troposphere (UT), (2) to evaluate the scavenging efficiency (SE) of CH2O by MCS and (3) to quantify the impact of CH2O on UT photooxidant production downwind of MCS. The intercomparison of CH2O measurements is first tested, providing a unique and consistent 3-D-spatially resolved CH2O database in background and convective conditions. While carbon monoxide (CO) is vertically uplifted by deep convection up to 12 km, CH2O is also affected by cloud processing as seen from its ratio relative to CO with altitude. A new observation-based model is established to quantify the SE of CH2O. This model shows that convective entrainment of free tropospheric air cannot be neglected since it contributes to 40% of the convective UT air. For the 4 studied MCS, SE shows a large variability within a 4% to 39% range at a relative standard deviation of 30%, which is consistent with MCS features. A time-dependent photochemical box model is applied to convective UT air. After convection, 60% of CH2O is due to its photochemical production rather than to its direct transport. Model results indicate that CH2O directly injected by convection does not impact ozone and HOx production in the tropical UT of West Africa. NOx and anthropogenic hydrocarbon precursors dominate the secondary production of CH2O, ozone and HOx.

Aircraft measurements of hydrogen peroxide (H2O2) were performed during the TROPOZ II meridional campaign. A specially designed automatic H2O2 analyser on board the airplane allowed us to obtain more than 43,000 H2O2 measurements. The data set covers a latitude range from 60°N to 60°S and altitudes up to 11 km. Concentration of H2O2 ranged from 0.42 ppb (percentile 5) to 6.31 ppb (percentile 95) and exhibited a variability factor of as much as 15. Hydrogen peroxide concentration was typically low ( 3 ppb) could be noticed. Some episodes of high hydrogen peroxide mixing ratio were encountered in the vicinity of cloud systems probably by exchange of H2O2 from the liquid phase to the gas phase.

Problem: Changes in endometrial Natural Killer (NK) cells during the luteal phase of the ovarian cycle are important in initiating/maintaining a subsequent pregnancy. In the present study it was investigated whether during the menstrual cycle changes occur also in peripheral blood (PB) NKs. Method of study: Blood samples during the follicular and the luteal phase were collected from 30 women without fertility problems. Samples were analyzed by flow-cytometry for: (1) NK cells (CD3-CD16+CD56+) and (2) intracellular production of interferon-γ (IFN-γ) by NK cells. For the comparison and correlation of the two populations between the two phases, Wilcoxon signed-rank test and Spearman's Coefficient were used. Results: The differences in percentages of CD3-CD16+CD56+ cells and that of CD3-CD16+CD56+/IFN-γ+ cells between the follicular and the luteal phase were not statistically significant (10.61 ± 5.11 versus 9.76 ± 4.57 and 6.48 ± 7.90 versus 7.30 ± 6.77, respectively, P > 0.05). The correlation between the two variables (NK% and NK/IFN-γ%) was weakly positive (P = 0.07) only in the follicular phase. Conclusion: The study did not reveal menstrual cycle-depended changes in PB NK cells. Thus, a suggestion to measure these cells in a specific phase of the cycle in order to predict the outcome of a subsequent pregnancy in women with fertility problems is objected. © 2009 John Wiley & Sons A/S.

A large dataset of reactive trace gases was collected for the first time over West Africa during the African Monsoon Multidisciplinary Analysis (AMMA) field experiment in August 2006. Volatile Organic Compounds (VOC from C5–C9) were measured onboard the two French aircrafts the ATR-42 and the Falcon-20 by a new instrument AMOVOC (Airborne Measurement Of Volatile Organic Compounds). The goal of this study is (i) to characterize VOC distribution in the tropical region of West Africa (ii) to determine the impact of deep convection on VOC distribution and chemistry in the tropical upper troposphere (UT) and (iii) to characterize its spatial and temporal extensions. Experimental strategy consisted in sampling at altitudes between 0 and 12 km downwind of Mesoscale Convective Systems (MCS) and at cloud base. Biogenic and anthropogenic VOC distribution in West Africa is clearly affected by North to South emission gradient. Isoprene, the most abundant VOC, is at maximum level over the forest (1.26 ppb) while benzene reaches its maximum over the urban areas (0.11 ppb). First, a multiple physical and chemical tracers approach using CO, O3 and relative humidity was implemented to distinguish between convective and non-convective air masses. Then, additional tools based on VOC observations (tracer ratios, proxy of emissions and photochemical clocks) were adapted to characterize deep convection on a chemical, spatial and temporal basis. VOC vertical profiles show a "C-shaped" trend indicating that VOC-rich air masses are transported from the surface to the UT by deep convective systems. VOC mixing ratios in convective outflow are up to two times higher than background levels even for reactive and short-lived VOC (e.g. isoprene up to 0.19 ppb at 12 km-altitude) and are dependent on surface emission type. As a consequence, UT air mass reactivity increases from 0.52 s−1 in non-convective conditions to 0.95 s−1 in convective conditions. Fractions of boundary layer air contained in convective outflow are estimated to be 40 ± 15%. Vertical transport timescale is calculated to be 25 ± 10 min between 0 to 12 km altitude. These results characterize deep convection occurring over West Africa and provide relevant information for tropical convection parameterization in regional/global models.

We describe two unrelated men who both developed teratomas in one testis followed by seminomas in the contralateral testis followed by papillary thyroid carcinomas. Neither man had a family history of cancers. Although random occurrence is possible, genetic predisposition and/or environmental influence would seem a likely explanation for this previously unreported combination of tumours.

The African Monsoon Multidisciplinary Analyses (AMMA) fourth airborne campaign was conducted in July–August 2006 to study the chemical composition of the middle and upper troposphere in West Africa with the major objective to better understand the processing of chemical emissions by the West African Monsoon (WAM) and its associated regional-scale and vertical transports. In particular, the french airborne experiment was organized around two goals. The first was to characterize the impact of Mesoscale Convective Systems (MCSs) on the ozone budget in the upper troposphere and the evolution of the chemical composition of these convective plumes as they move westward toward the Atlantic Ocean. The second objective was to discriminate the impact of remote sources of pollution over West Africa, including transport from the middle east, Europe, Asia and from southern hemispheric fires. Observations of O3, CO, NOx, H2O and hydroperoxide above West Africa along repeated meridional transects were coupled with transport analysis based on the FLEXPART lagrangian model. The cross analysis of trace gas concentrations and transport pathways revealed 5 types of air masses: convective uplift of industrial and urban emissions, convective uplift of biogenic emissions, slow advection from Cotonou polluted plumes near the coast, meridional transport of upper tropospheric air from the subtropical barrier region, and meridional transport of Southern Hemisphere (SH) biomass burning emissions. O3/CO correlation plots and the correlation plots of H2O2 with a OH proxy revealed not only a control of the trace gas variability by transport processes but also significant photochemical reactivity in the mid- and upper troposphere. The study of four MCSs outflow showed contrasted chemical composition and air mass origins depending on the MCSs lifetime and latitudinal position. Favorables conditions for ozone production were found for MCSs with increased MCS lifetime (>1.5 days), which allowed for more H2O2 formation, and with trajectories crossing the 10° N latitude, which increased CO transport to the upper troposphere. The upper tropospheric concentrations sampled in the MCS outflow regions showed mixed origins including local vertical convective transport, and uplifting of air from the low troposphere over the middle-east related to the summer Asian low pressure system or from the southern hemispheric fires.

PAN has been measured continuously for 1 year in Creteil, a southeastern suburb of Paris Correspondence analysis was used to analyse the important PAN database obtained during this period, in relation to associated meteorological parameters and the location of precursors sources. This analysis revealed a complex relation (U-shaped curve) between PAN and temperatures, with a minimum in the range of 4–12°C and an increase in the lower and higher temperatures, arising from the competition between photochemical production and thermal decomposition. Long-range transport of PAN is associated with easterly winds and occurs under anticyclonic conditions in all seasons, particularly in winter. The highest PAN values (maximum 33.6 ppb) are observed in summer. They have a local origin and are associated with northwesterly to southwesterly winds, revealing the net impact, in summer, of nearby sources such as the urban conglomeration of Paris on PAN levels recorded in the surrounding areas.

During the wet season of the African Monsoon Multidisciplinary Analyses (AMMA) campaign, airborne measurements of several chemical species were made onboard the French Falcon-20 (FF20) aircraft. The scientific flights were planned in order to document, on one hand the regional distribution of trace gas species related to the oxidizing capacity of the troposphere, and on the other hand their spatial variability in the outflow of mesoscale convective systems (MCSs). The main objectives of this paper are the analysis of the main transport processes responsible for the observed variability, and the discussion of differences and similarities related to the convective transport by 4 different MCSs. This work is needed before using this data set for future studies of the convective transport of chemical species or for modeling work in the frame of the AMMA project. Regarding the regional distribution, five air masses types have been identified using the Lagrangian particle dispersion model FLEXPART, and by considering relationship between the measured trace gas concentrations (O3, CO, NOx, H2O, and hydroperoxides). This paper specifically discusses the advantage of hydroperoxide measurements in order to document the impact of recent or aged convection. The highest values of O3 are found to be related to transport from the subtropical tropopause region into the mid-troposphere at latitudes as low as 10° N. The lowest ozone values have been always explained by recent uplifting from the monsoon layer where O3 is photochemically destroyed. Regarding the analysis of the MCS outflow, the CO and H2O2 enhancements are related to the age and the southernmost position of the MCS. The analysis of the long range transport of the air masses where convection occurred, shows a connection with the Persian Gulf emissions for the largest CO concentrations in MCS outflow. However for our observations, Lagrangian particle dispersion modelling shows that this possible source is always modified by the convective transport of CO from the African lower troposphere when the air masses encounter a convective system at latitudes below 10° N.

National audience; While sulfur dioxide (SO2) emissions have been dramatically restricted in the past few decades, some cities in developing countries still encounter high pollution levels. This makes it essential to implement an air quality monitoring network in these sensitive regions. Results from a program of measuring ground-level concentration of SO2 (from December 2004 till July 2006) at 22 curbside and background sites within the city of Beirut (Lebanon) are presented for the first time. Four-week sampling period measurements were made over 20 periods for all sites by passive sampling. Low SO2 concentrations were observed (3.1 parts per billion on average for the whole period). This value is among the lowest observed in urban areas worldwide. Thus, Beirut is not polluted by SO2 on an annual basis. Highest concentrations were measured in winter time, resulting from low height of the boundary layer and higher emissions of SO2 (e.g., heating). Cluster analysis revealed two different SO2 variation patterns over the city (high- and low-level patterns), highlighting the effects of local sources location and wind direction variability on SO2 distribution. Analysis of seasonal variations pointed out a springtime SO2 maximum in 2005. Beside local sources, long-range transport can account for an important source of SO2 in Beirut, explaining around 50% of SO2 levels within the city.

To determine whether acute insulin-induced hypoglycaemia provokes a detectable alteration in peripheral plasma endothelin (ET) concentrations in humans with Type 1 diabetes.Serial plasma concentrations of ET were measured in 20 patients with Type 1 diabetes during controlled hypoglycaemia induced by intravenous infusion of soluble insulin.A significant increase was observed in plasma ET concentrations, from 3.80 +/- 0.31 pg/ml at baseline to 6.72 +/- 1.47 pg/ml at 60 min after the onset of the hypoglycaemic reaction (P0.05).Acute insulin-induced hypoglycaemia induces a rise in plasma endothelin concentrations in people with Type 1 diabetes. This finding is consistent with a putative role for ET in the mediation of hypoglycaemia-induced vasoconstriction, and the possible precipitation of macrovascular or microvascular events.

The European Group on Graves’ Orbitopathy(EUGOGO) was established in order to promotebetter clinical care of patients with Graves’ orbito-pathy (GO) (1, 2) and to facilitate research in thisdisease. EUGOGO believes that patients with GOshould be managed in multidisciplinary clinics withinput from endocrinologists and ophthalmologists,who have an interest and experience in managingthis disease (3). Although the expertise of theclinicians is critical and the setting perhaps less so,evidence from other clinical disciplines wouldsuggest that a dedicated multidisciplinary clinicresultsinbetteroutcomes(4, 5).EUGOGO isaware that many patients with GO in Europenever reach specialist centres or are referred toolate to benefit from treatments (6), which results ina suboptimal outcome and sometimes loss of vision.EUGOGO recommends that primary care physicians,general practitioners, general internists and special-ists, who have no particular expertise in managingsuch patients, should refer all but the mildest casesof GO to tertiary centres with established multi-disciplinary clinics for further assessment andmanagement. Selecting which patients should bereferred and with what degree of urgency, ischallenging for the generalist. EUGOGO proposes asimple clinical tool, which can be completed in lessthan 5 minutes by any medically qualified personand can help to identify patients who merit urgentor routine referral (Table 1).

Objective: To determine management patterns among clinicians who treat patients with Graves’ orbitopathy (GO) in Europe. Design and methods: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians. Results: A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P < 0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P < 0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P < 0.05) and surgical decompression (from 20.9 to 52.9%, P < 0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P < 0.01). Conclusion: Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.

International audience; Among seven airplanes involved in the Experience sur Site pour COntraindre les Modèles de Pollution atmosphérique et de Transport d'Emission (ESCOMPTE) experiment in 2001, four measured classical meteorological parameters, radiation fluxes, trace gases and turbulence (for three among four): the Dornier 128 from the Institut für Meteorologie und Klimaforschung, the Fokker 27 ARAT from the Institut National des Sciences de l'Univers, the Merlin 4 and Piper Aztec 23 from Météo France. This paper presents the results of intercomparison flights between three pairs of aircraft. The results are very similar for mean parameters except for the horizontal wind measurements provided by the Merlin that showed a problem that is probably linked to the measurement of the aircraft velocity. Further investigation is required to know whether corrections are possible or not for these wind measurements. Turbulence is studied along two legs over a flat and homogeneous area: in spite of the heterogeneity of the measured functions (one leg is close to the top of the boundary layer), the comparison is rather good. The relative accuracy of the data provided to the data base is given. It easily allows to use the huge amount of aircraft data collected during the experiment with very few restrictions. We underline some points where efforts should be borne for future experiments: wind coupling between Inertial Navigation System data and Global Positioning System (GPS) data, CO and NOx measurements.

International audience; The main objective of ‘Expérience sur Site pour COntraindre les Modèles de Pollution atmosphérique et de Transport d'Emissions' (ESCOMPTE) is to generate a relevant data set for testing and evaluating mesoscale chemistry-transport models (CTMs). During ESCOMPTE, measurements have been performed at numerous surface stations, by radars and lidars, and several aircraft in the planetary boundary layer. The data from these different sources have been merged to obtain a consistent description of the spatial distribution of wind, temperature, humidity, and ozone for the photosmog episode on June 25, 2001 (IOP 2b). On this day, moderate synoptic winds favour the evolution of different mesoscale circulation systems. During daytime, the sea breeze penetrates towards the north in the Rhône valley. As the winds above the sea breeze layer come from the east, polluted air from the metropolitan area of Marseille leads to an increase of ozone at elevated layers above the convective boundary layer (CBL). At the mountainous station of Luberon about 55 km north of Marseille around noon, when the CBL top surpasses the height of the mountain summit, polluted air with ozone concentrations of about 120 ppbv arrived from southerly directions, thus indicating the passage of the city plume of Marseille. At Cadarache and Vinon in the Durance valley, about 60 km inland, the ozone maximum at the surface and at flight level 920 m MSL appears between 14 and 15 UTC. At this time, southwesterly valley winds prevail in the valley, while southerly winds occur above. This finding highlights the height-dependent advection of ozone due to interacting mesoscale circulation systems. These dynamical processes need to be represented adequately in CTMs to deliver a realistic description of the ozone concentration fields.

A defaut d'etre completement exhaustif, cet article traite la majorite des polluants d'interet qui sont presents en phase gazeuse dans la basse couche de la troposphere, de la proximite des sources aux regions eloignees ou sejournent en faibles traces des substances persistantes et des sous-produits induits par reactions (photo)chimiques. Les composes decrits dans cet article presentent de l'interet pour des raisons tres diverses: soit ce sont des traceurs de source, soit ils retiennent l'attention en raison de leur impact sur la sante et/ou sur l'ecosysteme. Leur suivi peut aussi s'inscrire dans d'autres demarches telles que la comprehension des mecanismes reactionnels et le support a la modelisation des phenomenes. De ce fait, le domaine des concentrations couvert est tres etendu: si les preoccupations sont le plus souvent de repondre a des limites de detection de l'ordre de la partie par billion (ppbv), pour certaines substances, les exigences peuvent etre plus severes puisqu'il faudra s'orienter vers des techniques capables de quantifier au niveau de la partie par trillion (pptv), voire moins. Certains polluants sont qualifies de « semi-volatils », c'est-a-dire qu'ils ont la propriete d'etre presents en phase gazeuse et aussi dans les particules en suspension dans l'air. Il a ete choisi d'integrer a cet article les hydrocarbures aromatiques polycycliques et les dioxines qui possedent cette particularite. Pour chaque compose, on donne successivement et brievement les sources et les proprietes, puis les differentes techniques utilisables, en renvoyant le lecteur si necessaire aux principes generaux traites dans l'article [P 4 030], les recommandations plus techniques de mise en œuvre etant presentees dans l'article [P 4 032]. Le lecteur interesse pourra aussi se reporter a la rubrique Air du traite Environnement des Techniques de l'Ingenieur [19].

International audience; In this paper, the "Experience sur Site pour COntraindre les Modeles de Pollution atmospherique et de Transport d'Emissions" (ESCOMPTE) program is presented. The ESCOMPTE program is used to produce a relevant set of data for testing and evaluating regional pollution models. It includes high-resolution (in space and time) atmospheric emission inventories and field experiments, and covers an area of 120 X 120 km, centered over the Marseilles-Berre area in the southeast of France during Summer 2001. This region presents a high occurrence of photochemical pollution events, which result from numerous industrial and urban sources of primary pollutants. From the dynamical characteristics of the area, sea-breeze circulation and channeling effects due to terrain features highly influence the location of the pollutant plumes. ESCOMPTE will provide a highly documented framework for dynamics and chemisty studies. Campaign strategies and experimental set up are described. During the planning phase, existing modeling results helped defining the experimental design. The campaign involved surface measurement networks, remote sensing, ship-borne, balloon-borne, and airplane measurements. Mean standard meteorological parameters and turbulent fluxes, ozone, ozone precursors, photochemically active trace gases, and aerosols were measured. Five intensive observation periods (IOPs) were documented using a wide spectrum of instruments, involving aircraft (7) (one of them equipped with a Doppler lidar, the others for in situ meteorological and chemical measurements), constant volume balloons (33), ozone lidars (5), wind profilers (15 sodars and radars), Doppler scanning lidar (1), radiosonde systems (at 4 locations), instrumented ships (2). In addition to the air quality networks from environmental agencies, 15 supplementary ground stations equipped for chemistry and/or meteorology and/or surface flux measurements, were operational. All instruments were calibrated and compared during a Quality Control/Quality Assurance (QC/QA) week, at the very beginning of the campaign. Fifteen days were intensively documented during five IOPs, referenced as 1, 2a, 2b, 3, and 4. High pollution levels were encountered during sea-breeze conditions observed during IOPs 2b and 3, whereas IOPs 2a and 4 corresponded to moderate wind, and channeled plume regimes. In addition, hourly emissions inventories for all IOPs were established to complete data sets and to finalize the ESCOMPTE database (EDB). Two other projects were associated to ESCOMPTE: urban boundary layer (UBL) and tropospheric water vapor content by GPS tomography (GPS/H2O). They took advantage of the scientific environment provided by ESCOMPTE.

Graves' ophthalmopathy (GO) is a challenging disease that poses therapeutic dilemmas for endocrinologists and ophthalmologists. Progress in medical therapy has been slow. Numerous new treatments have been reported to have a beneficial effect. However, current evidence indicates that glucocorticoids (GC) represent the only class of drug therapy which either in isolation or combined with other therapies has an unequivocal role in the routine clinical management of patients with GO. Recent advances include better definition of factors predictive of response to treatment and the formulation of specific GC regimens that combine high efficacy with a low risk of unwanted side-effects.

To ascertain whether local guidelines for diabetes management influence the content of GP referral letters to a diabetes specialist clinic.Retrospective survey of hospital outpatient clinic casenotes and GP referral letters of patients with Type 2 diabetes.An examination was made of 200 GP referral letters submitted before (Set 1), and 200 GP referral letters submitted after (Set 2), local guidelines on the management of adult diabetes had been issued to GPs in Lothian. The frequency with which micro- and macrovascular complications of diabetes were documented in the GP referral letters was compared with the frequency ascertained at the first attendance to the specialist clinic.Following the distribution of diabetes guidelines, no significant change was noted in the frequency with which specific conditions were documented in GP referral letters (Set 1 vs Set 2): hypertension (72% vs 79%); cerebrovascular disease (89% vs 80%); ischaemic heart disease (74% vs 79%); peripheral vascular disease (42% vs 64%); cataract (35% vs 44%); retinopathy (18% vs 40%) and peripheral neuropathy (17% vs 12%). At the diabetic clinic many unreported diabetic complications were found in patients who had been referred after varying periods of treatment in primary care. However, the guidelines did appear to have encouraged the active treatment of hyperglycaemia by GPs before referral of newly-diagnosed diabetic patients.Diabetes guidelines per se appeared to have very little effect on increasing the information provided in GP referral letters on relevant medical problems and did not appear to have influenced screening for complications in patients with Type 2 diabetes by GPs before specialist referral. Methods other than the issue of written guidelines are required to achieve optimal assessment of diabetic patients in the community.

Recent studies have shown that Graves' disease (GD) is linked to and associated with alleles of the cytotoxic T lymphocyte antigen-4 (CTLA4) locus. However, the true pathogenic polymorphism(s) at this locus remains uncertain. Moreover, the association studies of the promoter CTLA4(-318)C/T polymorphism in white GD populations have produced conflicting results. Therefore, we have analysed three CTLA4 single nucleotide polymorphisms, including promoter CTLA4(-318)C/T, exon 1 CTLA4(49)A/G and intron 1 CTLA4(1822)C/T in our GD cohort from the UK.We studied 301 white patients with GD and 349 healthy ethnically matched local controls. Amongst GD probands, 129 had significant thyroid-associated orbitopathy (TAO; NOSPECS class III or worse). The CTLA4(-318)C/T, CTLA4(49)A/G and CTLA4(1822)C/T polymorphisms were genotyped by using the restriction enzymes MseI, Bst71I and HaeIII, respectively.We found no association between GD and alleles of CTLA4(-318)C/T. GD was found to be associated with the G allele of CTLA4(49)A/G[P = 5.9 x 10(-6), odds ratio (OR) 1.65] and the T allele of CTLA4(1822)C/T (P = 7.7 x 10(-6), OR 1.64). The frequencies of these alleles were significantly higher in GD probands with significant TAO than in those without TAO (G allele: P = 0.001, OR 1.68; T allele: P = 0.001, OR 1.70).The promoter CTLA4(-318)C/T polymorphism is not in linkage disequilibrium with the pathogenic polymorphism(s) at the CTLA4 locus. The alleles of both the exon 1 CTLA4(49)A/G and the intron 1 CTLA4(1822)C/T polymorphisms are associated with GD, which is stronger in patients with TAO.

[1] Tropospheric photooxidant pollution was investigated in detail for the first time over the Paris area during the Air Pollution Over the Paris Region (ESQUIF) project. From 1998 to 2000, 12 intensive observation periods (IOPs) were carried out. They represented various meteorological situations, all leading to strong polluted events over Paris and its surroundings. During these periods, measurements were performed with a new strategy of circular flights around the city, coupled to stations or remote sensing surface measurements. Such data obtained at various altitudes and at different ranges from the city center document the evolution of pollution events on horizontal and vertical scales. In addition, ESQUIF also allowed for the evaluation of models developed in parallel to the project. In this overview, ESQUIF is presented in terms of the set of IOPs. Periods are compared in terms of meteorology and resulting types of pollution episodes. The occurrence of these latter events is discussed in terms of local production and influence of long-range transport. Using both measurements and model simulations, some important results are highlighted, especially concerning accuracy of boundary conditions, processes of mixing within the boundary layer, surface emissions estimation (including biogenic), and photolysis attenuation. Finally, results from data assimilation studies and sensitivity studies using adjoint modeling and a Monte Carlo approach are also presented.

Despite many learned publications over recent decades, the assessment of active thyroid-associated orbitopathy (TAO) remains difficult and controversial. There are no biochemical, immunological or imaging investigations which can identify active disease reliably, and clinical assessment is still of paramount importance. We therefore review the strengths and weaknesses of all methods of clinical assessment. A new atlas for clinical assessment of soft tissue signs has been developed, and its reproducibility assessed. It details a suggested protocol that could help standardize descriptions of TAO and allow more objective assessment of its activity and severity. This is relevant to general endocrinologists, who have a crucial role in the identification of patients who require ophthalmological assessment. Certain aspects are more relevant to ophthalmologists and endocrinologists who have a special clinical and research interest in TAO. Unless a reproducible system of assessment is devised and widely adopted, it will remain difficult to interpret research meaningfully, particularly if results appear to contradict.

A 31-year-old woman presented with neutropenia due to thionamide drug therapy for Graves' disease. She also reported 8 weeks of amenorrhoea and had a positive pregnancy test. Her drug therapy was discontinued and her neutropenia resolved uneventfully. The hyperthyroidism recurred a week later. After consideration of all treatment options, it was decided to observe until 14 weeks when an elective thyroidectomy was planned. Mother and fetus were monitored closely and both tolerated moderate hyperthyroidism well. At 14 weeks the patient underwent a total thyroidectomy after rendering her euthyroid with a short course of sodium ipodate. Labour was induced at 41 weeks. Delivery was complicated by fetal distress and precipitated a forceps delivery. A 3250 g male infant was born with poor Apgar score and required 2 h of ventilation. At 1 year, the child had reached all developmental milestones at appropriate times. Both mother and fetus may tolerate moderate thyrotoxicosis well in early pregnancy, an alternative that should be considered when thionamide drug therapy is contraindicated.

Graves' disease (GD), which has a strong female preponderance (female/male ratio,5:1), is inherited as a complex genetic trait. Loci for GD have started to be defined using genome-wide approaches for genetic linkage. To date, 3 loci have been confirmed in at least 2 cohorts of GD patients, the strongest effect being at the cytotoxic T lymphocyte antigen-4 (CTLA-4) locus on chromosome 2q33 in our population. Two other loci for GD have recently been proposed, but not confirmed, on chromosomes Xq21 (GD3) and 14q31 (GD1). We studied a cohort of 75 sibling pairs with GD from the United Kingdom for linkage to 12 markers over a 83-cM region of the X chromosome and for 8 markers over a 36-cM region of 14q31-q33. A peak multipoint nonparametric linkage score of 2.21 (P = 0.014) was found at marker DXS8083 on Xp11, which increased to a nonparametric linkage score of 3.18 (P = 0.001) in data that had been conditioned for allele sharing at the CTLA-4 locus under an epistatic model. There was no evidence to support linkage of GD to Xq21.33-q22 (GD3) or at the 14q31-q33 (GD1) region in our population. A locus with a moderate contribution to GD susceptibility (lambda(s) = 1.4) is likely to exist in the Xp11 region, but we are unable to confirm that the GD1 or the GD3 regions contain major susceptibility loci in our United Kingdom GD population.

The biochemical confirmation of acromegaly is rarely difficult and is based on an elevated fasting serum growth hormone (GH) concentration, which fails to suppress in response to an oral glucose load. Impaired glucose tolerance and Type 2 diabetes are common in patients with acromegaly, however the development of acromegaly in a patient with pre-existing Type 1 diabetes has not been well documented. Poorly controlled Type 1 diabetes in non-acromegalic patients is associated with dysregulation of the hypothalamic-GH/insulin-like growth factor-1 (IGF-1) axis, leading to elevation of serum GH concentrations. Therefore the diagnosis of acromegaly in a Type 1 diabetic patient may be fraught with practical difficulties in performing and interpreting the results of an oral glucose tolerance test (OGTT) and other biochemical investigations. When, in addition, the clinical and radiological features of acromegaly are equivocal, the clinician is faced with a formidable diagnostic challenge. In this paper we report such a case, review the pathophysiology of hypersomatotrophinaemia in poorly controlled Type 1 diabetes, and recommend a diagnostic algorithm for the investigation of acromegaly in patients with diabetes.