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The overall goal of MENELAS is to provide better access to the information contained in natural language patient discharge summaries (PDSs), through the design and implementation of a prototype able to analyse medical texts. The approach taken by MENELAS is based on the following key principles: (i) to maximise the usefulness of natural language analysis and the usability of its results, the output of natural language analysis must be a normalised conceptual representation of medical information; and (ii) to maximise the reuse of resources, language analysis should be domain-independent and conceptual representation should be language-independent. This paper discusses the results obtained and the issues raised when implementing these principles during the project.

In a retrospective study, we compared the months of birth of 3,106 psychiatric inpatients to those of 1,943 surgical patients collected during the same period 1981-1991 in the same hospital, and of a sample of 10,003,572 births in France in 1977-1989. DSM III-R categories were modified so to allow a comparison with former studies, and psychiatric patients were distributed among seven categories: Bipolars (N = 294), Unipolars (N = 287), Neurotic-reactive depressions (N = 582), First Major Depressive episode (N = 214), Schizophrenia (N = 244), Schizo-Affectives (N = 52) and Other Diagnosies (N = 1,433). Months of birth were grouped in quarters and semesters, according to the usual calendar, but also to temperature and the photoperiodic cycle. The main results were: 1. A seasonnality of births in the General Population sample, with a spring maximum (p < 0.001). 2. An absence of deviation from the general population and the surgical sample among Neurotic-reactive Depressions and Other Diagnoses. 3. A deviation from the general population and from other comparison groups (surgical cases and Other Diagnoses) among Unipolars and First Major Depressive Episodes (most of those being late episodes), with a significant excess of births during the "dark" or "cold" season of the year, especially around the winter solstice. The Bipolar group followed the same tendency, though to a lesser degree and for subjects born before 1940 only. The most significant results were found among Unipolars, which differ from the general population either by quarters (p < 0.0005) or by semesters (p < 0.0005) and from surgical cases by quarters (p < 0.01) and by semesters (p < 0.001). The results were similar for First Major Depressive episodes, although this category was theoretically "anosological". As the median age was high in this category, it might group a number of late depressive episodes, near to "involutionnal melancholia". Thus, our results seem to be relevant to the traditional endogenous-psychogenetic dichotomy, with a "cold" or "dark" seasonnality of births in the first case, and no particular seasonnality in the second case. Some former studies showed the same results, but the most significant deviation was found in mania. Our results cannot be explained by differences in the sex-ratio among the categories, and only partially by an age-incidence effect or an age-cohort effect.(ABSTRACT TRUNCATED AT 400 WORDS)

Elevated levels of tumor necrosis factor alpha (TNF-alpha) have been reported to correlate with the development of transplant-related complications after bone marrow transplantation (BMT). In a recent phase I-II trial, oral administration of pentoxifylline (PTX), a xanthine derivative capable of downregulating TNF-alpha production in vitro, was reported to reduce morbidity and mortality in patients undergoing BMT. We conducted a prospective randomized trial of PTX therapy among 140 patients undergoing either allogeneic (n = 51) or autologous BMT (n = 89). Patients were randomized to receive (n = 70) or not receive (n = 70) oral PTX, 1,600 mg/d in four divided doses from day -8 until day + 100 post-BMT. The incidence of mucositis requiring morphine sulfate (MSO4) was similar in both groups (42.9%), with the mean number of days with MSO4 being 7.8 (SD = 3.4) in the PTX group versus 8.2 (SD = 3.4) in the control group (NS). The incidence of renal insufficiency was not affected by PTX administration (15.7% in the PTX group v 21.4% in the control group [NS]) and the highest serum creatinine value during the first 100 days post-BMT was 119 mumol/L (SD = 82.4) in the PTX group versus 103.9 mumol/L (SD = 57) in the control group (NS). The incidence of grade > or = 2 graft-versus-host disease was similar in each group (11/25 [44%] in the PTX group v 12/26 [46%] in the control group). No significant difference was observed in hematologic toxicity, transfusion requirements, duration of fever, and hepatic toxicity between the treatment groups. In conclusion, our study failed to show a prophylactic effect of PTX in transplant-related toxicities after BMT. On the basis of these findings, we cannot recommend that PTX be part of early mortality and morbidity prevention programs after BMT.

Risk factors for developing cytomegalovirus (CMV) infection and pneumonitis were analysed in 100 unselected consecutive patients undergoing allogenic BMT. This series is homogeneous because of the same diagnostic procedures, BMT technique and supportive care (exclusive seronegative blood products, no CMV immunoglobulin, no prophylactic antiviral). The incidence of CMV infection and CMV interstitial pneumonitis (CMV-IP) were 44% and 13% respectively, of whom five patients died. Variables such as age, sex, underlying disease, conditioning regimen and occurrence of GVHD were not found as significant risk factors. We confirm that the only major factor was recipient's serology as CMV infection and IP occurred in 4% and 0% respectively among negative recipients (R-) compared with 79% and 25% among positive R. In contrast to some studies among R+, neither donor's immunity nor recipient's CMV humoral response improved the clinical outcome. This study validates the good predictive value of viremia and urinary virus excretion for the occurrence of CMV-IP (respectively positive in 11 and 13 patients out of 13 with IP), always preceding IP by a median of 37 and 27 days. The highest risk patients for lethal CMV-IP were older recipients (> 30 years). Thus, prospective prophylactic trials with antiviral agents are suggested in such viremic or viruric patients. Furthermore, the use of seronegative blood products is highly effective and sufficient to prevent CMV infection in R-patients.

The personality abnormalities observed during unipolar and bipolar manic-depressive disorders are known for years by german psychiatry as depressive temperament. In USA many works based on DSM III criteria have studied personality abnormalities coexisting with depression. The most frequently abnormalities are dependent, avoidant, compulsive, border line personality, observed with a frequency of 48% (P.A. Pilkonis) to 74% of patients (T.M. Shea et al.). But the personality traits or disorders are not the disorders only observed during remissions and intercrisis. Our personal work have studied the other disorders. This work concern pre-morbid period and intercrisis of 95 manic-depressed patients (45 unipolar and 50 bipolar patients). The time of remission is at least three months. Remission is certified by maximum scores of 10 on MADRS, 12 on Bech-Rafaelsen scale. The study of personality traits and other mental disorders is based on DSM III-R criteria. It is completed by Hamilton-Anxiety-Scale, Eysenck Personality Inventory and Beth-Israel Questionnaire of Sifneos. This study shows the following results. In pre-morbid period, the anxiety disorders are statistically more frequent in unipolar patients: generalized anxiety (35%), panic disorder (27%), psychosomatic disorders (30.5%). During intercrisis, the anxiety disorders are statistically more frequent in unipolar patients: generalized anxiety (51.1%), agoraphobia (31.1%) obsessive disorders (26.6%), panic disorder (18.2%). But this co-morbidity with anxious disorders is highly correlated with the incomplete characteristic of remission. During remission the personality abnormalities are similar to american studies, more frequent in unipolar patients, particularly obsessive personality (22.2 to 4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatic veno-occlusive disease (VOD) is a major regimen-related toxicity after bone marrow transplantation (BMT). Endothelial injury, leading to deposition of coagulation factors within the terminal hepatic venules, is believed to be the key event in the pathogenesis of VOD. To evaluate the benefit and the safety of a VOD prophylaxis with anticoagulants, we conducted a prospective randomized trial of continuous infusion of low-dose heparin among 161 patients under-going either allogeneic (n = 79) or autologous BMT (n = 81). Patients were randomized to receive (n = 81) or not receive (n = 80) prophylactic heparin 100 U/kg/d by continuous infusion from day -8 until day +30 post-BMT. Heparin was found to be highly effective in preventing VOD, which occurred in 11 of 80 patients (13.7%) in the control group versus 2 of 81 (2.5%) in the heparin group (P less than .01). Furthermore, none of the 39 patients in the heparin group developed VOD after allogeneic BMT, versus 7 of 38 (18.4%) in the control group (P less than .01). This prophylactic effect was achieved without added risk of bleeding. Indeed, the low-dose heparin we used did not prolong the partial thromboplastin time and did not increase the red blood cell and platelet requirements. It is therefore recommended that heparin prophylaxis be part of early mortality prevention programs after BMT.

The authors discuss the results of a double-blind, placebo-controlled, randomised study on the efficacy of mebendazole versus placebo in the treatment of human toxocariasis in 45 and 43 patients respectively, who exhibited evocative clinical and biological symptoms and a seropositivity. Scores were used to quantify clinical (20 parameters) and biological (blood count, sedimentation rate, determination of total and anti-Toxocara IgE, serodiagnosis by immunoelectrophoresis) abnormalities. The reassessment were done 1 month after the end of treatment. Analyzing the results showed a similar efficacy of mebendazole and placebo on the score of clinical signs; the score of biological abnormalities was significantly reduced in mebendazole group, but the serodiagnosis by immunoelectrophoresis was the only parameter that was significantly normalized. These results corroborate previous prospective studies and allow to make a conclusion in favour of a moderate efficacy of mebendazole.

A transversal study on consumption of medicines was performed in 1,020 children and adolescents (10 to 21 years; mean age 15.3 years) questioned at school. 60.2% used at least one medicine during the week before the study. The mean number of used drugs was 2 by each consumer. There was no increase in drug consumption according to the different classes of age (10 to 14, 15 to 17, 18 to 21 years). However, from 15 years old, girls used more drugs than boys. The most used medicines are neuropsychotropic drugs (analgesics or psychostimulants). Prescription from non medical origin (self-medication or prescription by parents) was found in 46.1% of subjects. Some factors are significantly corelated with a more marked consumption of medicines: familial or personal problems in the whole population, social class of parents in the population aged from 10 to 14 years, regular use of medicines by other members of the family for adolescents from 15 to 17 years.

A new haematology analyser--the Sysmex NE-8000--provides among other results a bi-dimensional representation of leucocyte populations. Unusual patterns are frequently observed due to platelet aggregation or fibrin polymerisation, and a specific 'rocket-shaped' pattern is also sometimes noted. During a seven month period of routine use 68 such cases were investigated, revealing that this pattern is associated with either severe hepatic dysfunction responsible for patient admission or with various asymptomatic constitutional haemoglobin anomalies. This 'rocket' phenomenon is probably due to incomplete erythrocyte lysis in the leucocyte detector. In some cases it causes spurious leucocyte counting (avoidable by a 1 in 5 pre-dilution of the sample), and alteration of the differential count. To take advantage of this aberrant pattern and to orientate immediate complementary investigations on the basis only of the NE-8000 results, we established a discriminative index.

The purpose of this study was the epidemiology of toxoplasmosis in Congo, Ivory Coast (IC), Niger, Centrafrican Republic, Zaïre. This statistical study was relied upon the search of IgG and IgM antibodies. In Niger, the risk connected with the first contact of the parasite was very low for children and young women, since only 2.6% of children under 15 years were carrying IgG and 5.4% of women between 15 and 30. In the other countries, the highest risk of first contact occurred before reaching 10 years and mostly between 5 and 9 (the IgG survey was confirmed by IgM survey). Nevertheless, IgM survey had indicated that for the young women there was a risk of first contact until reaching 20 years in IC and 30 years in Congo. A comparative study of antibodies developed among the couple mother-children was conducted in IC and Congo.

Our study group, which was composed of over 2,500 subjects, aged between 0 and 65 years, came from different regions of Congo. The samples obtained were examined for the presence of IgG and IgM against Toxoplasma gondii. IgG were detected in about 33% of children over 9 years and in about 40% of adults. A study of IgM confirmed the early contact of children with the parasite (11% of positive samples for children between 4 and 9) and that of young women (5 to 7% positivity for subjects between 15 and 30). In spite of local variations, the extremely humid climate did not allow us to detect a difference based on the origin of the samples as furthermore there seems to be an ethnic factor involved. Among the different types of professions in our sample only farmers appear to be less frequently positive. Diet, as well as contact with animals do not seem to have an influence.

The epidemiological survey on the incidence of toxoplasmosis in rural areas of Central African Republic was carried out on a healthy population. The 814 samples came from 5 regions with 4 different climates. About 40% of the adults had IgG antibodies against Toxoplasma gondii except in pre-desert area where only 25% were positive. Girls became positive earlier than boys, but there was no difference between adult men and women except in pre-desert zone where men were more positive.

The efficiency of an immunoenzymatic technique (ELISA) for the systematic research of Chagas' disease in blood donors was compared with one of 2 well-known methods, indirect haemagglutination (IHA) and indirect fluoro immuno assay (IFA). For the ELISA technique two different antigenic extracts from epimastigote culture forms of T. cruzi, were used for sensitizing the polystyrene plates: a crude extract (Ag R) and a delipidized one (Ag B). Firstly the authors tested these 3 techniques in 5 control groups: sera from Chagas' disease, negative control sera, sera from visceral leishmaniasis, african trypanosomiasis and finally monoclonal gammapathies, the high levels of blood proteins being a possible cause of false positives. Secondly the screening of Chagas' disease was performed in the same way in 976 blood donors from Recife, Brazil. In the case of the Ag-R extract used in the ELISA technique a high cross-reactivity was found with visceral leishmaniasis sera, along a risk of false positives with gammapathic ones. The sensitivity of this technique was found to be high (3,3 +/- 1 p. cent of positive blood donors) and a very good correlation was found with the reference techniques, IFA and IHA, the sensitivity of which is lower (2,3 +/- 1 and 1,7 +/- p. cent). The use of a delipidized antigenic extract (Ag B) for the ELISA technique is not suitable, in spite of an apparent higher specificity: indeed, the positives rate is high (11,5 +/- 0,2 p. cent), but the correlation is very weak or non existent in the case of IHA or IFA. In conclusion, the ELISA technique using a crude extract of T. cruzi appears to be a very convenient method for screening blood donors with Chagas' disease, the lack of specificity due to leishmaniasis or monoclonal blood proteins not posing any real problem to blood banking.

Human plasma butyrylcholinesterase (E.C.3.1.1.8) was highly purified by a three-step procedure involving affinity and ion-exchange chromatography techniques. The final product was about 15,000-fold purified with a yield of 12% and a specific activity of 450 U/mg.

Authors report results of stimulation test of prolactin by T.R.H. in 72 inpatients with affective disorders. They find well known effects of physiological factors (age, sex), and treatments (neuroleptics, lithium, L-Dopa). They did statistical analysis on plasma levels before and after T.R.H. stimulation. This test has no value for differential diagnosis between types of depressions. But it shows particular relation between high levels of prolactin and bipolarity.

The antinociceptive effects and the plasma levels (evaluated by high liquid pressure chromatography) of clomipramine during a subchronic (5 days) treatment were studied in rats using the Nilsen's test. Clomipramine (10, 20, 30 and 40 mg/kg administered by mouth) showed a clear dose-dependent analgesic effect. The study of the partial correlation coefficients did not found a relationship between plasma levels and antinociception under our experimental conditions. These results suggest that regular monitoring of plasma levels of clomipramine appears to be useless in the treatment of patients with chronic pain.

The analgesic effect of clomipramine and the possible relationships between the antalgic action, the doses and the plasma levels of this tricyclic drug have been studied in 15 patients with chronic pain induced by nervous lesions determining a deafferentiation. Eight of 15 patients treated with clomipramine (100 mg/IV during 10 days and then 150 me per os) reported a significant improvement (up to 50 per cent during 3 to 18 months). The study of the partial coefficients of correlation did not show a relationship between plasma levels and analgesia in the total population or in the subgroup of the 8 improved patients. These results confirm the analgesic properties of clomipramine and suggest that regular monitoring of plasma levels of clomipramine does not appear of practical interest in the treatment of chronic pain.

We report on 29 treatment courses in 25 children aged 1.5-18 years who received captopril because of severe renal hypertension. The mean initial dosage was 1.3 (0.5 to 3) mg/kg/day and the mean sustaining dose 2.2 mg/kg/day. The treatment was followed for 2-40 (mean 15) months. We observed a lowering of both systolic and diastolic blood pressure (BP) from 26% at the 2nd day to 65% at the 6th month. The isolated use of captopril was ineffective in 13% of cases, but blood pressure dropped in all of them after addition of beta blocking agents. No clear-cut relation was found between response of blood pressure and etiology, degree of HT or plasma renin activity (PRA). No side effects occurred during treatment except for one case of reversible acute renal failure in a transplanted patient with renal artery stenosis.

Pulmonary edema after re-expansion of a pneumothorax occurs within a maximum of 3 days of the pneumothorax and manifests by intense clinical signs (cough, abundant foamy expectoration, major cyanosis), marked hypoxia and a "white lung" radiologic image. The outcome was rapidly favorable in the case reported, despite the severity of the initial symptomatology. Currently accepted physiopathologic mechanisms implicate numerous factors in the genesis of edema due to re-expansion. The lesional pulmonary edema can be explained by alteration in alveolar capillary permeability, by the atelectasis, hypoperfusion and stretching during revascularization, and possibly by the action of free radicals. A hemodynamic edema also exists as a consequence of the reduction in pulmonary interstitial pressure. Possible prophylactic measures are discussed, the most appropriate appearing to be very progressive evacuation of the pneumothorax.

The Octopus automatic perimeter was used to determine changes in visual field of 90 patients with chronic open angle glaucoma. Mean sensitivity value calculated from 62 of the 73 points of the apparatus program 33 - after elimination of those 11 points corresponding to Mariottes's zone and the central 10 degrees - provides an effective paracentral visual field monitoring numerical parameter. The authors named the parameter "global value". Statistical analysis of "global value" variations between two successive examinations showed: significant improvement between the first and the second tests; disappearance of the phenomenon between two further successive tests. The reasons for this pseudo-improvement remain unclear: perhaps the patients experience gained from the precious tests plays a part in the phenomenon. This should in any case be taken into account when assessing possible aggravation between two tests. Analysis of results suggests that, as a standard evaluation method, any "global value" degradation of the order of 1 db between the first two tests and 3 db between two successive tests performed after the second one is significant of a visual field degradation with a 1% range of error.

The purpose of this study was to determine the prevalence of toxoplasmosis in samples of healthy populations in Ivory Coast. Various factors have been studied: age, sex, ethnic group, occupation, food, contacts with animals, climate. The samples were obtained in four places which were different by geographical situation and climate: Abidjan (urban site), Bonoua (littoral site), Bin-Houye (forest site), Odienne (predesert site). The samples of sera or blood were deposited on filter-papers and tested by latex agglutination (for IgG) and ISAGA (for IgM). Results were analysed by statistical methods. More than 2,000 samples have been studied, showing a prevalence higher in humid tropical zones (55.6% to 70%) than in predesert zone (37.2%). The first contact of the child with the parasite was more often before reaching 10 years but the risk for women was important until the age of 20. The other studied factors didn't appear to have any effect.

Factor VIII complex was studied in patients presenting arterial hypertension. Visceral involvement was quantified using a clinical index calculated from ocular fundus, renal function and left ventricular hypertrophy data. A significant correlation was found between the mean arterial pressure, the visceral involvement and the level of complex VIII. Nevertheless, other data obtained in different patients (Conn's disease) suggest that the visceral involvement (and not the mean arterial pressure) is the main determining factor in the increase of factor VIII complex.

The effect of loperamide (Imodium) on fecal excretion of electrolytes was studied using a double-blind protocol in 63 infants aged 1 to 32 months, presenting with acute diarrhea. The etiology of these infections was due to virus (n = 9), E. coli (n = 4), Salmonella (n = 4), Shigella (n = 2) or was of undetermined origin (n = 34). The therapeutic protocol was the same for all the infants: ad libitum oral rehydration, with no drug being administered except for Imodium at an average dose of 20 to 25 drops/kg/24 h (0.16 to 0.20 mg/kg/24 h), given every 8 hours for at least 48 hours. Stool Na+ and K+ concentrations were determined in samples taken before and after the double-blind trial. In patients receiving loperamide, we observed a non-significant decrease in fecal Na+ concentration as compared with values before treatment. Comparison of the two groups of infants, one receiving Imodium, the other a placebo, showed a significant difference (p less than 1%) in fecal sodium concentration, due rather to an increase in stool Na+ in the placebo group than to a decrease in the group treated with Imodium. Moreover, the use of loperamide, compared with the placebo, did not result in a significant decrease in the number of stools, modified fecal K+ values, or more rapid recovery from the diarrheal syndrome.

An investigation of "kidney outpatient" first consultations carried out in 1985 with the cooperation of 19 nephrological teams distributed all over France. Each team had taken part in a similar investigation in 1980. The work allowed to collect 1200 records. Analysis of the main results is presented. The comparison between the 1980th and the 1985th investigations shows a remarkable stability of the results, but suggests two new and interesting features: the progress of Dip-stick studies and serum creatinine concentration in general practice and the decreasing part taken by hypertension in "kidney disease out-patient" activity in 1985.

The activities of several lysosomal hydrolases (beta-galactosidase, beta-hexosaminidase, alpha-mannosidase, beta-glucuronidase and acid phosphatase) were determined in serum and blood lymphocytes from patients affected with scleroderma. Statistical comparisons between means of patient and control groups (Student's t test) showed a significant difference in serum beta-galactosidase and acid phosphatase between patients and controls (serum beta-galactosidase: 36.5 +/- 22 nmol/h/ml in the scleroderma group versus 24 +/- 13 nmol/h/ml in the control group; serum acid phosphatase 853 +/- 345 nmol/h/ml in the scleroderma group versus 634 +/- 295 nmol/h/ml in the control group). These differences were significant (p less than 0.01). Both enzyme activities were also significantly increased in the group with systemic scleroderma, but the difference was less in the group with localized scleroderma (this is discussed in terms of statistics and pathophysiology). The other enzyme activities determined were not significantly modified. The validity of these results is discussed, together with their diagnostic value and with the pathophysiological hypotheses put forward to explain the high levels found.

A simple, inexpensive method for measuring the cerebral circulation time (CCT) was developed. The CCT was considered to be equal to the time that an intravenously injected bolus of sodium pertechnetate Tc 99m took to go from the subclavian artery to the posterior venous confluence. The dilution curves were externally recorded at these two vessels. Particular attention was given to the curve treatment. The computer programmes were specially conceived in order to detect and, if possible, correct the experimental curve defects. Several reliability criteria were also defined in order to test the validity of each measurement. From a physiological point of view, the CCT is equal to the ratio of the global cerebral blood volume to the global cerebral blood flow. Thus, it can be widely applied in clinical research. For example, in a study of the relationship between CCT and age, sex and light cerebrovascular impairment, the technique was sensitive enough to discriminate between healthy subjects and patients suffering from-transient ischemic attack, or regressive stroke, and to show the action of a drug on the cerebral circulation in such patients.