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Evidence of post-mortem breath movements are rarely reported. We present two cases of broncho-pulmonary aspiration of brain and cartilage tissue following two fatal suicidal gunshots to the head. We also discuss the physiopathological implications for the agony.

Resume Introduction De nombreuses etudes soulignent l’interet de la musicotherapie dans le traitement de la douleur. Le montage en « U » est une technique de musicotherapie developpee en tenant compte des recommandations de la litterature. Un logiciel a ete realise au CHRU de Montpellier avec la societe Music Care © permettant son utilisation standardisee par les soignants. Objectif L’objectif principal de ce travail est de rapporter des travaux de recherche ayant permis de standardiser et d’evaluer une nouvelle technique de musicotherapie dans la prise en charge de la douleur. Methode Suite a une revue complete de la litterature sur ce sujet, une serie d’etudes controlees et randomisees a ete realisee dans les services de rhumatologie, de reeducation fonctionnelle, d’anesthesie-reanimation, de neurologie et du centre de traitement de la douleur du CHRU de Montpellier. Resultats L’effet de la musicotherapie a ete evalue sur differents types de douleurs aigues et chroniques d’origines diverses : mecaniques, inflammatoires, fibromyalgiques et neurologiques. Une action physiologique (sur les parametres hemodynamiques et respiratoires, etc.) mais aussi psychologique, en favorisant la relation d’« ecoute » entre soignant et soigne, a ainsi pu etre mise en evidence. Cette action se traduit par une reduction de la douleur, de l’anxiete et de la depression permettant une baisse significative des consommations d’anxiolytiques et d’antidepresseurs. Conclusion La revue de la litterature internationale et les premieres etudes controlees et randomisees francaises temoignent de l’interet de l’utilisation de la musicotherapie dans la prise en charge de la douleur.

Vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome can be managed either by various surgeries or dilation. The choice still depends on surgeon's preferences rather than on quality comparative studies and validated protocols.We sought to compare dilation and surgical management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome, in terms of quality of life, anatomical results, and complications in a large multicenter population.Our multicenter study included 131 patients18 years, at least 1 year after completing vaginal agenesis management. All had an independent gynecological evaluation including a standardized pelvic exam, and completed the World Health Organization Quality of Life instrument (general quality of life) as well as the Female Sexual Function Index and Female Sexual Distress Scale-Revised (sexual quality of life) scales. Groups were: surgery (N = 84), dilation therapy (N = 26), and intercourse (N = 20). One patient was secondarily excluded because of incomplete surgical data. For statistics, data were compared using analysis of variance, Student, Kruskal-Wallis, Wilcoxon, and Student exact test.Mean age was 26.5 ± 5.5 years at inclusion. In all groups, World Health Organization Quality of Life scores were not different between patients and the general population except for lower psychosocial health and social relationship scores (which were not different between groups). Global Female Sexual Function Index scores were significantly lower in the surgery and dilation therapy groups (median 26 range [2.8-34.8] and 24.7 [2.6-34.4], respectively) than the intercourse group (30.2 [7.8-34.8], P = .044), which had a higher score only in the satisfaction dimension (P = .004). However, the scores in the other dimensions of Female Sexual Function Index were not different between groups. The Female Sexual Distress Scale-Revised median scores were, respectively, 17 [0-52], 20 [0-47], and 10 [10-40] in the surgery, dilation therapy, and intercourse groups (P = .38), with sexual distress in 71% of patients. Median vaginal depth was shorter in dilatation therapy group (9.6 cm [5.5-12]) compared to surgery group (11 cm [6-15]) and intercourse group (11 cm [6-12.5]) (P = .039), but remained within normal ranges. One bias in the surgery group was the high number of sigmoid vaginoplasties (57/84, 68%), but no differences were observed between surgeries. Only 4 patients achieved vaginas6.5 cm. Delay between management and first intercourse was 6 months (not significant). Seventy patients (53%) had dyspareunia (not significant), and 17 patients all from the surgery group had an abnormal pelvic exam. In the surgery group, 34 patients (40.5%) had complications, requiring 20 secondary surgeries in 17 patients, and 35 (42%) needed postoperative dilation. In the dilation therapy group, 13 (50%) needed maintenance dilation.Surgery is not superior to therapeutic or intercourse dilation, bears complications, and should therefore be only a second-line treatment. Psychological counseling is mandatory at diagnosis and during therapeutic management.

Lymphoepithelioma-like carcinoma (LELC), which is commonly reported in the nasopharynx and occasionally in other organs, remains a rare condition in gynecology. It is morphologically defined as a poorly differentiated carcinoma with prominent lymphoplasmacytic infiltrate. We present a case of an 82-year-old woman with a 10 cm LELC of the ovary shown by inguinal lymph nodes. There was no peritoneal carcinomatosis. Cytoreductive surgery was performed to remove a left ovarian neoplasm and multiple involved lymph nodes. Cytoreduction was complete. The tumor was a mixed poorly undifferentiated ovarian carcinoma consisting of 95% LELC and 5% moderately differentiated serous adenocarcinoma. Immunohistochemistry showed a large infiltration of T lymphocytes and plasma cells. Epstein-Barr virus was not detected by immunolabeling and polymerase chain reaction. The patient was still alive at 24 months of follow-up. To our knowledge, this is the second case of ovarian LELC and the first description of the native tumor before chemotherapy. In conclusion, this rare tumor of the ovary is difficult to diagnose both preoperatively and perioperatively. However, clinicians and pathologists should be aware that ovarian tumors with massive involvement of lymph nodes and no peritoneal carcinomatosis are suggestive of such a diagnosis and that prognosis is relatively good.

BACKGROUND: Menstruation is associated with a striking increase in matrix metalloproteinase (MMP) activity. However, it is still unknown whether the level of MMP activity correlates with the amount of menstrual bleeding. METHODS: We used histochemistry to investigate the degradation of the extracellular matrix (ECM), and immunohistochemical labelling and zymographic analysis to determine the level of expression and activity of MMP-2 and -9, and of their tissue inhibitors (TIMPs) -1, -2 and -3, in endometria sampled during menstruation in 14 women experiencing excessive menstrual bleeding and in 10 women successfully treated for menorrhagia by thermal ablation of the endometrium. RESULTS: After thermal ablation, regenerated menstrual endometria showed reduced areas of collagen fibre lysis and increased content of TIMP-1 and TIMP-2 compared with endometria from non-treated menorrhagic women. Surprisingly, treated endometria contained more latent gelatinase A (proMMP-2) but a lower proportion of the active form of gelatinase B (MMP-9) than non-treated endometria. CONCLUSIONS: These results suggest that ECM degradation is decreased at menstruation in the endometrium regenerated after thermal ablation, mostly because of an increased TIMP expression. This represents the first molecular explanation for the decreased amount of menstrual bleeding.

This article describes the potential interest in physical and forensic anthropology of the microscopic analysis of residues of putrefaction fluid, a calcified deposit frequently found associated with bone rests. Its sampling and analysis seem straightforward and relatively reproducible. Samples came from archeological material (Monterenzio Vecchia, an Etruscan necropolis from the north of Italy dated between the fifth and third century B.C.; body rests of Agnès Sorel, royal mistress died in 1450 A.D.; skull and grave of French King Louis the XI and Charlotte of Savoy dated from 1483 A.D.). All samples were studied by direct optical microscope and scanning electron microscopy. Many cytological, histological, and elemental analysis were possible, producing precious data for the identification of these remains and, in some cases, the cause of death.

Objectives. To report various descriptions of the combination of a benign genital tumour with pleural and/or abdominal effusion throughout the years and to determine the paternity of this syndrome, commonly known as Meigs' syndrome. Methods. A systematic review of the literature from 1728 to 2004. Results. Before 1880, publications were rare and limited to clinical and anatomical descriptions drawing no conclusions between the cause and effect of this condition and even less about its management. Demons described the syndrome between 1887 and 1902. He was the first to specify that removal of the tumour (benign ovarian cyst, solid ovarian tumour, fibroma of the broad ligament) was essential for the patient to be cured of the effusions and that it was wrong to postpone surgery. In 1937, Meigs arrived at the same findings concerning ovarian fibromas and granulosa cell tumours, hence the name of Demons–Meigs which was given to this syndrome with the agreement of Meigs. Current literature reports on pseudosyndromes of Demons–Meigs including genital malignancies with negative cytology. These entities should not be called Demons or Meigs pseudosyndromes. Inversely, all benign tumours of the genital tract should be included in Demons syndrome, even if Demons did not actually encounter any during his years of practice, but it was in the spirit of his observations. Conclusion. Demons' syndrome includes all benign genital tumours, the Demons–Meigs eponym is reserved for the description of ovarian fibromas and granulosa cell tumours, and the Demons' pseudosyndrome includes all other entities.

International audience; Objective The aim of the study was to assess whether direct colposcopic ă vision (DCV) of the cervix during large loop excision of the ă transformation zone (LLETZ) is associated with a decrease in the volume ă and dimensions of specimens or affects margin status at histology. ă Materials and Methods A prospective multicenter observational study of ă 216 women who underwent LLETZ for grades 2 and 3 cervical ă intraepithelial neoplasia was conducted. The volume and dimensions ă (circumference, length, and thickness) of the surgical specimens were ă measured before fixation. Data were compared according to the use of ă colposcopy during LLETZ. The following 3 groups were considered: LLETZ ă performed without colposcopy (n = 91), LLETZ performed immediately after ă colposcopy (n = 51), and LLETZ performed under DCV (n = 74). ă Results Patient characteristics were comparable with regard to age, ă parity, history of excision, indication of the procedure, and the size ă of the cervix. We found a significant decrease in all dimensions of the ă specimens obtained under DCV (p < .001). Margin status was not affected. ă After adjusting for confounders, the mean volumes were significantly ă lower in the DCV group (adjusted mean difference = -0.66 mL; 95% CI = ă -1.17 to -0.14). The probability that negative margins would be achieved ă together with the attainment of a volume less than 5 mL and a thickness ă less than 10 mm was the highest in the DCV group (adjusted OR = 2.80; ă 95% CI = 1.13 to 6.90). ă Conclusions Direct colposcopic vision is associated with a significant ă decrease in the volume and in all dimensions of LLETZ specimens with no ă compromise in the margin status.

To assess the impact of the surgical case volume on the accuracy of preoperative staging and compliance with the European Society of Medical Oncology (ESMO) guidelines for the management of endometrial cancer (EC).Centers were divided into those taking care of 20 or fewer EC cases, and those with more than 20 per year.Seventeen university teaching hospitals fully responded to the questionnaire. The differences between the preoperative assessment and postoperative risk groups were significant for all centers (p=0.001). However, this difference was not due to the volume of patients of centers (p=1.00). Lymphadenectomy was performed in 21% and 82% of patients in the ESMO low-risk and high-risk groups, respectively, without differences between centers overall and centers managing more or fewer than 20 ECs per year. For the ESMO intermediate-risk group, the difference was significant when taking all groups into account (p=0.02), but it was not significant between centers managing fewer than 20 ECs (85%) or more than 20 ECs (59%) per year (p=0.12).The accuracy of preoperative staging in EC is not improved in centers managing more than 20 ECs per year. Lymphadenectomy practice in the presumed low- and high-risk groups was homogenous. In the presumed intermediate-risk group, lymphadenectomy practice is heterogeneous and centers managing more than 20 ECs tend to perform lymphadenectomy more frequently.

International audience; Graph edit distance corresponds to a flexible graph dissim-ilarity measure. Unfortunately, its computation requires an exponential complexity according to the number of nodes of both graphs being compared. Some heuristics based on bipartite assignment algorithms have been proposed in order to approximate the graph edit distance. However , these heuristics lack of accuracy since they are based either on small patterns providing a too local information or walks whose tottering induce some bias in the edit distance calculus. In this work, we propose to extend previous heuristics by considering both less local and more accurate patterns defined as subgraphs defined around each node.

An original case of incomplete (and reasonably fatal) human trepanation is described in this short paper. The diagnosis was made on the cremated remains of a young adult individual who died in Rome, Italy during the 2nd century AD.The trepanation was incomplete, as death occurred quickly due to vascular lesions, according to the anatomic analysis of the bone piece. Comparable trepanation from Roman times are described and related to this case.Even if archaeological, this case highlights the possibility of such a diagnosis on post-fire fragmented bones. Very suggestive lesions of section are of great interest for the history of such a practice during classical Antiquity. Lastly, from a medical and forensic point of view, such a diagnosis may be of interest during any identification process and research for a cause of death during anthropological analyses.

International audience

Objectives The objectives were to estimate the prevalence of Chlamydia trachomatis infection in subfertile couples and to study the relationship between markers of C. trachomatis infection and male infertility as well as pregnancy rates after in vitro fertilization (IVF). Study design All consecutive couples consulting for infertility and IVF in Pellegrin Hospital were screened for C. trachomatis by direct (PCR test) and serological methods. Results Two hundred and seventy-seven couples were included in the study (mean age in years: 35 for men, 32 for women; mean duration of infertility: 4 years). The most frequent indication for IVF was tubal factor in 33%, endometriosis in 6%, dysovarian function in 12%, male infertility in 36% and others in 13%. C. trachomatis PCR was positive in 1.2% of men, 95% confidence interval (CI 95% ): (0.2%; 3.3%) and in 2.7% of women, CI 95% : (1.1%; 5.5%). When combining all chlamydial markers, 17.3% of men, CI 95% : (12.7%; 22.8%) and 20.4% of women, CI 95% : (15.6%; 25.9%) had at least one positive marker. The presence of positive markers was not associated with altered semen characteristics. Couples with positive markers had a pregnancy rate of 23.1% (12 out of 52) compared with 20.2% (24 out of 119) among those with negative markers. Conclusion In this population, the presence of past or current C. trachomatis infection was associated with neither semen characteristics nor outcome of IVF in subfertile couples.

The paper briefly reviews the main pathologies of the endometrium that can be detected by hysteroscopy. Emphasis is put on dysfunctional endometrial bleeding and the recently discovered molecular mechanisms that trigger its occurrence, on the difference between hyperplasia and intra-epithelial neoplasia of the endometrium and on the DNA alterations commonly found in endometrial adenocarcinomas. This review of uterine pathology is intended for gynecologic endoscopists and is accordingly focused on lesions of the endometrium and of the inner portion of the myometrium.

Objectives: To evaluate oxidative and antioxidative status in pregnant diabetic women between 26 and 32 weeks of gestation. Design and Methods: Free and total malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX), and vitamins A and E were determined in plasma and erythrocytes of 54 pregnant women. Among these, 27 were diabetics with either gestational diabetes mellitus (GDM), sub-group I, or previous insulin-dependent diabetes mellitus (type 1 diabetes), sub-group II. The other 27 patients were controls. Fasting plasma glucose and HbA 1c levels were determined in all women. Results: HbA 1c levels, plasma-, and erythrocyte-free MDA levels were significantly higher in all diabetic women and in both sub-groups than in controls. Plasma vitamin E and erythrocyte vitamin A levels were significantly lower in all diabetic women than in controls. Moreover, GPX and SOD activities were significantly reduced in all diabetic women, GPX in both sub-groups and SOD only in type 1 diabetes. Conclusions: The increased oxidative stress we demonstrated in pregnant women with previous type 1 diabetes or with GDM should be monitored by strictly controlling blood glucose during pregnancy with stringent recommendations and perhaps antioxidant supplementation.

Introduction Depuis quelques annees, Mycoplasma genitalium est une cause reconnue d’uretrite sexuellement transmissible chez l’homme. Chez la femme, M. genitalium est en train de devenir une cause emergente d’infection sexuellement transmissible, on parle de « nouveau chlamydia ». De nombreuses etudes ont montre une association positive entre M. genitalium et la survenue de cervicites muco-purulentes mais aussi d’infections genitales hautes a type d’endometrites et de salpingites. Cependant, il n’a jamais ete etabli d’association claire entre la presence de M. genitalium et la survenue de consequences obstetricales pejoratives de type menace d’accouchement premature ou prematurite. L’objectif de cette etude est d’evaluer la prevalence et les consequences obstetricales des infections a M. genitalium chez les femmes enceintes suivies au CHU de Bordeaux. Methodes Il s’agit d’une etude epidemiologique transversale, prospective basee sur la recherche par PCR en temps reel de M. genitalium chez les femmes enceintes suivies au CHU de Bordeaux de janvier a juin 2011. Cette recherche est realisee a partir d’un ecouvillonnage vaginal realise dans le cadre de la consultation gynecologique de suivi de la grossesse. Si le prelevement etait positif, un traitement par Azithromycine 1 g en dose unique etait prescrit a la patiente et a son partenaire. Les patientes âgees de plus de 18 ans et ayant donne leur consentement oral sont incluses dans l’etude. Resultats Sur 1062 patientes eligibles, 12 patientes n’ont pas ete incluses (prise d’antibiotiques dans les 3 dernieres semaines), 44 patientes ont refuse de participer a l’etude et 1006 patientes ont ete incluses. Huit patientes ont ete detectees, soit une prevalence globale de l’infection a M. genitalium etait de 0,8 %. La prevalence differe notablement en fonction de l’âge, de 2,4 % chez les patientes âgees de 18 a 24 ans a 0,6 % chez les patientes âgees de plus de 25 ans. Les 8 patientes etaient âgees de 19 a 32 ans (26 ans en moyenne). Elles ont ete diagnostiquees entre 12 et 40 SA avec une moyenne a 29 SA. Toutes, ainsi que leur partenaire, ont recu un traitement adapte. Elles ont toutes accouche a terme (40 SA en moyenne), par voie basse. Six patientes se sont mises en travail spontanement, 2 ont ete declenchees (une pour diabete gestationnel desequilibre a 40 + 2 SA et une pour un monitoring type Oxford non conforme a 41 + 2 SA). Tous les enfants etaient eutrophes avec un poids moyen a 3342 g. Le pH moyen etait de 7,26, les lactates etaient a 3,37 en moyenne. Il n’y a pas eu d’evenements infectieux en suites de couche. Discussion Dans notre etude la prevalence globale est de 0,8 % avec une prevalence augmentee a 2,4 % chez les patientes âgees de moins de 24 ans. Ceci est conforme aux donnees de la litterature ou la prevalence varie de 0,7 % a 20 % selon les donnees demographiques. Presque toutes les etudes ont echoue a montrer un lien entre M. genitalium et la prematurite. Sur 8 etudes publiees, seulement deux cohortes prospectives ont montre une association entre M. genitalium et la prematurite mais M. genitalium etait associe a d’autres microorganismes egalement impliques. Conclusion Compte tenu de la faible prevalence de M. genitalium et de l’absence de preuve en faveur d’une pathogenicite obstetricale, il n’y a pas lieu de depister systematiquement M. genitalium en debut de grossesse.

A hierarchical structure is a stack of successively reduced image representations. Each basic element of a hierarchical structure is the father of a set of elements in the level below. The transitive closure of this father-child relationship associates to each element of the hierarchy a set of basic elements in the base level image representation. Such a set, called a receptive field, defines the embedding of one element on the original image. Combinatorial pyramids are defined as a stack of successively reduced combinatorial maps, each combinatorial map being defined by two permutations acting on a set of half edges named darts. The basic element of a combinatorial pyramid is thus the dart. This paper defines the receptive field of each dart within a combinatorial pyramid and study the main properties of these sets.

Graph pyramids are made of a stack of successively reduced graphs embedded in the plane. Such pyramids overcome the main limitations of their regular ancestors. The graphs used in the pyramid may be region adjacency graphs, dual graphs or combinatorial maps. Compared to usual graph data structures, combinatorial maps offer an explicit encoding of the orientation of edges around vertices. Each combinatorial map in the pyramid is generated from the one below by a set of edges to be contracted. This contraction process is controlled by kernels that can be combined in many ways. This paper shows that kernels producing a slow reduction rate can be combined to speed up reduction. Conversely, kernels decompose into smaller kernels that generate a more gradual reduction. We also propose one sequential and one parallel algorithm to compute the contracted combinatorial maps.

Capsule Local first-year survival is higher in La Crau than in Spain with a high proportion of first-year birds returning to their natal area. Aims To understand life history parameters that may be responsible for a population growth since the 1990s. Methods Between 1994 and 1998, 342 birds were ringed as fledglings. From capture–recapture data, annual local survival and the proportion of first-year birds returning to their natal area were computed. Results The annual survival probabilities of adult and first-year birds were constant during the study period (0.67 and 0.57, respectively). A high proportion (0.72) of birds ringed as fledglings returned to their natal area after one year. Of these, an estimated 53% bred in that first year. Local first-year survival is higher in La Crau than other areas in Spain. Conclusion The high local survival rate, the product of survival and philopatry, might be responsible for the positive trend of the population. A peculiar aspect of the La Crau population is that gro...

Deciduosis classically occurs in the context of known endometriosis in the pelvis, most commonly in the ovaries, but also in the peritoneum. However, ovarian deciduosis outside the context of endometriosis is rare and makes diagnosis difficult, especially as the sonographic appearance suggests a malignant process. We report a case of decidualized ovarian mass in a patient without prior history of endometriosis that mimicked an ovarian malignancy. MRI may be a useful imaging modality to monitor these lesions and guide management. Consultation with a multidisciplinary team accustomed to such conditions will help to tailor the management to each individual.

International audience; Quantitative Structure Activity and Property Relationships (QSAR and QSPR), aim to predict properties of molecules thanks to computational techniques. In these fields, graphs provide a natural encoding of molecules. However some molecules may have a same graph but differ by the three dimensional orientation of their atoms in space. These molecules, called stereoisomers, may have different properties which cannot be correctly predicted using usual graph encodings. In a previous paper we proposed to encode the stereoisomerism property of each atom by a local subgraph. A kernel between bags of such subgraphs then provides a similarity measure incorporating stereoisomerism properties. However, such an approach does not take into account potential interactions between these subgrahs. We thus propose in this paper, a method to take these interactions into account hence providing a global point of view on molecules's stereoisomerism properties.

UNLABELLED: In patients chronically treated with angiotensin converting-enzyme inhibitors (ACEI), typically selected doses of ephedrine do not always restore arterial blood pressure when anesthesia-induced hypotension occurs. We postulated that the administration of terlipressin, an agonist of the vasopressin system, with ephedrine more effectively restores pressure in this setting than the administration of ephedrine alone. This prospective, randomized, cross-over, double-blinded study compared terlipressin combined with ephedrine (n = 19) with ephedrine alone (n = 21) in treating hypotension at the induction of anesthesia in 40 ACEI-treated patients undergoing hypotension (mean arterial blood pressure [MAP] IMPLICATIONS: Vascular surgical patients chronically treated with drugs that inhibit the functioning of the renin-angiotensin system may experience hypotension unresponsive to conventional therapy. This double-blinded, cross-over study demonstrated that in these patients the use of a vasopressin analog, terlipressin given with ephedrine, was effective in reversing intraoperative systemic hypotension refractory to ephedrine.

International audience

In this paper we propose a graph based approach for detecting abnormal behaviors starting from the analysis of vehicles’ trajectories. The scene is partitioned into zones and is dynamically represented as a graph by evaluating the distribution of trajectories belonging to the training set. Furthermore, four different strategies are proposed in order to verify if a test trajectory belongs to the scene and then can be considered normal by evaluating the probability that this trajectory belongs to the graph. Our algorithms have been tested on the standard MIT Trajectories dataset and the obtained results confirm the effectiveness of the proposed approach.

International audience; Chemoinformatics aims to predict molecular properties using informational methods. Computer science's research fields concerned by this domain are machine learning and graph theory. An interesting approach consists in using graph kernels which allow to combine graph theory and machine learning frameworks. Graph kernels allow to define a similarity measure between molecular graphs corresponding to a scalar product in some Hilbert space. Most of existing graph kernels proposed in chemoinformatics do not allow to explicitly encode cyclic information, hence limiting the efficiency of these approaches. In this paper, we propose to define a cyclic representation encoding the relative positioning of substituents around a cycle. We also propose a graph kernel taking into account this information. This contribution has been tested on three classification problems proposed in chemoinformatics.

Cervical cancer may be prevented by human papillomavirus (HPV) vaccination and the treatment of intraepithelial lesions diagnosed using cervical pap smears. HPV vaccines are effective for the prevention of CIN2/3 related to HPV 16, 18 and some other oncogenic HPV subtypes in HPV-naïve women. They are very well tolerated and to date, no increase in the incidence of auto-immune diseases has been reported. HPV vaccines primarily target girls aged 11-14 years old and catch-up programs include girls aged 15-19 years old. Vaccination coverage is below 40% in France, which is insufficient to induce herd immunity. Screening via pap smears is performed every three years in women between 25 and 65 years old, after two normal annual smears. However, screening is an individualised decision and is only performed in 57% of women. Abnormal smears require subsequent diagnostic investigations. Apart from high grade intra-epithelial lesions which generally require treatment, these abnormalities may be observed as they often undergo spontaneous regression due to viral clearance.

International audience; We present here the results of our inter-disciplinary examination of the mummified heart of Blessed Anne-Madeleine Remuzat (1696–1730). This organ has been examined in the context of a canonization process. This analysis is related to important aspects of the early history of anatomy in Europe, that of “Holy autopsies”, and to the relationship between anatomical investigations, Catholic theology, and religious/medical customs. According to anatomical, genetic, toxicological, and palynological analyses, it has been shown that this organ has not been naturally (“miraculously”) conserved but embalmed using myrtle, honey, and lime. Moreover, a right ventricle dilatation has been diagnosed, that may represent a post-tuberculosis condition and may have played a role in the cause of death of this religious figure.

Transvaginal pelvic ultrasound is the first-line imaging examination for presumed benign ovarian tumors (PBOT) in adult women (Grade A). Ultrasound is sufficient for characterizing a unilocular anechoic cyst smaller than 7cm (Grade A). Magnetic resonance imaging is the recommended second-line investigation for indeterminate masses or masses larger than 7cm (Grade B). Serum CA-125 assay is not recommended for first-line diagnosis in adult women (Grade C). In women with a unilocular anechoic cyst, hormone therapy is ineffective and not recommended (Grade A). Ultrasound-guided aspiration is not recommended (Grade B). Abstention is an option in adult women with a unilocular asymptomatic anechoic cyst smaller than 10cm and no history of cancer (Grade B). If symptoms develop, laparoscopy is the gold standard for surgical treatment of PBOT (Grade A). Conservative surgical treatment (cystectomy) should be preferred to oophorectomy in pre-menopausal women without a previous history of cancer (Grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (Grade B). Conservative treatment or detorsion without oophorectomy is recommended for pre-menopausal women regardless of the estimated torsion duration and macroscopic appearance of the ovary (Grade B). During pregnancy, expectant management is recommended for unilocular asymptomatic anechoic cysts smaller than 6cm (Grade C).

Based on an analysis of 19 mummified Maori heads (mokomokai) referred to our forensic laboratory for anthropological analysis prior to their official repatriation from France to New Zealand, and data from the anthropological and medical literature, we propose a complete forensic procedure for the analysis of such pieces. A list of 12 original morphological criteria was developed. Items included the sex, age at death, destruction of the skull base, the presence of argil deposits in the inner part of the skull, nostrils closed with exogenous material, sewing of eyelids and lips, pierced earlobes, ante-mortem and/or post-mortem tattoos, the presence of vegetal fibers within nasal cavities, and other pathological or anthropological anomalies. These criteria were tested for all 19 mokomokai repatriated to New Zealand by the French authorities. Further complementary analyses were limited to fiberscopic examination of the intracranial cavities because of the taboo on any sampling requested by the Maori authorities. In the context of global repatriation of human artifacts to native communities, this type of anthropological expertise is increasingly frequently requested of forensic anthropologists and other practitioners. We discuss the reasons for and against repatriating non-authentic artifacts to such communities and the role played by forensic anthropologists during the authentication process.

Angiotensin II antagonists (AIIA) are part of a new rational treatment of hypertension. Because adverse circulatory effects during anesthesia can occur in patients chronically treated with angiotensin-converting enzyme inhibitors, some clinicians discontinue them at least 24 h before operation. No data are available concerning AIIA administration in patients scheduled for vascular surgery performed under general anesthesia. The aim of this prospective randomized study was to compare hemodynamics during induction of anesthesia in patients chronically treated with AIIA and those of patients not receiving this drug on the morning before operation. Thirty-seven patients chronically treated with AIIA for hypertension were randomly assigned to two groups: Group I: AIIA discontinued on the day before surgery (n = 18); Group II: AIIA given 1 h before anesthesia (n = 19). Patients received sufentanil 0.4 microg/kg, propofol 1.5 mg/kg, and atracurium 0.5 mg/kg. During the procedure, the anesthesiologist was required to maintain systolic blood pressure and heart rate within 30% of baseline values using intravascular fluid administration and vasoconstric- tors (e.g. , ephedrine, phenylephrine, or terlipressin). Hemodynamic variables were recorded each 1 min. Hemodynamic study ended at incision. The number and duration of hemodynamic events were collected, and total doses of vasoactive drugs were noted in each group. Systolic arterial pressure was significantly decreased in Group II at 5, 15 and 23 min after induction of anesthesia (*P0.05). In this group, the decrease in systolic arterial pressure was associated with more frequent episodes of hypotension (AIIA withdrawn: 1 +/- 1; AIIA given: 2 +/- 1; P0.01), with a larger number of patients developing at least 1 episode of hypotension (AIIA withdrawn: 12; AIIA given: 19; P0.01), and a longer duration of an episode of hypotension (AIIA withdrawn: 3 +/- 4 min; AIIA given: 8 +/- 7 min; P0.01), and an increased need for vasoactive drugs. In conclusion, blockade of the renin-angiotensin system increases the potential hypotensive effect of anesthetic induction. A severe hypotensive episode, requiring vasoconstrictor treatment, occurs after induction of general anesthesia in patients chronically treated with AIIA. Recommendations to discontinue AIIA drugs on the day before the surgery may be justified.This prospective randomized study demonstrated that more severe hypotensive episodes, requiring vasoconstrictor treatment, occur after induction of general anesthesia in patients chronically treated with AIIA and receiving this drug on the morning before operation, in comparison with those in whom AIIA were discontinued on the day before operation. Recommendations to discontinue these drugs on the day before the surgery may be justified.

The aim of this study was to evaluate long-term results and to assess prognostic factors which have an impact on overall survival in patients with epithelial ovarian cancer.A retrospective analysis of 287 patients treated between 1975 and 1995 was performed. All operations were performed by senior surgeons. Histologic sections were reviewed by the same pathologist. Successive adjuvant chemotherapy regimens are described. Survival was evaluated in 1997. Follow-up lasted 25-260 months (median 90). Statistical methods included Kaplan-Meier survival curves, log-rank test, and multivariate analysis.The 5-year survival rates were 76, 42, 21, and 6% for patients with stage I, II, III, and IV disease, respectively. Age, FIGO stage, cytology of ascites, histologic type and grade, extent of surgery, and number of residual tumors were significant prognostic indicators in univariate analysis. Multivariate analysis showed that the risk of mortality according to FIGO stage was 2.8, 95% CI [1.2-6.3], P = 0.01 for FIGO II, 5.6, 95% CI [2.9-10.8], P0.001 for FIGO III, and 10.5, 95% CI [4.9-22. 1], P0.001 for FIGO IV in comparison with FIGO I. Patients with a serous epithelial carcinoma had a 1.7-fold higher risk of mortality than patients with other histologic types: RR = 1.7, 95% CI [1.1-2. 8], P0.001. Patients whose tumors distribution permitted optimal surgery had a 2.3-fold lower risk of mortality than patients treated with sub- or nonoptimal surgery: RR = 0.43, 95% CI [0.29-0.64], P0.001. The risk of mortality for patients treated with alkylating agents, platinum-based combination chemotherapy without taxanes, or carboplatin plus paclitaxel regimens compared with patients who did not receive treatment was reduced by 47%, 95% CI [8-69%], P = 0.025, 55%, 95% CI [22-74%], P = 0.005, and 70%, 95% CI [35-86%], P = 0.002, respectively.Our study confirms the benefit of cytoreductive surgery and the efficacy of platinum plus paclitaxel first-line chemotherapy which has recently been recognized as the standard treatment for advanced epithelial ovarian cancer.

Objective: To study the prevalence of Cervical Intraepithelial Neoplasia (CIN) and its association with HIV-1 infection, controlling for other risk factors of CIN. Design: Cross-sectional survey. Subjects and methods: HIV-1 seropositive (HIV+) and seronegative (HIV−) women were enrolled at the Obstetrics-Gynecologic Departments of the Bordeaux University Hospital from April 1993 to June 1995. A gynecologic check-up was performed with a clinical examination, a colposcopy and a Papanicolaou smear. Sexually Transmitted Diseases (STDs) were screened. Colposcopy was interpreted as: normal, low-grade or high-grade lesions. Interpretation of Papanicolaou smears was based on the 1988 Bethesda system using three descriptive diagnoses: normal, low-grade and high-grade Squamous Intraepithelial lesions (SILs). If colposcopy showed a high grade lesion or Papanicolaou smear a high-grade SIL, a cervical biopsy was performed. Absence of CIN was defined by normal Papanicolaou smear and colposcopy. High grade CIN was defined by either identification of high grade SIL on Papanicolaou smear or high grade lesion on colposcopy confirmed by CIN2-3 lesion on biopsy. Other cases were classified as low-grade CIN. HPV infection was diagnosed on presence of koilocytosis on cytological or histological specimens. Results: Prevalence of CIN was significantly higher in the 128 HIV+ women than in the 102 HIV− women: 34.4% vs. 13.7% (O.R.=3.30). Among HIV+ women, 25.8% had low-grade CIN and 8.6% high-grade CIN versus 10.8% and 2.9%, respectively among the HIV− women. Prevalence of HPV infection was 50.0% among women with CIN vs. 5.8% in women without CIN ( P =10 −6 ). In the multivariate analysis of the determinants of CIN, smoking more than ten pack-years and HPV infection were the only two variables associated with CIN while association with HIV infection disappeared. Among HIV+ women, the variables associated with CIN were clinical AIDS and HPV infection.

RÉSUMÉ. Le domaine de la reconnaissance statistique de formes est basé sur la représentation numérique des objets et peut donc être facilement combiné avec des méthodes d’apprentissage automatique. D’autre part, la reconnaissance structurelle de formes utilise un ensemble limité de méthodes d’apprentissage automatique mais encode une riche description des objets via les chaînes de caractères ou les graphes. Cette dernière décennie a vu l’émergence de deux tendances étroitement liées, visant à combler l’écart entre ces deux représentations en combinant leurs avantages respectifs : les méthodes à noyaux pour des graphes ou chaînes de caractères d’un côté et la représentation par dissimilarité de l’autre. Cependant, une large famille de méthodes de représentation par dissimilarité exigent la connaissance de l’univers en entier lors de la phase d’apprentissage afin de construire un plongement implicite des données structurelles. Cette dernière propriété est une limitation importante dans de nombreuses applications pratiques où l’ensemble de test est illimité et n’est pas connu lors de la phase d’apprentissage. De plus, l’exigence de l’ensemble d’apprentissage en entier représente en soi un obstacle pour le traitement des masses de données. Nous présentons dans cet article une solution pour surmonter ces limitations et montrons le lien entre cette solution et le contexte des noyaux.

This paper aims at dynamically understanding the properties of a scene from the analysis of moving object trajectories. Two different applications are proposed: the former is devoted to identify abnormal behaviors, while the latter allows to extract the k, most of the similar trajectories to the one hand-drawn by an human operator. A set of normal trajectories' models is extracted using a novel unsupervised learning technique: the scene is adaptively partitioned into zones using the distribution of the training set and each trajectory is represented as a sequence of symbols by considering positional information (the zones crossed in the scene), speed, and shape. The main novelty is the use of a kernel-based approach for evaluating the similarity between the trajectories. Furthermore, we define a novel and efficient kernel-based clustering algorithm, aimed at obtaining groups of normal trajectories. Experimentations, conducted over three standard data sets, confirm the effectiveness of the proposed approach.

Throughout the world, dunes are being altered by human activities. Dunes can be restored to naturally functioning systems to protect human settlements and coastal strips and preserve biotopes. This study took place on the Jai dunes, on the shore of a coastal lagoon in southeastern France, which were mainly degraded by vehicles. The objectives of this work were (1) to define the reference ecosystem by gathering historical information and exploring other regional sand dunes; (2) to find out about the restoration potential of the site by studying the degraded seed bank; (3) to test the efficacy of a few basic restoration actions. Historical information was of little help in defining the reference ecosystem. The description of EU Habitat Directive habitat types and the selection of regionally less degraded sites allowed us to compile the following list of plant species that we could expect to find in the restored area: Anthemis maritima, Elytrigia juncea, Glaucium flavum and Sporobolus pungens. The se...

Background: An original case of incomplete (and reasonably fatal) human trepanation is described in this short paper. The diagnosis was made on the cremated remains of a young adult individual who died in Rome, Italy during the 2nd century AD. Clinical Presentation: The trepanation was incomplete, as death occurred quickly due to vascular lesions, according to the anatomic analysis of the bone piece. Comparable trepanation from Roman times are described and related to this case. Conclusion: Even if archaeological, this case highlights the possibility of such a diagnosis on post-fire fragmented bones. Very suggestive lesions of section are of great interest for the history of such a practice during classical Antiquity. Lastly, from a medical and forensic point of view, such a diagnosis may be of interest during any identification process and research for a cause of death during anthropological analyses., Uvod: Ovaj kratki rad opisuje izvorni slučaj nedovršene, fatalne trepanacije. Dijagnoza trepanacije postavljena je temeljem pregleda kremiranih ostataka mlade odrasle osobe umrle u II. stoljeću u Rimu. Klinička slika: Anatomskom analizom kostiju utvrđena je nedovršena trepanacija, vjerojatno zbog smrti koja je nastupila netom nakon početka zahvata kao posljedica oštećenja krvožilja. Uz to, prikazani nalaz uspoređuje se sa sličnim slučajevima trepanacije iz rimskog razdoblja. Zaključak: Iako temeljen na arheološkim ostacima, ovaj slučaj ističe mogućnost dijagnosticiranja trepanacije iz kremiranih i fragmetniranih koštanih ostataka. Sugestivna oštećenja utvrđena na koštanom materijalu od značajnog su interesa za povijest trepanacije u klasičnoj antici. Također, ovakav slučaj može biti od interesa medicinskoj struci tijekom identifikacijskih procesa i antropološkog utvrđivanja uzroka smrti iz koštanih ulomaka.

Evidence of post-mortem breath movements are rarely reported. We present two cases of broncho-pulmonary aspiration of brain and cartilage tissue following two fatal suicidal gunshots to the head. We also discuss the physiopathological implications for the agony.

Dear Editor, Medical education in Western African countries is at a very important evolution stage: how to integrate occidental research modalities into traditional beliefs? How to accommodate both? We agree with the opinion expressed by Dr Kieran Walsh1 saying “insight into beliefs alone is insufficient”; before changing things, things have to be described. With our previous article2, we just focused on a description of such beliefs as the first step of any educational process. Indeed, minds have to be changed for both medical and general public groups, in order to help and facilitate the acceptation of post-mortem body openings, but also long-term conservation for scientific/educational or forensic purposes. But not too fast. Giving courses of medical anthropology at the university of Parakou, Benin, showed to one of us (PC) that even if the scientific level of medicine graduate students is high, some details or some parts of the courses remain strictly taboo or, at least, “delicate”. For example, speaking about the death of individuals from the student's families, or their future death (maybe for superstition reasons? that has to be respected). Dr Kieran Walsh is right again when writing that respected opinion leaders may be recruited in order to facilitate the acceptation of autopsies; religious ones may be some of them, helping by giving strong and clear positions toward autopsies. But also international experts in the fields of medicine, biomedical sciences, and bioethics may play a key role by influencing positively previously reticent minds. In the University of Paris 5 (France), a special course has been created, entitled “from the student of medicine to the responsible physician” (EM2R program); it gives opportunity to all students to discover and take into account the values of their specialty, and the inherent responsibilities. Patients are integrated into these courses, and express their wills during the treatment process (and after, for example after their death with the post-mortem utility of their cadaver for medical education and scientific research). Administrative and political authorities have to understand that autopsies (whatever their exact nature: forensic and scientific ones) are clearly carried out for the benefits of the dead's family (in order to get a diagnosis and eventually prevent an hereditary disease) and for general sanitary reasons. Autopsies are mainly part of any public health program3, as an objective indicator of the pathological background of a population. This description of attitudes toward autopsies, whatever the geographic origin of the group, may be at the origin of an ethical reflection. A student of medicine cannot just be facing a dead individual, or he is just a materialistic one. Modern medicine is a living proof that the collective is more important than the individual (at the only one condition of respecting individual liberties). But when one is dead, the global health is clearly preeminent. A French expression qualifies this point of view: “l'humanite en marche”.

All physicians will be confronted one day to the death of one of their patients, but what is the position of traditional populations subject to modern medicine and ethic principles?1 Little is known about cultural beliefs related to death in Black Africa, and medical students attitudes towards working with human cadavers, for example at the occasion of anatomy courses or post-mortem examinations (dissections).

Myomas induce menorrhagia and pelvic pain, and increase the risk of infertility and obstetrical complications. Symptomatic sub-mucosal myomas are classically treated by hysteroscopic resection. Symptomatic interstitial and sub-serosal myomas may be treated by myomectomy, either by laparotomy or laparoscopy according to their number and size. Prophylactic myomectomy is not recommended to prevent from obstetrical complications or the risk of leiomyosarcoma. Although all myomas have a negative effect on fertility, the removal of sub-mucosal myomas is the sole recommendation to improve spontaneous fertility or assisted reproduction technology.

Background: To best accompany bereaved couples facing a dead fetus, as a midwife or a physician, and understand more precisely what they live, it seems important to ask us on what represents for the mother, parents, this little being whom they had to separate. This brings us to the question: what represents this fetus lost for parents? How is he regarded by contemporary society? Do parents feel respect or revulsion to the body of the deceased children? What is the place of these “babies” in our society. Objective: The objective of our study was to determine, in relation to the term, the beginning of “humanity” for the parents of a dead fetus. We wanted to determine a term (in the medical sense), if it exists, which can be considered the body as “sacred” (not just an inert entity) from the point of view of the parents. Material and Methods: The study was retrospective and single site: it was carried out at the hospital Necker (Paris 5). Anonymous data collection was carried out from September 2011 to March 2012. Inclusion criteria were: medical interruption of pregnancy, in-utero fetal death, and late miscarriage. In order to define some “humanity” of the fetus from the point of view of the parents, from the 9 binary variables collected, four independent qualitative scores were constructed: “Announcement”, “Vision”, “Investment” and “Offering”. Results: The study population included 310 cases, corresponding to fetus expulsed between September 2010 and November 2011. On all of those fetal deaths, we distinguished three different modes: 233 medical interruptions of pregnancy (75.16%), 57 in-utero fetal deaths (18.39%), 20 late miscarriages (6.45%). After a statistical analysis, the average term of “humanity” was determined as around 180 days (95%CI [167;192]). Discussion: Facing this term, we try to answer some questions: is the fetus a patient like any other? What is the place of the fetus in the society? Is there a special work of mourning for fetal deaths? Does-it change anything to see and feel the child? What is the place and importance of the fetus for the main religions? Practically, does-it change anything to the legal status of the fetus in France and elsewhere?