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Unlabelled: Hodgkin's disease without peripheral lymphadenopathy or hepatosplenomegaly is exceptional., Case Report: Hodgkin's disease was revealed by lung nodules, one of them cavitating, with mediastinal enlargement. Diagnosis was confirmed on a video-assisted pleuroscopic biopsy., Conclusion: Hodgkin's disease should be considered in case of mediastinal enlargement with lung nodules.

Unlabelled: Chronic adenopathies usually reveal lymphoma or infectious disease, particularly tuberculosis., Case Report: We report a case of Kikuchi-Fujimato's disease revealed by cervical adenopathies, associated with fever and inflammatory syndrome., Conclusion: The diagnosis of Kikuchi-Fujimato's disease lies on histological examination. Resolution is faster with steroids.

Objective and Methods: epidural localization is a rare presenting sign of non Hodgkin's lymphoma. In this study, we describe the clinical, histological and immunohistochemical data in 13 cases (9 men and 4 women) of non-Hodgkin's lymphoma with epidural involvement., Results: the median age was 63 years (range 36-76 years). Clinically, most patients complained of back pain (median duration, 3.4 months) followed by acute neurological deterioration. In 10 out of 13 tumors, a thoracic localization was observed and a decompressive laminectomy was performed in all cases. Histology and immunohistochemistry showed all tumors to be B-cell lymphomas which were classified as: lymphocytic lymphoma (3 cases), prolymphocytic lymphoma (1 case), follicular lymphoma (2 cases), diffuse large cell lymphoma (6 cases) and AIDS associated Burkitt lymphoma (1 case). Post-operative staging revealed bone and/or paravertebral involvement in 11 cases and disseminated disease in 5 cases. Median survival following complementary therapy, radiotherapy and chemotherapy in most cases, was 20 months., Conclusion: histological features of epidural lymphomas are similar to other extranodal lymphomas and their prognosis is better than other epidural neoplasms, especially when the tumor is localized.

To determine if p53 abnormalities could be involved in the pathogenesis of T- or natural killer (NK)-cell lymphomas, we investigated 51 cases of these lymphomas for the expression of p53 and its relationship with p53 gene mutations, the expression of the p21 protein as well as the proliferative and apoptotic indices. Overexpression of p53 was found in 19 cases (37%), whereas mutations of the p53 gene were observed in only 5 of 28 tested cases. The analysis of immunohistochemical data showed some entity-related phenotypic profiles. Anaplastic large cell lymphomas showed a frequent overexpression of p53 (7/8 cases) and p21 (6/8 cases) proteins and rare p53 mutations (1/7 cases), suggesting accumulation of a functional wild type p53 protein able to induce p21 expression. Nodal peripheral T-cell lymphomas unspecified showed relatively frequent overexpression of p53 protein (5/7 cases), infrequent p21 expression (2/7 cases), and rare p53 gene mutations (1/6 cases). In angioimmunoblastic lymphomas, the common phenotype was p53-/p21- (15/17 cases), with only a few scattered p53-positive cells, which, on the basis of double staining results, were mostly Epstein-Barr virus-infected B cells. A p53 gene mutation was only found in 1 case (1/8 cases) of angioimmunoblastic lymphoma, which showed cytologic tumor progression. Mycosis fungoides showed p53 overexpression in 2 of 4 cases, including 1 case with p53 gene mutation and features of cytologic tumor progression. Nasal NK/T lymphomas showed p53 overexpression in 2 of 5 cases, 1 of which had a p53 gene mutation. Finally, all lymphoblastic T-cell lymphomas (5 cases) and gammadelta hepatosplenic T-cell lymphomas (3 cases) were negative for expression of p53 and p21 proteins. We conclude that p53 protein overexpression is a common finding in some entities of T- and T/NK-cell lymphomas, whereas a p53 gene mutation is a rare, sporadic, and rather late event associated with tumor progression in some instances. The p53/p21 expression pattern appears to be variable in T- and T/NK-cell lymphoma entities, reinforcing the concept of distinct, entity-related mechanisms of pathogenesis in these tumors.

Most peripheral T-cell lymphomas (PTCL) express the alphabeta T-cell receptor (TCR) whereas rare PTCL express the gammadelta TCR. Most if not all gammadelta PTCL are extranodal lymphomas and among them, hepatosplenic gammadelta PTCL constitute a distinct clinicopathological entity. Besides alphabeta and gammadelta PTCL, there is a recently recognized group of extranodal, mainly nasal tumours, which display, in most instances, phenotypic and genotypic features of Natural-Killer cell non-Hodgkin's lymphomas (NK-NHL). Cytotoxic cells, including NK cells and cytotoxic alphabeta and gammadelta T lymphocytes may induce lysis of the target by using granule-associated cytotoxic proteins such as the T-cell intracellular antigen-1 (TIA-1), perforin and granzyme B. Expression of TIA-1 can be detected in all cytotoxic cells whereas granzyme B and perforin expression can be detected in high levels only in activated cytotoxic cells. Recently, several studies showed that the expression of these cytotoxic proteins in tumour cells of PTCL and NK-NHL is associated with a) extranodal site of clinicopathological presentation b) NK or Tgammadelta-cell phenotype c) CD30 expression in cutaneous T-cell lymphoproliferations and d) anaplastic morphology in nodal PTCL. This latter finding contrasts with the data that only rare Hodgkin lymphomas (HL) express cytotoxic proteins in Hodgkin and Reed-Sternberg cells. Altogether the data of the literature indicate that most extranodal T and NK-NHL are activated cytotoxic lymphomas with the notable exception of hepatosplenic gammadelta PTCL which represent tumours of non-activated cytotoxic cells. On this basis, it is suggested that the expression of cytotoxic proteins may be useful for the identification and classification of extranodal T and NK-cell lymphomas and, to some extent, for the differential diagnosis between HL and CD30+ anaplastic large cell lymphomas. Cytotoxic lymphomas are preferentially localized in extranodal sites such as skin, lung, upper respiratory and gastrointestinal tracts, which are continuously exposed to various antigens. Since cytotoxic T and NK cells are regarded as first line of defense in these sites, and some cytotoxic tumours such as nasal lymphomas and enteropathy-type intestinal lymphomas are associated with EBV and gliadin, respectively, it is likely that chronic antigen exposure may play a role in the pathogenesis of cytotoxic lymphomas occurring in mucosa and/or skin. Besides chronic antigenic stimulation, chronic immunosuppression may also have pathogenetic significance in cytotoxic lymphomas in view of their increased incidence in immunocompromised patients.

This study examined the influence of light additional arm cranking exercise on the VO2 slow component observed during severe cycling exercise. During incremental tests, eleven triathletes exercised to exhaustion cycling with leg, cranking with arm and combined arm and leg cranking and cycling (arm work-rates being set at the third of leg work rates) to determine arm, leg and combined arm and leg lactate threshold and VO2max. After these incremental tests subjects performed in random order severe exercises until exhaustion at work-rates corresponding to the lactate threshold + 50% of the difference to the work rate associated with VO2max and the lactate threshold, i.e., delta50: 1) with legs only (leg delta50) 2) leg delta50 plus a very light arm cranking exercise at 25 % of the arm lactate threshold (Ldelta50 + A25). VO2 slow component was the increase of VO2 (in ml x min(-1)) between the third and the sixth minute of exercise (deltaVO2 63 min). Results showed 1) Nine of the eleven triathletes had a VO2 slow component in arm delta50; 2) a light cycle arm exercise (25% of lactate threshold) added to a severe leg cycle exercise did not decrease time to exhaustion in severe exercise (493 +/- 154s vs 418 +/- 84, P=0.4); 3) For the five subjects who had a VO2 slow component in leg cycling, the addition of a light arm exercise (25% of arm LT) decreased the VO2 slow component significantly (from 457 +/- 173 ml x min(-1) for leg delta50 to 111 +/- 150 ml x min(-1) for Ldelta50 + A25, Z = -2.0, P = 0.04). In conclusion, light additional arm cranking decreases the VO2 slow component in severe cycling. Further studies are needed to confirm the hypothesis that extra work due to an increasing handgrip on the handlebars may contribute to the VO2 slow component in cycling.

Arterial endofibrosis is a rare disease usually affecting the external iliac artery in highly trained athletes. We report a case of bilateral external iliac endofibrosis in a 44-year-old cyclist. Microscopic examination of the resection specimen showed an isolated thickening of the arterial intima, and confirmed the diagnosis of this entity of unknown etiology.

Pancreatic neuroendocrine tumors are rare in von Hippel-Lindau disease, most often asymptomatic, nonfunctioning, non secreting, and benign. We report a case of low grade malignant pancreatic, secreting and asymptomatic neuroendocrine tumors, occurring in a 27 year old woman in the setting von Hippel-Lindau disease with recurrent pheochromocytoma, retinal and medullary hemangioblastomas, paraganglioma of the carotid body and ovarian cystadenoma. Neuroendocrine pancreatic tumors of von Hippel-Lindau disease are often constituted by clear cells, in the contrary of other neuroendocrine tumors of the pancreas. Occurrence of a pancreatic neuroendocrine tumor, especially in association with pheochromocytoma, may be misdiagnosed with a type 2 multiple endocrine neoplasia syndrom instead of von Hippel-Lindau disease.

The aim was to compare physiologic responses during exhaustive runs performed on a treadmill at 100 and 120% maximal aerobic speed (MAS: the minimum speed that elicits VO2max). Fourteen subelite male runners (mean +/- SD; age = 27+/-5 years; VO2max = 68.9+/-4.6 ml/kg(-1)/min(-1); MAS = 21.5+/-1 km/h(-1)) participated. Mean time to exhaustion tlim100% at 100% MAS (269+/- 77s) was similar to those reported in other studies. However, there was large variability in individual tlim100% MAS (CV = 29%). MAS was positively correlated with VO2max (r = 0.66, p<0.05) but not with tlim100%) MAS (r = -0.50, p<0.05). tlim100% MAS was correlated with t(lim) at 120% MAS (r = 0.52, p < 0.05) and to blood pH following the rest at 120% MAS (r = -0.68, p<0.05). The data suggest that running time to exhaustion at MAS in subelite male runners is related to time limit at 120% (tlim120%) MAS. Moreover, anaerobic capacity determined by the exercise to exhaustion at 120% MAS can be defined as the variable 'a' in the model of Monod and Scherrer (1954).

The purpose of this study was to compare the effect of two different types of cyclic severe exercise (running and cycling) on the VO2 slow component. Moreover we examined the influence of cadence of exercise (freely chosen [FF] vs. low frequency [LF]) on the hypothesis that: 1) a stride frequency lower than optimal and 2) a pedalling frequency lower than FF one could induce a larger and/or lower VO2 slow component. Eight triathletes ran and cycled to exhaustion at a work-rate corresponding to the lactate threshold + 50% of the difference between the work-rate associated with VO2max and the lactate threshold (delta 50) at a freely chosen (FF) and low frequency (LF: - 10 % of FF). The time to exhaustion was not significantly different for both types of exercises and both cadences (13 min 39 s, 15 min 43 s, 13 min 32 s, 15 min 05 s for running at FF and LF and cycling at FF and LF, respectively). The amplitude of the VO2 slow component (i.e. difference between VO2 at the last and the 3rd min of the exercise) was significantly smaller during running compared with cycling, but there was no effect of cadence. Consequently, there was no relationship between the magnitude of the VO2 slow component and the time to fatigue for a severe exercise (r = 0.20, p = 0.27). However, time to fatigue was inversely correlated with the blood lactate concentration for both modes of exercise and both cadences (r = - 0.42, p = 0.01). In summary, these data demonstrate that: 1) in subjects well trained for both cycling and running, the amplitude of the VO2 slow component at fatigue was larger in cycling and that it was not significantly influenced by cadence; 2) the VO2 slow component was not correlated with the time to fatigue. If the nature of the linkage between the VO2 slow component and the fatigue process remains unclear, the type of contraction regimen depending on exercise biomechanic characteristics seems to be determinant in the VO2 slow component phenomenon for a same level of training.

The purpose of this study was to show the relationship between oxygen deficit and the time to exhaustion (tlim) at maximal aerobic speed (MAS). The minimum speed that elicits VO(2max) was assumed to be the maximal aerobic speed (MAS). Fourteen subelite male runners (mean (SD: age = 27 +/- 5 yrs: VO(2max) = 68.9 +/- 4.6 ml kg (-1). min ( -1); MAS = 21.5 +/- 1 km h (-1) ) participated in the study. Each subject performed an incremental test to determine and MAS. The subjects ran to exhaustion at velocities corresponding to 100 and 120 % MAS. Oxygen deficit was measured during the period exercise to exhaustion at 120% of MAS and was calculated from the difference between O(2) demand and the accumulated O 2 uptake. The tlim values at 100% MAS were correlated with the values of tlim at 120% MAS (r = 0.52). The results reveal that the oxygen deficit was related to the time to exhaustion at MAS and indicate that the greater the oxygen deficit, the greater the time to exhaustion at MAS. It was also noted that the adjustment of oxygen consumption is related to the oxygen deficit. In other words, the subjects who have an important anaerobic capacity are the most efficient during an exercise time to exhaustion at MAS. The time limit values can be expressed by a linear regression making intervene MAS and anaerobic capacity. This conclusion could be of great interest in the training of middle distance runners.

Background: Paragangliomas rarely involve the cauda equina region. In this location, these tumors can show misleading morphological features such as trabecular or papillary growth patterns and variable expression of cytokeratins., Methods: We comparatively studied the immunohistochemical and ultrastructural patterns of 3 paragangliomas of the cauda equina (PCE) and of 8 paragangliomas from other sites., Results: All the paragangliomas expressed neuroendocrine markers (neuron-specific enolase, chromogranin A, synaptophysin and neurofilament protein). In PCE, chief cells exhibited a strong positivity with a broad spectrum anti-cytokeratin antibody. The staining was diffuse in the cytoplasm or had a paranuclear dot-like disposition. In other sites, only one paraganglioma showed a focal expression of cytokeratins. At ultrastructural level, chief cells of PCE contained characteristic dense core granules and intermediate-sized filaments sometimes grouped in paranuclear whorls., Conclusion: The dual immunophenotype of PCE, paraganglionic and epithelial, must be recognized in order to distinguish these tumors from, for example, a metastasis of a neuroendocrine carcinoma. PCE are slow-growing tumors and have mostly a favorable prognosis after complete surgical excision.

The stability of the experimental anti-tumour agent pancratistatin in human plasma has been investigated. A solid-phase extraction technique and an HPLC assay with external standards have been developed and validated. Extraction was performed using C18 cartridges and HPLC, analysis was performed on a 15 cm Hypersil BDS column using isocratic elution with 13% acetonitrile and aqueous solution of 1% (w/v) acetic acid. The lower limit of quantification for pancratistatin in 5% DMF-95% water was found to be 0.58 ng/ml (+/-10.58%) and 2.3 ng/ml (+/-9.2%) following extraction from human plasma. Mean recovery of 89.4% (+/-4.73%) was obtained over the concentration range 0.0023-9.45 microg/ml for a five day validation study. Pancratistatin was stable at room temperature in light or dark for at least 15 days, in the refrigerator at 4 degrees C for at least 16 days and in the freezer at -20 degrees C or -80 degrees C for at least 28 days. Under all conditions monitored, % recovery of pancratistatin from human plasma was greater than 95% and no evidence of degradation had occurred. There also was no loss of pancratistatin after three cycles of freezing and thawing.

We studied gastro-oesophageal reflux (GOR) with a face mask and laryngeal mask airway (LMA), and the effects of inflation pressure and volume of the LMA cuff on oesophageal pH, in 60 patients. Patients were managed with either a face mask (group I) or LMA inflated to obtain a seal in the anaesthesia circuit at 7 cm H2O (group II) or 15 cm H2O (group III). A pH-sensitive probe with two electrodes, 10 cm apart, was placed in the oesophagus during anaesthesia and recordings were made continuously until patients awakened. There was a significant difference in the incidence of GOR between the face mask (group I) and the LMA (groups II-III) (P < 0.05) in the lower oesophagus but there was no difference in the mid-oesophagus. No correlation was found between pressure and volume inside the cuff and variations in oesophageal pH. We conclude that LMA use was associated with increased reflux in the low oesophagus but oesophageal pH was not influenced by variations in pressure or volume inside the LMA cuff.

Purpose: Between inefficient training and overtraining, an appropriate training stimulus (in terms of intensity and duration) has to be determined in accordance with individual capacities. Interval training at the minimal velocity associated with VO2max (vVO2max) allows an athlete to run for as long as possible at VO2max. Nevertheless, we don't know the influence of a defined increase in training volume at vVO2max on aerobic performance, noradrenaline, and heart rate., Methods: Eight subjects performed 4 wk of normal training (NT) with one session per week at vVO2max, i.e., five repetitions run at 50% of the time limit at vVO2max, with recovery of the same duration at 60% vVO2max. They then performed 4 wk of overload training (OT) with three interval training sessions at vVO2max., Results: Normal training significantly improved their velocity associated with VO2max (20.5+/-0.7 vs 21.1+/-0.8 km x h(-1), P = 0.02). As a result of improved running economy (50.6+/-3.5 vs 47.5+/-2.4 mL x min(-1) x kg(-1), P = 0.02), VO2max was not significantly different (71.6+/-4.8 vs 72.7+/-4.8 mL x min(-1) x kg(-1)). Time to exhaustion at vVO2max was not significantly different (301+/-56 vs 283+/-41 s) as was performance (i.e., distance limit run at vVO2max: 2052.2+/-331 vs 1986.2+/-252.9 m). Heart rate at 14 km x h(-1) decreased significantly after NT (162+/-16 vs 155+/-18 bpm, P < 0.01). Lactate threshold remained the same after normal training (84.1+/-4.8% vVO2max). Overload training changed neither the performance nor the factors concerning performance. However, the submaximal heart rate measured at 14 km x h(-1) decreased after overload training (155+/-18 vs 150+/-15 bpm). The maximal heart rate was not significantly different after NT and OT (199+/-9.5, 198+/-11, 194+/-10.4, P = 0.1). Resting plasma norepinephrine (veinous blood sample measured by high pressure liquid chromatography), was unchanged (2.6 vs 2.4 nm x L(-1), P = 0.8). However, plasma norepinephrine measured at the end of the vVO2max test increased significantly (11.1 vs 26.0 nm x L(-1), P = 0.002)., Conclusion: Performance and aerobic factors associated with the performance were not altered by the 4 wk of intensive training at vVO2max despite the increase of plasma noradrenaline.

During prolonged and intense running exercises beyond the critical power level, a VO2 slow component elevates VO2 above predicted VO2-work rates calculated from exercise performed at intensities below the lactate threshold. In such cases, the actual VO2 value will increase over time until it reaches VO2max. The aims of the present study were to examine whether the VO2 slow component is a major determinant of VO2 over time when running at a speed beyond critical velocity, and whether the exhaustion latency period at such intensity correlates with the magnitude of the VO2 slow component. Fourteen highly trained long-distance runners performed four exhaustive runs, each separated by one week of light training. VO2 and the velocity at VO2max (vVO2max) were determined for each by a graded treadmill exercise. The critical velocity (86.1 +/- 1.5% vVO2max) of each runner was calculated from exhaustive treadmill runs at 90, 100 and 105% of vVO2max. During supra-critical velocity runs at 90% of vVO2max, there was no significant rise in VO2max (20.9 +/- 2.1 ml min-1 kg-1 between the third and last min of tlim 90), such that the runners reached a VO2 steady-state, but did not reach their vVO2max level over time (69.5 +/- 5.0 vs 74.9 +/- 3.0 ml min-1 kg-1). Thus, subjects' time to exhaustion at 90% of vVO2max was not correlated with the VO2max slow component (r = 0.11, P = 0.69), but significantly correlated with the lactate threshold (r = 0.54, P = 0.04) and the critical velocity (% vVO2max; r = 0.65, P = 0.01). In conclusion, the present study demonstrates that for highly trained long-distance runners performing exhaustive, supra-critical velocity runs at 90% of vVO2max, there was not a VO2 slow component tardily completing the rise of VO2. Instead, runners will maintain a VO2 steady-state below VO2max, such that the time to exhaustion at 90% of vVO2max for these runners is positively correlated with the critical velocity expressed as % of vVO2max.

Unlabelled: Following kidney transplantation, lymphoproliferative disorders (LD) are encountered at a frequency of 1%. The onset of these LD is correlated with the degree of immunosuppression. The mortality is elevated (> 50%) especially in late forms. Since 1984 we have performed two hundred and seventeen kidney transplantations. The patients received sequential quadruple-drug immunosuppressive therapy: antilymphocyte globulin (ALG), azathioprine, corticosteroids and cyclosporine. A diagnosis of LD was established in ten patients, four were of early onset (within twelve months of transplantation) and six late (after five to nine years). Rejection occurred in two patients, one of which was steroid resistant requiring ALG. Three LD arose from the graft hilum, four had a voluminous tumor mass with extranodal sites: the graft (1), stomach (2), gingiva (1), meninges (1), and bone marrow (1). Histologically there were eight cases of large-cell B lymphoma, 1 mononucleosis-like LD, and a MALT lymphoma. A search for EBV was positive seven times. Treatment consisted of decreasing immunosuppressive therapy only (1), combined with antiviral treatment (1), or with surgical removal of the graft (3), and/or chemotherapy (5). Nine patients are still alive, in complete remission, graft loss occurred in four cases., Conclusion: In our series, we found a high frequency of LD. Despite 4 LD with a voluminous tumor mass and unfavorable histological prognosis requiring chemotherapy, all the LD in our series had a favorable outcome.

We evaluated the clinical utility of an automated HPLC system (Remedi, Bio-Rad) for identification of drugs and metabolites in biological fluids. Serum or urine or both from 354 consecutive cases of poisoning were analyzed by the system and by a set of fluorescence polarization immunoassay (FPIA, Abbott) and thin-layer chromatographic (TLC) procedures. Antidepressants and most phenothiazines were recognized by the new system. Comparison of Remedi results with final clinical diagnoses yielded diagnostic specificity and sensitivity of 80% and 90%, respectively. Remedi detected 26 additional compounds that were neither reactive in the immunoassay screening tests nor detected by TLC procedures. Because the Remedi expands the range of drugs covered by the immunoassays and provides a rapid, preliminary report in emergency situations, we conclude that this system can be a useful complementary technique in the clinical toxicology laboratory. Although urine toxicological screening seemed adequate for a good toxicological report, blood analysis allows extra toxicokinetic data such as blood concentrations and half-life estimations.

A 76-year-old woman was admitted to the ICU for a meningitis with rhombencephalitis due to Listeria monocytogenes. The treatment included amoxicillin (250 mg.kg-1.day-1) and gentamicin (3 mg.kg-1.day-1 over 6 days). Neurological outcome was favourable. However at the 14th day, an acute renal failure occurred, following macroscopic haematuria and milkiness urine. CT scan and sonography confirmed the diagnosis of obstructive renal failure with bilateral ureteral obstruction. Crystalluria caused by amoxicillin was suspected. Endoscopic ureteral insertion of double-J catheters permitted the recovery of a normal renal function.

We have characterized immunohistochemically and biochemically the collagens accumulating in two compartments of the matrix formed by mature bovine articular chondrocytes in alginate beads. At all times of the 28-day culture period, more than 90% of the collagen molecules were recovered from the rim of cell-associated matrix (CM) which encapsulates individual chondrocytes and chondrocyte clusters. Both the total amount and concentration of collagens in this matrix compartment rose progressively with time. The ratio of collagen/proteoglycan remained relatively constant with time and was always five to seven times higher in the CM than in the interterritorial matrix compartment further removed from the cells. In the CM, collagen types II, IX and XI were present on Day 28 in relative proportions (95/l/3) similar to those in adult cartilage. A higher proportion of newly synthesized collagen type XI than types II or IX molecules did not become incorporated into the pericellular rim of matrix but accumulated in the further removed matrix. Although collagen type I was synthesized in small amounts by flattened cells at the surface of the beads, it did not become incorporated as heterotrimers or homotrimers in the matrix. Mature pyridinium crosslinks, principally pyridinoline, were detected as early as Day 7 of culture but became much more abundant between Days 15 and 28, especially in the CM which contained at all times more than 90% of the crosslinks formed. The codistribution of collagen types II, IX and XI and mature collagen-specific crosslinks support the contention that mature chondrocytes cultured in alginate matrix surround themselves with a protective shell whose composition is very similar to that which encapsulated the cells in vivo.

The velocity associated with the achievement of VO2 max during an incremental treadmill test (v VO2 max) has been reported to be an indicator of performance in middle distance running events. Previous study has shown the reproducibility of the time to exhaustion (time limit: tlim) at v VO2 max performed by well-trained males in the same condition at one week of interval (Billat et al., 1994b). It is essential in studies involving tlim at v VO2 max that the v VO2 max be precisely determined, or else the measured tlim will be meaningless. The purpose of this study was to examine the influence of the stage duration and velocity incrementation on the velocity at VO2 max and, consequently, on the two times to exhaustion (tlim) associated with the two v VO2 max generated by the two protocols. v VO2 max was determined in 15 trained male endurance athletes as the lowest speed at which VO2 max was attained in speed-incremented 0%-slope treadmill tests. For one test, increments were 1.0 km.h-1 and stages were 2 min in duration; for the other test, increments were 0.5 km.h-1 and stages were 1 min in duration. Results of paired means t-tests revealed no difference in v VO2 max obtained using the two protocols. v VO2 max was 20.7 +/- 1.0 km.h-1 with the 1.0 km.h-1 x 2 min protocol and 20.8 +/- 0.9 km.h-1 with the 0.5 km.h-1 x 1 min protocol. In addition, VO2, VCO2, VE, VE/VO2 and respiratory exchange ratio at the submaximal intensities that were common to both protocols (e.g., 17.0 km.h-1, 18.0 km.h-1, 19.0 km.h-1, 20.0 km.h-1) did not differ. Times to exhaustion at the two v VO2 max demonstrated a high degree of inter-individual variability (coefficients of variation were 35% and 45%) but did not differ (345 +/- 120 s versus 373 +/- 169 s). These results demonstrated that small changes in protocol have no significant impact on the value of v VO2 max and in consequence on tlim v VO2 max.

Previous studies had concluded that the treadmill velocity-endurance time hyperbolic relationship for runs could be accuratly approached with a regression at condition that bouts of exercise duration were included between 2 and 12 min. This regression allows to calculate the critical speed (CS) defined as the slope of the regression of work (distance) on time to exhaustion, the anaerobic running capacity (ARC) being the intercept of this line (Monod & Scherrer, 1965). The purpose of this investigation was to give practical indication concerning the choice of the velocities in reference to the maximal aerobic speed (MAS i.e. the minimum speed which elicits VO2max). Subjects were fourteen elite male long-distance runners (27 +/- 3 years old; VO2max = 74.9 +/- 2.9 ml.kg-1.min-1, MAS = 22.4 +/- 0.8 km.h-1, CS = 19.3 +/- 0.7 km.h-1 and 86.2 +/- 1.5% MAS). tlim 100 values (321 +/- 83 s) were negatively correlated with MAS (r = -0.538, p < 0.05) and with CS (km.h-1) (r = -0.644, p < 0.01). tlim 90 (1015 +/- 266 s) was positively correlated with CS when expressed in % MAS (r = 0.645, p < 0.01) and not when expressed in km.h-1 (r = -0.095, P > 0.05). tlim 105 (176 +/- 40 s) only was correlated with ARC (r = 0.526, p < 0.05). These data demonstrate that running time to exhaustion at 100 and 105% of MAS in a homogeneous elite male long-distance runners group is inversely related to MAS. Moreover, tlim 90 is positively correlated with CS (%MAS) but neither with tlim 100 and 105 nor with maximal aerobic speed. So from a practical point of view, the velocities chosen to determine the critical speed, would be closed to the maximal aerobic speed (time to exhaustion around 6 min), taking into account that the tlim 105 is correlated with the anaerobic capacity, whereas tlim 90 is correlated with the critical speed.

A recent paper (Billat et al., 1994a) has shown the reproducibility but also the great variability between subelite long-distance runners in their time to exhaustion at the velocity which elicits VO2max, called the maximal aerobic speed (MAS). The present study delved further into the reasons for this large difference between runners having the same VO2max. The question addressed was whether the exercise-induced hypoxemia (EIH) was more important for athletes having the longest time to exhaustion at 90 (Tlim 90), 100 (Tlim 100), or 105% (Tlim 105) of MAS. The study was conducted on 16 elite male runners. EIH was observed, that is, arterial oxyhemoglobin saturation and arterial partial pressure of oxygen dropped significantly after all the Tlim tests. However, EIH was only correlated with Tlim 90 (r = -0.757; -0.531, respectively).

Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.

The aim of the present study was to estimate the importance of lactate steady state velocity (WCL) of the running velocity at maximal oxygen uptake (Va max) and its time to exhaustion (Tlim), in the performance of a half marathon stated by the velocity over 21.1 km sustained by the runners during 1 h 12 min +/- 2 min 27 s. The population consisting of ten sub-elite male long distance runners (32 +/- 4 years old) was homogeneous with regard to their velocities on 21 km (V21 = 17.5 +/- 0.88 km.h-1, coefficient of variation, CV = 5%) and their aerobic maximal speed (Va max) (21.6 +/- 1.2 km.h-1, CV 6%). The fractional utilization of VO2max on 21 km was calculated from their own running economy (oxygen consumed per kilo of body mass and kilometer run (194 +/- 74 ml.kg-1.km-1). V21 represented 83 +/- 5% VO2max (VO2max = 68.1 +/- 4.1 ml.kg-1.min-1) and 81 +/- 3.3% Va max. The velocity corresponding to lactate steady state and called "lactate steady state velocity" (WCL) was measured according to a protocol proposed by CHASSAIN (1986). The subjects ran twenty minutes at a constant velocity representing 70-75% and 85-90% VO2max. Lactatemia was measured at the fifth (Lact 5) and the twentieth minute (Lact 20). Lactate slope was measured for two running velocities in order to determine the velocity (WCL) corresponding to lactate steady state, i.e. the lactate slope is equal to zero.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to assess the reproducibility of running time to exhaustion (Tlim) at maximal aerobic speed (MAS: the minimum speed that elicits VO2max), on eight subelite male long distance runners (29 +/- 3-yr-old; VO2max = 69.5 +/- 4.2 ml.kg-1.min-1; MAS = 21.25 +/- 1.1 km.h-1). No significant differences were observed between Tlim measured on a treadmill at a 1-wk interval (404 +/- 101 s vs 402 +/- 113 s; r = 0.864); however, observation of individual data indicates a wide within-subjects variability (CV = 25%). In a small and homogenous sample of runners studied, exercise time to exhaustion at MAS was not related to VO2max (r = 0.138), MAS (r = 0.241), running economy (mlO2.kg-1.min-1 at 16 km.h-1) (r = 0.024), or running performance achieved for 3000 m (km.h-1)(r = 0.667). However, Tlim at MAS was significantly related to the lactate threshold determined by the distinctive acceleration point detected in the lactate curve around 3-5 mmol.l-1 expresses in %VO2max (r = 0.745) and to the speed over a 21.1-km race (km.h-1) (r = 0.719). These data demonstrate that running time to exhaustion at MAS in subelite male long distance runners is related to long distance performance and lactate threshold but not to VO2max or MAS.

The aim of this study was to measure running times to exhaustion (Tlim) on a treadmill at 100% of the minimum velocity which elicits VO2max (vVO2max in 38 elite male long-distance runners (VO2max = 71.4 +/- 5.5 ml.kg-1.min-1 and vVO2max = 21.8 +/- 1.2 km.h-1). The lactate threshold (LT) was defined as a starting point of accelerated lactate accumulation around 4 mM and was expressed in %VO2max. Tlim value was negatively correlated with vVO2max (r = -0.362, p < 0.05) and VO2max (r = -0.347, p < 0.05) but positively with LT (% vVO2max) (r = 0.378, p < 0.05). These data demonstrate that running time to exhaustion at vVO2max in a homogeneous group of elite male long-distance runners was inversely related to vVO2max and experimentally illustrates the model of Monod and Scherrer regarding the time limit-velocity relationship adapted from local exercise for running by Hughson et al. (1984).

Type XI collagen was localized with polyclonal antibodies specific for alpha 1 (XI) and alpha 2 (XI) chains in the resting zone of epiphyseal cartilage from calf fetuses. The immunofluorescence technique was used on sections of cartilage, and the immunogold labelling technique for electron microscopy on fibrils isolated from cartilage and, for the first time, in situ on blocks of cartilage fractured in liquid nitrogen. Immunofluorescence showed that without pepsin treatment the staining of type XI collagen was restricted to the pericellular zones; after pepsin treatment, the staining was co-distributed with that of type II collagen. Immunoelectron microscopy performed on isolated fibrils and on cartilage blocks showed that after disruption of fibrils with pepsin, type XI collagen was labelled on small filaments on the fibrils. When the fibrils were not disrupted, labelling was observed in situ only at the ends of the fibrils or on cross-sections of some fibrils. These results indicate that type XI collagen is located inside type II collagen fibrils in fetal bovine epiphyseal cartilage, as already postulated for embryonic chicken sterna.

Fetal bovine chondrocytes isolated from the resting zone of epiphyseal cartilage were maintained in high-density culture for 4 weeks. From Day 2 in culture, the chondrocytes deposited an extracellular matrix composed of Types II, IX, and XI collagen. Types IX and XI collagen were restricted to the pericellular domain from Day 5. By 2 weeks the entire cell layer stained for antibodies to Type II and IX collagens. Type XI could be demonstrated throughout the cell layer by pepsinization of the sections. Results from both rotary shadowing and immunochemistry showed that the fibrils formed in culture were heterotypic, with Type IX collagen arranged along the surface and with Type XI collagen buried in Type II fibrils. Nonspecific Type VI collagen and the glycoproteins tenascin and fibrillin, previously described in cartilaginous tissue, were identified by their ultrastructural characteristics in the cell layer homogenate. Although the cells presented morphological characteristics of chondrocytes and still expressed cartilage-specific collagens, the appearance of Type I collagen in the culture cell layer after 4 weeks of culture demonstrates a partial dedifferentiation of the chondrocytes. The culture system described in this report provides an interesting tool for maintaining chondrocytes in a cartilage-like matrix to study the influence of different physical and chemical factors on the expression and differentiation of the cells.

Somatosensory evoked potentials (SEPs) were recorded in 165 patients from 185 operations for scoliosis and major spinal distortions, lumbar or cervical stenosis, post-traumatic malunions, or tumors. They were obtained by percutaneous stimulation of right and left median and tibial posterior nerves, and recorded on the scalp as recently, motor potentials (MPs) have also been obtained, by a trans-spinous stimulation rostral to the level of intervention. The protocol consists of pre- and post-operative recordings, as well as a continuous intra-operative monitoring. Neuromonitoring is justified in operations implying neurological risks, particularly scoliosis. A durable disappearance of SEPs and MPs was always associated with post-operative neurological disorders. Transient disappearances, not associated with neurological disorders, have been observed during certain manoeuvres such as vertebral traction, osteosynthesis, placing trans-pedicular screws or hooks, leading the surgeon to modify the operation. The role of medullary ischemia on the degradation of electrophysiological signals, obvious in cardiovascular decompensations, seems predominant in the post-operative occurrence of neurological impairment. During the post-operative period, SEPs allow one to discriminate between organic disorders and subjective complaints; they help in diagnosing hematomas, and distinguish between radicular and spinal cord injuries.

We reviewed our 41-year experience with tumors of the submandibular gland to determine what factors influence outcome and their implications for treatment. The most common benign neoplasm was pleomorphic adenoma (21), while among malignant tumors the adenoid cystic variety (37) predominated. For the 86 patients who had malignant tumors, the 2- and 5-year survivals by the life table method were 82% and 69%, respectively. For patients with malignant tumors, histology, size, perineural invasion, and prior treatment did not affect overall survival. Factors adversely affecting outcome were extraglandular soft-tissue extension and lymph node metastasis. Local-regional control was enhanced in patients with soft-tissue extension if they were treated by surgery followed by radiotherapy rather than by surgery alone.

The measurement of the venous distensibility by straingauge plethysmography during a semi-continuous variation (3 mm Hg every 20 seconds) of the cuff pressure during its inflation from 0 to 100 mm Hg and its deflation allow to record the venous hysteresis and to determine accurately the venous pressure. The standardized and automatic (Periflow J.S.I.) new method is highly discriminative between controls and varicose patients.

Children with recurrent infections of the upper respiratory tract were treated by injections of human immunoglobulins. Of the 58 children who were followed after treatment, the clinical outcome and the results of laboratory tests, i.e. serum protein profile and level of circulating immune complexes, were improved in 33. The improvement was significantly related to the in vitro antibody reaction of the immunoglobulin batch that was used for injections with unidentified antigens present, before treatment, in the patient's serum.

Angiectasia of the right colon is a new entity which must be considered in cases of lower intestinal haemorrhage. Moore's classification is the one that is generally accepted today; it distinguishes between 3 types the most interesting and best individualized of which is type I. It consists of acquired lesions occurring after the age of 60, often multiple, localized in the right colon and frequently associated with aortic stenosis and atheroma. The diagnosis of these vascular malformations is usually delayed because the lesions are submucosal and not visible at endoscopy. Bimesaraic arteriography may show typical images where extravasation of contrast medium is associated with vascular tuft or "tuff". Even the anatomicopathological confirmation of the diagnosis is difficult, since the lesion can only be located by special techniques, such as intra-arterial injection of a silicone-containing substance. Owing to the failure of modern techniques such as embolization, the only possible treatment is surgical, based on resection of the colonic segment involved.

A group of 25 patients having to undergo laparotomy were prescribed thrombo-embolic preventive stockings of graduated elasticity to be worm from 48 hours before the operation until 9 days afterwards. This group was compared to another group of 25 patients. The thromboses were detected using the fibrinogen test and the Doppler. This study demonstrates the efficiency of prophylactic anti-thrombotic stockings using graduated compression.

Fetal breathing movements were studied with real time ultrasound in 21 normal fetuses and 30 fetuses born small-for-dates (less than the 5th centile). The events of the study period were recorded on punched paper tape which was subjected to computer analysis. In the normal group the percentage time of breathing was 54 +/- 12.7 (mean +/- SD). The breath to breath interval was 1.34 +/- 0.25 seconds and the coefficient of variation of this interval was 49.6 +/- 7.7 per cent. In 17 of the small-for-dates group amount of breathing was reduced with short breathing episodes and long apnoea intervals. In the other 13 patients in the small-for-dates group the coefficient of variation for the breath to breath interval was significantly reduced (39.6 +/- 7.9 per cent, p less than 0.01).

The effect of a 90% small bowel resection on the exocrine pancreas was investigated over a three month period in adult Wistar rats. Control animals underwent a sham-resection consisting of a transection and reanastomosis of the small intestine. After jejunoileal resection, the wet weight of a gland increased significantly (52%) from the 15th day. The parallel increase in total protein, DNA and RNA content without any modification in the ratios of pancreatic weight, protein, and RNA to DNA suggests that there is cellular hyperplasia but not hypertrophy. Small intestinal resection decreased significantly the amount of amylase when expressed per unit pancreatic weight; it reduced slightly but not significantly that of chymotrypsin, while it did not modify the amount of lipase. However, the total amount of these enzymes in the pancreas remained unaltered when compared with controls. It is concluded that a massive resection of the small bowel induces cellular hyperplasia in the rat exocrine pancreas; this could compensate that reduced level of enzymes in acinar cells.