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RESUME La premiere semaine de la vie est une periode cruciale pour le nouveau-ne. La sortie precoce de maternite est une pratique qui se repand sans que des dispositifs de relais de soins a domicile soient partout organises. Ceci expose le nouveau-ne et sa mere a des risques accrus de morbidite et a des retards de diagnostic, en particulier dans les familles a risque medical ou social. Ce rapport de l’Academie nationale de Medecine, situe le contexte medical de cette premiere semaine dans ses dimensions physiologiques, pathologiques et organisationnelles. Un rappel chronologique de la physiologie de l’adaptation neonatale permet d’etablir que l’autonomie des grandes fonctions ne peut etre etablie qu’apres un delai de 3 a 5 jours apres la naissance. Apres la revue des principales categories de troubles susceptibles de mettre le nouveau-ne en danger, le contenu d’un suivi neonatal est esquisse. Ce rapport presente comme principales recommandations la surveillance du nouveau-ne par des professionnels pendant 5 jours au moins, le caractere individuel et medical de la decision de sortie de maternite, la necessite d’etablir un cahier des charges pour des structures de suivi a domicile, enfin, la non extension du terme au premature de moins de 37 semaines d’amenorrhee.

Automatic perimetry examination requires the patient's cooperation, but the programs used check response validity. This study evaluated the possibility of patient cheating on this examination.This study investigated 27 visual fields of automatic perimetry with patients who had no ophthalmological history. Each subject had to reproduce a visual field loss that was observed for 5 minutes (two diffuse losses, five fields reflecting hemianopsia, four reflecting quadranopsia, two tubular losses, five nasal steps, nine absolute and arciform losses). The 24-2 Fastpac of the Humphrey field analyzer and the G2 of the Octopus perimeter were used for this study.Simple deficits were easy to reproduce, but visual field defects are often deeper and simulated test results tend to be too perfect. On the other hand, complex defects such as arciform scotoma or nasal steps were more difficult to reproduce. Visual field defect simulations were exaggerated beyond what was reasonable.This study reports on whether it is possible to cheat with automatic perimetry. The different parameters analyzed by computer programs are not able to detect cheating patients.

Evaluate the psychological consequences of announcing the diagnosis of glaucoma.Two hundred patients completed a 20-item questionnaire designed to analyze the context in which glaucoma was discovered and the patients' reaction to this diagnosis. Behavioral modification in patients and their families are specified as well as their perception of the information received.Most patients had open-angle glaucoma and showed either an anxious or a passive reaction to the announcement of the diagnosis. Severe anxiety led to prescription of minor tranquilizers or antidepressants in 11% of cases. Nearly half of the patients declared that they had modified their behavior after receiving the diagnosis, indicating a need to play an active role in disease management. A large majority of the patients were conscious of the risk of blindness related to glaucoma; however, they did not feel ill but rather handicapped . Most were dissatisfied with the information provided by their doctor and sought other sources of information.Announcing a diagnosis of glaucoma is a decisive step in the physician-patient relationship, known to be important in future treatment compliance. Better adapted information with regular reevaluation of the need for additional information is necessary. The psychological impact should be evaluated regularly in order to promote an active role on the part of the patient and avoid a decline in quality of life.

After administration of a single loading dose (80 mg p.o.) of fluorophenindione, the prothrombin level decreased to 37% in 24 h, and the effect lasted for 48 h. Accordingly, fluorophenindione can be classified as an anticoagulant with an ""intermediate'' effect. Its elimination half-life was 31 h, which is longer than that of phenindione, because of the greater stability of the fluorinated derivate.

Summary A new immunoglobulin preparation, called IgGAM, has been obtained from fraction III. Fraction III obtained during large scale fractionation is used as starting material and caprylic acid for the precipitation of most proteins other than the immunoglobulins present in fraction III ; the immunoglobulin concentrate is finally obtained by ethanol precipitation of the supernatant. The IgGAM preparation contains IgG, IgA and IgM in various proportions according to the modifications of the initial technique, and we can obtain fractions more specially enriched in IgA or in IgM. The clinical results obtained with IgGAM preparation are summarized ; different types of antibody deficiency syndromes have been successfully treated. It can be injected once a week IM, at a dose of 0,5 ml/kg. No side effects, nor appearance of anti IgA antibodies have been observed.

SummaryThe interactions of oral and i.v. administrations of corticosteroids with the effects of ticlopidine were studied, in a search for an antidote for possible excessive prolongations of bleeding time induced by antiaggregating agents. Indeed, the results show that an i.v. injection of methylprednisolone or an oral treatment with prednisolone counteract the prolongation of bleeding time but do not interfere with the inhibition of platelet aggregation brought about by ticlopidine. This could be ascribed to a vasoconstrictive effect of corticosteroids, possibly through reduction of vascular prostacyclin release. If this mode of action was confirmed, this useful finding would essentially apply to ticlopidine, but not to cyclooxygenase inhibitors such as aspirin which, by themselves, abolish prostacyclin production.

Dilitazem, a coronary vasodilating agent, after oral administration of four different doses, was well and rapidly absorbed. The pharmacokinetics of the drug followed a two-compartment model, with a rapid distribution and an elimination with a half-life of 4-7 hours. After chronic treatment the pharmacokinetic parameters were practically unchanged and therefore no accumulation of the drug was observed. The comparison between capsule and tablet preparations showed that both forms had a similar bioavailability. Diltiazem was extensively metabilized and only a few percent of the drug was found in urine. Several metabolites, also present as conjugates, have been identified by means of gas chromatography-mass spectrometry.

The relatives of a 82 years old female patients with a Waldenstrom Macroglobulinemia were submitted to clinical and hematological investigations. A diclonal gammapathy (IgG kappa and IgG lambda) was found in the sister's serum and was related to a myeloma. A noticiable Bence Jones Proteinuria (light chain of lambda type) was equally found in serum and urines of the propositus brother but without any clinical or hematological evidence of myeloma. The examination of two other sisters of these patients does not reveal any immunological of hematological disorder. This new observation underlines the interest of a systematical investigation in the siblings of the patients with monoclonal gammapathies.

(+/-)-1-(Isopropylamino)-3-[p-(2-cyclopropyl-methoxyethyl)-phenoxy]-2-propanol HCl (betaxolol, SL 75212) was given to groups of healthy volunteers, 10 mg daily for 7 days followed by 20 mg daily 7 days in one group, and increasing daily doses up to 60 mg/day for a total of 15 days in the other group. The pharmacokinetics were studied during dosing and in the washout period. The pharmacokinetic characteristics were unchanged after repeated doses, T/2 16-22 h, Vd 7.7-8.8 l/kg; clearance 0.28-0.33 l/h/kg.

The clinical results obtained with fraction IgGAM are reported. Different types of antibody deficiency syndromes have successfully been treated : 8 cases of Bruton-type agammaglobulinemia. In one of these case a tenacious Pseudomonas infection cleared off during the treatment. Two cases of non sex-linked familial agammaglobulinemia. Three cases of isolated IgM deficiency. Five cases of isolated IgA deficiency. Five cases with Soothill type IgA deficiency associated with high IgE levels. Five cases of septicemia of the new-born. Three cases with acquired agammaglobulinemia and in the premature infant (5 cases). No side-effects nor appearance of anti-IgA antibodies have been observed.

A new immunoglobulin preparation, called IgGAM, has been obtained from fraction III. Fraction III obtained during large scale fractionation is used as starting material and caprylic acid for the precipitation of most proteins other than the immunoglobulins present in fraction III; the immunoglobulin concentrate is finally obtained by ethanol precipitation of the supernatant. The IgGAM preparation contains IgG,IgA and IgM in various proportions according to the modifications of the initial technique, and we can obtain fractions more specially enriched in IgA or in IgM. The clinical results obtained with IgGAM preparation are summarized; different types of antibody deficiency syndromes have been successfully treated. It can be injected once à week IM, at a dose of 0.5 ml/kg. No side effects, nor appearance of anti IgA antibodies have been observed.

In two different studies, the relation between plasma concentrations of acenocoumarol and apparent prothrombin levels (Quick test) was investigated, using a new specific analytical method for the assay of the drug. The prothrombin level appeared independent of the plasma concentration of the drug, which is higher in old patients (over 70 years) than in younger patients (under 51 years).

The authors report a case of IgM myeloma revealed by bilateral malignant exophtalmia, only the third case to be published in the world. This exophthalmia was due to plasma cell infiltration of the periorbital fat, and not to primary involvement of the orbit. Other rare localisations were found on autopsy: ovarian, pleuro-pulmonary and, above all, epicardiac. This was an IgM myeloma (0.5% of myelomatous disease) and not Waldenstrom's macroglobulinemia. In fact the patient had no adenopathy, no hepato or splenomegaly, and the tumour contained only plasma cells.

The interactions of oral and i.v. administrations of corticosteroids with the effects of ticlopidine were studied, in a search for an antidote for possible excessive prolongations of bleeding time induced by antiaggregating agents. Indeed, the results show that an i.v. injection of methylprednisolone or an oral treatment with prednisolone counteract the prolongation of bleeding time but do not interfere with the inhibition of platelet aggregation brought about by ticlopidine. This could be ascribed to a vasoconstrictive effect of corticosteroids, possibly through reduction of vascular prostacyclin release. If this mode of action was confirmed, this useful finding would essentially apply to ticlopidine, but not to cyclooxygenase inhibitors such as aspirin which, by themselves, abolish prostacyclin production.