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Silicon carbide composites are a candidate for fusion reactors structural material because of their low activation and after heat properties and good mechanical properties at elevated temperatures. These materials, to be more suitable with their use for fusion energy production, need a strong R&D effort in order to solve some critical issues such as thermal conductivity and radiation stability, hermeticity, chemical compatibility with the fusion environment, the capability to be formed in complex geometries, the joining process and long production time. Constant progress in the fibre quality and matrix–fibre interfaces contribute to support the use of SiCf/SiC composites as structural material for fusion application. This paper presents an overview of the current status of the European R&D activities on SiCf/SiC composites focussing on reactor design studies, composites manufacturing, material characterisation in particular after irradiation, chemical compatibility with different blanket environments and development of joining techniques.

Dans le cadre de la securisation de la prise en charge medicamenteuse dans les etablissements de sante, l’informatisation du circuit du medicament constitue un axe de travail prioritaire. Cette evolution majeure peut toutefois etre a l’origine d’erreurs et s’accompagner de difficultes pratiques. L’analyse des rapports d’etape 2013 du contrat de bon usage et les remontees d’evenements indesirables communiques, ont mobilise les structures institutionnelles regionales afin d’organiser une enquete. L’objectif de ce travail est de provoquer une reflexion autour des risques d’erreurs lies aux outils informatiques, et d’etablir une cartographie regionale de ces risques. Un questionnaire est propose en juillet 2014 a tous les etablissements de sante de la region disposant d’une pharmacie a usage interieur. Il s’adresse a un groupe pluridisciplinaire de professionnels de sante participant a l’informatisation du circuit du medicament. Il identifie l’organisation du schema informatique de chaque etablissement, et permet de coter la gravite et la frequence de survenue pour chaque erreur identifiee (risque fort pour une criticite superieure a 6). Sur les 76 questionnaires envoyes, 53 sont analyses. Parmi les 17 logiciels de prescription generale, 4 concernent 63 % des etablissements. Le dossier patient informatise (DPI) est utilise chez 89 % des etablissements, dont 70 % utilisent un logiciel unique pour la prescription generale, l’analyse pharmaceutique, l’administration et le DPI. Sur les 91 questions de l’enquete relatives a l’identification des risques d’erreurs, 13 erreurs ont une criticite superieure a 5. Elles surviennent lors de la prescription (erreur de selection de l’unite de prescription par exemple), de l’analyse pharmaceutique (intervention pharmaceutique non visualisee par le prescripteur) et/ou lors de la delivrance. Trois de ces erreurs ont une criticite superieure a 6, elles revelent le probleme lie a l’absence d’interoperabilite entre logiciels. Bien que facultative, cette enquete reflete la mobilisation des professionnels de sante autour de cette problematique (taux de participation de 75 %). Elle confirme la disparite des organisations en matiere informatique et la complexite des echanges d’information. Elle etablit les types d’erreurs les plus critiques et permet de degager des axes de travail prioritaires regionaux, afin de favoriser le partage d’experience et la confrontation des pratiques. Cette demarche va de paire avec un travail individuel indispensable a chaque etablissement afin de maitriser ses risques.

The possibility of light induced formation of sedimentary organo-sulfur compounds has been investigated with simulation experiments. These experiments, using mono- and diunsaturated hydrocarbons and reduced sulfur species, in particular H 2 S and elemental sulfur, were conducted under mild conditions (sunlight, low temperature) likely to occur in the photic zone of anoxic environments. These experiments showed an efficient sulphurization of the organic matter under sunlight conditions leading to the formation of organo-sulfur compounds, such as thiophenes and sulfur cross-linked macromolecules, very similar to those occurring in sediments deposited in anoxic environments. These results show the potential for photochemically induced sulfurization of organic matter in environments with photic zone anoxia. Such a process would be especially favored in evaporitic environments with a shallow anoxic boundary extending well into the photic zone.

Resume Il existe un consensus general sur la necessite d'eduquer tous les patients asthmatiques, quelle que soit la severite de leur asthme. Mais le contenu et les moyens de cette education restent encore imprecis. Il n'y a pas, a notre connaissance, de programme educatif comprenant les objectifs a atteindre et les outils a utiliser pour y parvenir. Nous presenterons les outils de l'education que nous avons developpes chez l'enfant asthmatique. Certains outils facilitent le diagnostic d'education, d'autre l'evaluation, les plus attractifs concernent l'education du patient. Il reste encore beaucoup d'outils educatifs a creer, mais avant de les diffuser l'experience nous a montre qu'il est essentiel de les tester aupres des patients asthmatiques.

This study is focused on enzymatically upgrading the functional properties of flax fibres. Green flax fibres were treated with a polygalacturonase and a pectate lyase (PaL) and their properties were compared with dew-retted fibres. Morphological observations, vapour-sorption analyses and mechanical measurements showed that PaL-treatment was able not only to mime retting in terms of bundle division, but also to improve the mechanical properties of technical fibres. Conversely, these properties were shifted down after the polygalacturonase treatment, mainly due to the presence of contaminating glycanases. At the level of the elementary fibres, nanoindentation data indicated the highest stiffness of the secondary wall for PaL-treated fibres. The tensile properties exhibited equal, but moderate values of the Young's modulus (∼37 ± 14 GPa) and breaking strength (∼650 ± 300 MPa) for retted and PaL-treated fibres; we hypothesize an impact of the growth conditions on the fibre chemical structure with an excess of matrix pectins compared to the amount of glucomannan coating the cellulose microfibrils.

It has been shown that in the chick dorsal root ganglion (DRG) about 8% of neurons, belonging to both the A and B classes of sensory neurons exhibit a clear dopamine immunoreactivity. In the present study are reported the results of measurements, by mean of HPLC-electrochemical detection (HPLC-ED), of DA and of the DA metabolites dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the rat DRG and their central nerves. Very low levels of DA, about 10 folds lower than the levels found in the dorsal horn of the spinal cord, were found in the DRG. However the levels of DOPAC and HVA were approximately equivalent to the levels found in the cord. The immunocytochemical study performed in parallel has shown that some dopaminergic-immunoreactive fibers in the DRG are located around the blood vessels. Few dopamine-immunoreactive sensory neurons were identified in the DRG and immunoreactive fibers, not linked to blood vessels, were identified in the dorsal root nerves. The present work indicates that there is a dopaminergic innervation of the blood vessels in the rat DRG but that dopamine may also be, as in the chick, a transmitter of primary afferent fibers.

In this work, in order to improve the adhesion between a polyester matrix (unsaturated polyester resin) and flax fibres (Linum usitatissimum L.) and to increase their moisture resistance, chemical surface treatments have been used. These different treatments were performed with maleic anhydride (MA), acetic anhydride (Ac), silane (Si) and styrene (S). The modified flax fibres were characterized by means of infrared spectroscopy and surface energy analysis. The effect of these treatments on water sorption was investigated by using a gravimetric static equilibrium method. Water sorption isotherms were derived from kinetic data. The Park model based on the three sorption modes: Langmuir, Henry’s law and clustering, was successfully used to simulate the experimental sorption data. It was found that the (Ac) and particularly (S) treatments reduced overall water uptake of flax fibres. We show that tensile modulus, breaking strength and breaking strain depend on the chemical treatment used.

The expression of gamma-aminobutyric acid was studied in sensory neurons and peripheral target tissues of the chick dorsal root ganglia by combining immunocytochemistry and electron microscopy. In the chick embryos, the first immunoreaction was observed at embryonic day 12 in 1.4% of ganglion cell bodies. The intensity of immunostaining gradually increased during development and the percentage of immunostained neurons reached an average of 7.3% after hatching. These immunostained cell bodies could be identified as sensory neurons belonging either to some large neurons of the A1 subclass or to a few small neurons of the B1 subclass. The other neuronal cell bodies, corresponding to the A2 and B2 subclasses, as well as the satellite and glial cells were apparently devoid of any gamma-aminobutyric acid immunostaining. Among the peripheral tissues innervated by the primary sensory neurons, the nerve endings of Achilles' tendon and the paravertebral autonomic ganglia appeared devoid of immunoreactivity. In contrast, immunoreactivity was found within nerve endings located in some neuromuscular spindles of the skeletal muscles and within some Herbst's corpuscles in the subcutaneous tissue of the skin. Thus, the present results provide evidence that gamma-aminobutyric acid may be expressed by neuronal cell bodies belonging to two subclasses of primary sensory neurons and could be a putative neurotransmitter involved in the peripheral sensory innervation of, at least in part, skin and skeletal muscles.

Dans le cadre de la semaine nationale de la securite des patients du 25 au 29 novembre 2013, le groupe de travail de la revue des erreurs medicamenteuses (REMED) et la direction des affaires generale et de la qualite du centre hospitalier de Mâcon ont organise la projection/debat du film documentaire « Que reste-t-il de nos erreurs ? », temoignage de familles et soignants touches par une erreur medicamenteuse. Le personnel de l’hopital a ete invite a cet evenement de sensibilisation sur l’erreur medicamenteuse. Une centaine de personnes a participe. L’objectif de ce travail a ete de recueillir leurs avis afin d’evaluer l’impact de cette action. La grille d’evaluation a ete structuree autour de 3 thematiques : l’organisation des seances, la qualite des debats, et un theme general sur la prise en charge de l’erreur medicamenteuse et sa perception au sein de l’etablissement. Au total 58 personnes ont repondu a cette enquete. L’organisation est globalement satisfaisante sauf pour les cadres de sante (CDS) et le personnel paramedical qui jugent le nombre de seances insuffisant. L’interet des differents items debattus est juge majoritairement tres important, un seul partage puisque 19 % (dont 45 % de CDS) jugent peu ou pas important la rencontre du soignant qui commet l’erreur avec la famille, soit 45 % des CDS. D’une maniere generale, 45 % connaissaient la REMED avant cet evenement, 64 % pensent modifier leur attitude face a une erreur medicamenteuse suite a cette seance, dont 100 % des internes et 75 % des eleves infirmiers, et 43 % des praticiens hospitaliers pensent le contraire. Les actions de sensibilisation pour lutter contre l’erreur medicamenteuse au centre hospitalier de Mâcon sont jugees non suffisantes a 72 %, et non satisfaisantes a 33 %. Le centre hospitalier de Mâcon s’est engage dans la lutte contre l’iatrogenie medicamenteuse en mettant en place des mesures preventives, une analyse des evenements indesirables par les membres de la REMED ainsi qu’un outil de communication et de sensibilisation, la breve REMED. Cette projection/debat participe a ces actions de sensibilisation. Cette enquete nous montre que ces actions n’ont pas encore la portee suffisante aupres des soignants. Cependant, nous pouvons souligner l’impact positif de cette action sur la modification de la perception de l’attitude a adopter face a une erreur medicamenteuse, preferentiellement au sein de la population etudiante. Dans les axes d’amelioration des actions de sensibilisation sur l’iatrogenie medicamenteuse au centre hospitalier de Mâcon, de nombreuses pistes sont explorees, en particulier la mise en œuvre effective d’un COPIL « administration des medicaments ».

Le CBU engage les etablissements de sante soumis a la tarification a l’activite (T2A), dans un processus de securisation du circuit des produits pharmaceutiques et d’amelioration de leurs pratiques. En Bourgogne, le premier CBU a ete signe en 2006 et fut proroge jusqu’en 2011, le CBU 2e generation signe en 2011 a ete abroge au 31 decembre 2013. Ce travail etablit un etat des lieux a l’issue des deux premieres generations de CBU et a servi de base a l’elaboration des nouveaux indicateurs pour le CBU 3e generation. Les donnees presentees proviennent de l’analyse des rapports d’etape annuels depuis 2006. Le premier CBU comportait une vingtaine d’indicateurs, le deuxieme une soixantaine. En 2013, le CBU portait sur 13 400 lits (dont 7200 MCO) repartis sur 36 etablissements, contre 7850 lits MCO en 2006 pour 42 etablissements. Il est a noter une amelioration de l’ensemble des indicateurs suivis depuis 2006 et 2011, sauf pour ceux relatifs au suivi et a l’analyse des pratiques de prescription des produits en sus de la T2A (97 % des etablissements ont declare les realiser en 2013 contre 100 % en 2011). Un seul etablissement ne disposait pas en 2013 d’un logiciel pour la prescription medicamenteuse informatisee contre 26 en 2006. La transmission de la prescription complete informatisee pour analyse pharmaceutique concernait 48 % des lits MCO en 2013 contre 4 % en 2006. L’analyse pharmaceutique etait effectuee pour 42 % des lits MCO en 2013 contre 9 % en 2006. La preparation centralisee des anticancereux sous responsabilite pharmaceutique a atteint 100 % des preparations en 2013 contre 82 % en 2006. Les nouveaux risques lies au systeme d’informatisation de la prise en charge medicamenteuse etaient evalues chez 58 % des etablissements contre 19 % en 2011. Certains objectifs sont restes cependant difficiles a ameliorer en 2013, comme le deploiement de la dispensation nominative (9 % des lits MCO contre 1 % en 2006). Les bilans des rapports d’etape annuels ont confirme la poursuite de l’effort des etablissements bourguignons pour l’amelioration de la prise en charge medicamenteuse. Si les resultats globaux ont montre une amelioration des indicateurs, certains etablissements doivent cependant rattraper leur retard pour garantir la securite de leur prise en charge. L’ARS de Bourgogne a conscience que la demarche de contractualisation n’est pas suffisante. C’est pourquoi, en lien avec les structures d’appui regionales, elle souhaite apporter un appui aux professionnels de sante en favorisant le partage d’experience, la mutualisation des outils et la confrontation des pratiques.

Neuroblastoma are pediatric tumors of neural crest origin, most often localized in adrenal glands and infrequently congenital. We report two fetal cases found at autopsy, performed at 24 and 28 weeks of gestation, respectively. The 24 week old fetus did not show any malformation; systematic histological analysis found neuroblastoma cells in both the adrenal glands and the retroperitoneal fat tissue. The 28 week old fetus was hydropic and exhibited a nodule (3 cm) in the posterior mediastinum, next to the thoracic spinal cord. This tumor responded to a neuroblastoma associated with small metastatic foci in the adrenal glands, the liver and the frontal brain cortex. The placenta was abnormally heavy and showed hemorrhagic and necrotic areas. Microscopically plugged clumps of neuroblastoma cells were found inside fetal vessels. Immunohistochemistry was employed in both cases and the cells showed immunoreactivity for NSE, NB 84, chromogranin, synaptophysin and neurofilaments, while desmin, MIC 2, and protein S-100 were negative. Congenital neuroblastomas are rare and, to our knowledge this is the thirteenth report of congenital neuroblastoma associated with placental metastasis.

Gestational trophoblastic diseases amalgamate several entities with a common denominator which is a hypersecretion of hCG: complete mole, invasive or not, partial mole or triploid syndrome, gestational trophoblastic carcinoma and trophoblastic carcinoma from the implantation site. These entities differ by their origins, their morphology, their evolution and their treatments. Complete moles are diploid and in 80% of cases, chromosomes are only from paternal origin (diandry or dispermy). Their evolution is unpredictable whatever the molecular biology or cytogenetical methods are. Partial moles, generally triploid, are much more frequent (10-20% of miscarriages) than the number of cases diagnosed during the pregnancy. In 85% of cases, two sets of chromosomes are of paternal origin. The gestational trophoblastic carcinoma is diploid and its genetic material comes from both parents. This probably excludes a direct filiation between complete mole and gestational trophoblastic carcinoma. The trophoblastic tumor from the implantation site comes from the trophoblast of the implantation site which explain why its evolution and its prognosis are totally distinct from the previous one. In this report, we successively discuss the natural history of gestational trophoblastic diseases, their epidemiology and the genetic data explaining their origins.

This study examines antibiotic resistance in Pseudomonas aeruginosa in hospitalized patients in relation to prior empirical antibiotic therapy.Two retrospective case analyses comparing patients who manifested P aeruginosa with differing patterns of antibiotic resistance.Patients acquiring P aeruginosa in a community hospital.Patients were compared on duration of hospitalization and days and doses of antibiotics prior to recovery of P aeruginosa. Patients were grouped, based on susceptibility patterns of their P aeruginosa isolates classified as follows: (1) fully susceptible (susceptible to all classes of antipseudomonal antibiotics [SPA]), (2) multidrug-resistant (resistant to two classes of antipseudomonal antibiotics [MDRPA]), or (3) highly drug-resistant (resistant toor = 6 classes of antipseudomonal antibiotics [HRPA]). To control for duration of hospitalization, antibiotic treatments of HRPA and SPA patients were compared during the first 21 days of care.Prior to recovery of HRPA, six HRPA patients received greater amounts of antibiotics, both antipseudomonal and non-antipseudomonal, than did six SPA patients prior to recovery of SPA. For 14 patients with hospital-acquired SPA who later manifested MDRPA, duration and dosage of antipseudomonal antibiotics, but not all antibiotics, were significantly higher for the SPA-to-MDRPA interval than for the preceding admission-to-SPA interval. The median duration of antipseudomonal antibiotic treatment prior to the recovery of P aeruginosa was 0 days for SPA, 11 days for MDRPA, and 24 days for HRPA.Duration of empirical antipseudomonal antibiotic treatment influences selection of resistant strains of P aeruginosa; the longer the duration, the broader the pattern of resistance.

To compare the cytologic history of patients with cervical cancer with that of patients with high grade cervical intraepithelial neoplasia (CIN) in order to analyze the causes of screening failure.In 337 patients treated for high grade CIN and 86 women treated for cancer of the cervix, all cytologic reports from the last five years before diagnosis were reviewed, and slides of normal smears taken within three years of diagnosis were reexamined.Among patients with cancer, 32/86 (37.2%) never had a smear, for 28/86 (32.6%) the time interval between screenings was greater than three years, 12/66 (18.2%) were incorrectly managed after the first abnormal smear, and 7/69 (10.1%) had a normal smear within three years of diagnosis. Conversely, among patients with high grade CIN, 45/337 (13.4%) never had a smear, 60/337 (17.8%) had a time interval between screenings greater than three years, 120/337 (35.6%) were incorrectly managed after the first abnormal smear, and 100/333 (30.0%) had a normal smear within three years of diagnosis. When compared with high grade CIN, cancer of the cervix was associated with absent or insufficient screening (adjusted odds ratio [aOR] = 3.28, 95% confidence interval (95% CI) = 1.86-5.80) but neither with incorrect management of the first abnormal smear (aOR = 1.32, 95% CI = 0.46-3.75) nor with a normal smear within three years of diagnosis (aOR = 0.22, 95% CI = 0.10-0.50).Better participation of patients is necessary to improve the efficacy of screening. Conversely, reducing the interval between smears to less than three years would cause a major increase in cost and earlier diagnosis of high grade CIN, but not a significant decrease in the number of cancers.

To compare the reliability of cytology with that of cervicography and with the use of both tests when screening for neoplasia of the cervix and to analyze the causes of false positive and false negative results with both methods.The results of cytology and cervicography in 1,709 patients (1,447 seen for routine screening, 82 for follow-up after treatment for cervical neoplasia and 180 referred because of cytologic anomalies) were correlated with colpohistologic findings.Cervicography entailed more defective examinations than did cytology (8.9% vs. 0.2%, P.0001). It was less sensitive (51% vs. 59%, P = .320) and less specific (96% vs. 98%, P = .004). Whatever the clinical criteria (patient's age, parity, pregnancy or history of cervical treatment), the rate of false positives with cervicography was always higher than with cytology, as was the rate of false negatives, except in pregnant women.Cervicography does not seem to offer a worthwhile alternative to cytology for cervical screening.

431 cone biopsy specimens referred for CIN2 and CIN3 between 1984 and 1993 were reviewed with a peculiar attention paid to the possible associated endocervical glandular changes. The following features could be demonstrated: microglandular hyperplasia (17 cases), tubal metaplasia (15 cases), mesonephric hyperplasia (10 cases), in situ adenocarcinoma (7 cases), tunnel clusters (5 cases), and ectopic endometrium (4 cases). Cervical glandular atypia could not be found. A classification of the glandular lesions in uterine cervix has been proposed for an accurate diagnostic approach of lesions who could simulate carcinomatous changes.

In 3 female patients, aged 46, 50 and 74 years respectively, ovarian angiomas measuring 3, 5 and 30 mm in diameter were discovered. All the angiomas were asymptomatic. They were either associated with endometrioid carcinoma or uterine leiomyomas, or detected casually by ultrasound scan in a patient with ascites, intrahepatic nodule and increased serologic CA 125. The immunohistochemical studies failed to reveal any affinity between the vascular endothelium of our ovarian angiomas and oestrogen and progesterone receptors.

Evaluation of the value of colposcopy and directed biopsy in the follow-up of pregnant women presenting with abnormal cervical smear.Retrospective study of 146 patients examined by colposcopy during pregnancy between January 1985 and December 1994.Colposcopy was satisfactory in 86% of patients. Colposcopic impression was concordant with the final diagnosis, overestimated and underestimated in 69%, 18% and 13% of the cases, respectively. Directed biopsies were performed in 115 patients. In one case, bleeding necessitated vaginal packing for 24 hours. Directed biopsy correlated well with the final diagnosis in 87% of low grade CIN and in 90% of high grade CIN. In 4 patients, conisation was performed between 10 and 16 weeks of gestation without subsequent obstetrical complications.Colposcopy with directed biopsy is a reliable tool to evaluate abnormal smear during pregnancy.

Two cases of histiocytic endometritis are reported in two 68 and 82 year-old women. One of the cases was associated with extensive endometrioid adenocarcinoma and areas of intra-myometrial histiocytic infiltration.

With the same aspect of multiple peritoneal leiomyomas, the diagnosis of typical leiomyomatosis peritonealis disseminata was established in two women aged 43 and 49, while in a third case the mature metastasis of a primary low-grade bilateral ovarian stromal sarcoma in a woman aged 63 was diagnosed.

Insulin-like growth factor binding protein-1 (IGFBP-1) [also known as placental protein 12(PP12)] and placental protein 14 (PP14) have been identified by specific immunostaining in early pregnancy specimens obtained 13–35 days of gestation. PP12 was evident in a discrete number of stromal decidual cells at the deciduotrophoblastic interface and under the endometrial surface epithelium. These cells did not have the rounded appearance of classic decidual cells but most often displayed cytoplasmic expansions. Staining for PP14 was strictly localized to the glandular epithelium of the endometrium. Implantation of the conceptus may be an important mechanism in the early expression of PP12 but not PP14.

Twelve ovarian leiomyomas were seen over a 12-year period, representing one quarter of all reported cases. Most of them were situated in the ovarian hilum (9/12 of our cases), some were situated in the medulla (2 of our cases) and one case was situated in the cortex. They were fairly small and, due to their site, they were generally asymptomatic and rarely diagnosed on ultrasonography.

Study of influence of different sequences of oral micronized progesterone (Pg) on endometrial morphology and the incidence of bleeding.Prospective comparative multicentric study conducted in 101 post-menopausal patients.98 patients who did not wish any regular withdrawal bleeding were given percutaneous oestradiol 17-beta (E2) (1.5 mg/d) associated with micronized Pg (100 mg/d) at bedtime during either 21 out of 28 days (group I), or 25 days per calendar month (group III), during a minimum of 6 months. For those wishing withdrawal bleeding (n = 3), E2 (3 mg/d) during 25 days was associated with Pg (300 mg/d) from the 16th to the 25th day of the month (group III). Endometrial biopsies were performed after 6 months of the same treatment and blindly analysed; transvaginal ultrasonography (measurement of endometrial mucosa thickness) was done in case of insufficient amount of tissue.Groups I and II: 61% of the endometrium were quiescent without mitosis, 23% were slightly active with rare mitoses, 8% partly secretory and 4% subatrophic. Sampling was inadequate in the remaining 4%. Mitotic activity of glands was low on the overall samplings (average0.53/1,000 cells). The average mucosa thickness was at 3.9 mm. No bleeding (spotting or withdrawal bleeding) occurred in 73.3% and 82.1% of cycles at the 3rd and 6th months of administration, respectively. Group III: endometrium were quiescent or slightly active and combined with frequent withdrawal bleeding.A relatively low dose of oral progesterone (100 mg/d) combined with E2 during 21d/28d or 25 d/month efficiently controls proliferation, induces a very low endometrial cyclic activity--while reducing spottings--and maintains an amenorrhea in the majority of women. This simple treatment is likely to improve compliance.

The effects of oral micronized progesterone-administered at a low dose-on the endometrium and on bleeding pattern have been evaluated during a multicenter study in which 101 patients were involved. For a minimum of 6 months, patients who did not wish to have withdrawal bleeding (98) received the association of 17 beta-percutaneous estradiol (1.5 mg/d) and oral micronized progesterone (100 mg/d, at bedtime) during 25 days per month (or 21 d/28). The few women (3) who wished regular bleeding were given progesterone (300 mg/d) with estradiol (3 mg/d), from the 16th to the 25th of the month. No hyperplasia was observed among the endometrial biopsies performed after 6 months minimum of treatment. 8% of the endometria were partially secretory, 4% were sub-atrophic, 23% were mildly active with rare mitoses and 61% were quiescent without mitoses. The remaining 4% were considered inadequate. Mitotic activity of the glands was minimal in all samplings (mean0.53/1,000 cells). The average thickness of the mucosa was measured by ultrasonography at 3.9 mm, in the cases of insufficient samplings. No bleeding (or spotting, or cyclic bleeding) occurred in 73.3% and 80.9% of the cycles, in the 3rd and 6th month of therapy. Therefore a low dose of oral Pg (100 mg/d) combined with E2 during 25 days/month efficiently controls endometrial proliferation, while allowing a very weak cyclic activity. This situation makes it possible to minimize spottings and to maintain an amenorrhea in the majority of patients, thus letting us hoping for an improvement in the observance of this simplified therapy.

The aim of our study is to evaluate the effects of a new combined association of percutaneous estradiol with oral micronized progesterone during 25 days/month and to confirm that a low dose of progesterone (100 mg/day) can adequately counteract endometrial proliferation induced by estradiol.78 endometrial tissue samples were obtained in a multicenter study on the effects of hormonal replacement therapy of the menopause. Endometrial biopsies were performed on average at the 6.6 month of the hormonal substitution (range: 5-13 months) after 12 days minimum exposure to progesterone. The morphological evaluation was performed blindly.All endometria are only slightly developed, without hyperplasia. Four groups were individualized: subatrophic endometrium (3), quiescent endometrium (48), slightly active endometrium (18), and endometrium with marginal secretion (6). Rare mitosis images have only been found in slightly active endometria. Their number is always very much below the normal proliferative phase with only 3 cases between less than 3 and 6 mitoses per 1000 glandular epithelial cells.A low micronized progesterone dose (100 mg/day) over a long period (25 days per month) allows to efficiently control the estrogen-induced endometrial proliferation. This adequate endometrial response is responsible for a high incidence of amenorrhea, often asked by patients, and for rare spottings.

Ciliated bodies, or detached ciliary tufts, are ciliated fragments of cytoplasm from columnar epithelial cells. In gynecologic cytology they have been observed in cervicovaginal smears and peritoneal washings and very occasionally in fluids from the pouch of Douglas. They occur frequently in the fluids of ovarian cysts. The authors detected ciliated bodies in 30 of 326 ovarian cyst fluid samples (9.20% of cases) taken from 27 patients aged 14-68 years. Ciliated bodies were found in the fluids from both bilateral cysts in one patient and in slides from both former and recurrent cysts in two. Surgery was performed in 14 of the cases, with histologic examination revealing 5 simple serous cysts, 3 paraovarian cysts, 3 serous papillary cystoadenofibromas, 1 serous cystoadenoma and 2 mature cystic teratomas. In the remaining cases the pertinent clinical data, including ultrasound ecography, revealed benign paraovarian and ovarian cysts. The existence of ciliated bodies in the fluids of ovarian cysts indicated the presence of ciliated columnar epithelial cells on the wall of the cysts, which would exclude cysts of follicular origin.

The expression of calcium binding protein parvalbumin (PV) and gamma-aminobutyric acid (GABA) was studied in the chick motoneurons by using pre- and postembedding immunocytochemistry. Our data reveal that PV and GABA are colocalized in the majority, but not all, of chick lumbo-sacral spinal motoneurons innervating the somatic muscles. It is suggested that, in this neuromuscular system, GABA does not act as a classical inhibitory neurotransmitter but, combined with calcium, could be involved, at least in part, in the maintenance of neurons and the prevention of cell death as in certain neurodegenerative disorders.

The relationship between adenofibroma and cystadenofibroma and the frequency and features of carcinomas developed on these benign tumours are little known. Eight-hundred and forty-five epithelial tumours of the ovary diagnosed over a 10-year period have been re-examined. One-hundred and eighteen adenofibromas and cystadenofibromas were recorded. One-hundred were benign and formed an architectural spectrum from which emerged: (1) surface papillary adenofibroma accounting for 5% of the cases and appearing at a mean age of 27 years; (2) cystadenofibroma in 77.5% of the cases at a mean age of 53 years; (3) adenofibroma in 17.5% of the cases at a mean age of 64 years. Adenofibroma was bilateral in 18 cases. Among the other cases were an endometrioid cyst and two simple serous cysts. The cells were serous in 110 cases, mucinous in 6 cases and weakly acidophilic to clear in 2 cases. Eighteen of these tumours were malignant: 13 were associated with epithelial hyperplasia and 5 with a carcinoma. The 13 adenofibromas with atypical epithelial hyperplasia (at a mean age of 60 years) were all made of serous cells; 6 of them were low-grade and 7 high-grade tumours with 3 microinvasions. One patient died at the age of 78, of an unknown cause; the others are still alive after a mean follow-up of 11.3 years. The 5 invasive carcinomas appeared on an adenofibroma at the mean age of 70 years; 3 patients died (2 of metastases), one is alive after 9 years and one was loss sight of.(ABSTRACT TRUNCATED AT 250 WORDS)

A 38 year old patient with multiple known risk factors for endometrial carcinoma (monophasic cycles, obesity, familial prediabetes, nulliparity, polycystic ovaries with diffuse thecal hyperplasia) presented with metrorrhagia caused by an endometrial lesion for which the diagnosis hesitated between atypical endometrial hyperplasia and carcinoma. Hysterectomy was performed because of the presence of a bicornuate uterus, obesity of 130 kg and the patient's lack of desire to have children. Examination of the uterus did not reveal any myometrial invasion in contact with the hyperplastic endometrium. The discovery of an endometrioid carcinomatous metastasis in the lower third of the vagina one year later allowed the retrospective detection of a 3 mm endometrioid carcinoma in the isthmus. No other metastases or recurrence were observed with a follow-up of 5 years.

to estimate the frequency, the age, the size, the bilaterality and the prognosis for "borderline" tumours according to the type of cell found. MATERIAL STUDIED: 132 low grade malignant tumours found in 845 primary ovarian carcinomas diagnosed between 1975 and 1984 in the Institute of Pathology in Strasbourg.borderline serous carcinomas (63 cases) were 16.9% of cases were serous neoplasias. The mean age at which the diagnosis was made was 50.3 years of age, and the tumour measured 10 cm. They were bilateral in 20% of the cases and the mean age of survival was 134.7 months. The borderline mucinous carcinomas (68 cases) were 18.2% of mucinous neoplasias. The intestinal sub-variety was found at the mean age of 50 years and was 15.3 cm in diameter. It was rarely bilateral and in some cases was accompanied by peritoneal pseudomyxomatosis. The endocervical sub-variety (18 cases) was diagnosed at a mean age of 41.5 years with a mean size of 13.5 cm. It was rarely bilateral. The two varieties of borderline mucinous carcinomas had a mean survival rate of 154 months. Only one borderline endometrioid carcinoma was found among the 54 endometrioid carcinomas, and none had clear cells, Brenner cells or mixed cells.under the heading of "borderline" carcinoma are different types of tumour with different prognoses. Only serous mucinous varieties which are more frequent, have a low potential for becoming malignant. Endometrioid types and clear cell or Brenner types which have a similar architecture are usually found out to be benign.

A-77-years old woman had a solitary ulcerated tumor on her vulva present for one year. It proved, on histologic examination, to be a sebaceous epithelioma of 1.5 cm wide because of a peripheral area with less differentiated cells, excess of mitoses and slight invasiveness. To the authors' knowledge this is the first sebaceous epithelioma documented in this region. Previously have been described one sebaceous hyperplasia and two sebaceous carcinomas, one of them eight years after hemicolectomy for adenocarcinoma of the colon (Torre-Muir syndrome).

Rhodococcus equi is a pathogen for some animal species. It can cause opportunistic pulmonary infections in immunocompromised people. The authors describe such an infection that causes malacoplakia in a patient with acquired immunodeficiency syndrome. The likeness between lesions due to Rhodococcus equi and those due to other opportunistic germs as Mycobacterium avium-intracellulare is emphasized.

A monoclonal antibody has been raised which recognizes an epitope, PAC 1 (postsynaptic density and cytoskeleton enriched), which is specifically associated with two novel glycoprotein components of forebrain postsynaptic density preparations and a novel neuronal cytoskeletal-associated polypeptide. The monoclonal antibody has been used to study the cellular and subcellular localization of these molecules and for the partial characterization of all three PAC 1 antigens in the rat. The PAC 1 epitope is present on two concanavalin A binding glycoproteins of apparent molecular weights 130,000 (pgp130) and 117,000 (pgp l 17). Both species are enriched in preparations of rat forebrain postsynaptic densities and to a lesser extent in synaptic membranes. The epitope is also expressed by a polypeptide of 155,000 mol. wt, cp155. This molecule is highly enriched in cytoskeleton rather than membrane preparations. Enzymic removal of N -linked carbohydrate lowers the molecular weights of the PAC 1 glycoproteins pgp130 and pgp117 by 11,000 and 14,000 respectively, and suggests that cp155 is not glycosylated. Detergent, alkaline and salt extractions of postsynaptic densities and synaptic membranes indicate that pgpl30 and pgp117 are integral membrane glycoproteins and are tightly bound components of postsynaptic density preparations. Immunocytochemical studies of adult rat forebrain show prominent staining of pyramidal cell dendrites and perikarya. There is no evidence of glial staining. Electron microscope studies show staining of microtubules together with punctate deposits of plasma membrane-associated reaction product. Several criteria have been used to show that pgp130 and pgp117 do not correspond to other known neuronal glycoproteins of similar molecular weight. We conclude that the PAC 1 epitope is expressed by two novel synaptic glycoproteins which are very probably integral components of the postsynaptic density and by a novel neuronal cytoskeleton-associated protein.

A detailed colposcopy study of the cervix, vagina and vulva was conducted in 365 women referred for genital human papillomavirus (HPV) lesions, abnormal cervico-vaginal smear or cervical intraepithelial neoplasia (CIN). Valvuloscopic abnormalities, all biopsied, were found in 144 women, i.e. 40% of the population studied. Five types of vulvoscopic abnormalities are described: diffuse acidophilia (55% of abnormalities), acidophilic maculae (17%), micropapillae (20%), papulae (4%) and leucoparakeratosis (4%). Histological examination of the biopsy specimens obtained from 144 women with abnormal vulvoscopy showed 55 typical flat condylomas (38%), 50 probable flat condylomas (35%) and no signs of condyloma in 38 cases (27%). It also revealed the presence of four vulvar intraepithelial neoplasias (VIN) stages 2-3, all of them associated with typical or probable condyloma. Comparison between the 144 abnormal vulvoscopies and a series of 14 normal vulvoscopies made it possible to establish a significant correlation between the presence of valvuloscopic abnormalities and the finding of histological signs of typical or probable flat condyloma. The vulvoscopic images of subclinical vulvar HPV infection, but apart from papulae and, to a lesser extent, leucoparakeratosis, correlations between vulvoscopic and histological images were imprecise.

Authors studied the parasitological and serological status of 108 new-born children from 102 deliveries during the 2nd term of 1987 at the Bécédi Maternity Hospital in Ivory Coast. The parasitism frequency of different studied bloods (mother, cord, delivery) is varying from 8 to 14%, antibodies have been found in 81 to 83% cases. The parity has an effect on the placental lesions frequency but not on the parasitism frequency. Children born with a pathogenic placenta have a lower birth weight. The retrospective study of 11,070 deliveries from last years shows that birth weight are lower while the two first pregnancies.

In neonates, teratomas infrequently involve the abdomen: among 51 known cases, 39 were gastric teratomas, which account for less than 2% of all germ cell tumors in the neonatal period. Associated malformations are minor, located in the region of the tumor, and apparently less frequent than in other sites. Malignancy is exceedingly rare (a single case) and well controlled as a result of the anti-tumor processes specific to the neonatal period. Gastric teratomas are diagnosed early and can be cured by tumorectomy removing a thin ring of the surrounding stomach wall.

Side-to-side anastomosis is a bad technique to restore intestinal continuity. In fact, it leads to the progressive distention of the cul-de-sac, which produces definite pockets of stasis and bacterial infection. Although it is well tolerated by a number of patients, it causes a number of gathered complications in others. This array of signs is called the blind pocket syndrome, the characteristics of which are described by the authors on the basis of a 76-case series, including 3 personal cases. They again condemn the side-to-side anastomosis and prefer end-to-end anastomosis, which prevents these disadvantages.

This is a case of a 38 year old woman in whom a small basophil cell tumour occurred with inguinal and iliac lymph node metastases followed by pulmonary metastases and extension of the tumour into the vagina and the bladder. The patient died eight months after having started multiple chemotherapy and radiotherapy with telecobalt. Extra studies were carried out ten years later on the cells. This made it possible to diagnose the condition as a neuro-endocrine carcinoma rich in serotonin.