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Initially employed for clinical analysis, the biological and chemical luminescence application was extended to food, agriculture, veterinary medicine and the environment. Several authors have described the use of optical fibres as optical transducers connected to the light detector of a luminometer within the context of bio-sensor development. This paper seeks to improve remote biological and chemical luminescence analyser design by evaluating remote versus local mode when modifying light collection and transmission. In spite of specific design, light losses were high, with a transmission of only approximately 20%. Further improvements are feasible: straight alignment of the optical fibre bundle without a mirror could reduce light losses, and an integration time increase could compensate for them.

Aims There is controversy over the value of the pathological classifications of gastric carcinomas in the prediction of patient survival. This study was designed to assess the prognostic value of four widely used pathological classifications, in addition to classical prognostic factors. Methods and results Records from the population-based registry of digestive tract tumours in the department of Cote d'Or (France) have been analysed. All available histopathological slides of gastric cancer resected between 1976 and 1985 were reviewed and classified according to World Health Organization (WHO), Lauren, Ming and Goseki pathological coding systems. A relative survival analysis was performed using a relative survival model with proportional hazard applied to net mortality by interval. WHO, Lauren or Goseki classifications were not found to be independent prognostic factors. In addition to advanced age group, depth of parietal involvement, nodal involvement, presence of metastases, tumour site and gross appearance of the tumour, the Ming's infiltrative type was associated with a lower survival. Conclusion This study suggests an independent prognostic value of the Ming subtypes with respect to survival in patients resected for gastric carcinoma.

A research programme was set up by European Institutes to compare the testing methods employed by their laboratories to measure characteristic parameters of air-assisted orchard sprayers. The parameters studied in this programme were: air flow rate, air velocity and liquid distribution. The study showed differences between the laboratories. which could partly be explained as resulting from the measuring devices or the testing methods. Recommendations are given to avoid major measurement errors.

We report a rare gastric tumour characterized morphologically by its hepatoid features and alpha-fetoprotein production and which presented clinically with gastric haemorrhage. Gastric fibroscopy showed a bleeding tumour of the antrum. The microscopic appearance of the tumor showed two different patterns. The most extensive presented hepatoid features. The second pattern showed undifferentiated features. The tumour cells showed immunohistochemical positivity for alphafetoprotein, EMA and p53 protein; 37% were aneuploid with a DNA index of 1.46. The serum level of alphafetoprotein was not measured before the gastrectomy but after ten days it was elevated at 1070 ng/ml. The patient died 6 months after the admission. This case provides, for the first time, information on the DNA content and the p53 expression of this unusual and aggressive variant of gastric adenocarcinoma.

Seven kidney tumors obtained from patients aged from 5 to 76 years were analyzed by flow cytometry for cell cycle, DNA content and P-glycoprotein expression involved in multidrug resistance. The DNA index seems to be an important criterion since all the tumors were aneuploid. In a case of clear cell carcinoma, two aneuploid clones were identified. In 5 cases of kidney tumors a high proportion of cells in proliferation (S + (G2 + M)) was observed; it was comprised between 13 and 33%. As for P-glycoprotein it was detected only in few tumor cells (5-15%) respectively in a case of clear cell carcinoma and in a case of Wilms' tumor.

Our purpose is to elaborate a model for deformable solids known only by a very small number of images in general crosssections. We distort a generic 3D model according to detected boundaries. In this paper, we first explain an image segmentation by a Split and Merge algorithm based on a texture analysis method, and a holefilling process using a priori knowledge. Then, our 3D model using B-splines interpolation polynomials is detailed, as well as its distortion process. Finally, results are presented.

The authors introduce the Hartley series and present the formulas for computing amplitude and phase images with the fast Hartley transform. This approach is then applied to image sequences digitized from conventional angiographic films. The computing times are roughly the same as with the fastest equivalent Fourier algorithms. >

Several texture analysis methods are studied, leading for each image region to a condensed textural information vector determined by stepwise discriminant analysis. Image segmentation is performed by split and merge, using a classification based on the Mahalanobis distance. More than 90% of the regions are well classified. >

The system described here is devoted to the automatic reading of antibiograms. It is composed of a PC compatible microcomputer with an image processing card and a camera. The software has two parts: a relational database management program that manages easily configurable tables, and an image analysis program that automatically measures the inhibition zones. The results are given in millimetres, in minimum inhibitory concentration, and as significant, intermediate or resistant susceptibility. The measures are fast and accurate. The system makes possible the realization of real epidemiologic and nosocomial studies. The accuracy of the measurements allows the prediction of the resistance of the bacteria to different antibiotics.

Record linkage, for compiling sameperson records from various source files, can improve the feasibility of epidemiological research using populationbased studies. The question is comply with the European legislation on data privacy and data security. For example, a computerized record hash coding and linkage procedure is described to link medical information within the framework of epidemiological followup. Before their extraction, files are rendered anonymous using a oneway hash coding based on the standard hash algorithm (SHA) function. Once rendered anonymous using the software ANONYMAT, the linkage of patient information can be accomplished by means of a mixture model, taking into account several identification variables. An application of this anonymous record linkage procedure was carried out in order to link medical files on cancer, from 3 hospitals of the French RhôneAlpes region. This application stresses how the use of the ANONYMAT software allows compliance with the legislation on data confidentiality without entailing problems on data availability.

This paper deals with the main security services of data protection: integrity, authentication, nonrepudiation and confidentiality. It describes the different tools which may be used to achieve these security objectives: encryption, digital signature, access controls, integrity control, audit and certification. The French legislation concerning encryption has been recently updated in order to simplify the use of encryption techniques for personal data security. This legislation describes different authorization or reporting procedures according to the type of the request (application, equipment, import or export of encryption techniques) and the security level required.

Sensitive data are most often indirectly identifiable and so need to be rendered anonymous in order to ensure privacy. Statistical methods to provide anonymity require data perturbation and so generate data processing difficulties. Encryption methods, while preserving confidentiality, do not require data modification.

In this paper, we present an application of EPIDWARE, medical data warehousing architecture, to our epidemiological follow-up project. The aim of this project is to extract and regroup information from various information systems for epidemiological studies. We give a description of the requirements of the epidemiological follow-up project such as anonymity of medical data information and data file linkage procedure. We introduce the concept of Data Warehousing Architecture. The particularities of data extraction and transformation are presented and discussed.

A major step toward improving the treatments of disabled persons may be achieved by using motion analysis equipment. We are developing such a system. It allows the analysis of plane human motion (e.g. gait) without using the tracking of markers. The system is composed of one fixed camera which acquires an image sequence of a human in motion. Then the treatment is divided into two steps: first, a large number of pixels belonging to the boundaries of the human body are extracted at each acquisition time. Secondly, a two-dimensional model of the human body, based on tapered superquadrics, is successively matched with the sets of pixels previously extracted; a specific fuzzy clustering process is used for this purpose. Moreover, an optical flow procedure gives a prediction of the model location at each acquisition time from its location at the previous time. Finally we present some results of this process applied to a leg in motion.

The rapid growth of telemedicine has created a need for a definition of the responsibilities of the doctors involved. These responsibilities must be analyzed according the tort of negligence as a function of the level of competence of each doctor, their unequal access to the relevant information and their command of the telemedicine system. This analysis leads on to a study of the legal value of the electronic records kept and the ways in which the doctors are remunerated.

To carry out epidemiological studies at a regional level, one may need to link information collected by medical doctors working either in hospitals or in private offices or laboratories. The first problem is to respect the European legislation on nominal data processing, which does not allow the linkage of nominal files. As a consequence, we have developed an anonymous record linkage procedure, which ensures an irreversible transformation of identity and allows the linkage of rendered anonymous files. The second problem is to ensure data security during the transmission and we discuss the advantages of different methods of communication such as the norms X400 and Internet protocols.

Modeling by mixed-distribution was proposed in order to analyze heterogeneity of costs and length of stays within Diagnosis Related Groups (DRGs). A mixed-distribution model based on Weibull distributions was applied to 791 discharge abstracts of French DRG no. 450 (Health Care Financing Administration 3 DRG no. 316 “Renal failure”) from a national database. Three subgroups of cost and length of stay were identified. Except for age, clinical criteria significantly linked with the long-stay subgroup were the same as those associated with the high-cost subgroup: acute renal failure, intensive care, infectious complications, and vascular investigations. The identification of factors associated with high costs, based on the proposed model, will allow physicians to understand more accurately how their choice of specific procedures influences hospital costs.

After the implementation of the Medicare Prospective Payment System (PPS) in the USA, many European countries like France have introduced DRGs to curb hospital overspending. However, there has been some reluctance from hospital actors, especially because of the heterogeneous nature of DRG's. To analyse this situation, we propose a method based on distribution modelization of length of stays and costs within DRGs. For each DRG, the model is based on a mixture of Poisson and Weibull distributions identified as subgroups. The subgroups are characterized by their means and their proportions which are estimated by maximization of data likelihood. For a particular DRG, the proportion of long stay or high-cost patients can be explained by the introduction of clinical variables in the model. First the model was applied to the DRG "leukemia and lymphoma" (HCFA V.3), using 133 discharge abstract files from the Dijon public teaching hospital which were classified into this DRG in 1993. Among the studies parameters only acute leukemia, neutropenia500 PNN/mm3, high dose aplastic chemotherapy, central venous catheterization, parenteral nutrition, use of protected or laminar air flow room, septicemia, large spectrum intravenous antibiotherapy, and blood transfusion had a significant influence on the distribution of the patients in the long stay or costly subgroup. Second, for DRG "chronic bronchopneumopathies" (n = 220) the significant parameters were mechanical ventilation, antibiotherapy, post hospitalization medicalized care.

A computerized record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the SHA function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks, two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by the means of a statistical model, taking into account several identification variables.

Telemedicine can provide an alternative solution to the lack of medical resources in areas where the population is no longer dense enough to justify the temporary or permanent presence of certain specialists such as anatomo-pathologists. In the long run certain pre-operational frozen section examinations cannot be carried out without putting the quality of healthcare at stake. The telematic transmission of macro and microscopic images of lesions, under the supervision of a surgeon, to an anatomo-pathologist consultant located off premises allows for the maintenance of equitable care of acceptable quality.

Computerization of medical records is making headway for patients' follow-up, scientific research, and health expenses control, but it must not alter the guarantees provided to the patients by the medical code of ethics and the law of January 6, 1978. This law, modified on July 1, 1994, requires to register all computerized records of personal data and establishes rights to protect privacy against computer misdemeanor. All medical practitioners using computerized medical records must be aware that the infringement of this law may provoke suing in professional, civil or criminal court.

To carry out the epidemiological study of patients suffering from a given cancer, the Department of Medical Informatics (DIM) has to link information coming from different hospitals and medical laboratories in the Burgundy region. Demands from the French department for computerized information security (Commission Nationale de l'Informatique et des Libertés: CNIL), in regard to abiding by the law of January 6, 1978, completed by the law of July 1st, 1994 on nominal data processing in the framework of medical research have to be taken into account. Notably, the CNIL advised to render anonymous patient identities before the extraction of each establishment file. This paper describes a recently implemented protocol, registered with the French department for computerized information security (Service Central de la Sécurité des Systèmes d'information : SCSSI) whose purpose is to render anonymous medical files in view of their extraction. Once rendered anonymous, these files will be exportable so as to be merged with other files and used in a framework of epidemiological studies. Therefore, this protocol uses the Standard Hash Algorithm (SHA) which allows the replacement of identities by their imprints while ensuring a minimal collision rate in order to allow a correct linkage of the different information concerning the same patient. A first evaluation of the extraction and anonymity software with regard to the purpose of an epidemiological survey is described here. In this paper, we also show how it would be possible to implement this system by means of the Internet communication network.

Dealing with telemedicine including telediagnosis and teleassistance, we have to assess the legal and ethical components of medical liability. With medical telediagnosis, the dispersion of medical liabilities is the main risk: how can we ensure a clear identification of the medical liabilities involved in case of damage? From a legal point of view, the dispersion of the liabilities is not authorized and the use of telediagnosis must ensure a total transparence. As we cannot presently establish a separate amount for a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient is a contract similar to the usual contract between laboratories which implies that the liability belongs to the practitioner who has received the sample. In the future, other legal obligations may appear when telediagnosis develops. Indeed, the increase in reliability due to telediagnosis could be normally required as a part of the medical obligation to use the latest technology. On the opposite, the excessive use of teleassistance, when there is neither emergency nor medical isolation, is dangerous because it affects the integrity and the quality of the medical act. A medical practice without any clinical examination of the patient is contrary to medical ethics.

An encryption method is proposed for nominal files to allow their linkage while respecting confidentiality rules. In contrast to most encryption algorithms, this encryption method must be non-reversible. The method is based on congruence, like the SAN MARCO algorithm, and satisfies the two following conditions. 1) Non-reversible enciphering, which implies the possibility of collisions. 2) The collision rate must be minimized, to allow file linkage. The security of this method is, in addition, guaranteed by a key, which is destroyed after enciphering and is not given to the recipient of the coded file.

We propose here a structural and conjunctural compensation method to improve budgetary allocation which could be based on Diagnosis Related Groups. This method consists in the determination of sub-group costs within DRGs. The specification of these sub-groups is possible by introducing clinical and social parameters in the statistical model. Hospitals could then compare their sub-group proportions and analyze their differences in relation to conjunctural factors (recruitment, medical practices) and structural factors (technical team, local medical structure). This method also allows an identification of specialty hospitals (outliers) and a compensation allocation for budgeting for these hospitals.

In dealing with tele-medicine including tele-diagnosis and tele-assistance, the legal and ethical components of medical liability must be satisfied. With medical tele-diagnosis, the spreading of medical liability is the main risk. How can we ensure a clear identification of the medical liabilities involved in cases where damage occurs? From a legal point of view, the spreading of the liability is not allowed and the use of tele-diagnosis must ensure a total transparence. As we cannot presently estimate the cost of a medical act based on the cost of the image records and the cost of image interpretation, it is necessary to establish a contract. Today the most convenient contract is similar to the contract between laboratories which implies that the liability is on the practitioner who has received the sample. In the future, other legal obligations may appear as tele-diagnosis develops. Indeed, with the increase in reliability in tele-diagnosis it could become a part of the medical obligation to use the latest technology. However, the excessive use of tele-assistance, when there is neither emergency nor medical isolation, is dangerous because it may affect the integrity and the quality of the traditional medical act. In general, medical practice without any clinical examination of the patient is contrary to medical ethics.

Sending images to the far end of the world and establishing a diagnosis that may save one human life is a technological success which is very extremely gratifying, scientifically. But it's only the first, though essential, stage towards developing an international telemedicine network. The difficulties of conforming the telemedicine network to technical standards, administrative regulations, and existent national and supranational legislations are presented in this paper; there are often no ready-made solutions to these problems.

First it is explained why medical information in hospitals is difficult to protect even when the legal conditions are adequate. Next the health care professional smart card is presented as the solution chosen in France.

The authors are reporting a case of papillary and cystic neoplasm of the pancreas. This rare malignant epithelial neoplasm occurs mostly in young women and has a more favorable prognosis than the adenocarcinoma. Radiologic investigations showed a well demarcated, heterogeneous, hypovascular mass. The histological study showed the proliferation of epithelial cells in a papillary pattern. The immunochemistry was negative for markers of adenocarcinoma but positive for vimentin, alpha-1-antitrypsin, alpha-1-antichymotrypsin and neuron specific enolase. Receptors of progesterone were also detected. By flow cytometric analysis, the tumours was hypoploid. The histogenesis of these tumours remained controversed. Ultrastructural details of the neoplastic cells suggest that these tumours originate from small duct cells; detection in several cases of markers for endocrine neoplasm suggests that they originate from primitive multipotential cells, that may show exocrine or endocrine differentiation.

The case described corresponds to a grade G2 urothelial tumor with stage pTa extension (according to the World Health Organisation classification). After transurethral resection of the tumor and treatment by Bacillus Calmette Guerin (BCG), the efficacy of treatment was evaluated by cystoscopy, standard cytology, flow cytometry or image analysis. According to these various methods it has been shown that a normal cystoscopy may or may not be associated with aneuploidy revealed by flow cytometry. Such a case clearly illustrates the value of combining macroscopic examination and a cytologic analysis in particular by flow cytometry in order to increase the accuracy of diagnosis and to evaluate without ambiguity the efficacy of treatment.

Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.

Expert systems, which are going to be an essential tool in Medicine, are evolving in terms of sophistication of both knowledge representation and types of reasoning models used. The more efficient they are, the more often they will be used and professional liability will be involved. So after giving a short survey of configuration and working of expert systems, the authors will study the liabilities of people building and the using expert systems regarding some various dysfunctions. Of course the expert systems have to be considered only for human support and they should not possess any authority themselves, therefore the doctors must keep in mind that it is their own responsibility and as such keep their judgment and criticism. However other professionals could be involved, if they have participated in the building of expert systems. The different liabilities and the burden of proof are discussed according to some possible dysfunctions. In any case the final proof is inside the expert system by itself through re-computation of data.

Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.

The data of the polyp registry of the Côte d'Or was used to study the characteristics of hyperplasic polyps detected in a well defined-population. In the 1976-1985 10-yr period, 1,222 hyperplasic polyps were resected in 874 Côte d'Or residents. They represented 17% of all polyps. The incidence rate standardized according to the world reference population was 21.9/100,000 in males and 8.1/100,000 in female. The male predominance was observed in all age groups. The incidence of hyperplasic polyps increased by a mean of 19.8% per year in males and 26.6% in females (P less than 0.001). Hyperplasic polyps were discovered twice as often in patients living in an urban area than in patients living in a rural area (P less than 0.001). Hyperplasic polyps were smaller than 5 mm in 91.4% of cases and were located in the rectum in 59.4% of the cases. They were associated with an adenoma in 21.0% of the cases. In the case of a rectal hyperplasic polyp, 10.5% of the patients had an adenoma in the left colon and 2.8% in the right colon. A rectal hyperplasic polyp cannot be considered as a marker of the presence of a large bowel adenoma. The relationship between hyperplasic polyp and colorectal cancer needs to be established.

Since 1985, a stroke registry has registered every stroke in this town, of about 140,000 inhabitants. A CT Scan and numerous sources of information have allowed to achieve an exhaustive survey. The annual incidence of stroke has been 145/100,000. The annual specific incidence for age is 170/100,000 in men, 126/100,000 in women. The annual specific incidence for age and sex has shown a female preponderance until 30 and a male preponderance after this age. At 80, the rates became equal. Sixty-eight per cent of stroke were due to an infarct, 12 p. 100 to lacunae, 5 p. 100 to subarachnoid hemorrhage and 15% to cerebral hemorrhage. A preponderance of young people was found in subarachnoid hemorrhage, of the fifth decade in cerebral hemorrhage, while infarct rose up with age in the 2 sexes. Infarcts appeared predominantly during winter, while transient ischemic attacks appeared more often during summer. Cerebral hemorrhage had a constant incidence over the year. Mortality was high, mainly during the first month with 12.5 p. 100 during the first week, 21.5 p. 100 during the first month, and 30 p. 100 the first year. Our results appear to set in the mean of white occidental countries as opposed to Japan. They emphasize the important and underestimated place of lacunae and the seasonal variations of several causal varieties of stroke.

Prostate specific antigen (PSA) is a prostate tissue marker detected by immunostaining in 97% of specimens examined. Tissue staining is variable and cancers are more heterogeneous than normal or hyperplastic prostate. Serum PSA levels in patients with normal or hyperplastic lesions are 12 ng/ml + 19 and are positively correlated with the weight of the gland. In patients with carcinoma serum PSA levels are 216 ng/ml + 782 and are positively correlated with tumor spread. PSA assay is of little value for screening for prostatic carcinoma. However, carcinoma of prostate is more frequent when PSA levels are above 10 ng/ml and the level of 50 ng/ml indicates capsular penetration, seminal vesicle or lymph node involvement or metastatic spread.

The improvements in obstetrical and neonatal care have considerably reduced perinatal mortality and focused interest of paediatricians on the neurological outcome of Low- Birth-Weight infants (

In order to define immediate criteria of prognosis for patients with cirrhosis, hospitalized in emergency for upper gastrointestinal tract haemorrhage, 164 cases of haemorrhages medically treated were reviewed. A prognostic study of each variant points to the clinical, endoscopic and biological data connected with death. That study illustrates the prognostic value of traditional data. Patients who died within the first 30 days had a significantly higher incidence of hepatic encephalopathy, hematemesis, ascites, low blood pressure, bleeding oesophageal varices during endoscopy, hypoprothrombinemia, hyperbilirubinemia. Those who survived had a significantly higher incidence of aspirin intake, numerous haemorrhages, good state of health, non bleeding peptic ulcer. Several series of multivariant analysis: multiple regression and linear discrimination, differing from one another in variates were done. They have allowed identification of 11 variables used in establishing a prognostic index. In the series studied, it gives an 87% probability of correct differentiation. Such an index allows an objective estimate of the value and limits of a group of patients in which the efficiency of other treatments could be tested in controlled trials.

The results of a 4-year prospective study of stroke in a community of 140,000 people are reported. Eight hundred and forty-two strokes were recorded, 70 per cent in University Hospitals, 20 per cent in private hospitals and 10 per cent at home. Ninety-four per cent of the patients had a CT scan. The annual incidence of stroke was 145/100,000 people, whereas the incidences of infarct, cerebral haemorrhage and subarachnoid haemorrhage were 121, 21 and 6.6/100,000 people respectively. These results, compared with those of other registers, clearly show the superiority of population-based registers over hospital-based registers.

In order to study the best distribution of anaesthesiologists in the different operating areas of a regional University Hospital we have analyzed different data gathered in our hospital : number of anaesthesia, number of hours spent in the operating area, number of “are K”. (In France, the “K” is used for surgery and the “are K” for preoperative care, anaesthesia and postoperative care. Both -K and are K- are the result of a dialogue between the Health Insurance people and the doctors. This set number of are K allows anaesthesists to determine their fees.)

Linear discriminant analysis is a multidimensional statistical method often used in spite of the hypotheses scarcely verified in practice. However, linear discriminant analysis provides a good description of data and is especially helpful and a relatively cheap tool for decision making.

A prospective study was carried out among 190 low birthweight neonates (less than 2,500 g) in order to assess their ratio of total body fat by 2 adiposity indices: Weight/Height3 (W/H3) at birth and Weight/Height2 (W/H2) subsequently. Adequate for gestational age (AGA) girls with weight indices (W/H3) above the 10th percentile (AGA/I+) had a lower height than AGA/I- girls on the 6th (p less than 0.01) and 9th (p less than 0.05) months of corrected chronological ages. Mean weight and height of small for gestational age (SGA) neonates with weight indices (W/H3) lower than the 10th percentile (SGA/I-) were similar to the SGA/I+ as soon as 3 months of corrected chronological age. SGA/I+ infants experienced a progressive increase in low weight indices (W/H2) until 15-18 months without significant differences with SGA/I- at 3, 6, 9 months of corrected chronological age. Meanwhile, low indices (W/H2) were more frequently observed in SGA/I- at 15-18 months. Thus the early characteristics in weight indices disclose a lower ratio of body fat in SGA infants than in normal children, at least up to age 15-18 months.

The plasma dopamine-beta-hydroxylase activity was measured in 10 healthy untrained volunteers during a graded physical exercise on a bicycle ergometer. The authors have shown a good correlation between the DbetaH activity and the noradrenaline content in plasma. It can therefore be concluded that the DbetaH activity could be a true measure of the sympathetic activity.

Beginning in 1985, the Dijon Stroke Registry has identified every case of stroke occurring in this city of 140,000 inhabitants. The systematic use of a CT scan and multiple other sources of information ranging from hospital doctors to general practitioners make it possible for us to have virtually exhaustive data on stroke incidence. The gross incidence was 170 per 100,000 among men and 126 per 100,000 among women. Specific incidence by age and sex shows female predominance up to 30 years of age, and male predominance among victims from 30 to 80 years old. Beyond 80, rates were identical for both sexes. In 68% of the cases, the strokes were caused by infarct; in 12%, by lacunae; in 15%, by cerebral hemorrhage; in 5%, by subarachnoid hemorrhage. Significant differences existed in this distribution according to age, with a clear predominance of young people among those having subarachnoid hemorrhage, while, for those over 40, cerebral hemorrhages were frequent; the proportion of infarct increased with age for both sexes. A peak of incidence for infarct appeared during winter, while transient ischemic accident was more frequent in summer. Cerebral hemorrhage had a similar incidence throughout the year. Mortality was high during the first month (12.5% during the first week, 21.5% during the first month), and reached 30% during the first year. These results are comparable to those generally observed among white occidental populations. They confirm the limited incidence of hemorrhages (contrary to what has been observed in Japan), emphasize the important and often underestimated role of lacunar syndromes, and the seasonal variations specific to each mechanism.