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Resume Introduction La sertraline fait partie des inhibiteurs selectifs de la recapture de la serotonine souvent utilises comme traitement de premiere ligne dans la depression. Plusieurs tableaux de pneumopathies interstitielles imputables a la sertraline ont ete decrits. Observation Une patiente de 69 ans, traitee par sertraline pour une depression severe depuis 10 mois, a consulte pour alteration de l’etat general et symptomatologie respiratoire associees a une pneumopathie bilaterale. Un bilan exhaustif n’a pas mis en evidence d’etiologie infectieuse ou auto-immune ; toutefois, la biopsie pulmonaire, par voie transthoracique, a permis le diagnostic d’une pneumopathie a eosinophiles. Une toxicite pulmonaire de la sertraline est alors suspectee et celle-ci est arretee avec disparition de la symptomatologie et normalisation de l’imagerie thoracique. Conclusions Notre observation suggere la mise en cause de la sertraline, plusieurs mois apres la premiere prise, dans le developpement d’un tableau de pneumopathie chronique a eosinophiles d’installation clinique insidieuse. Etant donne la prevalence de prescription de tels medicaments, nous encourageons tout clinicien a etre vigilant devant l’apparition de symptomes systemiques ou respiratoires chez des patients traites par sertraline.

Sertraline is a selective serotonin reuptake inhibitor which is often used as first-line treatment for depression. Several patterns of interstitial lung disease attributable to sertraline have been reported in the literature.A 69-year-old patient, who had been taking sertraline to treat severe depression for 10 months, presented with a deterioration in his general condition and respiratory symptoms found to be associated with bilateral pneumonitis. An exhaustive assessment did not reveal any infectious or autoimmune aetiology. Transthoracic lung biopsy revealed a pattern of eosinophilic lung disease. Sertraline-induced lung toxicity was then suspected and this treatment was therefore stopped. The patient's symptoms resolved and the chest imaging normalized.Our observation suggests that sertraline was the cause of chronic eosinophilic pneumonia characterized by an insidious clinical presentation several months after starting the medication. Given its widespread prescription, we encourage any clinician facing this disease to pay attention to possible drug-induced origins of lung disease.

The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology.

International audience; The carrot ideotype for carrot breeders could be a variety resistant to Alternaria leaf blight-the main foliar disease on carrot worldwide-with a low level of bitterness as consumers consider it as an undesirable taste of carrots. Our previous investigation on carrot resistance to Alternaria dauci allowed the identification of resistance QTLs (rQTLs). Based on these results, breeding for a higher level of resistance is possible but we could interrogate about the impact of selecting these genomic regions on carrot bitterness. To answer this question, we combined chemical and sensorial analyses of a set of resistant and susceptible carrot genotypes evaluated in different environments to identify the metabolites involved in bitterness. The genetic control and heritability field experimentation and colocalizations between rQTLs and metabolite QTLs (mQTLs) were searched in order to evaluate the link between bitterness and resistance traits. Our results showed that selecting the genomic regions mainly involved in carrot resistance is possible without compromising carrot taste. However, the colocalization of rQTLs and mQTLs suggest that some genomic regions are involved in the expression of both traits and should be avoided or even counter selected. INTRODUCTION While breeding for varieties highly resistant to Alternaria dauci is a top priority for carrot seed companies, consumers are more and more demanding on gustative quality, especially low bitter carrots. Amon others, terpens and polyacetylenes are considered key compounds for bitterness in carrots (Simon et al. 1980; Seljasen et al. 2001). Relying on sensory and chemical analyses, Kreutzmann et al. (2008) highlighted that a small number of metabolites, among them eight terpens, could predict bitterness. However, while the genetic control of carrot resistance to A. dauci has already been investigated, leading to the identification of rQTLs (Quantitative Trait Loci involved in resistance) in different genetic backgrounds (Le Clerc et al., 2009; 2015), no information were available except very recently published by Keilwagen at al. (2017) on terpens and polyacetylenes. Identifying the genomic regions involved in resistance and/or bitterness will be very helpful for breeders to develop resistant varieties while avoiding increasing bitterness. To answer this question, chemical and sensory analyses were performed on a set of five carrot genotypes during three years, in four environments to identify the terpens involved in bitterness. These metabolites were characterized during two consecutive years in field trials in a population already segregating for resistance to Alternaria dauci and their genetic control was determined. The colocalization between previously identified rQTLS and mQTLS (QTLs involved in the accumulation of metabolites) were examined and recommendations were made for breeders.

Resume Une etude retrospective a ete menee afin d’evaluer les complications des reductions mammaires a pedicule superieur, effectuees selon la technique du service de chirurgie plastique de Besancon. Cent patientes operees entre 2003 et 2007 ont ete reexaminees. L’intervention etait realisee selon la meme technique et par le meme operateur (Pr Tropet). Le recul postoperatoire moyen etait de deux ans (huit mois a cinq ans). L’entretien etait standardise par une fiche de revision, accompagnee des dossiers medicaux, de photographies et mensurations pre- et postoperatoires. Les complications (hematome, infection, necrose, desunion, maladie thromboembolique) sont survenues dans 16 % des cas. Elles ont donne lieu a trois reprises chirurgicales en urgence pour drainage et six reprises differees. Les imperfections de resultats concernaient la plaque areolomamelonnaire (PAM) et les cicatrices. Deux patientes ont souhaite une reprise cicatricielle. Les resultats sont superposables aux donnees de la litterature. Afin de reduire les complications ou defauts, certaines adaptations techniques sont proposees.

Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).

Summary Background The aim of the study was to evaluate the mean-term efficacy and tolerance of the polylactic acid injections (New-Fill®) for the correction of facial lipoatrophy occurring in HIV-positive patients under tri-therapy. Material and method The patients were managed at the University Hospitals of Besancon and Strasbourg (France) from January 2002 to December 2005 for a prospective study. The patients were consecutively included in this study once their consent was obtained. Patients not stabilized by their antiretroviral treatment were excluded. Facial lipoatrophy was classified in four clinical stages (stage I: mild, stage II: moderate, stage III: important, stage IV: severe) after a clinical examination. The polylactic acid solution was prepared according to the manufacturer's recommendations, and injected in a retrotracing manner in the hypoderm at the rate of one 5 ml flask per side, with an interval of one month. The number of sessions varied according to the severity of the stage. Treatment efficacy, assessed after a minimal follow-up of one year, was established clinically by comparing the initial and final photographs (changes in the clinical stage) and by the patient's and surgeon's satisfaction rate (from zero to ten). Treatment tolerance was established on the painfulness of injections and on socioprofessional constraints reported by the patients and made on a visual analogical scale. The occurrence of adverse-effects was checked. Finally, we compared the cost of the treatment with that of lipostructure. Results Twenty-five patients were included (mean age: 44, sex-ratio: 23 male/2 female patients). The mean body mass index was 21. The mean CD4 cell count was 600/mm3. The mean HIV-1 RNA was 276 copies/ml. The severity of the lipoatrophy was stage one in two patients (8%), stage two in 12 patients (48%), stage three in nine patients (36%), and stage four in two patients (8%). The mean number of sessions was 5.2. The mean follow-up time was 26 months. In 76% of the cases we observed a complete correction of lipoatrophy (100% of stages I, 92% of stages II, 66% of stages III, 0% of stages IV). However, among stages II, III, and IV that were incompletely corrected, an improvement was noticed in all patients (grading to an inferior stage, at least). The mean satisfaction rate was 8/10 by patients and 7.2/10 by surgeons. In six patients (24%) a renewal of the treatment was proposed because of inadequate results. The painfulness of injections was rated at 3.3/10 and constraints at 3/10 by patients. One single case of visible and palpable sub-cutaneous granuloma was noticed in a patient at the end of the follow-up period (18 months). Discussion The use of polylactic acid is a safe and efficient procedure for the treatment of facial lipo-atrophy in HIV-infected patients, however severe the clinical stage may be, after a two-year follow-up period. We recommend hypodermic (and not dermic) injections to prevent adverse effects. This treatment is not more expensive then lipo-structure and the progressive correction is considered as an important advantage by patients. Considering our results, the simplicity of the procedure, and the low rate of complications observed, the injection of poly-lactic acid has become our first intention treatment for this condition.

The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology.

Necrotizing fasciitis of the perineum is a rare but of fast evolution, and potentially fatal infectious disease process. It is characterized by progressive inflammation and extensive necrosis of subcutaneous tissue involving the fascia and other adjacent tissues. This infection may be idiopathic or secondary to local trauma or pelvic surgery. Its mortality rate is 20%. We report a case of necrotzing fasciitis of the perineum in a 34-year-old woman following incision and drainage of Bartholin's gland abscess. Streptococcus A, Proteus mirabilis, Escherichia coli, and Candida albicans were isolated. Intravenous broad spectrum antibiotic therapy was promptly instituted. Concurrent surgical debridement of all necrotic areas was required. Post debridement therapy required a long period of dressing changes until cicatrisation. Necrotizing fasciitis of the perineum is a surgical emergency. Early diagnosis and prompt aggressive debridement are the keys to successful management.

Background: Excluding a vascular origin of exercise-related pain is often difficult in clinical practice. Recent papers have underlined the frequent association of concurrent lumbar spine degenerative disease and peripheral arterial disease. Furthermore, even when suspected, isolated exercise-induced proximal ischemia is difficult to diagnose. Measurement of transcutaneous oxygen pressure (tcpO2) is an interesting and accurate method to differentiate proximal (buttock) from distal (calf) regional blood flow impairment (RBFI) during exercise. Objectives: We searched for isolated proximal-without-distal RBFI as a possible cause of claudication, in patients with borderline (ABI-b: 0.91 - 0.99) or normal (ABI-n: 1.00 to 1.40) ankle to brachial index at rest. Study design: Retrospective cohort design study. We analyzed patients referred to our laboratory with symptom limiting claudication and an ankle brachial index within normal limits. Settings: University-based exercise-investigation center. Methods: Over a 12-year period, we identified 463 patients referred to our laboratory that had their lowest resting ABI between 0.90 and 1.40. The tcpO2 on chest, buttocks, and calves were recorded during treadmill walking tests (3.2 km/h, 10% slope) in 220 ABI-b and 243 ABI-n unique consecutive patients complaining of limiting claudication (each patient’s ABI was the lowest of the 2 legs). Limiting claudication was defined as the reported inability to walk 1 kilometer without stopping. A DROP index (limb tcpO2-changes minus chest tcpO2-changes from rest) below -15 mmHg was used to indicate a positive result (i.e. exercise-induced RBFI). Results: Treadmill exercise showed evidence for proximal or distal RBFI, of at least one side, in 128 out of 220 patients (58.2%) and in 86 out of 243 (35.4%) patients with ABI-b and ABI-n, respectively. Isolated proximal-without-distal RBFI was found in 32 out of the 128 (25.0 %) positive tests in ABI-b and 32 out of the 86 (37.2%) positive tests in ABI-n patients. Limitations: Study limitations include the absence of systematic follow-up of diagnosed patients and absence of systematic search for cardio-respiratory co-morbid conditions. Conclusion: Isolated proximal-without distal RBFI is found in approximately one out of 7 patients complaining of symptom limiting claudication with a borderline or normal resting ABI. Exercise-tcpO2 may help to discriminate patients with arterial claudication that could benefit from invasive vascular investigations and procedures. Key Words: Claudication, diagnosis, prevalence, peripheral arterial disease, transcutaneous oxygen pressure, pathophysiology, exercise testing, arterial pressure, vascular disease

A retrospective study was made to assess complications of superior pedicle breast reduction, in the Besançon hospital plastic surgery ward. One hundred patients operated between 2003 and 2007 were reexamined. In every case, the intervention was performed by the same operator (Pr Tropet) using the same technique. The average postoperation time range was 2 years (from 8 months to 5 years). The interview's minutes were formalized via a revisions sheet, including medical files, photos, and pre- and postoperative measures. Complications (hematoma, infection, necrosis, suture disunion, thromboembolic disease) were reported in 16 % of the cases. These lead to three emergency reoperations for drainage, and six delayed reoperations. Result imperfections were related to areola and nipple, and to scars. Two patients requested a scar revision. The results match reported data. Technical modifications are suggested to reduce complications or imperfections.

Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).

malnutrition is highly prevalent in diseased elderly people, especially in hospital departments, and weight loss also occurs during hospital stays. Among the tools proposed to define malnutrition and to screen persons at risk of malnutrition, the nutritional risk score (NRS) has been suggested as a simple tool.the aim of the present study was to test the validity of the NRS to predict weight changes 3 months after discharge. NRS and visual analogue scales for hunger, early satiety, thirst, fatigue and pain were performed in 106 patients aged 65 yrs and over, 67 treated for cancer, without overt malnutrition.forty six patients lost more than 1 kg. None of the parameters tested was correlated with weight changes, except NRS which was weakly correlated (r=-0.22, P=0.037). However a 0 score at NRS was associated with weight changes ranging -9 to +5 kg. Furthermore, the 11 patients with a high NRS score and weight loss were in a clinical situation that made it very likely that they would lose weight. In conclusion, NRS is not a valid score to predict weight change.

The aim of the study was to evaluate the mean-term efficacy and tolerance of the polylactic acid injections (New-Fill) for the correction of facial lipoatrophy occurring in HIV-positive patients under tri-therapy.The patients were managed at the University Hospitals of Besançon and Strasbourg (France) from January 2002 to December 2005 for a prospective study. The patients were consecutively included in this study once their consent was obtained. Patients not stabilized by their antiretroviral treatment were excluded. Facial lipoatrophy was classified in four clinical stages (stage I: mild, stage II: moderate, stage III: important, stage IV: severe) after a clinical examination. The polylactic acid solution was prepared according to the manufacturer's recommendations, and injected in a retrotracing manner in the hypoderm at the rate of one 5 ml flask per side, with an interval of one month. The number of sessions varied according to the severity of the stage. Treatment efficacy, assessed after a minimal follow-up of one year, was established clinically by comparing the initial and final photographs (changes in the clinical stage) and by the patient's and surgeon's satisfaction rate (from zero to ten). Treatment tolerance was established on the painfulness of injections and on socioprofessional constraints reported by the patients and made on a visual analogical scale. The occurrence of adverse-effects was checked. Finally, we compared the cost of the treatment with that of lipostructure.Twenty-five patients were included (mean age: 44, sex-ratio: 23 male/2 female patients). The mean body mass index was 21. The mean CD4 cell count was 600/mm(3). The mean HIV-1 RNA was 276 copies/ml. The severity of the lipoatrophy was stage one in two patients (8%), stage two in 12 patients (48%), stage three in nine patients (36%), and stage four in two patients (8%). The mean number of sessions was 5.2. The mean follow-up time was 26 months. In 76% of the cases we observed a complete correction of lipoatrophy (100% of stages I, 92% of stages II, 66% of stages III, 0% of stages IV). However, among stages II, III, and IV that were incompletely corrected, an improvement was noticed in all patients (grading to an inferior stage, at least). The mean satisfaction rate was 8/10 by patients and 7.2/10 by surgeons. In six patients (24%) a renewal of the treatment was proposed because of inadequate results. The painfulness of injections was rated at 3.3/10 and constraints at 3/10 by patients. One single case of visible and palpable sub-cutaneous granuloma was noticed in a patient at the end of the follow-up period (18 months).The use of polylactic acid is a safe and efficient procedure for the treatment of facial lipo-atrophy in HIV-infected patients, however severe the clinical stage may be, after a two-year follow-up period. We recommend hypodermic (and not dermic) injections to prevent adverse effects. This treatment is not more expensive then lipo-structure and the progressive correction is considered as an important advantage by patients. Considering our results, the simplicity of the procedure, and the low rate of complications observed, the injection of poly-lactic acid has become our first intention treatment for this condition.

Necrotizing fasciitis of the perineum is a rare but of fast evolution, and potentially fatal infectious disease process. It is characterized by progressive inflammation and extensive necrosis of subcutaneous tissue involving the fascia and other adjacent tissues. This infection may be idiopathic or secondary to local trauma or pelvic surgery. Its mortality rate is 20%. We report a case of necrotzing fasciitis of the perineum in a 34-year-old woman following incision and drainage of Bartholin's gland abscess. Streptococcus A, Proteus mirabilis, Escherichia coli, and Candida albicans were isolated. Intravenous broad spectrum antibiotic therapy was promptly instituted. Concurrent surgical debridement of all necrotic areas was required. Post debridement therapy required a long period of dressing changes until cicatrisation. Necrotizing fasciitis of the perineum is a surgical emergency. Early diagnosis and prompt aggressive debridement are the keys to successful management.

Perinatal prognosis of pregnant drug abusers is better with intensive prenatal care and substitution maintenance programs. There is a large body of data in the literature on methadone (MTD), but very little on high-dose buprenorphine (HDB). The objective of this study was to compare 2 groups of pregnant women maintained on MTD or HDB for perinatal events.Prospective multicentric study; all neonates (NN) whose mothers has been maintained during pregnancy on MTD or HDB were included by 34 French perinatal centers with specialized staff for care of these pregnant drug abusers.Two hundred and forty-six pregnant women were included: 93 (38%) MTD and 153 (62%) HDB. Social and perinatal data, prenatal care and factors correlated with poor prenatal care are reported. Forty-six percent of the pregnant women had good prenatal care; 88% had peridural analgesia; mean birthweight=2838g; mean gestational age=38.7 weeks; prematurity37 weeks=13; intra-uterine growth retardation=32%. Sixty-five percent neonates had withdrawal neonatal syndrome (WNNS) at a mean age of beginning at H40, mean highest Lipsitz score was 8.2 at H78. Half of the neonates with WNNS received treatment, mainly with morphine chlorhydrate. Neonatal mortality was 0/246. Discharge of the neonates was 60% with their father and their mother, and 32% with their mother alone; 4% were placed in foster homes by judicial decision. The only statistically significant differences between the MTD and HDB groups were: maintenance program was more frequently initiated before this pregnancy for the HDB vs MTD group (p0.03); MTD maintenance was more often supervised by maintenance specialized centers and HDB by general practitioners (p0.001); prematurity was 18% for MTD group vs 9% for HDB group (p0.04); mean age of maximum Lipsitz score was H92 for MTD group vs H70 for HDB group (p0.001).The perinatal medical and social prognosis of these 246 pregnant drug abusers and of their neonates appeared to be improved by the specialized prenatal care, comparatively with literature data. Perinatal impact of substitution program during pregnancy would be similar with MTD or HDB.

Objectifs II n’existe pas actuellement de consensus, dans les plaies des doigts, sur la necessite de la reparation de l’artere digitale en plus de la suture du nerf. L’imagerie des arteres digitales ne peut etre effectuee en routine par des methodes invasives (TDM, angiographie) et est difficile a l’IRM. Ce travail montre l’interet de l’echo-Doppler dans l’evaluation de l’influence sur la recuperation nerveuse de la permeabilite des arteres digitales. Materiels et methodes Une etude retrospective sur la reinnervation des nerfs collateraux apres section d’un nerf digital palmaire a ete realisee chez 35 patients avec un recul minimum de 3 ans (total de 40 nerfs leses). L’analyse de la permeabilite des arteres etait realisee par echo-Doppler ; l’analyse de la qualite de la recuperation nerveuse par un chirurgien orthopediste specialise dans la microchirurgie de la main. Resultats La qualite de l’exploration Doppler etait bonne dans 100 % des cas. Vingt-cinq nerfs etaient associes a une artere permeable et 15 a une artere non permeable. Le resultat fonctionnel etait evalue par le test de Weber (8,84 mm versus 13,47 mm en cas d’artere non permeable) et l’existence d’un intolerance au froid (16 % versus 86,7 %). Conclusion Ce travail montre l’interet de la reparation systematique de l’artere digitale palmaire en plus de la reparation du nerf digital, ainsi que l’utilite pour le chirurgien de l’echo-Doppler, methode d’imagerie simple, non invasive et fiable dans l’exploration de la vascularisation des doigts.

Light microscopic immunolabeling studies were designed to identify and locate structural components within the cell-free extracellular matrix which lies between the embryonic endocardial and myocardial tubes. Affinity-purified antibodies were used to examine stage 15-22 embryonic chicken hearts. Specimens were immunolabeled by using three different methodologies: 1) postembedding labeling of 10 microns cryostat sections, 2) preembedding labeling (en bloc) of whole hearts, and 3) postembedding labeling of ethanol/acetic acid-fixed paraffin sections. Our results establish the spatial distribution of collagen type I and demonstrate for the first time the presence of collagen type IV and laminin in the myocardial-basement-membrane/cardiac jelly.

Ovarian carcinoma now appears as the most common fatal gynecologic malignancy. Surgery and radiotherapy are the most common modalities of therapy used in the treatment of these patients. Surgery provides the initial diagnosis, accurate staging, and initial therapy. Conventionally, radiotherapy has been used as an adjuvant to surgery in localized disease [6, 11]. Unfortunately, because of the poor initial symptomatology, approximately 60% of the patients are initially seen to be in an advanced stage of the disease [13]. In these conditions, the patients may be better helped by chemotherapy [14, 12, 4].

R 2323 (13-ethyl, 17 alpha-ethyl, 18-hydroxy-gona-4,9,11-trien-3-one) was administered orally, 50, 75, or 100 mcg/week in 2 or 3 divided doses with or without 3 100 mg testosterone implants to arrest spermatogenesis, to 20 healthy men 25-35 years of age with at least 2 children. There were 3 dropouts, 1 for a high triglyceride level. 7 men became azoospermic within 2-3 months after the combined treatment and 8 after receiving 75 or 100 mg/week of R 2323 only. No abnormal sperm forms appeared. Side effects were weight gain of 2-8 kg chiefly with the combined schedule. Libido declined in 3, erective capacity decreased in 2, and coital frequency fell in 8. 1 case of gynecomastia appeared after 4 months. 1 man had a superficial thrombosis in the left arm at the site of a biopsy for polyadenopathy. Testosterone fell from 5 to .5 ng/ml and follicle stimulating hormone and luteinizing hormone from 5-1 mIU/ml in both groups. The only remarkable change in a biological parameter was an increase in transaminase, especially SGPT, 25-50%. Testosterone and gonadotropins returned to normal within 1 month after stopping steroids, and sperm counts within 3-4 months. The testosterone implants failed to prevent plasma testosterone levels from falling, and seemed to cause more side effects such as weight gain and loss of libido than did R 2323 alone.

Piquet-Thepot M.-M. Contribution à l'anthropologie des Corses : Anthropologie de la tête (suite). In: Bulletins et Mémoires de la Société d'anthropologie de Paris, XII° Série. Tome 3 fascicule 3, 1968. pp. 183-218.

Background Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period. Methods Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24 ± 19.4 months, range 1-85.1 months) was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried. Findings Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5% (36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively. Conclusion Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions.