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To report an unusual incident of isolated conjunctival ulcerations which preceded all other signs of Behets disease.Description of a 34-year-old woman of West Indian origin with an unremarkable medical history presenting with bilateral bulbar conjunctival ulcerations.The authors noted the presence of a diffuse bilateral conjunctival hyperemia which was more pronounced at the temporal bulbar conjunctiva of the right eye and the nasal conjunctiva of the left eye, each having one ulceration. The rest of the ophthalmologic examination was normal. One month later, the appearance of buccogenital aphthosis led to the diagnosis of Behets disease.This observation is unusual, as the conjunctival ulcerations are isolated and precede the onset of all other symptoms of Behets disease. Conjunctival ulcerations are rarely seen with Behets disease, but are characteristic enough to be included among the diagnostic criteria.

Myelofibrosis is associated with numerous causes other than hematologic malignant neoplasms, including autoimmune diseases. We describe a 44-year-old woman who suffered bone lytic lesions with extramedullary haematopoiesis in the setting of myelofibrosis associated with systemic lupus erythematosus.

Resume Cet article decrit les techniques actuelles des prelevements fœtaux. Tous ces prelevements sont maintenant echoguides et donc globalement tres surs. Un apprentissage serieux est neanmoins indispensable ainsi qu’une attention particuliere a la qualite du dialogue medecin-patiente. Le choix de la technique depend de l’indication et du terme de la grossesse. Le prelevement le plus frequemment realise est l’amniocentese, avec un risque de fausse couche tres faible, estime entre 0,2 et 0,5 %. L’interet de la biopsie de trophoblaste est d’obtenir des resultats plus tot dans la grossesse — vers 10–11 semaines d’amenorrhee — avec une prise de risque moindre que lors d’une amniocentese precoce. Nous realisons ce geste, de facon quasi exclusive, par voie abdominale a l’aiguille. Le prelevement de sang fœtal est un acte plus delicat, avec un risque de complications estime autour de 1 %, mais qui reste a ce jour incontournable dans certaines indications.

En este articulo se describen las tecnicas de extraccion de muestras fetales que se emplean hoy en dia. En la actualidad, todas ellas se efectuan bajo control ecografico, por lo que, en terminos generales, son muy seguras. No obstante, resulta indispensable un aprendizaje formal, asi como una especial atencion a la calidad del dialogo medico-paciente. La eleccion de la tecnica depende de la indicacion y del termino del embarazo. La extraccion de muestras mas frecuente es la amniocentesis, con un riesgo de aborto muy bajo, estimado entre el 0,2-0,5%. El interes de la biopsia trofoblastica radica en obtener resultados lo antes posible en el embarazo -hacia las 10-11 semanas de amenorrea-; esta conlleva menos riesgo que una amniocentesis precoz. Los autores de este articulo realizan esta intervencion, de forma casi exclusiva, por via abdominal con aguja. La extraccion de sangre fetal constituye una intervencion mas delicada, con un riesgo de complicaciones que se estima en alrededor del 1%, pero que, hasta el momento, resulta ineludible en determinadas indicaciones.

The management of multiple pregnancies requires a correct diagnosis of chorionicity. This assessment is easy and reliable before 15 weeks of gestation by ultrasonography, but becomes much more difficult during the second and third trimester for same sex foetuses. From 5 to 8 weeks of gestation, the visualization of two gestational sacs assesses bichorionicity. From 8 to 14 weeks, the diagnosis of chorionicity is based on the presence of the lambda sign, completed by the evaluation of the thickness of the inter-twin membrane and the placenta localisation. From 15 weeks onward, the twin peak (or lambda) sign remains the best predictor of dichorionicity but is valuable only if it is present. The measurement of the thickness of the inter-twin membrane and the count of its layers are not available in all cases. From March 1999 to March 2000, we studied 31 multiple pregnancies with same sex foetuses, referred to our centre during the second trimester. The patients were asked for their former ultrasound reports. Chorionicity was mentioned only in 77% of the cases and when mentioned the information was correct in 85% of the cases. Thus, improving on that point is necessary. Prospective studies focusing on ultrasound determination of chorionicity show accuracy close to 100% when the ultrasonography is correctly realized before 15 weeks of gestation.

Resume Les auteurs rapportent 2 observations d'arthrite reactionnelles a anguillule (Strongyloides stercoralis), parasite dont la prevalence reste elevee aux Antilles. Ils soulignent quelques particularites cliniques, biologiques et therapeutiques de ces arthrites : affection rare, se presentant volontiers comme une spondylarthropathie, absence d'HLA B27, resistance aux AINS, contre-indication des corticoides, efficacite spectaculaire des anti-parasitaires specifiques. Le cadre nosologique et les criteres diagnostiques des rhumatismes parasitaires sont brievement discutes.

Alterations of phospholipid fatty acid composition in the renewing intestine were studied in the infant piglet. Newborn piglets were fed from birth to 2 weeks of age a concentrated cow's milk which defined a standard supply of dietary fatty acids. Phospholipids were isolated from the whole mucosa, isolated intestinal cells and purified brush border membranes. Intestinal cells were isolated according to their position along the crypt-villus axis and cell phospholipids were extracted at each step of differentiation. Changes in fatty acid composition of cell phospholipids were related to those of lactase activity in the corresponding cell homogenates. In cell phospholipids, the relative content of linoleic and linoleic acids increased about 2-fold from crypt base to villus tip. Substantial contents of alkenylacyl glycerophospholipids (plasmalogens) were found in crypt cell phospholipids and in purified brush border membrane phosphatidylethanolamine (11 and 14% of alkenyl groups by weight of total fatty acids, respectively). The proportion of alkenylacyl glycerophospholipids decreased as cells ascended the villus column and became more differentiated. The results show that fatty acid compositional changes in differentiating cell phospholipids occurred in the immature intestine (before weaning) and suggest that these alterations might be related to the appearance of specific functions.

Diabetic muscular infarction is an exceptional complication of diabetes mellitus. Patients with macro- and microvascular manifestations are mostly concerned. Muscular pain with swelling of the thigh is the main manifestation, sometimes associated with fever.We report here five cases of diabetic muscular infarction in three Afro-carribean patients with atypical clinical features. The surgical biopsy procedure allowed the diagnosis and ruled out pyomyositis, a more common bacterial disease on tropical condition.This report of three cases of this exceptional disease in a small population seems more related to the high prevalence of diabetes mellitus in the French West Indies than to their ethnic origin.

Les donnees concernant les modifications quantitatives et qualitatives des principaux composants lipidiques cellulaires liees aux processus de differenciation et de maturation de la muqueuse intestinale sont passees en revue

Background Chick is an epidemic disease due to an arthropod-borne virus ( Alphavirus ) transmitted by Aedes mosquitoes. CHIKV causes an acute illness with a febrile phase, followed by a period of severe polyarthritis that can persist for long time. There is no specific treatment, the best prevention is mosquito control and avoidance of bites. Martinique (French West Indies) is currently experiencing an outbreak of CHIK with 170 000 reported cases (Dec 1st). Objectives No data is available regarding the prognosis of Chikungunya in patients under biologics. We have observed 22 patients with Chik infection while on biotherapy and DMARDS for rheumatic diseases, between January and May 2014. Methods Physicians prescribing biologics were asked to declare patients under biologics experiencing Chik. For each patient we collected diseases characteristics and course, current treatment (steroids, immunosuppressant, biologics…), changes in the treatment during infection, and outcome. 22 patients were included, all with a diagnosis confirmed by PCR (20/22) or serology. Results Among these patients were 19 women and 3 men, 3 Caucasians and 19 Afro-Caribbean9s. There were 5 spondyloarthritis (3 associated with Crohn), 1 psoriatic rheumatism, 2 systemic lupus, 1 antisynthetase syndrome and 13 RA. 17 had methotrexate (mean dose 21.6 mg), 3 Plaquenil, 2 Imuran, 1 cellcept, 2 cyclophosphamide. 11/22 were under steroids (mean dose of 8.6 mg/d). All experienced fever (mean duration 1.7 day), skin rash (15/22, mean duration 1.3 d), and acute disabling polyarthritis (mean pain VAS 8.4, mean SJC 9.6, mean TJC 6.8) for a mean 11.5 days duration. Nine had back pain and 4 tenosynovitis. None of them showed any organ failure, one single episode of transient thrombopenia was noted. None of them was hospitalized for Chik. Analgesic treatment (alone 4/22), associated with NSAIDs (17/22) or prednisone (1/22) and rest were sufficient to overcome the crisis. All but one patient maintained their previous treatment (DMARDS, Biologic, steroids…) without specific complication. All patients were able to differentiate between Chik related complains and those related to their preexisting condition. Mean clinical disease scores before and after Chik (DAS, BASDAI, SLEDAI) remained unchanged. Conclusions This is the first report of the occurrence of Chik in patients under biologics. Patients under biologics are at increased risk for serious infections either viral or bacterial, but no data has been published regarding Chik. This study was not conducted to discover all cases of Chik among patients under biologic. Chik does not seem to be deleterious in patients under biologics who do not exhibit more severe or prolonged disease than common forms. Chik does not seem to aggravate pre-existing disease. It does not seem necessary to modify the basic treatment of rheumatism in the announcement of a Chik as the clinical pictures observed in these patients are quite benign. NSAIDs and best rest are mostly effective. Chik does not seem harmful in patients receiving biological and this issue should be given to travellers. Disclosure of Interest None declared

To report an unusual incident of isolated conjunctival ulcerations which preceded all other signs of Behçet's disease.Description of a 34-year-old woman of West Indian origin with an unremarkable medical history presenting with bilateral bulbar conjunctival ulcerations.The authors noted the presence of a diffuse bilateral conjunctival hyperemia which was more pronounced at the temporal bulbar conjunctiva of the right eye and the nasal conjunctiva of the left eye, each having one ulceration. The rest of the ophthalmologic examination was normal. One month later, the appearance of buccogenital aphthosis led to the diagnosis of Behçet's disease.This observation is unusual, as the conjunctival ulcerations are isolated and precede the onset of all other symptoms of Behçet's disease. Conjunctival ulcerations are rarely seen with Behçet's disease, but are characteristic enough to be included among the diagnostic criteria.

We report the effect of infliximab, a monoclonal anti-TNFalpha antibody, in two patients with refractory cutaneous and articular multicentric reticulohistiocytosis (MRH). One 37-year-old woman and one 53-year-old woman with polyarthritis, facial rash and nodular lesions on the hands related to MRH were refractory to multiple agents: cariolysine, corticosteroids, hydroxychloroquine and cytotoxic agents. Infliximab at 3 mg/kg which was then increased to 5 mg/kg in combination with methotrexate or azathioprine was effective on cutaneous manifestations of the disease but not on polyarthritis. A switch to etanercept did not improve polyarthritis in the second patient. Some data suggest that TNFalpha is involved in MRH, but based on our cases anti-TNFalpha therapy needs further evaluation in patients with refractory MRH.

The management of multiple pregnancies requires a correct diagnosis of chorionicity. This assessment is easy and reliable before 15 weeks of gestation by ultrasonography, but becomes much more difficult during the second and third trimester for same sex foetuses. From 5 to 8 weeks of gestation, the visualization of two gestational sacs assesses bichorionicity. From 8 to 14 weeks, the diagnosis of chorionicity is based on the presence of the lambda sign, completed by the evaluation of the thickness of the inter-twin membrane and the placenta localisation. From 15 weeks onward, the twin peak (or lambda) sign remains the best predictor of dichorionicity but is valuable only if it is present. The measurement of the thickness of the inter-twin membrane and the count of its layers are not available in all cases. From March 1999 to March 2000, we studied 31 multiple pregnancies with same sex foetuses, referred to our centre during the second trimester. The patients were asked for their former ultrasound reports. Chorionicity was mentioned only in 77% of the cases and when mentioned the information was correct in 85% of the cases. Thus, improving on that point is necessary. Prospective studies focusing on ultrasound determination of chorionicity show accuracy close to 100% when the ultrasonography is correctly realized before 15 weeks of gestation.

This article describes the current techniques of foetal sampling. All of them are actually ultrasound guided, and therefore generally very safe. Nevertheless, an elaborate learning process remains indispensable, in addition to a particular attention to the quality of the physician-patient dialogue. The choice of a technique depends on the indication and on the term of the pregnancy. The most frequently used technique is amniocentesis which presents a low risk of foetal loss, estimated between 0.2 and 0.5 percent. The interest of chorionic villus sampling is the possibility to obtain results at an earlier stage of pregnancy, with a lower risk taking when compared to early amniocentesis. We prefer the transabdominal chorionic villus sampling to the transvaginal. Foetal blood sampling is still required in some cases, but the risk of complications is higher--around 1 percent.

A 49-year-old man presented with a 8-month history of gait and sphincter disturbances. Examination revealed a spastic paraplegia predominant on the left limb, associated with decreased tactile sensitivity below T10. MRI showed a right posterolateral intramedullary lesion with an isosignal on T1-weighted images and a mild hypersignal on T2-weighted images, with an intense contrast enhancement; the spinal cord presented with an hypersignal on T2-weighted images. At operation, a vascular tumor presented at the spinal cord surface, was well demarcated from the parenchyma and was easily removed. Microscopic examination showed a capillary hemangioma. Three months later the patient exhibited a motor improvement with a right spasticity, deficits in proprioception, without sphincter abnormalities. A new MRI showed the disappearance of the hemangioma and of the preoperative spinal cord hypersignal. Capillary hemangiomas are unusual on nerves or roots. Cases found in the spinal cord are extremely rare: to our knowledge, 5 cases have been reported. On MRI, they are easily distinguished from cavernous hemangiomas, but microscopic examination is necessary to distinguish them from hemangioreticulomas. The postoperative prognosis is generally good. However, a report of a multiple location case, on roots and spinal cord, suggests the need for long follow-up.

To review epidemiological and clinical aspects of systemic lupus erythematosus (SLE) in Martinique, French West Indies.Cases of SLE were identified by attending physicians. Patients who presented with at least four of the criteria defined by the American College of Rheumatology were included. Determination of incidence and prevalence included the new cases arising during the 1990-1999 period and 1999 population census results. Probability of survival was based on the use of the Kaplan-Meier estimator.Two hundred and eighty-six patients were studied, including 265 females (92.7%). The average annual incidence was 4.7 cases per 100,000 inhabitants (95% confidence interval [CI]: 2.5-6.9). The prevalence for 1999 was 64.2 cases per 100,000 inhabitants (CI: 56.2-72.2). The mean age at onset was 30 years. Eleven percent of all patients had at least one parent with SLE. Renal disease was present in 139 patients (48.6%), and neurological disorders were diagnosed in 70 patients (24.5%). Patients tested positive for the following antibodies: anti-Sm (37.1%), anti-RNP (58.7%), anti-SSA (47.2%). Mean survival time was: 96.4% (CI: 94.1-98.7) at 5 years, 91.8% (CI: 87.9-95.7) at 10 years. Survival was significantly reduced in patients with end-stage renal disease (n = 40, chi 2 = 6.96, P0.01).The high incidence of SLE in Martinique and the immunological characteristics of patients were found to be similar to those described in other populations of African descent. The frequency of renal disease and survival rates were identical to those reported in Caucasians.

Risk factors for peripartum cardiomyopathy (PPCM) are controversial. PPCM seems to be more prevalent in women of African descent, the highest observed incidence is in Haiti (1 per 300 live births). Our retrospective study conducted in Martinique showed an incidence of 1 per 5500 live births. This incidence is significantly lower than in Haiti. Women from Martinique and Haiti do not differ for most classical risk factors: African descent, age, pregnancy-associated hypertension, multiple pregnancy and pre-eclampsia. However, the parity rate and the socioeconomic level are different. Thus, African descent could be confounded by high parity rate and socioeconomic status.

A case of acute disseminated encephalomyelitis (ADEM) preceding the features of cutaneous lupus is reported.To suggest that ADEM and cutaneous lupus are pathophysiologically related.Neurological complications of systemic lupus erythematosus are common. However, demyelinative central nervous system manifestations are rare, and restricted to neuromyelitis optica (NMO). NMO is thought to be a partial form of ADEM.A clinical, neuroradiological and immunological study was performed in this case.ADEM was diagnosed in a young black female. Three years later, she developed a cutaneous lupus without hypocomplementemia.A relationship between ADEM and cutaneous lupus is suggested. The normal serum complement level in our patient might be a predisposing factor for the development of ADEM.

The authors report an open prospective study in a group of 16 patients who presented systemic lupus erythematosus with cutaneous and articular symptoms, and who required treatment with a minimum dose of 15 mg per day of prednisone. Methotrexate was given at a dose of 7.5 mg IM per week. Efficacy was demonstrated at the third month with a statistical analysis of four evolution parameters. Improvement was observed in 13 patients out of 16 and permitted the reduction of the amount of prednisone required. Secondary relapse occurred in four cases in spite of an increase in the dose of methotrexate (10 mg per week). Minor side effects were observed in four cases, and methotrexate was discontinued in only two cases. This study suggests that treatment by low doses of methotrexate is beneficial to patients with articular and cutaneous manifestations of corticodependent systemic lupus erythematosus and this therapy could be corticosteroid-sparing.

A retrospective study was conducted in Martinique to identify patients with polyarthritis and positive serologic tests for the human T-cell lymphotropic virus Type I (HTLV-1). Patients with metabolic or bacterial causes of polyarthritis were excluded. We found 17 cases of HTLV-1-positive polyarthritis (6.7% of the total of polyarthritis patients followed in our department); there were 14 females and three males, and all the patients were West-Indian blacks. Mean age at diagnosis was 50 years. Five patients also had tropical spastic paraparesis. The polyarthritis was the inaugural manifestation of T-cell leukemia in one patient. Four patients had received blood transfusions. Fever, myalgia, and/or skin lesions were present at onset of the polyarthritis in seven cases. All 17 patients had peripheral, bilateral, symmetric polyarthritis; the most commonly involved sites were the hands (17/17) and knees (14/17). Three patients had rheumatoid factor and five had antinuclear antibody. Ten patients met at least four American Rheumatism Association criteria for rheumatoid arthritis; they accounted for 6.7% (10/150) of all polyarthritis patients managed in the same hospital department during the same period. We compared these ten patients with 20 HTLV-1-negative rheumatoid arthritis patients matched on gender, ethnic origin, and disease duration. There were no significant differences between the two groups for any of the parameters studied.

Survival in patients with cystic fibrosis has considerably improved over the last years. Young adults are particularly concerned. Fertility in these patients is greatly decreased, especially in men due to obstructive azoospermia. In women, intra-uterine insemination with her spouse's sperm can overcome anomalies in the cervical glair. Several pregnancies in patients with cystic fibrosis have been reported, especially in women with a mild form of the disease. Prematurity is frequent, about 35% as is perinatal mortality related to the mother's status. When lung involvement is severe leading to major obstruction and hypoxia, cor pulmonae and denutrition, pregnancy remains a contraindication. Care for pregnant women (when pregnancy is possible) should rely on a multidisciplinary team and include a rigorous nutritional and anti-infection support.

A retrospective study of 26 adults with acute T-cell leukemia showed that 14 patients (54%) had hypercalcemia at some point of the disease. Hypercalcemia was found at presentation in nine patients and revealed the disease in one. Eight patients had hypercalcemia at the time of death. Serum phosphorus and parathyroid hormone levels were normal. All patients with hypercalcemia tested positive for the HTLV-1 by Elisa and Western blot. Six patients had focalized or diffuse lytic roentgenographic bone lesions. Hypercalcemia in acute T-cell leukemia may involve production of interleukin-1-alpha and parathyroid hormone-related protein by HTLV-1-infected cells.

The effects of dietary polyunsaturated fatty acid (PUFA) deficiency on intestinal brush border membrane (BBM) fluidity, lipid composition and 5'-nucleotidase activity were examined in piglets. Cholesterol/phospholipid and sphingomyelin (SM)/phosphatidylcholine (PC) ratios were unaffected. However, fluidity was decreased in the external regions and also tended to decrease in the core of the PUFA-deficient pig membrane lipid bilayer. Therefore, the change in the membrane physical properties seemed to be due to the large diet-induced alteration in the phospholipid (PL) fatty acid composition and to the concomitant decrease in PC and increase in phosphatidylserine levels. In the membrane total PL, the arachidonic acid level was slightly lowered, while linoleic, eicosapentaenoic and docosahexaenoic acid levels markedly decreased. PC was mainly concerned by the altered distribution of unsaturated fatty acids, but not SM. However, a significant decrease in (n − 6)/(n − 3) ratio occurred in the latter. These structural changes were associated with a higher 5'-nucleotidase activity in the intestinal BBM of PUFA-deficient as compared to control piglets.

The HTLV-1 virus causes a disturbance of the immune system, the evaluation of which is often difficult. We report a case of sarcoidosis in a 49 year old woman of Martinique as evidenced by bilateral hilar adenopathy, hypercalcaemia, uveitis and granulomatous lesions on histological examination. Serological was positive for HTLV-1 antibodies. Three years later she developed an adult T-cell leukemia/lymphoma. The relationships between the HTLV-1 retroviral infection and different pathologies observed are discussed.

There have been few studies of the way women walk in pregnancy, though some of the causes of low back ache of which they complain have only been partially worked out. This is why this study has been carried out on ten women between the third and eighth month of pregnancy. The speed at which they walk and the parameters of the gait as well as the localization of the centre of gravity when keeping upright have been measured in these pregnant women as well as in twenty control women of the same age. The results show that the speed at which they walk whether with or without carrying a weight usually is identical at the beginning and the end of pregnancy. When walking normally the size of the steps taken are no larger in pregnant women than in the control patients (p less than 0.05). Though the results are not statistically significant the rhythm of the steps is faster as well as their being a reduction in the length of the steps between the third and eighth month of pregnancy. When carrying a weight the length of the steps does not change greatly with pregnancy (p less than 0.05) and it would seem therefore to be a good way of assessing the changes that locomotion undergoes in pregnancy. The fact that women do not walk faster or slower can give evidence that they adapt to the change in posture that happens in pregnancy and they make the best possible biomechanical use of the parameters of walking in order to economise total energy output of the organism.(ABSTRACT TRUNCATED AT 250 WORDS)

The human retrovirus HTLV-1 (Human T-cell Lymphotrophic Virus) is responsible for malignant proliferations of mature T lymphocytes. It is also now implicated in neurological disorders dominated by spastic paraplegia. A study of 140 cases of lumbar and root pain enabled us to identify 8 of apparently idiopathic atypical lumbar and root pain which led to the discovery of a positive HTLV-1 serology performed routinely. These cases were remarkable in terms of the rarity and minimal extent of spinal cord signs and of Lasegue's sign, their duration of more than a year and the existence of neurological signs indicative of central involvement. In 2 patients there was secondary progression to a spastic paraparesis. It would appear that the neurotropism of HTLV-1 virus is not limited to the central nervous system but that it can also involve the peripheral nervous system as indicated by certain cases in the literature as well as those collected in Martinique, an endemic area for the virus. Rheumatologists should be aware of this possibility when confronted with such cases of atypical lumbar and root pain and should seek the existence of an HTLV-1 virus infection among other viral etiologies, in particular when the patient concerned comes from an endemic area.

Summary The lipid components of columnar cells harvested from rat small intestine were analyzed at each step of cell maturation. The effect of dietary lipids on the evolution of lipids in differentiating cells was studied using two diets representative either of a control or of an essential polyunsaturated fatty acid deficient lipid supply. Two groups of weanling rats were fed a semisynthetic diet composed of corn oil (control diet) or hydrogenated coconut oil (deficient diet) for 11 weeks. Intestinal cells were extracted according to their position along the villus column. Linoleic and arachidonic acids constitutive of cell phospholipids increased as cells migrated from the lower to the mid-part of the crypt-villus axis only with the control diet. This gradient disappeared after a 3-week feeding period with hydrogenated coconut oil diet so that columnar cells of essential fatty acid deficient rats exhibited the same overall fatty acid composition all along the crypt-villus axis. Essential fatty acid deficiency resulted in an increase of both the triene to tetraene and arachidonic acid to linoleic acid weight ratios regardless of the maturational step of cells. As compared to the control diet, the essential fatty acid deficient diet induced a decrease of both the cholesterol and free fatty acid to phos-pholipid molar ratios only in lower villus cells. We conclude that (a) progressive compositional modifications of lipids occur while ascending the crypt-villus axis and (b) essential fatty acid deficiency induces substantial alterations of the lipid evolution normally linked to cell differentiation.

Alterations in lipids linked to intestinal maturation and enterocyte differentiation were reviewed. The 3 main lipid components of cell membranes, ie cholesterol, phospholipids and glycolipids, were examined. Cell phospholipid content increases from the crypts to the mid-villus, which accounts for membrane development and organelle growth in differentiating cells. Changes in the proportion of phospholipid polar head groups occur in brush border membrane during postnatal maturation of the small intestine. The possibility that phospholipid fatty acid composition in differentiating cells might be altered by dietary lipids is discussed. Cholesterol biosynthesis mainly occurs in crypt and lower villus cells whereas its absorption from luminal content and esterification into lipoproteins occur in upper villus mature cells. Cholesterol cell content increases in mature cells in comparison to immature cells on the one hand, and in the distal by comparison with proximal parts of the intestine on the other. Increasing cholesterol content is generally correlated with decreasing membrane fluidity, which in turn could modulate functional properties of the mucosa. Glycosphingolipids are mainly found in the brush border membrane, which contains 20-30% glycolipids by weight of total lipids. These components tend to reinforce the membrane stability and significantly contribute to the surface properties of epithelial cells. The latter undergo noticeable changes during cell differentiation and postnatal maturation. Significant changes in both the glycosidic and lipophilic parts of glycosphingolipid molecules occur in differentiating cells and are of possible importance in the process of mucosal maturation. It is possible that the addition of a terminal sialic acid (sialyltransferase activity) instead of a terminal galactose (galactosyltransferase) to an endogenous acceptor (lactosylceramide) could constitute an important event in the differentiation process, and may account for the increasing content of hematosides along the intestinal villus of rat. Alterations in lipid counterpart mainly consist of hydroxylation of fatty acids in hematosides during postnatal maturation or in glucosylceramides during cell differentiation. Collectively these intestinal lipid changes may contribute in part to the development of mucosal barrier, selective permeability and functional properties of the mature intestinal mucosa.

As incidence of SLE is high in Blacks, we studied HLA and SLE associations in the French West Indies, whose population is racially mixed. Forty-seven coloured SLE patients have been typed in HLA A, B, C and DR. We observed B8 association in nearly all of the studies. B15 association, more frequent in Caucasians, was found, also B53 association, a Black variant of B5 more frequent in Blacks. We did not find any class II association.

A 21-year-old man suffered severe (up to 15.5 mg%) and prolonged (7 months) hypercalcaemia as a result of immobilisation following severe trauma. During the period of hypercalcaemia, plasma parathormone and calcitonin levels were undetectable. A study using radioactive calcium revealed a very marked increase in bone resorption, a moderate increase in accretion and virtually no intestinal absorption. Iliac biopsy revealed dense calcification front and there was no osteoid substance. This hypercalcaemia appeared to be due to increased bone resorption, while the synthesis of osteoid substance seemed to be insufficient to permit an equivalent increase in calcium accretion.

Blount's disease is associated with agenesis of the medial tibial plateau leading to tibia vara. It appears to be more frequent in Scandinavian countries and in black populations. Twenty-six cases had been seen in Martinique (Antilles) of whom twenty were children. A classification into six stages was described. Stage IV is a critical one. Before it, corrective osteotomy will often lead to complete healing. After stage IV, lateral epiphysiodesis must be added to avoid recurrence of deformity. The technique of osteotomy was variable according to the age of the child and the obliquity of the joint line. In young children, a subtraction closing wedge osteotomy is suitable. In older children a "V" shaped osteotomy is recommended to lessen the amount of shortening. At the end of the growth period, a medial opening wedge osteotomy is advisable. In adults (six cases) whose deformity can reach as much as 50 degrees with considerable ligamentous laxity, reefing of the ligament must be added to the osteotomy. The problem of the opposite knee is discussed. Even when the disease is not bilateral, it can tend to develop towards arthrosis.

Aseptic osteonecrosis is observed in 25% of cases after renal transplantation. This etiological variety of osteonecrosis is unusual in that it is frequently bilateral and has multiple localisations. Apart from the classical radiological signs, attention in attracted by isolated images of osteocondensation in the metaphyses and/or the diaphyses suggesting massive bony infarction and the appearances of fatigue fractures observed frequently (14%). In 43% of cases, the obvious necrosis was proceeded by early bone pain, around the 7 th day, during massive administration of corticosteroids in the prevention or cure of graft resection. This finding suggested to us that the best time to observe ischemia of the bone or marrow is very early and led us to undertake an experimental study in the rabbit. Two series of New Zealand White rabbits were treated with massive doses of corticosteroid and sacrificed between the 3rd and the 21st day. The treated animals presented an early peak of hyperlipemia from the 7th day onwards, and diffuse lesions of hepatic and renal steatosis. Fat emboli associated with appearances of parietal thrombosis were observed in most cases. In the same animals, there were also appearances of stage I or stage II necrosis. Referring to the description of bone marrow necrosis in stages by Arlet and Ficat, there was observed in all the series, a frequency of marrow lesions of all stages much higher in treated animals (16 out of 20) than in controls. Only one lesion of stage I was observed in controls; the difference was highly significant. (0,000001p0,00001). If one only considers necroses of stage II and III (10/20 in the treated group nil in controls) the frequency was still significant p0.001. The preliminary results of the fixation of tetracycline are reported.

The surface properties of small intestine brush-border membranes (BBMs) were examined by frontal affinity chromatography using three types of unsolubilized ligands: phlorizin polymer, immobilized lectins and linolenic acid bound to agarose gel. BBM vesicles were purified from piglets fed a corn oil diet (control diet) or a hydrogenated coconut oil diet. The second diet was representative of a deficient supply of essential polyunsaturated fatty acid (EPUFA). It induced a marked decrease in 18:2 n –6 content in membrane choline phosphoglycerides and ethanolamine phosphoglycerides, whereas 20:3 n –9 appeared in each class of phospholipids. Control and EPUFA-deprived BBM vesicles bound to phlorizin polymer, linolenic acid-agarose and wheat germ agglutinin (WGA) gel. In contrast, concanavalin A gel and Lens culinaris A gel exhibited a low binding capacity towards the two types of vesicles. EPUFA deficiency induced a slight decrease in binding on phlorizin polymer and a marked increase in binding on WGA gel, whereas the two types of vesicles similarly bound to linolenic acid—agarose. Desorption of phlorizin polymer-bound membranes was performed using several detergents with special regard to sodium deoxycholate (NaDOC) micelles. Sucrase activity recovery showed that the efficiency of NaDOC desorption was diminished in the case of EPUFA-deprived vesicles. EPUFA-deprived membrane domains involved in the binding would be less sensitive to the detergent attack. This assumption agrees with the putative decrease in membrane fluidity induced by the deficient diet. The possibility that fatty acid compositional changes induced by dietary lipids are extensive enough to alter some chromatographic properties of BBM vesicles is discussed.

The cycle ergometer (an exercise cycle) Monark was used to study the repercussions on the fetus of physical exercises carried out by the mother at the end of pregnancy (after 37-39 weeks of amenorrhoea). The maternal and fetal heart rates were measured at the same time while the mother was pedalling against increasing resistance. This was a form of sub-maximal aerobics. Fourteen women took part in the study but only six traces could be analysed. The mean duration of the exercises was 15 (+/- 2.5) minutes. The mothers' heart rate rose from 84 (+/- 7) beats a minute (bpm) before exercise to 153 (+/- 14) bpm at the last level reached. It took 15.6 (+/- 4) minutes for the maternal heart rate to return to what it was before exercise. The basal fetal heart rate was around 144 (+/- 5) bpm before exercise and rose to 170 (+/- 12) during exercise with no change in the oscillations in the fetal heart rate. After exercise the fetal rate slowed down very slowly and there was a marked diminution in the amplitude of the oscillations (Hammacher's Type 1). They never disappeared. Those few women who were in "false labour" during the test went out of false labour. We have hypothesised that the fetal heart rate rises significantly during the mother's exercise and this action is a mechanical one rather than a humoral or hormonal one. When exercise stops the diminution in oscillations, which is rapid, could be a sign of the fetus becoming drowsy, or it could be due to the intervention of maternal factors.

The authors report 30 cases of aseptic osteonecrosis in 65 different bones, including 37 hips, 13 knees, 5 taluses, 1 cuboid, 8 shoulders, 1 humeral condyle, following renal transplantation. One patient had osteonecrosis in six different bones. In 24 cases, the necrosis occurred before the end of the 18th month following the graftmin 21 cases, radiodiagnosis of the first localisation was made before the end of the first month following the first clinical sign. The usual presenting symptom of osteonecrosis is a clear, sub-chondral crescent. In 2/3rds of cases of osteonecrosis of the femoral neck, there is a rapidly destructive form often well tolerated clinically. In 1/3rd of cases, the course was slow with mainly osteocondensation. The course is particularly destructive when, following failure of the graft, the transplanted patient is submitted to periodic hemodialysis. In 8 cases, the femoral condyles were involved, and in 4, the tibial condylesm the appearance may be that of osteochondritis dissecans, but more often the course resembles the destructive form of aseptic necrosis of the femoral head. Shoulder involvement leads to a radiological picture identical with that of the hips. One transplanted patient out of 5, has a chance to develop osteonecrosis within two years following the graft.

Over a period of observation of 14 years, one or more aspetic osteonecroses (AON) were discovered in 29 patients who had undergone renal transplantation. Altogether 64 AON were discovered. In patients who had survived at least 1 year, the frequency of this lesion was 18 percent. These transplantation necroses were often bilateral (16 cases out of 21 AON of the femoral head) or multiple (6 patients presenting AON in more than 3 sites) ; necroses were sometimes found in unusual sites (shoulder, ankle, upper end of the tibia, scaphoid, condyle of the humerus). The AONs of the lower limbs were remarkable because of their extent and because of the rapid evolution of the radiological signs. This is in contrast to the moderate nature of the pain. Latent types of necrosis are also found (3 cases of AON of the femoral head). During a search for factors favouring the development of AON, the authors noted that the average duration of haemodialysis was longer in the patients with AON than in a control group of transplant patients. The average daily dose of corticoids for the first six months after transplantation was not significantly different in the two groups studied. However, the 15 patients with transplants who were not given corticoids did not develop AON.

The immense possibilities offered by the computer can be utilized in medical education, through a free dialogue between the student and the machine thanks to a terminal. A diagnostic simulation program has been carried out in diagnosing adult polyarthritis. This program neccesitates an analysis of diagnostic behavior and, on this basis, the preparing of a diagnostic tree or graph. The reasons leading to the plan adopted in constructing the graph, are discussed. Cases of increasing difficulty are proposed to the student, who must follow the course plan in order to arrive at a diagnosis. This teaching method, applied for thing pedagogical advantages both for the teacher and the student. The operating cost seems reasonable.