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Hypercholesterolemia is a main risk factor of cardiovascular disease. Probiotics are a safe approach to reduce elevated cholesterol without any deleterious effect to human health. Saccharomyces boulardii CNCM I-745 probiotic properties are well documented in a context of intestinal dysbiosis. Recent in vitro and preclinical studies have suggested its potential effects on dyslipidemia. This is the first controlled study investigating the effects of S. boulardii CNCM I-745 on lipidemic profile and gut microbiota in a hamster hypercholesterolemic model. Daily administration (3 g/kg) of S. boulardii for 21 or 39 days in hamsters fed a 0.3% cholesterol-diet significantly reduced total plasma cholesterol (P

In this paper, we present a novel numerical approach for predicting the fluid flow in a solid rocket motor chamber with burning propellant grain. We use a high-order technique to track the regressing grain surface. Spectral convergence toward the exact burning surface is achieved thanks to Fourier differentiation. For the computation of the internal chamber fluid flow, we make use of a body-fitted volume mesh deforming with the grain surface. We describe several methods to deform the volume mesh and to keep good mesh element quality without global remeshing. We then couple the surface and volume approaches and integrate them into a complex code for compressible, multispecies, turbulent flow simulations. Thanks to these methods, we are able to exhibit one of the first three-dimensional simulations of the internal flow in a realistic solid rocket motor coupled to complex grain surface regression. In prior work, burning grain surface methods have only been coupled with one-dimensional internal ballistics sol...

Resume Interet du travail Depuis 2011, les etudiants classes aux epreuves classantes nationales (ECN) font leur choix d’exercice futur parmi 11 disciplines avec la selection precise d’une specialite medicale ou chirurgicale. Notre objectif etait de decrire le choix des etudiants a l’issue des ECN quant a leur future discipline d’exercice et leur future ville de formation en troisieme cycle des etudes medicales. Methodes Nous avons analyse le fichier Excel® fourni par l’Agence regionale de sante d’Aquitaine a l’issue du choix des etudiants apres les ECN 2012. L’analyse par rang median national a ete realisee pour le choix des disciplines et des villes de formation. Pour les specialites (medicales ou chirurgicales) et la medecine generale, une analyse comparative en fonction des densites medicales regionales a ete effectuee selon les donnees du Conseil de l’Ordre des medecins. Resultats Par rang median national de choix, les six premieres disciplines choisies etaient l’ophtalmologie, la nephrologie, la medecine interne, la radiologie, la cardiologie et la dermatologie. Les etudiantes etaient plus attirees par la gynecologie medicale ou obstetrique, la pediatrie ou la dermatologie ; les etudiants par la neurochirurgie, la chirurgie generale, la medecine nucleaire et la cardiologie. Les villes les plus prisees selon le rang median national de choix etaient Lyon, Montpellier et Ile-de-France. La plupart des etudiants (59 %) ont change de ville pour acceder a une specialite. En medecine generale, 56 % des etudiants sont restes dans leur ville de formation. Perspectives Notre etude permet de donner un objectif concret aux etudiants en deuxieme cycle des etudes medicales, et d’apporter des donnees supplementaires en matiere de gestion de la demographie medicale.

Introduction La pneumonie est une des causes principales de morbi-mortalite chez les patients âges. Son diagnostic est parfois rendu difficile par le manque de sensibilite et de specificite des symptomes cliniques, mais aussi par les difficultes d’interpretation des radiographies thoraciques (RT). Une etude recente rapporte l’interet du scanner thoracique dans le diagnostic de pneumonie aux urgences [1] . L’objectif de notre etude est d’etudier l’apport d’un scanner thoracique (CT) basse energie ( low-dose ) dans la prise en charge des pneumonies du sujet âge, en particulier son impact sur l’antibiotherapie empirique. Materiels et methodes Une etude prospective interventionnelle, portant sur des patients âges de plus de 65 ans, hospitalises en medecine interne et en geriatrie aigue a ete menee de mai 2015 a avril 2016. Tout patient avec une suspicion clinique de pneumonie (au moins un symptome respiratoire et un symptome infectieux), traite par antibiotherapie depuis les urgences pouvait etre inclut. Les patients traites par antibiotherapie pour une pneumonie durant les six mois precedents ont etes exclus ainsi que ceux ayant recu une antibiotherapie depuis plus de 48 heures ou ayant eu un CT thoracique pour une autre indication. Une RT et une CT low-dose ont etes pratiques a tous les patients inclus dans les 72 heures de leur admission. La probabilite de pneumonie etait evaluee par le clinicien a partir d’une echelle de Likert a 5 degres (exclue, bas, intermediaire, eleve, certain) avant et apres le CT. L’ outcome primaire etait represente par le nombre de diagnostic modifie : upgrade (augmentation de la probabilite diagnostique) ou downgrade (diminution de la probabilite diagnostique). Resultats Parmi 898 patients screenes, 203 ont ete inclus : 98 F (48,3 %) d’âge median 84 ans (65–103) ; 154 (75,9 %) avaient une pneumonie communautaire, 72 (35,5 %) avaient ete hospitalises durant les 6 mois precedents. Le score CURB65 median etait de 2. La mortalite a 30 jours etait de 5,4 %. Quatre-vingt-cinq patients (41,9 %) etaient porteurs d’un infiltrat sur la RT de facon certaine ou elevee selon le clinicien. Parmi les 200 patients analyses, la probabilite de pneumonie avant et apres CT est exposee dans le Tableau 1 . La probabilite du diagnostic de pneumonie a ete modifiee apres le CT chez 134 patients (67 ont eu un diagnostic downgrade [soulignes], 67 upgrade [gras]). L’antibiotherapie a pu etre interrompue chez 18 patients (9 %) apres CT. Conclusion Cette etude originale est a notre connaissance la premiere qui evalue l’utilisation du CT low-dose dans une population geriatrique hospitalisee pour suspicion de pneumonie. Ces premiers resultats montrent l’interet du CT dans le diagnostic et la prise en charge de ces patients, en particulier en permettant de diminuer l’utilisation de l’antibiotherapie probabiliste. D’autres etudes prospectives devront toutefois prouver l’interet du CT chez certains patients ayant une suspicion de pneumonie.

The main purpose of this work is to present a new parallel direct solver: Dissection solver. It is based on LU factorization of the sparse matrix of the linear system and allows to detect automatically and handle properly the zero-energy modes, which are important when dealing with DDM. A performance evaluation and comparisons with other direct solvers (MUMPS, DSCPACK) are also given for both sequential and parallel computations. Results of numerical experiments with a two-level parallelization of large-scale structural analysis problems are also presented: FETI is used for the global problem parallelization and Dissection for the local multithreading. In this framework, the largest problem we have solved is of an elastic solid composed of 400 subdomains running on 400 computation nodes (3200 cores) and containing about 165 millions dof. The computation of one single iteration consumes less than 20 min of CPU time. Several comparisons to MUMPS are given for the numerical computation of large-scale linear systems on a massively parallel cluster: performances and weaknesses of this new solver are highlighted. Copyright © 2011 John Wiley & Sons, Ltd.

RADIOLOGIE ET IMAGERIE MEDICALE : Musculosquelettique - Neurologique - Maxillofaciale - 31-657-A-10

Aeroelastic systems may exhibit vibrations that are induced by a forced periodic motion of their elements. For example, the forced periodic motion of an aileron on a deformable wing produces vibrations of this wing. Accurate numerical simulation of such problems is usually based on a time-marching scheme and a code-coupling strategy. Such computations are costly, since before the periodic-vibration cycles, a long transient has to be computed. A technique called time-harmonic balance has been developed in the field of computational fluid dynamics to accelerate the computation of unsteady periodic flows. This technique allows the periodic state of these flows to be computed directly without computing their transients. In this paper the time-harmonic-balance strategy is applied to an aeroelastic solver consisting of two coupled codes. The time-harmonic-balance technique allows the resulting aeroelastic solver to compute the periodic-vibration cycles caused by a periodic forced motion directly, without computing the long transients. The time-harmonic-balance-based aeroelastic solver is analyzed and validated on a two-dimensional aeroelastic pitch-plunge airfoil undergoing a forced pitching. Furthermore, application to an industrial case is considered, where the flexibility of an aircraft wing is taken into account in the computation of unsteady aerodynamic forces caused by an oscillating aileron.

Resume Propos Cette etude avait pour objectif de decrire les aspects epidemiologiques, cliniques et biologiques du liquide cephalorachidien (LCR) dans les meningites a Enterovirus . Methodes Il s’agissait d’une etude retrospective monocentrique conduite sur la periode 2004 a 2008, de toutes les meningites aseptiques dues a une infection a Enterovirus . Resultats Cinquante-neuf patients, d’âge moyen de 31,4 ans, ont ete inclus. La triade, fievre, cephalees, raideur de nuque etait presente chez 62 % des patients. Une hyperleucocytose sanguine a polynucleaires neutrophiles (PNN) etait presente chez 12 patients (20 %), la C-reactive proteine etait elevee dans 23 cas (39 %). Vingt-huit patients (47 %) avaient une predominance de PNN dans le LCR et neuf (15,2 %) presentaient une hypoglycorachie. Un traitement probabiliste anti-infectieux a ete initie chez 47 patients (80 %) pendant 3,2 jours en moyenne. Conclusion L’absence de specificite des signes cliniques et biologiques des meningites a Enterovirus rend necessaire la generalisation de la PCR a Enterovirus en temps reel pour limiter les hospitalisations et les traitements anti-infectieux inutiles. Les regles de decision aident a distinguer les meningites bacteriennes des meningites virales.

Resume Objectif de l’etude Rechercher dans la litterature des arguments permettant de guider dans le choix entre radiochirurgie et radiotherapie stereotaxique hypofractionnee dans le traitement des metastases cerebrales. Patients et methodes Quatre cent quarante-huit patients ont ete traites dans huit series par irradiation stereotaxique hypofractionnee avec une contention non invasive, une marge de securite de 2 a 10 mm (mediane 3 mm) a une dose de 24 a 40 Gy delivree en trois a cinq seances sur cinq a huit jours dans six series et 15–16 jours dans deux autres series, completant une irradiation encephalique totale de modalites variables dans 30 % des cas. Deux mille cent cinquante-sept patients ont ete traites dans 12 series recentes par radiochirurgie avec une contention invasive, sans marge perilesionnelle, a une dose de 10 a 25 Gy en une seule seance, completant une irradiation encephalique totale, le plus souvent de 30 Gy en dix fractions et 12 jours, dans des 58 % des cas. Les comparaisons ont porte sur les volumes tumoraux macroscopiques medians, la duree mediane de survie, les taux de survie a un an, de controle local et de toxicite. Resultats Pour les series de radiotherapie stereotaxique hypofractionnee, le volume tumoral macroscopique median etait de 0,52–4,47 cm 3 (mediane : 2,8 cm 3 ), la duree mediane de survie de cinq a 16 mois (mediane : 8,7 mois), le taux de survie a un an de 68,2 a 93 % (mediane : 82,5 %) et le taux de necrose de 3,1 %. Pour les series de radiochirurgie, le volume tumoral macroscopique median etait de 1,3 a 5,5 cm 3 (mediane : 2 cm 3 ), la duree mediane de survie de 5,5–22 mois (mediane : 11 mois), le taux de survie a un an de 71 a 95 % (mediane : 85 %) et la taux de necrose de 0,5 a 6 % (mediane : 2,4 %). La toxicite de la radiochirurgie est documentee dans les metastases volumineuses mais elle n’est pas connue pour la radiotherapie stereotaxique hypofractionnee. La marge de tissus sains incluse dans le volume cible previsionnel majore les risques de toxicite. L’association variable a une radiotherapie stereotaxique fractionnee rend l’interpretation des resultats difficile. Il s’agit d’une premiere etude exploratoire dont la methodologie est discutable. Conclusion Les volumes tumoraux macroscopiques ≤ 500 mm 3 (diametre de moins de 10 mm) necessitent une contention invasive et donc la radiochirurgie. Pour ceux de plus de 4200 mm 3 (diametre de 20 mm), la radiotherapie stereotaxique hypofractionnee parait preferable. La radiochirurgie ou la radiotherapie stereotaxique hypofractionnee sont utilisables pour les metastases cerebrales dont le volume tumoral macroscopique est compris entre 500 et 4200 mm 3 . Le fractionnement et l’etalement optimaux restent cependant a determiner.

Points essentiels Le syndrome FXTAS (Fragile X associated Tremor Ataxia Syndrome) est un syndrome neurodegeneratif specifique des sujets porteurs d’une premutation du gene FMR1 (fragile X mental retardation 1). Il touche essentiellement les hommes premutes âges de plus de 50 ans . Ce syndrome est distinct du syndrome de l’X fragile . Le syndrome FXTAS reste encore sous estime . Il devrait etre evoque chez un patient de plus de 50 ans qui presente un tremblement d’action avec une ataxie cerebelleuse, d’autant plus qu’il existe un parkinsonisme et/ou des troubles cognitifs, des antecedents familiaux d’infertilite, de menopause precoce ou de retard mental. La presence d’hypersignaux T2 et FLAIR des pedoncules cerebelleux moyens en IRM justifie, dans ce contexte, la recherche de la premutation FMR1.

Resume Introduction La retinopathie liee a la prise d’interferon-α est un fait etabli chez les patients atteints d’hepatite C. Seuls cinq cas de retinopathie secondaire a l’interferon-s ont ete rapportes dans la litterature. Observation Un homme, âge de 58 ans, atteint d’une sclerose en plaques traitee par interferon-s 1a 44 μg sous-cutane (SC) trois fois par semaine depuis 2001, presenta une gene visuelle bilaterale en juillet 2007. L’acuite visuelle etait normale. A l’examen du fond d’œil, etaient retrouves des nodules cotonneux de maniere bilaterale et isolee a l’origine d’une retinopathie. Il n’avait aucun facteur de risque cardiovasculaire. L’ensemble du bilan etiologique etait normal. La iatrogenie de l’interferon-s 1a SC fut evoquee. Ce traitement fut arrete en juillet 2007. Le fond d’œil de controle a deux mois se normalisa et le patient etait asymptomatique sur le plan visuel. Conclusion Tout nouveau symptome visuel chez un patient traite par interferon (IFN) doit inciter a realiser un fond d’œil a la recherche d’une retinopathie. En cas de negativite du bilan etiologique, l’imputabilite de l’IFN pourrait etre evoquee et justifier eventuellement de l’arret du traitement.

Resume Introduction L’hypotension intracrânienne spontanee du liquide cerebrospinal est definie par une hypovolemie du liquide cephalorachidien survenant en l’absence de toute breche durale connue. Ce syndrome se caracterise cliniquement par des cephalees recidivantes soulagees par le decubitus. Nous rapportons le cas d’un patient de 38 ans atteint de ce syndrome et effectuons une revue de la litterature. Exegese De diagnostic parfois difficile dans les formes atypiques ou anciennes, il est source d’une gene fonctionnelle souvent invalidante et de complications engageant parfois le pronostic vital. Son diagnostic, avant tout clinique, a ete facilite depuis une dizaine d’annees par le developpement de l’imagerie par resonance magnetique et permet la mise en place de traitements efficaces dont le principal est la technique du blood patch. Une fuite de liquide cerebrospinal par une breche de la dure-mere est suspectee a l’origine des symptomes, en l’absence de traumatisme evident comme une ponction lombaire ou un traumatisme medullaire. Conclusion Un interrogatoire precis permet d’en faire rapidement le diagnostic, evitant ainsi le stade des complications.

Resume Propos Le syndrome de ballonisation apicale transitoire du ventricule gauche egalement connu sous le nom japonais de tako-tsubo est une entite recemment decrite et caracterisee a la phase aigue par une large akinesie de tout l'apex du ventricule gauche. Ce syndrome prend le plus souvent la forme d'un syndrome coronarien aigu, plus rarement celle d'une defaillance cardiaque ou d'un trouble du rythme. Nous rapportons le cas typique d'une patiente de 77 ans atteinte d'un syndrome de tako-tsubo revele par une douleur thoracique aigue secondaire a un stress emotionnel intense. Le diagnostic a ete evoque devant l'absence de lesion coronarienne a l'angiographie malgre des anomalies majeures et diffuses de la cinetique du ventricule gauche. Actualite et points forts Le syndrome de tako-tsubo fait actuellement l'objet d'un nombre croissant de publications du fait d'une meilleure reconnaissance de celui-ci, notamment lors des syndromes coronariens aigus a coronaire angiographiquement saine. Sa physiopathologie, bien que non elucidee, est clairement rapportee a un stress aigu. Differentes hypotheses sont actuellement discutees, profitant depuis peu de l'apport de modeles animaux experimentaux. De pronostic tres favorable a moyen terme, sa decouverte permet une prise en charge adaptee a la phase aigue notamment des complications. Perspectives et projets L'etablissement de criteres cliniques et electrocardiographiques fiables et eprouves pourrait permettre un diagnostic precoce afin d'eviter des traitements potentiellement deleteres. Son traitement specifique, non consensuel a ce jour, devrait beneficier des progres realises dans la comprehension de la physiopathologie de ce syndrome.

Resume Les oligodendrogliomes cerebraux representent plus de 30 % des tumeurs gliales de l’adulte. L’âge moyen au moment du diagnostic est de 41 ans pour les grades A et 45 ans et demi pour les B, l’epilepsie etant leur mode principal de revelation (91,5 % des A, 76 % des B). Leur survie a 5, 10 et 15 ans est respectivement de 75,5 %, 51 % et 22,5 % pour les A (mediane a 136 mois) et de 45,2 %, 31,3 % et 0 % pour les B (mediane : 52 mois). Celle-ci est influencee par l’âge au moment du diagnostic : mediane de survie avant 40 ans, a 12 ans pour les A et a 8 ans et demi pour les B ; entre 40 et 60 ans, a12 ans pour les A et a 4 ans et demi pour les B ; au dela de 60 ans, a 4 ans pour les A et a 1 an et demi pour les B. Chez l’enfant, ils representent moins de 2,5 % des tumeurs cerebrales. On retrouve : 23 % de grade A et 77 % de grade B ; 48,5 % de grade OMS II et 51,5 % grade III, un âge moyen au moment de l’intervention de 9 ans et demi ± 5 ans. Un tiers a un siege hemispherique, deux tiers se revelent par une crise comitiale. Ils font l’objet d’une exerese complete dans 60 % des cas. La survie moyenne est de 13 ans (154 mois ± 20 mois), avec une mortalite a 5 et 10 ans de 60 % ± 9 %, et un risque de recidive de 54 % ± 9 % a 5 ans et 46,5 % ± 10,5 % a 10 ans. Le principal diagnostic differentiel des oligodendrogliomes de grade A est les tumeurs neuro-epitheliales dysembryoplasiques (DNT). A l’inverse, les localisations thalamiques, plus souvent de grade B, se traduisent surtout par un deficit moteur et ne peuvent faire l’objet d’une exerese complete que dans 15 % des cas. L’efficacite de la chimiotherapie est bien demontree, ce qui rend necessaire la recherche d’une chimio-sensiblite (deletion 1p19q, expression du gene MGMT, analyse par spectro RM et PET-scan). Une cytoreduction chirurgicale aussi importante que possible est logique, mais necessite de respecter les fonctions neurologiques et cognitives du patient grâce aux progres de l’imagerie moderne (IRM fonctionnelle, IRM de diffusion et de perfusion, tractographie, TEP) et des techniques per-operatoires (navigation interventionnelle, stimulation corticale, voire IRM operatoire). Les tumeurs relevant d’une exerese sont celles qui ont une evolutivite clinique et/ou radiologique. La mortalite operatoire varie de 0 a 6 %, la morbidite transitoire de 20 a 25 %, la morbidite definitive de 5 a 10 %. La radiotherapie ne modifie pas significativement la survie, quelle que soit la dose delivree. Ce qui compte est le caractere radio-sensible des patients : lorsqu’ils sont radio-repondeurs, leur survie est de 148 mois versus 12 mois pour les non repondeurs. L’etude et le developpement de tests pre-therapeutiques de radio-sensibilite des tumeurs seraient donc une voie de recherche fondamentale (TEP, etudes des echantillons tumoraux).

Service de medecine interne, hopital d’instruction des armees Legouest, 27, avenue de Plantieres, BP 90001, 57077 Metz cedex 3, France Service de biologie medicale, hopital d’instruction des armees Legouest, 27, avenue de Plantieres, BP 90001, 57077 Metz cedex 3, France Service d’hematologie clinique, hopital Bon Secours, 1, place Ph.-de-Vigneulles, 57038 Metz cedex 01, France Service de medecine interne, hopital Nord, CHU d’Amiens, 2, place Victor-Pauchet, 80054 Amiens, France

TO THE EDITOR: Streptomyces spp. are aerobic, gram-positive bacteria of the order Actinomycetales, known for their ability to produce antimicrobial molecules such as streptomycin. Streptomyces spp., usually saprophytic to humans, can cause local cutaneous fistulized nodules known as actinomycetoma or mycetoma. Severe invasive infections have seldom been reported, but most cases reported have occurred in immunocompromised patients (1-5). We report a case of invasive pulmonary infection caused by a Streptomyces sp. in a splenectomized patient with sarcoidosis.

International audience

In France, internal medicine is a speciality obtained after 5 years of theoretical and practical training, often completed by additional years. The last version of the official training program was released in 2004 and was characterised by its polyvalence. After the reform of medical studies was announced, the French young internists group decided to carry out a survey in order to know the vision of the young internist about their initial theoretical and practical training. This survey was done online using a questionnaire from February 10th to April 8th, 2010. One hundred and twenty-three young internists under training completed the questionnaire. The results showed that a high number of trainees chose a subspeciality and took a complementary training afterwards. About 63% of them would rather have more theoretical training through lectures (72%) and oral presentations (58%). Eighty-eight per cent of young internists would rather have a national frame of reference with a common training program. According to 73% of the young internists who completed the survey, the practical training is adapted but 95% of them would like to be given the opportunity to have some consultation during their initial training. Seventy-nine per cent of the young internists seem to be interested in the clinical research but most of them (89%) think to be not well trained enough to do it.

The Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuritis. The pathophysiology remains unknown but the existence of triggering factors such as external antigens is regularly suspected. We report the case of a 30-year-old patient with a past medical history of Graves disease, who presented with GBS within the month after receiving an anti-hepatitis A vaccination. GBS rarely happens after a hepatitis A vaccination. However, the responsibility of this vaccine should be considered in the clinical presentation of an acute polyradiculoneuritis.

Idiopathic intracranial hypertension is a rare disorder characterized by elevated intracranial pressure without hydrocephaly or intracranial process. Its mechanism is poorly understood. Most cases of benign intracranial hypertension are presumed to be idiopathic but some of them may be related to some treatment. We report a 26-year-old female with benign intracranial hypertension due to tetracycline, revealed by headaches and gradual visual loss. Standard investigations were unremarkable and favourable outcome after therapeutic lumbar puncture confirmed the diagnosis.

Amatoxin poisoning constitutes the main cause of death due to mushroom intoxication in Europe. This one was initially reported for the ingestion of Amanita phalloides with frequently fatal outcome. Prognosis of amatoxin poisoning initialy depends on the acute deshydratation and secondarily of the liver failure. Emergency liver transplantation is sometimes necessary. With the knowledge of mushroom, most of them involved other species which can often be linked to edible mushroom. We report a collective intoxication by Lepiota brunneoincarnata.

International audience; El cálculo científico se ha convertido en una herramienta imprescindible en numerosos campos como la física, la química, la biología, las finanzas o la industria. La simulación de fenómenos cada vez más complejos permite reducir el número de experimentos o incluso prescindir de ellos, así como explorar nuevas soluciones a los problemas propuestos. Nada de esto sería viable sin el desarrollo de algoritmos eficientes y adaptados a las nuevas arquitecturas computacionales paralelas de las que hoy disponemos.El objetivo de este libro es explicar las técnicas del cálculo científico paralelo para la simulación numérica de problemas de gran tamaño, derivados de la resolución de ecuaciones en derivadas parciales que rigen los fenómenos a resolver. Todo ello quedará ilustrado a través de ejemplos concretos para facilitar su comprensión

The overall haemorrhagic risk of a cerebral arteriovenous malformation (cAVM) is 2–4 % per year. However, the individual risk of haemorrhage has never been determined. This study was undertaken to assess the haemorrhage risk of an individual cAVM. Neuroangiographic findings of 160 cAVM were analysed retrospectively, looking at 30 angiographic features. A statistical model was established by logistic regression to evaluate the risk of an individual cAVM. We statistically correlated 15 parameters with the haemorrhage risk. The statistical model includes five independent parameters. Four are unfavourable: exclusively deep drainage, venous stenoses, venous reflux and the radio of afferent to efferent systems; one is favourable: venous recruitment. This model quantifies the individual risk of haemorrhage. When this model is applied to the population studied, the error rate is 5 %. This model can contribute to therapeutic strategy, and to a better understanding of the natural history of cAVM.

Radiosurgery of cerebral arteriovenous malformations (cAVM) can induce parenchymal changes seen on MRI. The purpose of this study was to classify these changes and to correlate them to clinical outcom

Patient centred care is now considered the gold standard and there should be 'no decision about me, without me'. Internists who treat patients with complex multi-morbidities should consider patients' preferred outcomes, following a 'goal-oriented' principle. Perhaps the most important barrier to goal-oriented care is that medicine is deeply rooted in a disease-outcome-based paradigm. Rather than asking what patients want, the culture of modern medicine has prioritised optimal disease management according to guidelines and population goals. Doing what is right for the patient should be based on trust. Patients and internists must therefore meet as equals: 'I' and 'you' should be replaced by 'we'.

New technical advances have made feasible the utilization of laser to destroy deep-seated brain tumors under real-time monitoring. Experience with interstitial laser thermotherapy (ILTT) in animal and clinical studies has been obtained. These studies are summarized and the future potential of ILTT in neurosurgery is discussed. (C) 1996 by Elsevie Science Inc.

Design of artificial materials or radiating element mock-up need a specific effort for full wave modeling. Due to the heterogeneity of the structure, Finite Element Method is chosen. A high performance solver based on FETI Method is developed and applied to an X band EBG material.

Chloroquine-proguanil association is recommended for prophylaxis against falciparum malaria in countries with a low prevalence of chloroquine resistance. It is usually well tolerated with mild side effects consisting mainly of transient digestive discomfort and buccal manifestations (mouth sores or ulcers). The purpose of this report is to describe a case of duodenal ulcers presenting as epigastric pain with 10-kg weight-loss in a 32-year-old man taking chloroquine-proguanil for malaria prophylaxis during a stay in Haiti. No other causes of duodenal ulcers or weight-loss were found. Chloroquine-proguanil prophylaxis was discontinued and replaced by omeprazole for four weeks. Symptoms improved quickly and full recovery was observed within one month. To our knowledge, the occurrence of duodenal ulcers under chloroquine-proguanil association is quite rare, but possibly severe. Upper digestive endoscopy should be performed if a patient under chloroquine-proguanil develops abdominal pain especially in association with weight-loss. If endoscopy reveals duodenal ulcers, chloroquine-proguanil should be discontinued and replaced by another prophylactic regimen.

In France, internal medicine is a speciality obtained after 5 years of theoretical and practical training, often completed by additional years. The last version of the official training program was released in 2004 and was characterised by its polyvalence. After the reform of medical studies was announced, the French young internists group decided to carry out a survey in order to know the vision of the young internist about their initial theoretical and practical training. This survey was done online using a questionnaire from February 10th to April 8th, 2010. One hundred and twenty-three young internists under training completed the questionnaire. The results showed that a high number of trainees chose a subspeciality and took a complementary training afterwards. About 63% of them would rather have more theoretical training through lectures (72%) and oral presentations (58%). Eighty-eight per cent of young internists would rather have a national frame of reference with a common training program. According to 73% of the young internists who completed the survey, the practical training is adapted but 95% of them would like to be given the opportunity to have some consultation during their initial training. Seventy-nine per cent of the young internists seem to be interested in the clinical research but most of them (89%) think to be not well trained enough to do it.

Two cases of meningeal sarcoidosis with unusual and misleading presentations are reported. In the first case, CT scan, angiographic, and MRI findings were indistinguishable from those of meningioma. CSF pleiocytosis may help in diagnosing sarcoid pseudo-meningioma. The second patient had transient focal deficits and pachymeningitis of the convexity. The transient deficits were probably of epileptic origin based on their response to antiepileptic treatment. The diagnosis of neurosarcoidosis was made only after meningeal biopsy, despite thorough investigations.

The authors present their first experience with laser interstitial thermotherapy, (ITT). Four patients with deep-seated non-infiltrative benign tumours (three astrocytomas, one oligodendrocytoma) underwent ITT. Previously, a stereotactic procedure had been performed to determine the exact location of the tumour, its spatial configuration and its histological diagnosis. The MRI controls confirmed the efficacy of hyperthermia on the tumour tissues. The authors discuss the possible ITT mechanisms. The indications of such laser ITT in neurosurgery should be enlarged to malignant tumours (gliomas, metastases) and to certain hypophyseal adenomas.

To describe the epidemiological and clinical features of enteroviral meningitis as well as the biological profile of the cerebrospinal fluid (CSF).A retrospective study conducted in a single centre between 2004 and 2008. All aseptic meningitis due to Enterovirus were included.Fifty-nine patients were included. The triad including fever, headache and neck stiffness was reported in 62% of patients. Twelve patients (20%) had a neutrophilic leukocytosis and 23 (39%) an elevated CRP level. Twenty-eight patients (47%) had a prominent neutrophilic reaction in the CSF and nine (15.2%) had a low glucose concentration. A presumptive anti-bacterial treatment was initiated in 47 patients (80%) for an average of 3.2 days.Due to the lack of specificity of clinical features and biological manifestations of Enterovirus meningitis, the widespread use of real-time Enterovirus PCR is a priority for reducing the number of unnecessary anti-bacterial treatment. Guidelines based on clinical and biological features may be associated to help physicians in the differential diagnosis between bacterial and viral meningitides.

A survey of the literature has been performed to find arguments in order to help the choice between radiosurgery and hypofractionated stereotactic radiotherapy in the treatment of brain metastases.A comparison of two groups of brain metastases treated with hypofractionated stereotactic radiotherapy or radiosurgery, with or without WBRT was performed. Hypofractionated stereotactic radiotherapy: there were eight series including 448 patients published from 2000 to 2009; treated with 5-6 MV X-Rays, non invasive head immobilization, a margin 2 to 10mm; 24 to 40Gy in three to five fractions; a 5 to 8 days duration in six series and 15-16 days in two other series. WBRT (30%) ; radiosurgery: there were 12 series (1994 to 2005) including 2157 patients; an invasive head immobilization, no margin; doses from 10 to 25 Gy; six series over 12 had Gamma Knife radiosurgery and six had Linacs X-Rays. WBRT (30 Gy/10 F/12 days) associated to radiosurgery in several series. The following parameters were compared: median GTV, median survival, 1-year survival rate, local control rate, necrosis and WBRT rates.Hypofractionated stereotactic radiotherapy series: the parameters were respectively: 0,52-4,47 cm(3) (median 2,8 cm(3)); 5-16 months (median 8,7 months); 68,2-93% (median 82,5%); necrosis rate 3,1%; associated WBRT 30%. Radiosurgery series: the parameters were respectively: 1,3 to 5,5 cm(3) (median 2 cm(3)); 5,5 to 22 months (median 11 months); 71 to 95% (median 85%); 0,5 to 6% (median 2,4%); associated WBRT 58%. Results seem similar in the two groups: Hypofractionated stereotactic radiotherapy with non invasive immobilization could theoretically treat all brain metastases sizes except lesions10 mm (500 mm(3)). In large volumes,4200 mm(3) GTV, the toxicity of hypofractionated stereotactic radiotherapy was not reported, thus it was difficult to compare its results with the published reports of radiosurgery toxicity. WBRT was a confusing parameter. Obviously, this initial survey has important limitations, specifically its methodology.Radiosurgery and hypofractionated stereotactic radiotherapy could be used to treat brain metastases with GTV500 mm(3) andor = 4200 mm(3) (Ø 20mm); for GTV500 mm(3) (Ø 10mm) an invasive procedure with radiosurgery is necessary. For GTV4200 mm(3) (Ø 20mm), hypofractionated stereotactic radiotherapy could be proposed, provided further studies, using 4 to 6 Gy fractions, a duration less or equal to 10-12 days and a margin of 2mm will be performed.

The Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuritis. The pathophysiology remains unknown but the existence of triggering factors such as external antigens is regularly suspected. We report the case of a 30-year-old patient with a past medical history of Graves disease, who presented with GBS within the month after receiving an anti-hepatitis A vaccination. GBS rarely happens after a hepatitis A vaccination. However, the responsibility of this vaccine should be considered in the clinical presentation of an acute polyradiculoneuritis.

Subfrontal approaches were first proposed and described by Horsley and Cushing in the early beginning of neurosurgery. These approaches were mostly bifrontal flaps for skull base surgery. First combined craniofacial approaches were described by Dandy [1] in 1941 and by Ray and McLean [6] in 1943 for orbital tumors removal. Principles of transcranial and transfacial surgery were then precised by Smith et al. [8], Ketcham et al. [3] and Derome [2]. Later, enlarged approaches with mobilization of orbital rims and nasal pyramid were proposed. Subfronto-orbito-nasal (SFON) approach was first described in 1978 by Raveh as “anterior extended subcranial approach” for anterior skull base fractures [4, 5]. He extended the indications in 1980 for benign and malignant tumor resection [4, 5]. This approach allows performing a mediofrontonasal monobloc flap including nasal pyramid and orbital rims. We first used it for removal of ethmoidal tumors such as adenocarcinomas but we rapidly discovered the large field of vision given by this approach for anterior cranial fossa, ethmoidal, sphenoidal and maxillary sinuses, internal part of the orbit and clivus as well [7].

Interferon-alpha associated retinopathy is an ocular complication of hepatitis C treatment well established in the literature. But, there are far fewer reports on multiple sclerosis related interferon-beta retinopathy.A 58-year-old male while receiving subcutaneous interferon-beta 1a 44microg thrice a week since 2001 for multiple sclerosis developed blurred vision. Visual acuity remained stable throughout the course of surveillance. Cotton wool spots were found on fundus exam. The retinopathy disappeared without specific therapy 2 months after discontinuing interferon injections. The diagnosis of interferon-beta 1a retinopathy was retained due to the lack of any other etiology.An ophthalmological examination including a fundus examination to search for a retinopathy should be undertaken when new ocular symptoms develop in a multiple sclerosis patient receiving interferon. An adverse event linked to interferon can be discussed and favored if the retinopathy resolves after interferon withdrawal.

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Idiopathic intracranial hypertension is a rare disorder characterized by elevated intracranial pressure without hydrocephaly or intracranial process. Its mechanism is poorly understood. Most cases of benign intracranial hypertension are presumed to be idiopathic but some of them may be related to some treatment. We report a 26-year-old female with benign intracranial hypertension due to tetracycline, revealed by headaches and gradual visual loss. Standard investigations were unremarkable and favourable outcome after therapeutic lumbar puncture confirmed the diagnosis.

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Proposed as an additive symptomatic treatment of refractory epilepsy, vagus nerve stimulation (VNS) has proven to be effective and well-tolerated in patients presenting with refractory epilepsy for whom cortical resection is not indicated. After two years of treatment, the overall reduction of seizure frequency averaged 40%. In 50% of the patients, the frequency of seizures decreased by at least 50%. Moreover, even in absence of a significant reduction of seizures, patients who undergo this treatment reported an improvement in their quality of life. Economic surveys also demonstrate a favorable impact of VNS on the management of refractory epilepsy. Since 1988, 65,000 patients with refractory epilepsy throughout the world have been treated by VNS for this indication (1000 in France). The surgical implantation technique used in our department, the effects of vagus nerve stimulation reported in the literature, and our experience with a cohort of 70 patients with refractory epilepsy who received implants over the last 10 years are described.

Surgical resections for intractable epilepsy are generally associated with a high risk of permanent neurological deficit and a poor rate of seizure control. We present a series of 89 patients operated on from 1992 through 2007 for drug-resistant partial epilepsy, in whom surgery was performed in a functional area of the brain: the central (sensorimotor and supplementary motor areas) region in 48 cases, posterior regions (parietal and occipital) in 27, the insula in eight, and the language areas in six. Epilepsy was cryptogenic in 12 patients, and lesion-related in 77: malformation of cortical development in 43, tumor in 17, perinatal cicatrix in 13, vascular lesion in three, and another prenatal lesion in one. Seventy patients underwent stereoelectroencephalographic (SEEG) exploration. The surgical procedure was resective (lesionectomy or SEEG-guided corticectomy) in 83 patients and multiple stereotactic thermocoagulations in six. Ten patients were reoperated because of early seizure recurrence. A postoperative complication was observed in 12 patients. Postoperative deficits were observed in 54 patients (61%) and resolved completely in 29. In 25, a permanent deficit persisted, minor in 19 and moderate to severe in six, which did not correlate with localization or etiology. With a one-year follow-up in 74 patients (mean, 3.6 years), 53 (72%) were in Engel's class I, including 38 (51%) in class IA. Seizure outcome was significantly associated with etiology: 93% of Taylor-type focal cortical dysplasia, whereas only 40% of cryptogenic epilepsies were in class I (p0.05). This suggests that resective or disconnective surgery for intractable partial epilepsy in functional areas of the brain may be followed by excellent results on seizures and a moderate risk of permanent neurological sequelae.