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Effects of gamma-radiations on human sperm nuclei in vitro were studied by cytophotometrical quantification on fixed smears stained by acridine orange some of which had undergone heat-treatment. Following irradiations at different doses (0.0, 2.5, 5.0, 7.5 gy) using a cobalt source, changes in distribution of acridine orange fluorescences emitted by nuclei (total fluorescence greater than 515 nm versus green fluorescence = 525 nm) appeared to be dose-dependent. Heat-treatment of irradiated heads was confirmed to be a complementary procedure necessary for a good evaluation of the initial degree in chromatin compactness. Chromatin alterations related to changes in emitted fluorescence could be due to the initial fragility of the DNA-nucleoprotein complex. These preliminary results suggest that the normality of sperm chromatin could be used as a biologic dosimeter.

Although the interactions of sulfur mustard (HD) with nucleic acids and proteins have been well studied, the toxic interactions with the membrane matrix and specially the phospholipid bilayer have so far been poorly investigated. We have used several NMR techniques to study these interactions: 1H NMR to observe the localization of HD in membranes of small unilamellar vesicles (SUV) of lecithin; 31P NMR to verify the hypothesis of pore formation in membranes of large unilamellar vesicles (LUV); and pseudo solid state 31P and 2H NMR to analyze the dynamic consequences of the presence of HD in multilayer dispersions of dimyristoylphosphatidylcholine (DMPC). Immediate and late modifications of the DMPC–HD complexes have been observed at the macroscopic and microscopic levels. After intoxication, HD is spontaneously incorporated into the membrane and locates at the level of the chain methylene groups. This incorporation occurs without formation of pores in the membrane. The presence of HD in the phospholipid dispersion differentially increases the membrane fluidity depending upon the level involved. Weak at the superficial level (phosphate group), this increase is dose-dependent on progression into the membrane. This increase is related to a lowering of transition temperature when measured at the chain level. Macroscopically, HD induces dose- and time-dependent modifications of the DMPC–HD complexes, leading to the formation of an optically transparent gel. This gel formation is confirmed at a microscopic level, where all structures disappear after intoxication.

Why initially normal wound healing sometimes shifts toward an impaired cicatrization is poorly understood. Collagen gels with incorporated fibroblasts constitute valuable in vitro models to study mechanisms of connective tissue reorganization. Such 1-week-old, partially contracted normal dermal equivalents were treated with concentrations of TGF-beta1 ranging from 1 to 10 ng/ml. The cytokine was applied in a single dose or four times at regular intervals, over a 2-week period. Dose-dependent activation of fibroblasts was observed after treatment. The cytokine induced a myofibroblastic transformation of dermal cells, significantly enhanced the process of dermal contraction, and stimulated synthesis of such proteins as cellular fibronectin, tenascin and smooth-muscle actin. Our approach is more informative than models using pathological or pretreated dermal cells, since it demonstrates newly induced modulation of fibrotic transformation in an initially normal dermal equivalent. This in vitro assay will enable us to study mechanisms involved in the shift between normal and impaired fibrotic transformation during wound healing.

Skin intoxication by bis(β-chloroethyl)sulfide (BCES; sulfur mustard) induces cutaneous lesions similar to thermal burns, characterized by slowness of skin healing. We have developed an in vitro model of skin equivalent to investigate mechanisms involved in this delay. Direct intoxication of dermal equivalent produced dose- and time-dependent cytotoxicity. A decrease of macroscopic retraction of collagen gels was observed, parallel to the toxic concentration with, at histological level, absence of collagen fiber reorganization. Fibroblast synthesis of fibronectin was also inhibited by intoxication, as demonstrated at an immunobiochemical and immunohistochemical level. These dermal alterations were correlated with secondary modifications of epithelial maturation of nonintoxicated normal human keratinocytes. Cellular adhesion was perturbed, as visualized by a delay in expression and reorganization of basement membrane components, laminen, collagen IV, and fibronectin. Epidermal terminal differentiation was also affected, as shown by the absence of profilaggrin/filaggrin biosynthesis.

The healing of minimal skin lesions is usually obtained by epidermal migration and proliferation from peripheral wound margins. However, cutaneous grafts or reconstituted skin are necessary for severe injuries. Various models have recently been reproduced for this purpose. The aim of this work is to report the histopathologic evolution of burn lesions treated two years ago by autologous epidermis (Genzyme Tissue Repair, Boston, USA). Fifteen patients with severe burns (more than 80% of surface) have been treated. These observations have been based exclusively on biopsies of grafted wounds. Cultured epidermis is rapidly fully differentiated after grafting with temporary hyperplasia and normal strata. At 18 months, rete ridges formation is present only in young patients. Melanocytes and Langerhans' cells repopulated grafts rapidly. The use of cultured epidermis nowadays represents an important improvement in burn treatment.

Human keratinocyte cultures were treated with bis(betachloroethyl)sulphide (BCES), an alkylating and vesicant agent. At concentrations of 5 × 10−4 to 5 × 10−3 m , spontaneous detachment of the epithelium from the culture plate was observed, reproducing in vitro the cutaneous vesication observed in vivo. Progressive cellular alterations were shown with increasing concentrations of BCES (5 × 10−5 to 5 × 10−3 m ). At low concentrations (5 × 10−5 m ), lesions of the nucleus, a significant target for BCES, were observed, along with lesions in the cytoplasmic organelles. An acute, dose-dependent depletion of cellular glutathione was observed, which occurred within 1 hr of treatment. Mechlorethamine, an analogue of BCES, induced at equivalent doses the same glutathione depletion and similar spontaneous detachment in vitro. We suggest that BCES, in addition to its genetic effects, acts by direct metabolic toxicity and induces glutathione depletion by direct conjugation. The lesions obtained in vitro reproduced those observed in vivo. Human keratinocyte cultures can be proposed as a good model for the study of the mechanisms of action of BCES.

Although the interactions of sulfur mustard (HD) with nucleic acids and proteins have been well studied, the toxic interactions with the membrane matrix and specially the phospholipid bilayer have so far been poorly investigated. We have used several NMR techniques to study these interactions: 1H NMR to observe the localization of HD in membranes of small unilamellar vesicles (SUV) of lecithin; 31P NMR to verify the hypothesis of pore formation in membranes of large unilamellar vesicles (LUV); and pseudo solid state 31P and 2H NMR to analyze the dynamic consequences of the presence of HD in multilayer dispersions of dimyristoylphosphatidylcholine (DMPC). Immediate and late modifications of the DMPC-HD complexes have been observed at the macroscopic and microscopic levels. After intoxication, HD is spontaneously incorporated into the membrane and locates at the level of the chain methylene groups. This incorporation occurs without formation of pores in the membrane. The presence of HD in the phospholipid dispersion differentially increases the membrane fluidity depending upon the level involved. Weak at the superficial level (phosphate group), this increase is dose-dependent on progression into the membrane. This increase is related to a lowering of transition temperature when measured at the chain level. Macroscopically, HD induces dose- and time-dependent modifications of the DMPC-HD complexes, leading to the formation of an optically transparent gel. This gel formation is confirmed at a microscopic level, where all structures disappear after intoxication.

Extensive third degree burn wounds can be permanently covered by the transplantation of autologous cultured keratinocytes. Many modifications to Green and colleagues' original technique have been suggested, including the use of a fibrin matrix. However, the properties of the cultured cells must be assessed using suitable criteria before a modified method of culture for therapeutic purposes is transferred to clinical use, because changes in culture conditions may reduce keratinocyte lifespan and result in the loss of the transplanted epithelium.To evaluate the performances of human keratinocytes grown on a fibrin matrix, we assay for their colony-forming ability, their growth potential and their ability to generate an epidermis when grafted onto athymic mice. The results of these experiments allowed us to compare side by side the performance for third degree burn treatment of autologous cultured epithelium grafts grown according to Rheinwald and Green on fibrin matrices with that of grafts grown directly on plastic surfaces.We found that human keratinocytes cultured on a fibrin matrix had the same growth capacity and transplantability as those cultured on plastic surfaces and that the presence of a fibrin matrix greatly facilitated the preparation, handling, and surgical transplantation of the grafts, which did not need to be detached enzymatically. The rate of take of grafts grown on fibrin matrices was high, and was similar to that of conventionally cultured grafts. The grafted autologous cells are capable of generating a normal epidermis for many years and favor the regeneration of a superficial dermis.We have demonstrated that: 1) fibrin matrices have considerable advantages over plastic for the culture of skin cells for grafting and that it is now possible to generate and transplant enough cultured epithelium from a small skin biopsy to restore completely the epidermis of an adult human in 16 days; and 2) the generated epidermis self-renews itself for years. The use of fibrin matrices thus significantly improves the transplantation of cultured epithelium grafts for extensive burns as recently demonstrated in a follow-up work.

Why initially normal wound healing sometimes shifts toward an impaired cicatrization is poorly understood. Collagen gels with incorporated fibroblasts constitute valuable in vitro models to study mechanisms of connective tissue reorganization. Such 1-week-old, partially contracted normal dermal equivalents were treated with concentrations of TGF-beta1 ranging from 1 to 10 ng/ml. The cytokine was applied in a single dose or four times at regular intervals, over a 2-week period. Dose-dependent activation of fibroblasts was observed after treatment. The cytokine induced a myofibroblastic transformation of dermal cells, significantly enhanced the process of dermal contraction, and stimulated synthesis of such proteins as cellular fibronectin, tenascin and smooth-muscle actin. Our approach is more informative than models using pathological or pretreated dermal cells, since it demonstrates newly induced modulation of fibrotic transformation in an initially normal dermal equivalent. This in vitro assay will enable us to study mechanisms involved in the shift between normal and impaired fibrotic transformation during wound healing.

Skin intoxication by bis(beta-chloroethyl)sulfide (BCES; sulfur mustard) induces cutaneous lesions similar to thermal burns, characterized by slowness of skin healing. We have developed an in vitro model of skin equivalent to investigate mechanisms involved in this delay. Direct intoxication of dermal equivalent produced dose- and time-dependent cytotoxicity. A decrease of macroscopic retraction of collagen gels was observed, parallel to the toxic concentration with, at histological level, absence of collagen fiber reorganization. Fibroblast synthesis of fibronectin was also inhibited by intoxication, as demonstrated at an immunobiochemical and immunohistochemical level. These dermal alterations were correlated with secondary modifications of epithelial maturation of nonintoxicated normal human keratinocytes. Cellular adhesion was perturbed, as visualized by a delay in expression and reorganization of basement membrane components, laminen, collagen IV, and fibronectin. Epidermal terminal differentiation was also affected, as shown by the absence of profilaggrin/filaggrin biosynthesis. We demonstrated in vitro, that direct dermal alterations secondarily induce disturbance of epithelial maturation. Taken together, these data show the fundamental role of dermal-epidermal interactions in a normal skin reconstruction. Clinical slowness of wound healing observed after cutaneous intoxication by BCES may thus be explained by direct alkylation of some structures and further disturbances of their biosynthesis.

A patient with a filarial infection due to Loa loa, received single oral dose of ivermectin A few hours after, he has presented a severe renal impairment. Native of the Cameroons, he was also treated for malaria. A renal biopsy has been done, because of chronic proteinuria. It has showed microfilariae in glomeruli, thickening of the basement membrane and a segmental and focal mesangial hyalinosis. By immunofluorescence microscopy there were granular deposits of IgM and C3 along this membrane. Electron microscopy has showed subepithelial electron- dense deposits. This suggests that the renal disease is immunologically induced. During the therapy, adverse reactions seemed to be related with massive liberation of filarial antigens. This is well known with diethylcarbamazine but also now, sometimes with ivermectin.

Total repair of congenital heart disease in the very young is nearly always feasible when two balanced ventricles are present. Refinements in antenatal and fetal cardiology, and progress in pediatric cardiac surgery have improved both the surgical results and the long-term outcome of these critically ill infants.

Dermal papilla cells of rat vibrissa follicles cultivated in monolayers and in three-dimensional collagen gels show a different morphology in these culture systems. Dermal papilla cells cultured in lattices tend to express morphological features resembling those seen in vivo. Quantification of total collagen by incorporation of 3H-proline in monolayer cultures and in collagen lattices show that the amount of collagen found in dermal papilla cells is higher than that secreted. Moreover, collagen synthesis measured in lattices is reduced to about 50% of that found in monolayer cultures. The influence of growth factors on collagen synthesis by hair dermal papilla cells was investigated. We studied the effects of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and minoxidil on collagen synthesis in monolayers and in lattices. VEGF, bFGF and minoxidil significantly decreased the total amount of collagen. In monolayer cultures, there was approximately a 30% inhibition of collagen production with 5 ng/ml bFGF, 0.1 ng/ml VEGF and 100 ng/ml minoxidil. However, in the lattices this inhibition was reduced to about half. These results suggest that both culture substrate and growth factors influence collagen production by rat hair dermal papilla cells.

Adenoid cystic (cylindromatous) carcinoma is a rare tumor. It accounts for approximately1-3% of primary adenocarcinomas of the cervix uteri. Its origin is debatable. It has a higher incidence in postmenopausal women but can develop in patients under 40. An association of adenoid cystic carcinoma with squamous cell carcinoma has been reported.A case of invasive adenoid cystic (cylindromatous) carcinoma associated with an in situ squamous cell carcinoma of the cervix detected on Papanicolaou smears is reported. Ultrastructural studies provided findings that confirmed that the hyaline material corresponded to the remnants of the lamina densa of the basement membrane of malignant cells.The concurrence of these two tumors supports the hypothesis that adenoid cystic carcinoma of the cervix may develop from multipotent reserve cells.

An otherwise healthy 21-year-old man with no evidence or family history of Von Recklinghausen's neurofibromatosis presented a posterior mediastinal mass detected on routine chest radiographs. The findings of standard light microscopy, ultrastructural examination and immunohistochemical studies suggested the working hypothesis of an unusual malignant "Triton" tumour: -arising in a pre-existing de novo ganglioneuroma; -fortuitously detected; -predominantly made of multinucleated spindle cells with only ultrastructural and immunohistochemical rhabdomyoblastic differentiation.

A tumour of the posterior mediastinum was removed via thoracoscopy. The histology report was a triton tumour. This is a rare (less than 80 cases reported in the literature) malignant tumour of the nervous system: malignant schwannoma with rhabdomyoblastic differentiation. The characteristics of this rare tumour and the consequences of videoassisted surgery in this specific case are discussed: a second access is required to widen the thoracotomy and complementary radiotherapy is needed.

The authors report a case of adenoid cystic (cylindromatous) carcinoma of the endocervical canal associated with an intraepithelial squamous cell carcinoma of the cervical os in a 60-year-old woman suffering from metrorrhagia. Immunohistochemical study demonstrated labeling of cylindromatous cells with anti-actin, anti-vimentin and anti-keratin antibodies. Ultrastructural study provided significant findings to confirm that the hyaline material surrounded by tumor cells was derived from the remnants of the lamina densa of the basement membrane of tumor lobules. These morphological data are similar to those observed in adenoid cystic carcinomas (cylindromas) of salivary glands. They support the hypothesis that adenoid cystic carcinoma of the cervix may develop from the multipotent reserve cells.

Involvement of the deep grey matter is unusual in Progressive Multifocal Leukoencephalopathy (PML), which is disease of the white matter. Basal ganglia involvement is usually secondary to extension from lesions of adjacent white matter and easy to recognize. We report a biopsy-proven case of PML in which lesions were mainly thalamic.

The contraindication to curative excision of mediastinal and pulmonary cancers because of invasion of the superior vena cava is now challenged by the existence of vascular prostheses that are suitable for venous replacement. Between 1979 and 1990 22 patients underwent resection of lung cancer (n = 6) or malignant mediastinal tumors (n = 16) involving the superior vena cava. Resection was done with concomitant venous reconstruction, and polytetrafluorethylene grafts were used. All bronchogenic carcinomas necessitated right pneumonectomy, whereas the excision of mediastinal tumors had to include pulmonary resections in nine patients (five lobectomies and four sublobar resections) and the right phrenic nerve in 12 patients. Venous reconstruction was performed by interposition of a large polytetrafluoroethylene graft between the proximal and cardiac ends of the superior vena cava (n = 8), or between one (n = 10) or both brachiocephalic veins (n = 4) and the right atrium. One patient died postoperatively (4.5%), and another had mediastinitis that was successfully treated by omentopexy. Chemotherapy was administered preoperatively to five patients and postoperatively to seven patients; radiotherapy was administered to two and 10 patients, respectively. The overall actuarial survival rate is 48% at 5 years, with 11 patients presently alive. The survival rate of patients with mediastinal tumors is 60% at 5 years. Among the patients with lung cancer, two with N1 disease are alive at 16 and 51 months, and one died at 38 months; the two patients with N2 disease died at 6 and 8 months. Only one graft occlusion occurred in the postoperative period; another occurred 14 months after operation and was precipitated by insertion of a central venous catheter. The patency of all remaining grafts was demonstrated after an average time of 23 (1 to 98) months. On the basis of these results, polytetrafluoroethylene graft replacement of the superior vena cava should be part of the planning and execution of radical excision with curative intent of mediastinal and right pulmonary malignant tumors that are not present with other contraindications, such as pleural or distant metastasis and severe systemic disease.

Cavo-bipulmonary anastomosis (CBPA) in an anastomosis between the superior vena cava and the right pulmonary artery in continuity with the left pulmonary artery. This shunt is used in complex cyanotic congenital heart disease with pulmonary stenosis. It is the first stage of a total cavo-pulmonary shunt (TCPS). Thirty patients underwent this procedure at Laënnec Hospital between April 1988 and April 1990. The surgical indications were retained when TCPS appeared to be too risky, mainly because of the associated malformations, the correction of which was performed at the same time. There were to early deaths; one patient was lost to follow-up and 27 patients have been followed up for an average period of 12 +/- 6 months. The surgical result was judged according to the degree of cyanosis; a poor result was defined as systemic saturation of less than 75% and a haematocrit of over 55%. One child died 5 months after surgery; there were 16 good results and 10 poor results. Seven patients were reoperated to carry out the second stage of the TCPS. The average gain in saturation was 9.7% in our series. Analysis of the patients who died or who had poor surgical results showed an anatomic cause in 11 of the 13 cases (pulmonary arteriovenous fistula, stenosis of the branches of the pulmonary artery, regurgitation of an atrioventricular valve) or a physiopathological cause (mean pulmonary artery pressure greater than 20 mmHg, or ventricular failure). The CBPA is a palliative procedure to reduce ventricular load, repair stenosis of the right pulmonary artery and to prepare the patient for a total cavopulmonary shunt.

The risk of surgical closure of the ductus arteriosus in the adult is greater than in children. The ductus arteriosus can now be occluded by venous catheterisation using a Rashkind umbrella. This procedure vas performed in a 63 year old woman. The diagnosis was confirmed and the anatomy of the lesion defined by catheterisation with aortography. The patent ductus was then occluded with a balloon catheter to assess the reversibility of the pulmonary hypertension. A 17 mm Rashkind umbrella was then used to completely occlude the ductus. The advantages of the method over surgical closure are: absence of morbidity related to thoracotomy, to general anaesthesia, to blood transfusion and the reduction of hospital stay to 3 days.

Ten of 1,025 patients undergoing coronary bypass surgery received one or two bovine internal mammary artery grafts. Surgery consisted in quadruple coronary bypass in 1 case, triple coronary bypass in 3 cases and double coronary bypass in 6 cases using 4 autologous saphenous vein grafts, 6 autologous internal mammary artery grafts and 13 bovine internal mammary artery grafts. It was necessary to use bovine internal mammary artery grafts because of total bilateral venous stripping in 5 patients, diffuse, bilateral varicose veins in 4 patients and because of the insufficient length of the vein in 1 patient. Short and medium-term (12 months) angiographic studies of the bovine grafts showed 5 occluded grafts, 2 proximal graft stenoses, and 1 patient graft up to the time of his death of extracardiac causes, with a maximum follow-up of 13 months. One of these 10 patients died in the early postoperative period of extracardiac causes with a patent bovine coronary graft. Another patient died in the 5th postoperative month during reoperation motivated by occlusion of the two implanted bovine coronary grafts. The other 8 patients are alive and stable from the coronary view point. Bovine internal mammary artery grafts may be used to manage an acute episode of coronary insufficiency by providing the time for the collateral circulation to develop but it does not provide a complete and durable method of revascularisation. Their use should therefore be reserved for exceptional cases.

The cytologic presentations of two adult-type rhabdomyomas of the soft palate are reported. Fine needle aspiration smears of the lesions contained globular tumor cells that had striations and intracytoplasmic rod-shaped inclusions. These inclusions, corresponding to hypertrophied Z bands, were pathognomonic of rhabdomyoma tissue. The cytologic diagnosis was confirmed by histologic and immunologic studies in both cases. The cytologic preparations fixed in alcohol or air dried did not show the "spiderweb cells" observed in the histologic sections of tissue fragments fixed in formaldehyde; this clearly illustrates that the morphology of the cells of this tumor depends primarily on the specimen preparation technique used. These cases suggest that aspiration cytology can establish the diagnosis of this benign tumor of striated muscle, for which total surgical removal is usually sufficient to effect a cure. The differential diagnosis is discussed in detail.

This study reports the cases of 14 patients aged 5 months to 13 years (average: 3.5 years) at the time of the initial repair of an atrioventricular septal defect (AVSD). The AVSD was partial in 5 and complete in the other 9 cases. After failure of the initial mitral valvuloplasty, the patients underwent mitral valve replacement with a prosthesis at the age of 1 to 29 years, after an interval of 0 days to 15 years. A second valvuloplasty had been attempted in 3 cases beforehand. The aim of this paper was to analyse the causes of failure of mitral valvuloplasty and to determine the conditions of mitral valve replacement and the specific complications of this type of surgery. Failure of mitral valvuloplasty was related to complex valvular malformations (5 cases), technically inadequate valvuloplasty procedures (4 cases), deterioration of an initially satisfactory valvuloplasty (5 cases). Four bioprostheses were implanted (repeat valvular replacement was necessary in 3 patients). Early mortality was 28% (4 patients). The postoperative complications specific to this condition were: immediate atrioventricular block (8 cases) but only 1 persistant complete atrioventricular block; traumatic fistula between the left ventricle and right atrium (4 cases); moderate stenosis of the left ventricular outflow tract (4 cases). There was one late death (due to isolated cardiac arrhythmia).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of gamma-radiations on human sperm nuclei in vitro were studied by cytophotometrical quantification on fixed smears stained by acridine orange some of which had undergone heat-treatment. Following irradiations at different doses (0.0, 2.5, 5.0, 7.5 gy) using a cobalt source, changes in distribution of acridine orange fluorescences emitted by nuclei (total fluorescence greater than 515 nm versus green fluorescence = 525 nm) appeared to be dose-dependent. Heat-treatment of irradiated heads was confirmed to be a complementary procedure necessary for a good evaluation of the initial degree in chromatin compactness. Chromatin alterations related to changes in emitted fluorescence could be due to the initial fragility of the DNA-nucleoprotein complex. These preliminary results suggest that the normality of sperm chromatin could be used as a biologic dosimeter.

Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and later intrauterine repair or postnatal repair. Intrauterine creation of pulmonary artery stenosis was performed in 23 fetal lambs at 90 +/- 1 days of gestation. Eight lambs underwent intrauterine repair of pulmonary artery stenosis at 135 +/- 1 days of gestation and were studied 110 +/- 13 days after repair. Seven lambs underwent postnatal repair at 57 +/- 9 days after birth and were studied 162 +/- 32 days after repair. Eight fetal lambs with unrepaired pulmonary artery stenosis were studied 89 +/- 18 days after birth. All study lambs were compared with normal control lambs. The systolic right ventricular pressure was significantly higher after unrepaired stenosis (78.6 +/- 6.8 mm Hg) than in other lambs, but there was no statistically significant difference after intrauterine repair (23.3 +/- 2.9 mm Hg), postnatal repair (25.9 +/- 3.4 mm Hg), and normal lambs (21.6 +/- 1.1 mm Hg). The systolic pulmonary artery pressure was also not statistically different in these three groups. The weight measurements were age-adjusted for comparison of postnatal and intrauterine repair with normal lambs. The adjusted heart weights were similar in the three groups. The comparison of the adjusted heart weight/adjusted body weight ratio (10(-3) showed a significantly higher ratio in postnatal repair (7.4 +/- 0.1) than in intrauterine repair (6.1 +/- 0.1). The adjusted right ventricular weight/adjusted left ventricular weight ratio was significantly higher in the postnatal repair group (0.71 +/- 0.01) than in both the intrauterine repair group (0.59 +/- 0.01) and normal lambs (0.59 +/- 0.01). The transverse myocyte diameter was not statistically different in all groups of animals and there were no ultrastructural changes even when the pulmonary stenosis was unrepaired. We conclude that intrauterine repair was more satisfactory than postnatal repair in terms of age-adjusted heart weight results, but we did not find any advantages of intrauterine repair in terms of histologic and ultrastructural changes.

From January 1980 to July 1988, 62 infants aged under 6 months with an uncomplicated Tetralogy of Fallot (single ventricular septal defect, normal coronary arteries, no localised pulmonary artery branch stenosis) underwent 64 surgical procedures. The indications for surgery were increasing cyanosis and/or anoxic spells. Fourteen systemic-pulmonary shunts (21.5%), 49 complete repairs (75.4%) and one enlargement of the right ventricular outflow tract and of the main pulmonary artery without closure of the ventricular septal defect, were performed. The results of palliative shunts are preoccupying: cumulative mortality of 36 per cent; high rate of early reoperation for complete repair: 14 per cent. Complete repair was associated with an operative mortality of 14 per cent. Only one child had to be reoperated. There was no late death after complete repair compared with 2 late deaths after shunt. Ultimate results of complete repairs are good. Some risk factors were statistically significantly associated with complete repair: age (2.5 months or less), weight (4,500 g or less), measurements of the pulmonary arteries estimated by the diameter of the right pulmonary artery (5 mm or less). Conversely there was no death in the subgroup of 31 infants aged more than 2.5 months without major pulmonary hypoplasia (diameter of the right pulmonary artery over 3.5 mm). One-stage complete repair give the best short and medium-term surgical results in treatment of uncomplicated Tetralogy of Fallot in infants, irrespective of age and weight providing they have no diminutive pulmonary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

From June 1983 to April 1988, 100 consecutive infants with symptomatic tetralogy of Fallot (without pulmonary atresia) were operated on. Ages ranged from 0.5 to 12 months (mean 7.3 +/- 3.7). Twenty patients were 0.5 to 3 months, 21 were 3 to 6 months, and 59 were 6 to 12 months of age. Mean weight was 6.5 kg +/- 1.7. Seventy patients received a transannular patch. The hospital mortality rate was 3% and there were no late deaths. Cumulative follow-up was 180 patient-years. Causes of death included hypoplastic pulmonary arteries (4 and 5 months old) and right ventricular failure (4 months old). The most important factors influencing right ventricular outflow tract reconstruction were neither weight (p = 0.90) nor age (p = 0.05) but rather were the ratio between weight and pulmonary arterial outflow tract diameter (p = 0.0005) and the ratio between body surface area and pulmonary arterial outflow tract diameter (p less than 0.0001). The last 48 patients were operated on with no deaths. During this period, operative management differed essentially in myocardial protection with blood cardioplegia. The predicted 30-day survivorship after repair was 90% to 99% (95% confidence limits). No ventricular arrhythmias have been detected after repair (mean follow-up 22.2 months). Mean right ventricular/left ventricular end-diastolic dimension ratio was (0.53 +/- 0.10 with M-mode echocardiography. These early results encourage us to proceed with primary repair of infants with symptomatic tetralogy of Fallot thanks to improved surgical management and enhanced myocardial protection.

Among 760 patients who underwent coronary artery bypass graft (CABG) 8 received one or two bovine internal mammary artery grafts. The surgical procedures were 4, 3 and 3 CABG respectively in 1, 3 and 4 cases with greater saphenous veins in 4 cases, internal mammary artery in 4 cases and bovine internal mammary artery in 11 cases. The 3 mm bioflow grafts were used to revascularize the left coronary artery in 6 cases (to the left anterior descending, circumflex artery) and the right coronary artery in 5 cases. The indications for the use of bovine mammary artery grafts were lack of suitable autologous vessels because of bilateral saphenous vein stripping in 4 cases, bilateral varicose veins in 3 cases and inadequate length of vein in 1 case. Post-operative angiographic studies of these bovine mammary grafts with a maximum follow-up of 11 months showed 5 occluded grafts, 2 grafts with proximal stenosis, one graft which remained patent until the patient died and 3 grafts still under evaluation. Bovine internal mammary artery grafts provide a solution for the acute stage of coronary disease, but do not achieve total and durable revascularization. Their use must remain exceptional.

In this paper, the authors report two cases of adult type rhabdomyomas of the soft palate. This tumor is composed of striated muscle cells containing striations and intracytoplasmic rod-shaped inclusions. In specimens already fixed in aqueous fixators (formalin...), some tumor cells presented a fixation artefact and displayed the morphology of so-called "spiderweb cells". Adult type rhabdomyoma is a real tumor. Total surgical removal is sufficient to cure the patient of this tumor in most cases.

Between February 1985 and March 1987, 5 children underwent resection of primary cardiac neoplasms, 3 of them in the first days of life and 2 before the age of 6 months. Routine echocardiographic follow-up of pregnancies allowed detection of cardiac tumors in 2 foetuses 30 and 36 weeks old. In 3 children the diagnosis was suspected by the discovery of cardiac murmur or congestive heart failure. The first case was an hemangioma, originating from outside of the left ventricular wall, which could be resected without cardiopulmonary bypass (CPBP). The other case was a pseudomyxoma, spreading extensively inside the right atrium. The third case was a rhabdomyoma arising from the pulmonary infundibulum with clinical manifestations of tuberous sclerosis. The last two patients had intraseptal lesions, just above the aortic valve; complete resection was therefore impossible, particularly in one patient with multiple tumors. There was one death related to congestive heart failure. The remaining four survivors were followed up for an average of 18.4 months (+/- 12.9) and all were in functional class I. Echocardiographic follow-up showed evidence of a residual subaortic lesion in one asymptomatic patient.

Resume La comparaison de criteres fonctionnels plaquettaires etudies in vitro par l'agregation a differents agents, la reponse du choc osmotique, la teneur en ATP, et l'evolution des distributions des volumes au cours de la conservation des plaquettes pendant 6 jours dans 2 types de poches PVC differents par leur plastifiant est effectuee ; elle permet : -- de montrer une meilleure qualite fonctionnelle des plaquettes conservees dans le nouveau type de PVC, appreciee in vitro par l'agregation a une forte dose de collagene, le choc osmotique et l'evolution des volumes, avantage significatif des le 3e jour de conservation ; -- de definir un choix de criteres utilisables dans le cadre d'un controle de qualite, sans prouver pour chacun d'eux la signification exacte en terme d'efficacite transfusionnelle.

The phagocytic activity of rat alveolar macrophages was studied in vitro for up to six weeks after whole-body gamma irradiation (7.5 Gy). Ingestion of fluorescent latex microspheres was evaluated using both microscopic examination and flow cytometric quantitation. After a transient decrease on first day post-irradiation, a slight increase in the phagocytic ability was observed from day 14 to day 28, with a maximum on day 21. From day 35 onwards, phagocytic capacities returned approximately to those of the controls. The percentage of phagocytic cells (cells having ingested one microsphere or more) increased by 75 per cent on day 21 after irradiation and the phagocytic index (percentage of phagocytic cells X the average number of ingested microspheres per cell) increased by 250 per cent while at the same time, the number of recovered alveolar cells decreased by 37 per cent. The augmentation of phagocytic capacities after irradiation was particularly characterized by an increase in the percentage of cells ingesting more than five microspheres. Flow cytometric studies showed a significant increase in mean cell size on day 21 post-irradiation. The augmentation of the phagocytic activity was not found when macrophages from control rats were incubated with serum or alveolar lavage fluid from an irradiated donor. Augmentation of phagocytic capacity was also observed after 8.5 Gy but no effect could be observed after 6.5 Gy.

In relation with the report of two cases of branching of one of the pulmonary arteries from the aorta, it was recalled that this is a rare malformation, responsible for a severe cardiac failure with or without cyanosis in the first months of life, intensly suggestive of a left-to-right shunt. Demonstration of surprizing or unhabitual clinical or haemodynamic findings should indicate the performance of a right-sided angiography then an aortography, this being the only way to secure the diagnosis. Combination of such an anomaly with Fallot's tetralogy is exceptional. The clinical diagnosis is made more difficult by the presence of an anastomosis between the pulmonary and the systemic circulations. Only a careful analysis of right angiograms might make it possible to suspect the presence of an abnormal branching of the pulmonary artery, and to perform the aortography. The treatment is surgical in all cases, and should be undertaken early in life, as it is the only way to control the heart failure or to prevent irreversible pulmonary arteriolar lesions.

The appearance of acute eczematous dermatitis in fishermen from the estuary of the Seine, about which the responsibility of Alcyonidium gelatinosum (L.) is still under discussion, led us to estimate the ability of this Bryozoa to induce cutaneous responses of delayed hypersensitivity. Intradermal tests carried out in guinea-pigs after subcutaneous, respiratory or percutaneous sensitization, gave evidence of a clear allergenic ability of this alcyonelline. The deposit of the biological product on normal skin during four consecutive days is enough to induce strong responses of delayed hypersensitivity. This experimental study needs further investigations in which the possible existence of anaphylactic reactions should be confirmed.

Aiming at investigation, a Beall's valve was implanted in mitral or in mitral-tricuspid positions only on 100 patients, between November 1969 and February 1972. The details of the initial valve lesions, the clinical condition of the patients, and the modalities of prosthetic replacement are described. The causes of death within the first month were analysed. None could be related with the prosthesis itself. At distance, 17 patients were lost of sight, 18 died and 51 were studied from 12-42 months after operation. It results from this investigation: -- that 84% of the patients reexamined were improved. Most of them were included in a better functional class; -- that the incidence of thrombo-embolic accidents amounted to 12% for the whole group of patients, a percentage similar to that observed with other types of prostheses; -- that in contraat, haemolysis is an obvious disadvantage of Beall's prosthesis (20 of 51 cases); -- that abnormal wears in two valves resulted in valve dysfunction compelled to re-operation. These latter two incidents have lead to abandoning this type of prosthesis.

Complete atrioventricular canal with tetralogy of Fallot is a rare occurrence (8%). Diagnosis rests on the association with Down syndrome and on data from EKG, ultrasonography and angiography. The high operative risk explains why radical surgery is done at an older age (9 years) than in the usual form of complete atrioventricular canal without associated anomalies (33 months) and why antecedent surgical palliation with anastomotic procedures is so frequent (68% of the cases reported in the medical literature). The same surgical procedure was done in all patients: closure of the defects with two separate patches lined with pericardium, suture of the mitral cleft and relief of the infundibular and pulmonary obstruction without valvulation.

Palliative treatment for transposition of the great vessels with pulmonary stenosis (combined or not with ventricular septal defect) was studied in relation with 24 patients operated upon at Laennec's Hospital in Professor Mathey's section between January 70 and January 74. Three therapeutic attitudes are possible according to whether or not an atrial septal defect is created (Blalock-Hanlon's operation) in combination with the systemic-pulmonary artery anastomosis, and according to whether the operations are performed in one or many steps. It seems that for the badly-tolerated forms of the new-born, combination of both operations seems to be the best attitude, the curative treatment being impossible at this age.

Two cases of a very uncommon congenital association (cor triatriatum and total anomalous pulmonary venous connection) are presented. This association should be suspected in any infant with signs of pulmonary venous obstruction.

Congenital aortic stenosis presenting in the neonate must be distinguished from the commoner hypoplastic left heart-syndrome, which is beyond surgical correction. It is certainly a serious problem, but early diagnosis and supporting angiography to rule out the presence of an associated left ventricular malformation and to check the volume of the left ventricular cavity should lead to a decision to operate. Out a 4 neonates from this series who were presented for surgery, the 2 survivors had good long-term results.

In the context of investigation of a prognostic marker applicable to bladder tumours, the authors propose the cytofluorometric study of the membrane potential of malignant urothelial cells using a molecular probe, 3,3' dihexyloxacarbocyanine. This preliminary study demonstrated a significant increase in the membrane potential of malignant urothelial cells in comparison with normal cells, which leads the authors to propose this cellular parameter as a new tool in the prognostic evaluation of bladder tumours.