[The access of independent midwives to maternity ward technical facilities: the experimentation of a level-1 department]. / Accès des sages-femmes libérales au plateau technique: l'expérimentation d'une maternité de type 1.

OBJECTIVES: The first aim of this study was to evaluate the access of independent midwives to the technical facilities of a level-1 maternity hospital, with a follow-up of 2 years. The second aim was to evaluate the transfer of clinical responsibility, when a patient stops being managed by the independent midwife to be taken care of by the hospital team. PATIENTS AND METHODS: A retrospective study including 51 patients. Analysis of maternal and perinatal data. RESULTS: Of the 51 births, there were 42 vaginal deliveries without intervention (82.35%), 3 instrumental deliveries (5.88%), 6 caesarean sections (11.76%). The midwife-led care was completed in 70.59% of cases. The rate of transfer of clinical responsibility during labor was 25.49%. We conducted a neonatal transfer due to a respiratory distress syndrome. DISCUSSION AND CONCLUSION: The access to technical support appears as an opportunity for independent midwives to establish a special relationship with their patients. However, this device preserves the possibility of a traditional hospital care when needed. This way, access to the technical support is a safe alternative that has the consent of the users (patients and midwives) as well as of the entire hospital team. Moreover, such device allowed an increase of 5% per year of our obstetrical activity with an estimated increase of 10% per year.

Mutations in BHD and TP53 genes, but not in HNF1beta gene, in a large series of sporadic chromophobe renal cell carcinoma.

BHD, TP53, and HNF1beta on chromosome 17 were studied in 92 cases of renal cell carcinoma (46 chromophobe, 19 clear cell, 18 oncocytoma, and nine papillary). Six, thirteen, and zero cases had, respectively BHD, TP53, and HNF1beta mutations, (84% mutations involved chromophobe), suggesting a role for BHD and TP53 in chromophobe subtype.

[Von Hippel-Lindau disease: recent advances in genetics and clinical management]. / Maladie de von Hippel-Lindau: progrès génétiques et cliniques récents.

Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome that predisposes to the development of a panel of highly vascularized tumors including CNS and retinal hemangioblastomas, endolymphatic sac tumors, clear-cell renal cell carcinomas (RCC), pheochromocytomas and pancreatic neuroendocrine tumors. CNS hemangioblastomas and RCC are the two main life-threatening manifestations. The disease is caused by germline mutations in the VHL tumor-suppressor gene that plays a major role in regulating the oxygen-sensing pathway by targeting the hypoxia-inducible factor HIF for degradation in proteasome. Somatic inactivation of the VHL gene occurs also in most sporadic RCC and sporadic CNS hemangioblastomas. The demonstration of the critical role of VHL in angiogenesis is paving the way for the development of new specific drugs that could represent an attractive potential treatment for VHL but also for sporadic RCC and other cancers.

Spontaneous activity of rat dorsal horn cells in spinal segments of sciatic projection following transection of sciatic nerve or of corresponding dorsal roots.

Natural forms of stimulation were used to compare the spontaneous and evoked activity of dorsal horn neurons in three groups of rats: controls with no surgical lesion, rats with transection of the sciatic nerve and rats with transection of the dorsal roots at the same segmental level. In control rats, cells encountered in the dorsal horn were classified according to their peripheral field as tactile specific, convergent tactile and nociceptive, nociceptive, or movement driven. In 20 control animals, only 20% of the 140 cells with a peripheral field were spontaneously active. After sciatic nerve transection made on the side of recording a few days previously (18 rats), all of the 141 cells studied showed spontaneous activity, only 69 of them having a peripheral field. After dorsal root transections a few days previously (nine rats), 25 spontaneously active cells were found in the dorsal horn ipsilateral to the section, none with a peripheral field. Spontaneous activities of cells without a peripheral field were separated into three types as a function of bursting pattern, which were similar following both types of transection. The spontaneous activity shown by dorsal horn cells without peripheral fields following dorsal root transection precludes attribution of spontaneous spiking in such cells to abnormal input from the periphery, and shows that abnormal activity can develop in deafferented dorsal horn cells themselves. A possible role played by this spontaneous activity in deafferentation pain is considered.

A comparative study on the efficacy of CD8-positive cells in enhancing allogeneic bone marrow engraftment: cell sorting vs microbead selection.

We have used a superparamagnetic microbead selection system to positively select a murine bone marrow CD8+ cell population. The functional ability of these cells to enhance allogeneic bone marrow engraftment was compared with that of fluorescence activated cell sorter purified CD8+ cells. The CD8+ cell population prepared by the microbead selection procedure was as effective as cell sorter purified CD8+ cells in enhancing T cell-depleted allogeneic bone marrow engraftment in lethally irradiated mice. Phenotypic characterization of these cells shows that most of these CD8+ cells express CD3 and the T cell antigen receptor complex.

Stimulation in the rat of a nerve fiber bundle by a short UV pulse from an excimer laser.

A bundle of central nervous fibers was excited in the rat with a short pulse (40 ns) of UV light produced by an excimer laser. Evoked responses were recorded in the thalamic ventralis posterior nucleus after stimulation of the medial lemniscus or the cuneate bundle in the spinal cord. The effects of electrical and optical fiber applied UV stimulation were compared in both cases. At threshold, the latency for the UV light stimulation was slightly longer than for electrical stimulation. The excitation threshold was 0.9 J/cm2, very close to the UV photoablation threshold (order of 1 J/cm2). The intermediary events mediating the light excitation are discussed.

[Chemotherapy in Alzheimer's disease. Retrospective study in a specialized hospital center]. / Chimiothérapie dans la maladie d'Alzheimer. Etude rétrospective dans un Centre Hospitalier Spécialisé.

In this study, our aim was to analyse the prescriptions of drugs used to improve Alzheimer's disease at CHS Paul Guiraud. This study was carried out a posteriori on 16 hospitalized patients. We have seen that for our patients there is no general rule, nor therapeutic scheme but the choice of treatment is carried out according to the professional experience of the physician. The treatment therefore is composed of symptomatic drugs alone or associated with etiologic drugs. Eleven anxiolytic or hypnotic drugs were prescribed. Alimemazine is the most prescribed in the sixteen cases. The preferential use of this drug can be explained by its presentation in the form of drops. In two cases, behavioural improvements were noted, in two other cases, we noted accentuation of dementia. Meprobamate used in seven cases of the sixteen, was never used alone. We find neuroleptics in fifteen of the sixteen cases studied: In seven cases they were administered from the beginning of the hospitalisation; for the others they were introduced later during a phase of agitation or delirium. On the whole, they were effective on aggressive agitation, in particular thioridazine. Eight of the patients, were treated with halopéridol. In two cases, the behaviour disorders were not stopped; in four cases, there was a worsening of dementia. We noted depression in 6 cases from the beginning of hospitalization, and two cases during hospitalization. The anti-depressive drugs besides their main effect, reduce also anxiety. In two cases, we observed an aggravation of disorientation and confusion following of the prescription of amitryptiline and mianserine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of two drugs substituted o-anisamides: sulpiride and sultopride on the sleep awakening cycle (author's transl)]. / Action sur le cycle veille-sommeil de deux dérivés des o-anisamides substituées: le sulpiride et le sultopride.

The study of the sleep awakening cycle was carried out on implanted cats free of their movements, which received separately each drug in long lasting intake, inorder to differentiate their behavioural and electrophysiological activities. The qualitative and quantitative changes induced by these o-anisamides are reported. Like in man, sulpiride was found to be quite an original substance. It may be distinguished from the other psychotropic drugs studied because it has no effect on the sleep awakening cycle. The effects of sultopride are comparable with those of some neuroleptics, although its both incisive and sedative activity is very special. The neurophysiological results are discussed in the light of other studies and clinical data.

[Benzodiazepines and limbic system. Anxiety and vigilance (author's transl)]. / Benzodiazépines et système limbique. Anxiété et vigilance.

A neurophysiological study of 4 benzodiazepines in the free implanted cat serves as basis to a discussion concerning tranquilizers, anxiety and vigilance. The electrophysiological and behavioural effects of diazepam, nitrazepam, lorazepam and of clorazepate dipotassique are analysed and compared between them and other psychotropic drugs. Their mode of action on the behaviour, on the bioelectric cortical and hippocampal rhythms, is explained according to recent biochemical data. The relations with anxiety, vigilance and neuro-psycho-physiologic mechanisms which subtend them are discussed at the light of clinical effects provoked by substances called tranquillizers.

[Effects of two drugs substituted o-anisamides: sulpiride and sultopride on the sleep awakening cycle (author's transl)]. / Action sur le cycle veille-sommeil de deux dérivés des o-anisamides substituées: le sulpiride et le sultopride.

The study of the sleep awakening cycle was carried out on implanted cats free of their movements, which received separately each drug in long lasting intake, in order to differentiate their behavioural and electrophysiological activities. The qualitative and quantitative changes induced by these o-anisamides are reported. Like in man, sulpride was found to be quite an original substance. It may be distinguished from the other psychotropic drugs studied because it has no effect on the sleep awakening cycle. The effects of sultopride are comparable with those of some neuroleptics, although its both incisive and sedative activity is very special. The neurophysiological results are discussed in the light of other studies and clinical data.

[The use of an articulated brace in the treatment of juvenile kyphosis (author's transl)]. / Le traitement orthopédique des cyphoses régulières: le corset articulé.

The authors have attempted to assess the efficiency of an articulated brace in the treatment of juvenile kyphosis (Scheuermann's disease and idiopathic kyphosis). Two series of patients were compared. Patients in both series were treated in a first stage by a plaster cast and in a second stage by a bivalve brace in the first series and an articulated brace in the second series. The technique of treatment by a plaster cast and by the brace is fully described. It is concluded that control of the lumbar lordosis is of great importance. The results were better with an articulated brace. The indications for treatment are given depending on the age at the onset of treatment, the type of spine deformity and its severity. In some cases of severe dorsolumbar kyphosis, surgery may be indicated.

[Reliability of the results of the ultrasonic hemodynamic recording (Doppler effect) in the diagnosis of cerebral ishemic ischemia of carotid origin]. / Fiabilité des résultats du bilan hémodynamique ultrasonographique (effet Doppler) dans le diagnostic de l'ischémie cérébrale d'origine carotidienne.

The Doppler ultrasound diagnosis of carotid artery stenosis (asymetrical systolic and diastolic flows; elevated resistance index: ratio of flow pulse amplitude to systolic and diastolic values; flow reversal in the ophtalmic artery) is compared, in 52 patients, to the clinical, angiographic (40 patients) an surgical findings and to the peroperative measure of intra-arterial pressure and flow (30 patients). Its reliability is proved as a guide for angiographic exploration and for postoperative watching, but it is restricted to great vessels (cervical carotid artery) and is unable to detect ulcerated plate without stenosis.