[Awareness and understanding of consent in Alzheimer's disease]. / Conscience et compréhension du consentement dans la maladie d'Alzheimer.

Before a patient can take part in a clinical research, French legislation requires his/her free, express and informed consent. In the same way, the information must be given in a clear, fair and appropriate manner. However, in the context of Alzheimer's disease, one might wonder about the patient's capacity to consent. The goal of our research was to study the capacity to provide informed consent in a group of patients with mild Alzheimer's disease and in a control group, using two specialized clinical vignettes inspired by Marson's studies. The aim of the study was to assess discernment in capacity to consent to a treatment and to determinate the possible links between impaired capacities to consent and cognitive and behavioral impairments involved in Alzheimer's disease. The data collected confirm that the capacity to make and maintain a choice is preserved while the capacities to appreciate the consequences of choosing a treatment, to reason and to understand the treatment situation are already impaired in mild Alzheimer's disease. The impairment of these capacities can be linked to dysexecutive syndrome, apathy and impaired self-awareness. Caregivers and family should take into account the risk of weakened capacities of discernment as soon as possible.

[Visuoverbal disconnection (optical aphasia) for objects, pictures, colors and faces with abstractive alexia]. / Disconnexion visuo-verbale (aphasie optique) pour les objets les images, les couleurs et les visages avec alexie "abstractive".

The case is reported of a patient who, after a left occipital infarction, presented a deficit in naming visually presented objects with neither aphasia, nor perturbation in the perceptive and associative processing of visual informations. This visuo-verbal disconnection was accompanied by disturbance of the semantic function when this was explored via the visual channel. In addition the patient showed an alexia which could be described as an abstraction defect. Finally, the patient showed a deficit in naming colors and faces, without evidence for agnosia. This observation argues in favor of maintaining a distinction between visual associative agnosia and optic aphasia. It also demonstrates that the naming deficit implies a deficit in extracting semantic values from visual informations such as objects or graphic symbols.

[The effects of normal aging on face naming and recognition of famous people: battery 75]. / Les effets du vieillissement normal sur la dénomination des visages et la reconnaissance de personnages célèbres: batterie 75.

The difficulty to recall proper nouns is often something elderly people complain about. Thus, we tried to build and standardize a tool that could allow a quantified estimation of the naming and recognition abilities about famous people faces, specifying the part of gender, age and cultural level for each kind of test. The performances of 542 subjects divided in 3 age brackets and 3 academic knowledge levels were analysed. To carry out the test material, the artistic team of the Grevin Museum (Paris) was called upon. Their work offers a homogeneous way to shape famous people faces. One same person thus photographed 75 characters from different social categories with the same conditions of light, during only one day. The results of the study show that men perform better than women as concerns naming task, but that there's no difference between genders as concerns recognition task. Recognition performances are significantly better whatever the age, the gender and the cultural level may be. Generally, performances are all the more better since subjects are younger and have a higher cultural level. Our study then confirms the fact that normal aging goes hand in hand with rising difficulties to name faces. Moreover, results tend to show that recognition of faces remains better preserved and that the greater disability to recall a name is linked to difficulties in lexical accessing.

[Parkinson disease and cognitive evoked potentials]. / Maladie de Parkinson et potentiels évoqués cognitifs.

Long latency auditory evoked potentials were recorded in 50 patients with Parkinson's disease, some case were also investigated by the Rapid Evaluation of Cognitive Functions test (RECF) and Trail Making A test (TMA). Latencies of P2, N2 and P300 waves were longer in the parkinsonian group than in a control group matched for age. Latencies of N2 and P300 waves were correlated significantly with scores for RECF and TMA presumed to be sensitive to organic brain lesions. On the other hand no significant correlation was found between RECF and P1 and P2 latencies. In addition, correlation was lacking between Verbal Automatism test scores, presumed to be resistant to organic brain lesions, and P300 wave latencies. Cognitive evoked potential (CEP) latency increases with age in normal subjects. In the parkinsonian group the coefficient of correlation between these two factors was lower but still significant. The parkinsonian patients with dementia as defined by DSM III criteria, or an RECF score of less than 46, showed longer N2 and P300 latencies but no significant difference in N1 and P2 latencies. In contrast, comparison of P300 and N2 wave latencies in depressed and non-depressed parkinsonian patients failed to show any significant difference. The bilateral akinetic forms had marked lengthening of P300 wave latencies and a lower TMA score. Neither the duration of the disease, type of treatment, duration of L-Dopa therapy significantly influenced the latency of cognitive event-related potentials.

[Critical study of ELISA technique and high sensitivity direct agglutination test for the screening of antitoxoplasma IgG]. / Etude critique d'une technique ELISA et d'un test d'agglutination directe haute sensibilité pour le dépistage des IgG antitoxoplasmiques.

The authors have evaluated an ELISA (Toxo-IgG EIA; bioMérieux) and a direct agglutination test using a sensitized antigen (Toxo-Screen DA; bioMérieux), with a fluorescent test antibody (Toxo-Spot IF; bioMérieux) as a reference for the screening of toxoplasmosis IgG antibodies. A good correlation was obtained for these two methods with fluorescent test antibody (p less than 0.00001) on 841 sera. However, results obtained with direct agglutination test were better than those obtained with ELISA (direct agglutination versus fluorescent test antibody: 97.4% of agreement; ELISA versus fluorescent test antibody: 96.1% of agreement). In addition, the use of the Receiver Operating Characteristic (ROC) curve, showing the changes of sensitivity and specificity as a function of the possible values of each threshold, indicated that sera with titers between 15-20 IU/ml should be interpreted very cautiously.

[The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients]. / Intérêt de l'antibioprophylaxie lors de gestes intra-utérins au cours d'un accouchement par voie basse. Etude comparative à partir de 550 patientes.

This comparative study carried out on 550 patients has made it possible for us to show how valuable prophylactic antibiotic therapy is when certain intra-uterine manipulations (such as forceps delivery, manual removal of the placenta or exploration of the cavity of the uterus) are carried out during vaginal delivery. Furthermore, we have been able to show that there are certain risk factors of which the most important are premature rupture of the membranes, infected liquor, birth weight of the infant less than 2,500 g and epidural analgesia. The financial study has shown that it is cheaper to use prophylactic antibiotics when the comparison is made with the cost of treating complications of infection associated with these intra-uterine procedures.

[High school students and tobacco. A survey of 630 students in Poitiers]. / Les lycéens et le tabac. A propos d'une enquête chez 630 lycéens de Poitiers.

A survey of high school pupils and their attitudes to tobacco was carried out by an anonymous auto questionnaire by 630 pupils at the Alienor Aquitaine Lycee in Poitiers in April 1991. The population study had the following characteristics: 30% were boys, 70% were girls. The mean age was 18 +/- 1.31 years. The proportion of regular smokers (at least one cigarette per day, every day) was 33.9% in boys and 34.9% in girls. The boys had smoked on average 10.7 cigarettes per day for 3.5 years and the girls 9.1 cigarettes per day for 2.9 years. The smoker above all, used light colour tobacco (with filters 98%) but 29% only bought mild cigarettes. On the other hand 55% of the subjects wished to stop smoking. There was no statistically significant relationship between the smoking habits of the pupils and that of their parents on the one hand or on the regular participation in a sport, on the other. However, boarders smoked a lot more than the other pupils. The knowledge of the dangers of smoking were imperfectly understood, in particular, for chronic bronchitis, myocardial infarction, small birth weight of the newborn and cancer of the bladder. The changers of passive smoking were known by 91.6% of the pupils. Finally this study explored the opinion of the lycee pupils as regards to the six measures in the propaganda against smoking and on seven methods of information relating to the dangers of tobacco.

[Recovery following anesthesia with diazepam-ketamine and fentanyl-methohexital]. / Réveil après anesthésie par diazépam-kétamine et fentanyl-méthohexital.

The quality of recovery from general anaesthesia for day-case surgery is assessed by the Trailmaking test in a randomized study of 100 women scheduled for termination of pregnancy on an outpatients basis. All patients are in ASA group I or II. Recovery following diazepam-ketamine based anaesthesia is compared to that following fentanyl-methohexital based anaesthesia. In group A, 5 min after intravenous injection of diazepam (0,2 mg.kg-1), anaesthesia is induced with ketamine (1 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of ketamine (0,5 mg.kg-1) are administered. In group B, 5 min after intravenous injection of fentanyl (1 microgram.kg-1), anaesthesia is induced with methohexital (2 mg.kg-1). If necessary, in response to spontaneous movement, for maintenance of anaesthesia, 1 or 2 supplementary doses of methohexital (0,7 mg.kg-1) are administered. The quality of recovery is assessed by Trailmaking test 1/2 h and 1 h after surgery and compared with pre-anaesthetic score. The two groups are comparable with regard to age, weight, educational level and average duration of anaesthesia. In group A, the mean score for the two parts of the test is not significantly different 1 h after surgery from the pre-anaesthetic score. In group B, the mean score for the two parts of the test is not significantly different 1/2 h after surgery than the pre-anaesthetic score. This better post-anesthetic score is explained by a learning effect of the test when used several times.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of two media for antibiotic susceptibility testing of anaerobic bacteria using the receiver operating characteristic procedure.

Wilkins-Chalgren agar and Meat-Yeast agar were evaluated as media for antibiotic susceptibility testing using 112 anaerobic bacterial strains. The results obtained with the two media using the diffusion method were compared with those obtained by the dilution method as reference method. The results were analyzed by the receiver operating characteristic (ROC) procedure allowing a graphic representation of sensitivity and specificity of the technique for each cut-off value. The area under the ROC curves was calculated to compare the accuracy of the two methods. Six antibiotics were tested including amoxicillin, cefoxitin, piperacillin, doxycycline and clindamycin. For amoxicillin and clindamycin, the two methods showed a high and identical discriminative power for distinguishing susceptible bacteria from the others. Diffusion in Wilkins-Chalgren agar appeared better than diffusion in Meat-Yeast agar for separating resistant bacteria from bacteria of intermediate susceptibility (amoxicillin p less than 0.005; clindamycin p less than 0.04). For other drugs, diffusion in Wilkins-Chalgren agar always had a discriminative power higher than that obtained with diffusion in Meat-Yeast agar for separating susceptible bacteria from the others (cefoxitin p less than 0.0005; piperacillin p less than 0.02; doxycycline p less than 0.05). The Wilkins-Chalgren agar medium thus appeared superior to the Meat-Yeast agar medium using the ROC evaluation method, which would deserve wider utilization in the field of microbiology.