Churg-Strauss syndrome revealed by granulomatous acute pericarditis: two case reports and a review of the literature.

BACKGROUND: Churg-Strauss syndrome (CSS) is a necrotizing systemic vasculitis with extravascular granulomas and eosinophilic infiltrates of small vessels. CSS is usually revealed by nonspecific signs of necrotizing vasculitis in a context of late-onset asthma and blood eosinophilia. It is considered a systemic vasculitis with the highest prevalence of cardiac involvement and can lead to rapid-onset heart failure due to specific cardiomyopathy. Pericardial effusion may also occur during CSS and is usually well tolerated. OBJECTIVE: The objective of these case reports was to indicate that CSS may present as tamponade, with or without other visceral involvement. METHODS: Among CSS patients treated during the past 10 years at 2 French university hospitals, we have identified and described 2 cases revealed by tamponade with pericardial biopsy-proven granulomatous vasculitis. We have also reviewed the international medical literature in PubMed on cardiac involvement in CSS. RESULTS: The first case report describes a 66-year-old man who had an isolated cardiac tamponade with both inflammatory syndrome and eosinophilia. Long-term remission was obtained with corticosteroids. The second case report describes a 46-year-old woman whose CSS presented with tamponade and associated central nervous system and myocardial involvement. Remission was obtained with corticosteroids and cyclophosphamide. In both cases, CSS was assessed by histological analysis of a pericardial sample. CONCLUSIONS: CSS may present as isolated cardiac tamponade. Whereas pericarditis with myocardial injury warrants immunosuppressive therapy, isolated pericarditis without other visceral involvement of poor prognosis only requires corticosteroid therapy.

[Prevalence and description of hyponatremia in internal medicine departments of the France west area. A "one day" multicentric descriptive study]. / Prévalence et description des hyponatrémies dans les services de médecine interne de l'ouest de la France. Une enquête descriptive multicentrique type "jour donné".

PURPOSE: Few data are available on the prevalence and causes of hyponatremia in medical setting and to our knowledge, no recent descriptive study has been performed about hyponatremias in the French Departments of internal medicine. METHOD: A "one day" descriptive multicentric study was performed in the medicine departments of the France West area. A questionnaire was mailed to physicians who had to take part in a annual regional meeting about "hyponatremias", one month later. Hyponatremia was defined by a blood sodium level under the normal value of the local laboratory. Each internist had to precise for all hyponatremias in course at the study day, the exact value, the discovery circumstances, the mechanisms and etiologies, the associated diseases, the course and treatments. RESULTS: Seventy-four hyponatremias were identified. The overall prevalence was 12,1%. The prevalence of severe hyponatremias (under 120 mmol/l) was 1,1%. These latter represented 9,4% of the whole hyponatremias (7/74). Associated symptoms and diseases, the mechanisms, the suspected etiologies, the course and treatments are described in detail. CONCLUSION: This multicentric study reports for the first time the prevalence, the clinical and etiological characteristics of hyponatremias coming from Internal Medecine Departments of the West area from France. The overall prevalence is lower in comparison with values usually reported in hospitalized patients, but the frequency of severe and moderate hyponatremias, the mechanisms and the suspected etiologies are identical to those reported in others countries.

[Screening of abdominal aortic involvement using Doppler sonography in active giant cell (temporal) arteritis at the time of diagnosis. A prospective study of 30 patients]. / Dépistage de l'atteinte aortique abdominale par échographie-doppler au diagnostic de maladie de Horton. Etude prospective de 30 patients.

BACKGROUND: Inflammatory involvement of extracranial large-sized arteries occurs in 10-20% of patients with giant cell (temporal) arteritis. Aortic involvement may reveal giant cell arteritis or occur as a late-onset complication, and represents one of the most serious manifestation of the disease with the risk of aortic dissection and/or aneurysm rupture. The thoracic aorta is more frequently involved but abdominal aortitis may also occur in giant cell arteritis. To date, few data are available about abdominal aorta changes at the initial stage of giant cell arteritis. PATIENTS AND METHODS: This prospective monocentric study was conducted between May 1998 and May 2002, and included 30 consecutive patients with biopsy-proven giant cell arteritis. Standard clinical and biological data were collected. Each patient underwent an abdominal aortic Doppler-sonography that looked for aneurysm, ectasia, thickening of the vascular wall, and hypoechoic halo around the aorta. RESULTS: Among the 30 patients of this study (25 women, 5 men, mean age 68.5 years), 4 (13%) had an abdominal aortic aneurysm, with a low diameter (23 to 27 mm), measuring 2 to 5.5 cm in length. A vascular wall thickening superior or equal to 3 mm was noted in 17 patients (68%). A 4 to 8 mm periaortic hypoechoic halo was found in 10 patients (33%). This halo was present in 3 out of the 4 patients with aneurysm. CONCLUSION: Aortic involvement is a potentially serious complication of giant cell arteritis. The question of a systematic screening of this complication remains open to discussion. Our study shows that Doppler sonography may detect morphological abnormalities on the abdominal aorta at the initial stage of giant cell arteritis. These abnormalities comprise mild aneurysms, thickening of the vascular wall and periaortic halo, which could correspond to inflammatory locations of the disease. Complementary studies are needed to assess their specificity and their seriousness.

[Evaluation of the instruction and the instructors by the students during a clinical training period in a gynecology and obstetrics unit]. / Evaluation des enseignements et des enseignants par les externes lors d'un stage clinique dans un service de gynécologie-obstétrique.

OBJECTIVES: The evaluation of an educational system is part of the essential process to get high-quality teaching. We wanted to assess the teaching and the teachers in a gynaecological unit with a view to improve the education of the trainees within a dynamic educational system. MATERIALS AND METHODS: It is a prospective study which took place in the gynecology-obstetric unit of the University of Nantes. Thanks to a questionnaire called "Evaluation of the teaching during a gynecologic-obstetric training course", we evaluated the feelings of 21 medical students about their two-month training course. This questionnaire of 27 items is divided in several parts. The first one is about the quality of the teaching, the second about planification, the third about the quality of the learning resources, and the fourth is about the educational quality of each teacher (interaction teacher-student). The fifth one evaluates the perception of this work experience by the student, notably his clinical activity and his personal implication in the unity. There are also some open questions which point out the positive aspects of the teaching but also its failings and the parts that must be improved. We give here the details of the different stages of this assessment from the questionnaire up to the results, mentioning their limits considering the conceptual orientations and the methodological orientations chosen. RESULTS: Analysis of the data was done determining the percentage of agreement and disagreement to a statement of the questionnaire. All the students find the teachings interesting and stimulating, objectives were gone through thoroughly. Courses were well organised. Their integration in the medical team was good. They feel responsible especially when they are on call (88.3%). On the other hand, for a quarter of them, educational supports are not adapted, teaching documents are not clear and adapted to the National Test. Half of them (45%) are not satisfied by the numerical campus which does not facilitate understanding. Staffs are not an opportunity to learn for 37% of them. Management by senior doctors is insufficient. CONCLUSION: Students are completely integrated into the process of evaluation but concrete actions to improve the teaching have to be realised in the hospital departments. Questionnaire is an informative and adapted tool. It permits to highlight the flaws in the learning process and to remedy them.

[Empirical treatment of granulomatous hepatitis of unknown origin: practice investigation in the French National Society of Internal Medicine]. / Traitement d'épreuve d'une hépatite granulomateuse symptomatique de cause indéterminée: enquête de pratique au sein de la Société nationale française de médecine interne.

PURPOSES: Ten to fifteen percent of granulomatous hepatitis are idiopathic. If symptoms like prolonged fever are present, empirical treatment is discussed. The goal of this study is to describe the empirical treatment proposed in this situation by French specialists of internal medicine. METHODS: We conducted a practice investigation among the French national society of internal medicine (SNFMI), using an anonymous questionnaire that related a case of idiopathic granulomatous hepatitis. This questionnaire was proposed to all French internists present at the SNFMI congress in June and December 2004. French specialists of internal medicine had to answer if they would prescribe an empirical treatment and if so, to specify this treatment. RESULTS: Thirty-six French specialists of internal medicine answered to the questionnaire. In the proposed situation, 89% of them initiate an empirical treatment. In 18/36 cases (50%), a first-line anti-tuberculosis empirical treatment is proposed (quadritherapy in 11 cases). In 7 cases (19%), an empirical treatment with prednisone, 0.4 mg/kg/d (N=1) and 1 mg/kg/d (N=6), would be prescribed. Seven internists (19%) would prescribe an empirical treatment with cyclins at the dose of 100 to 400 mg/d. Median duration of the empirical treatment would be 28 days (range: 8-252d). The evaluation parameters mentionned are: fever (69%), weight (59%), seric level of C-reactive protein (59%), and liver biology (53%). In case of failure of first-line empirical treatments, 69% of all questionned internists prescribe a second-line treatments: prednisone at the dose of 0.4 to 2 mg/kg/d (72%), anti-tuberculosis treatments (16%), cyclins 200 mg/d (12%), with a median duration of 28 days. Seven internists (19%) propose to combine two empirical treatments. DISCUSSION: Faced with a problem of idiopathic granulomatous hepatitis, French internists questionned propose four therapeutics options: no treatment, anti-tuberculosis treatment, cyclins or steroids treatment. First-line anti-tuberculosis treatment is a coherent proposition regarding to the high prevalence of tuberculosis. There are only few data available concerning empirical treatment with steroids or cyclins. Specific proposition of such empirical treatments should be defined. CONCLUSIONS: The management of idiopathic granulomatous hepatitis is difficult. Our study shows that therapeutics practices of French internists are heterogenous. The main proposition consists in a first-line anti-tuberculosis empirical treatment, that has to be evaluated after four weeks, and switched with steroids (prednisone, 1 mg/Kg/d) in case of failure. This study is not an expert proposition but contributes to suggest clinical practice guidelines for a rare, complex, heterogenous, and typically internist situation.

[Combining corticosteroid and aspirin for the prevention of recurrent villitis or intervillositis of unknown etiology]. / Association des corticoïdes à l'aspirine pour la prévention des récidives de villite ou d'intervillite chroniques d'étiologie indéterminée.

We report the cases of two patients who had a favorable outcome with aspirin and corticosteroid therapy during pregnancy for chronic villitis of unknown etiology complicated by labor asphyxia and further intrauterine fetal demise in one gravida 3 patient and for chronic intervillositis of unknown etiology diagnosed after three perinatal deaths in another patient (gravida 4). Chronic villitis of unknown etiology (CVUE) is detected in 7 to 33% of placentas, mainly after intrauterine growth retardation (IUGR), unexplained prematurity, preeclampsia, perinatal asphyxia and intrauterine fetal death (IUFD). The less frequent chronic intervillositis of unknown etiology (CIUE) (0.6 to 0.9/1.000) has been implicated in recurrent severe pregnancy complications, such as spontaneous abortions, IUGR and IUFD. Histopathology and immunohistology are in favor of an immune response against the foreign fetal allograft. The favorable results obtained with corticosteroids and aspirin remain to be confirmed by larger series.

[Is training on basic skills and management of critical events responsible of ethical considerations in anaesthesia and intensive care?]. / L'apprentissage des gestes invasifs et de la gestion d'une situation critique pose-t-il des problèmes éthiques en anesthésie-réanimation?

OBJECTIVE: To provide information on morbidity and ethical questions associated with learning of invasive techniques (tracheal intubation, positioning of central venous or epidural catheters) and management of anaphylactic shock. STUDY DESIGN: Retrospective survey. METHODS: Written questionnaire to 54 anaesthesiologists and 55 residents. RESULTS: Training was primarily performed by residents having a 6 months-experience for general anaesthesia and by more experienced residents for epidural analgesia. Residents observed first two or three procedures performed by seniors, but did not have theoretical lectures in 30 to 50% of cases. Dead bodies or manikins were rarely used. Despite the presence of experienced anaesthesiologists during the first attempts, there was a high morbidity rate which was considered by 22 to 37% of the interviewed anaesthesiologists a loss of benefit for the patients. Despite a high level of coaching, a high morbidity rate was associated with the first attempts. However, only few residents explicitly stated to be concerned by ethical questions. Among anaesthesiologists, who had yet to manage anaphylactic shock, 21 and 35% of them reported that diagnostic and treatment could have been performed faster. Virtual learning was misunderstood but 46% of anaesthesiologist described numerous advantages in using simulator of anaesthesia. CONCLUSION: Despite an apparent morbidity with a loss of benefit, informed consent of the patients were rarely obtained.

Alterations in the ganglioside composition of rat cortical brain slices during experimental lactic acidosis: implications of an enzymatic process independent of the oxidative stress.

Several in vitro studies have shown that lactic acidosis plays a role in brain damage by enhancing free radical formation and lipid peroxidation. The purpose of this study was to determine whether gangliosides are affected by lactic acid-induced oxidation in rat brain tissues. Cortical brain slices were incubated at 37 degrees C for 5 or 17 h in Krebs-Ringer buffer containing 20 mM lactic acid (final pH 5.5) previously equilibrated with 100% O2. Damage from lipid peroxidation was estimated by measurement of thiobarbituric acid-reactive substances (TBARS) and analysis of polyunsaturated fatty acids (PUFAs). Gangliosides were studied by high-performance thin-layer chromatography. Incubation with lactic acid induced overproduction of TBARS, whereas PUFAs were only slightly degraded, even after 17 h of incubation. However, the major modifications in the ganglioside profile occurred after 17 h of incubation. Gangliosides GD1a and GT1b decreased in conjunction with a substantial increase in the GM1 percentage. The addition of butylated-hydroxytoluene and desferrioxamine in the incubation medium, or incubation under 100% nitrogen, abolished TBARS production but not the ganglioside modifications, indicating that the change in ganglioside distribution was not related to oxidative stress induced by lactic acid. To investigate the possibility of an enzymatic process activated by the pH shift, slices were incubated with lactic acid in presence of 2,3-dehydro-2-deoxy-N-acetylneuraminic acid, a specific inhibitor of sialidase. In these conditions, no change in gangliosides profile occurred. These results demonstrate that sialidase is responsible for the alterations in the gangliosides composition of rat cortical brain slices during lactic acidosis.

[Comparison of medical ethical competencies of pregraduate third and sixth year students during their internal medical hospital rotations]. / Comparaison des compétences médicales éthiques des étudiants de 3e et de 6e année en stage hospitalier en médecine interne.

PURPOSE: The study looks for medical students ethical understanding during their internal medicine hospital rotations. As a secondary purpose, the study screens if internal medicine ward provides an environment appropriate for pregraduate medical students ethical training. METHOD: Retrospective analysis and comparison of logbook writings from 2 different pregraduate groups of students : Group A = 29, third year medical students and Group B = 28, sixth year medical students, (that is last year pre-graduation). The task instructions were the same for the two groups : to identify and to analyse an ethical problem personally witnessed on the ward and to propose a solution either local or personal. Cognitive semantic units (CSU) were first drawn from the writings then subsequently analysed through two grids 1* according to fundamental principles (P) and 2* according to professional responsibilities (R). RESULTS: Students from group A produced a mean of 13,7 CSU per writing (total of 396 CSU) and those from Group B, 7,3. (total of 205 CSU) ; significant difference with P <0,004 between the 2 groups. Both identification of ethical dilemma itself and outbreaking it in (P) and (R) items and articulating solutions were significantly different between the 2 groups(P <0,004 Wilcoxon). Patient-physician relationship was predominantly present in both groups. While end-of-life and therapeutic issues were more prominent among group B, students of group A disagreed more with staff. Students of group B focused on external causes to excuse their demotivation (final exams'preparation), being more fatalist than cynical towards ethical issues. CONCLUSION: There is an erosion of clinical ethical sensitivity during pregraduate training. This study shows that internal medicine hospital rotation provides enough opportunities (both in number and in variety) to promote keen clinical ethical learning.

Endocrine function in 98 HIV-infected patients: a prospective study.

Endocrine function was prospectively evaluated in 98 patients (73 men and 25 women) infected by HIV in various stages of illness: Centers for Disease Control groups II (19), III (20), IVA and IVC2 (27), IVC1 and IVD (32). Testing included baseline and post-stimulation evaluation of gonadal, thyroidal, and adrenal axes. Although adrenal function was within normal values in most cases, with no differences between patient groups, nine out of 98 patients had either a low baseline or post-stimulation serum cortisol, cytomegalovirus adrenalitis being suspected in two cases. Mineralocorticoid response was normal in all individuals. The main abnormalities were sick euthyroid syndrome with low tri-idothyronine and/or thyroxine in 16% of patients and hypotestosteronemia in 29% of men with AIDS. These abnormalities, related to a functional deficiency of the hypothalamic-pituitary axis, were highly correlated with the degree of illness, i.e. weight loss and low CD4+ cell count. It was concluded that endocrine dysfunction in HIV-infected patients is rarely of clinical significance, that it is related more to cachexia and advanced disease than to HIV or opportunistic infections, and that it could serve as a prognostic marker.

Greater initial adaptations to submaximal muscle lengthening than maximal shortening.

The purpose of this study was to compare the short-term strength and neural adaptations to eccentric and concentric training at equal force levels. Forty-two sedentary women (age = 21.5 yr) were ranked based on the initial quadriceps strength score, and trios of subjects were randomly assigned to either an eccentric (n = 14), a concentric (n = 14), or a nonexercising control group (n = 14). Training involved a total of 824 eccentric or concentric quadriceps actions at 1.05 rad.s-1 administered in four sets of 6-10 repetitions, four times per week for 6 wk. Before and after training, all subjects were tested for unilateral maximal isometric and eccentric and concentric actions at 1.05 rad.s-1 and for a 40-repetition eccentric and concentric fatigue series of the left and right quadriceps. Surface electromyographic activity of the vastus lateralis and medialis was monitored during testing. Concentric training increased concentric (36%, P < 0.05), isometric (18%, P < 0.05), and eccentric strength (13%), and eccentric training increased eccentric (42%, P < 0.05), isometric (30%, P < 0.05), and concentric (13%) strength. Eccentric training improved eccentric and isometric strength more (P < 0.05) than did concentric training. The electromyographic adaptations were greater with eccentric training. Cross-education was 6%, and neither training mode modified fatigability. The data suggest that training of the quadriceps muscle with submaximal eccentric actions brings about greater strength adaptations faster than does training with maximal-level concentric actions in women. This greater adaptation is likely to be mediated by both mechanical and neural factors.

'Localized amyloidosis': 123I-labelled SAP component scintigraphy and labial salivary gland biopsy.

In apparently localized amyloidosis, there is no appropriate test to determine whether systemic deposits exist. We studied the value of serum amyloid P component (SAP) scintigraphy and labial salivary gland (LSG) biopsy on patients with apparently localized amyloidosis in 12 patients who had neither clinical nor biological evidence of systemic amyloidosis. All patients had an LSG biopsy and echocardiography. Iodine-123-labelled serum amyloid P component (123I-SAP) scintigraphy was performed in all patients. Whole-body scintigraphy was done, and tissue retention was evaluated at 24 h and 48 h. Of these 12 patients, three had amyloidosis in their LSG and had abnormal 123I-SAP scintigraphy; these three had a secondary clinical history of systemic amyloidosis. Three other patients had abnormal 123I-SAP scintigraphy without detectable systemic amyloid deposits, but one had a previous history of bilateral carpal tunnel syndrome treated with infiltration. 123I-SAP scintigraphy in association with LSG biopsy may be helpful in determining the localized or systemic character of amyloid disease.

Gait biomechanics are not normal after anterior cruciate ligament reconstruction and accelerated rehabilitation.

PURPOSE: Accelerated rehabilitation for anterior cruciate ligament (ACL) injury and reconstruction surgery is designed to return injured people to athletic activities in approximately 6 months. The small amount of empirical data on this population suggests, however, that the torque at the knee joint may not return until 22 months after surgery during walking and even longer during running. Although the rehabilitation has ended and individuals have returned to preinjury activities, gait mechanics appear to be abnormal at the end of accelerated programs. The purpose of this study was to compare lower extremity joint kinematics, kinetics, and energetics between individuals having undergone ACL reconstruction and accelerated rehabilitation and healthy individuals. METHODS: Eight ACL-injured and 22 healthy subjects were tested. Injured subjects were tested 3 wk and 6 months (the end of rehabilitation) after surgery. Ground reaction force and kinematic data were combined with inverse dynamics to predict sagittal plane joint torques and powers from which angular impulse and work were derived. RESULTS: The difference in all kinematic variables between the two tests for the ACL group averaged 38% (all P < 0.05). The kinematics were not different between the ACL group after rehabilitation and healthy subjects. Angular impulses and work averaged 100% difference for all joints (all P < 0.05) between tests for the ACL group. After rehabilitation, the differences between injured and healthy groups in angular impulse and work at both the hip and knee remained large and averaged 52% (all P < 0.05). CONCLUSIONS: Results indicated that after reconstruction surgery and accelerated rehabilitation for ACL injury, humans walk with normal kinematic patterns but continue to use altered joint torque and power patterns.

Effects of standard and eccentric overload strength training in young women.

PURPOSE: According to the force-velocity relationship of human skeletal muscle, the maximal load one can lift is limited by the concentric movement phase, and the eccentric phase is always underloaded. In the present study, we hypothesized that acute exercise training using an eccentric overload compared with standard loading would lead to greater neuromuscular and strength adaptations. METHODS: Sedentary women (age 20.9 yr) were tested for concentric and eccentric three-repetition maximum (3RM), maximal isokinetic eccentric and concentric and isometric force and associated EMG activity of selected thigh muscles before and after 7 consecutive days of exercise training of the left quadriceps. The exercise program was designed so that the total weight lifted was similar between the eccentric overload (EO, N = 10) and standard group (ST, N = 10), but EO exercised with about 50% greater eccentric load whereas the controls did not exercise (N = 10). RESULTS: There was a 22% increase in the total weight lifted over 7 d. On the average, EOs compared with STs strength gains were approximately twofold greater. Changes in EMG paralleled the changes in muscle strength without changes in biceps femoris coactivity during knee extension. CONCLUSION: Because the strength gains were achieved by exercising at low intensities and over a short time period, exercise prescription of eccentric overloading appears especially suitable for elders, individuals deconditioned due to an injury, and the chronically diseased.

Foot placement modifies kinematics and kinetics during drop jumping.

PURPOSE: Sprinting, bouncing, and spontaneous landings are associated with a forefoot contact whereas walking, running, and jumping are associated with heel-toe foot placement. Because such foot placement strategies influence landing mechanics or the ensuing performance, the purpose of this work was to compare lower extremity kinematics and kinetics and muscle activation patterns between drop vertical jumps performed with heel-toe (HTL) and forefoot (FFL) landings. METHODS: Ten healthy male university students performed two types of drop jump from a 0.4-m high box placed 1.0-m from the center of the force plate. They were instructed to either land first on the ball of the feet without the heels touching the ground during the subsequent vertical jump, i.e., forefoot landing jump (FFL), or to land on the heels followed by depression of the metatarsals, i.e., heel-toe landing jump (HTL). Three successfully performed trials per jump type were included in the analysis. The criteria for selection of the correct jumps was proper foot position at contact as judged from video records and the shape of force-time curve. RESULTS: The first peak and second peak determined from the vertical force-time curves were 3.4 times greater and 1.4 times lower for HTL compared with those with FFL (P<0.05). In the flexion phase of HTL, the hip and knee joints contributed 40% and 45% to the total torque, whereas during FFL the greatest torque contributions were 37% for both the knee and ankle joints. During the extension phase, the greatest torque contributions to the total torque were 41% and 45% by the knee and ankle joints during HTL and 34% and 55% during FFL. During the flexion phase, power production was 20% greater (P<0.05) in HTL than in FFL, whereas during the extension phase power production was 40% greater in FFL than in HTL. In the flexion phase of HTL the hip and knee joints produced the greatest power, and during the extension phase the knee and ankle joints produced the greatest power. In contrast, during both the flexion and extension phases of FFL, the knee and ankle joints produced the greatest power. The EMG activity of gluteus, vastus lateralis, and plantar flexor muscles was similar between HTL and FFL in most cases except for the greater vastus lateralis EMG activity during precontact phase in HTL than in FFL and the greater gastrocnemius activity in FFL than in HTL. CONCLUSION: Foot placement strategy modifies the individual joint contributions to the total power during drop jumping.

Gait adaptations before and after anterior cruciate ligament reconstruction surgery.

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

Septicaemia due to Actinobacillus actinomycetemcomitans with endocarditis and spinal epidural abscess.

A case of tricuspid valve endocarditis with spinal epidural abscess caused by Actinobacillus actinomycetemcomitans is reported in a 74-year-old male with an endocardial pacemaker. Despite antibiotic treatment, removal of the endocardial wire was necessary for recovery.

Hybrid process for the conversion of lignocellulosic materials.

Because of the recalcitrant nature of lignocellulosic materials, it is important to pretreat the biomass in order to obtain a suitable material for the bioconversion. In this study, two different types of pretreatments were performed. The first experiment used a 2-gal Parr reactor operated at 140, 150, 160, and 170 degrees C with sulfuric acid concentrations varying from 0.5 to 2%. A second pretreatment was performed with a two-stage low-temperature process. The first-stage pretreatment was performed at 100 or 120 degrees C with sulfuric acid concentrations of 0.5, 2, and 5% followed by a second-stage pretreatment at 120 degrees C with 2% acid concentration. The best residues for enzymatic hydrolysis and simultaneous saccharification and fermentations (SSF) came from the higher temperature pretreatment with the Parr reactor. However, a large portion of the xylose fraction was degraded to furfural and glucose was degraded to HMF. On the contrary, the two-stage low temperature pretreatment resulted in a very low percentage of xylose degradation, and no glucose degradation. The residues from this two-stage pretreatment performed satisfactorily toward the production of ethanol by SSFs. This study discusses the results obtained from these experiments.

[Finger plethysmography for studying the blood rheological and hemodynamic components of an acrosyndrome]. / L'apport de la pléthysmographie digitale pour l'étude des composantes hémorhéologiques et hémodynamiques d'un acrosyndrome.

Digital plethysmography allows investigation of maximum digital pulse (M.D.P.) after immersion of hands at 45 degrees C over three minutes. It is correlated with digital arterial blood flow. Reactivity to cold is determined from the ratio M.D.P./digital pulse after local and body cooling over 3 minutes. Tests were performed on 65 controls, 69 patients with idiopathic Raynaud's syndrome, 12 with scleroderma, 10 with digital arteritis and 15 with Raynaud's phenomenon secondary to hemorheologic affections. Maximum digital pulse was significantly decreased in patients with digital arteritis and scleroderma. The M.D.P. was normal in controls and patients with idiopathic Raynaud's syndrome, and was significantly increased in patients with a rheologic Raynaud's phenomenon. Digital artery reactivity differentiates the populations studied: it was maximum in patients with scleroderma, moderate in controls and patients with isolated digital arteritis and marked in patients with idiopathic Raynaud's disease and those with rheologic Raynaud's phenomena.

[Epidemiology of Horton's disease. Is there an environmental factor, infective in particular?]. / Epidémiologie de la maladie de Horton. Existe-t-il un facteur d'environnement, en particulier infectieux?

Epidemiological studies of temporal arteritis have essentially only been reported in the English literature. The authors of this study were concerned with this aspect of temporal arteritis in the Loire-Atlantique region of France over a period of 10 years (1970-1979). The high prevalence in white races has been confirmed. The annual incidence in France is comparable to that seen in Northern Europe and the USA. The incidence of the disease is especially high between 70 and 80 years. The apparent female predominance is related to the greater life expectancy in women. The study of several conjugal cases does not suggest the intervention of an infectious agent. The same is true for isolated cases where the responsibility of a bacterial or viral agent has not been demonstrated. Other environmental factors (sun exposure, life-style, socio-professional classification) do not affect the incidence of the disease. The genetic background would seem to be of particular importance. This study found a significantly higher prevalence of HLA DR4 antigen, confirming the results of American and British studies. However, in contrast to previous studies, this series did not confirm an increase in HLA B8 antigen.