[Patterns of prescription and usage of triptans in Alsace (France): misuse is frequent and avoidable]. / Modes de prescription et de consommation des triptans en Alsace: un mésusage fréquent mais évitable.

AIMS: To analyze use of triptans in the Alsace region of France: patients, disorders motivating, doses, analgesics and migraine prophylactics associated treatments, contra-indications. To study major consumers (more than 144 intakes per year) and to determine among them the proportion who suffering from chronic headache. METHOD: Data concerning all prescriptions of triptans and analgesics as well as migraine prophylaxis prescriptions were obtained from the computer databases of five of the French National Health's local health agencies in Alsace, recorded between April 1, 2003 and March 31, 2004. Data about motivating disorders and the clinical context were obtained using a questionnaire sent to prescribers. Data about patients with more than 144 intakes per year were provided by medical advisors of French Health insurance. RESULTS: We founded 20686 users: 92.1 percent used between 0 and 6 intakes per month. 11.5 percent of disorders motivating the prescription that were mentioned by prescribers were for off-label use: tension-type headache 2.7 percent, mixed headache, 8.8 percent. Prescribers declared at least one contra-indication for triptan use for 7.8 percent of patients. Over all, prescriptions were off-label for 16.1 percent of patients. Patients who used more than 144 intakes per year accounted for 1.9 percent of the total number and self-medication accounted for 19.2 percent of all triptan intakes. Half of the patients were suffering from daily chronic headache (chronic migraine in 66 percent). 15.6 percent of these patients presented at least one contraindication (high blood pressure or ischemic disease). All in all we estimate that use of triptan is a misuse for 25 percent to 30 percent of the intakes. Quantities of other analgesics used increased simultaneously with triptan use: on average 65, 119 and 244 Defined Daily Doses (DDD)/person/year for patients who used between 1 and 72, 73 and 144 and more than 144 intakes respectively. On average 35.4 percent (in DDD) of analgesics used were opiates (dextropropoxyphene, codeine, tramadol). This proportion increased simultaneously with triptan use: 58.9 percent for major users. Prophylactic treatment for migraine was used by 27.9 percent of the patients: lack of prophylaxis was a prescriber's choice in 90 percent of the cases. CONCLUSIONS: The high rate of triptan misuse emphasizes the importance of improving prescription of these drugs.

Viscosity and scattering of very weakly charged polyelectrolytes.

Careful examination of the concentration range where both intrinsic viscosity and light scattering show a polyelectrolyte effect, even for singly charged halato-telechelic ionomers in DMF, together with the neutron scattering results at higher concentration show that weakly charged polymers may be a very useful tool to understand the complicated effects of coulombic interaction in polyelectrolyte solutions. A theoretical framework is given for a systematic study of such weakly charged polymers. The current state of understanding is presented of the properties of solutions of strong polyelectrolytes and of charged rigid particles. Finally it is shown how the transposition to weak polyelectrolytes solutions sheds light on the respective contributions of intra- and intermolecular interactions.

Polarized fluorescence in an electric field: steady state and transient values for the fourth moment of the orientation function at arbitrary fields.

Steady state and time dependent expressions for the field dependence of the fourth moment of the orientation function at arbitrary fields, which are requested for the interpretation of polarisation of fluorescence in an electric field, have been obtained for permanent and induced dipole orientation. Some general features of the results and some problems connected with their application are pointed out.

Polarized fluorescence in an electric field: comparison with other electrooptical effects for rodlike fragments of DNA and the problem of the saturation of the induced moment in polyelectrolytes.

Electrical birefringence, electrical dichroism and polarisation of fluorescence in an electric field experiments have been performed at high fields on sonicated fragments of DNA labelled with Acridine Orange. The latter electrooptical effect gives access to the field dependence of the fourth moment of the orientation function while the two former give access to the field dependence of the second moment. The origin of the large departure from an E2 dependence at rather low degrees of orientation is extensively discussed. Following a suggestion of Shirai on the calculation of orientational averages for a saturated induced moment, we can show that this model rationalizes the existence of a linear E dependence of the orientation factor at intermediate fields and explains very well our experimental results. When applied to previous dichroic data at higher fields it shows that the low value of the dichroism at saturation introduced to fit with other models, in contradiction with the absence of base tilting in the B form of DNA, is not required for a quantitative fit with this new orientation mechanism. The transition from an E2 dependence at low fields to an E dependence at intermediate fields gives an estimate of the field required for the saturation of the ionic polarisation E approximately 6 kV/cm.

Magnetic resonance distinction between site bound and atmospherically bound paramagnetic counterions in polyelectrolyte solutions.

A combination of the water protons NMR chemical shifts, longitudinal and transversal relaxation rates and of the paramagnetic counterion EPR signal is shown to provide a clear distinction between site binding, atmospheric trapping and free counterions in solutions of polyelectrolyte TMA salts with increasing concentrations of the divalent counterions Co++ and Mn++. Site binding is defined by the loss of water in the counterion first hydration shell while atmospheric binding results in a change in the counterion correlation time as compared to a free ion.

Dynamics of single-stranded DNA in polyacrylamide gels during pulsed field gel electrophoresis. A birefringence study.

The study of the orientation of single-stranded DNA in polyacrylamide gels in denaturing conditions has been undertaken by electric birefringence in order to determine the mechanism involved in the electrophoretic transport. The presence of an overshoot in the birefringence signal, when applying the electric field, and the study of the influences of the electric field and of the gel concentration on the dynamics show that a mechanism of reptation with elongation of the molecule occurs in polyacrylamide gels with low T values. Therefore it is suggested that the use of pulsed fields in sequencing electrophoresis is possible and can lead to a large increase of the length of the fragments that can be sequenced in one single run.

Site binding as a local equilibrium. Mn2+ binding to poly(acrylic acid) as a function of the degree of ionization.

Mn2+ binding to poly(acrylic acid) at different degrees of ionization, alpha, has been studied from the frequency dependence of the water protons' relaxation rates T1(-1) and T2(-1). Site binding is treated as an equilibrium with the concentration of free ions at the immediate vicinity (CIV) of the polyion. The CIV is calculated as the solution of the Poisson-Boltzmann equation at the surface of the cylindrical polyion. A single value of K is shown to fit the results at all values of alpha. The amount of site binding is higher than the total amount of condensed divalent counterions predicted for a finite polyion concentration in the presence of monovalent counterions by Manning's theory.

Electric birefringence of polytetrafluoroethylene particles in agarose gels.

Electric birefringence studies of strongly elongated, rod-like particles of polytetrafluoroethylene (PTFE) in agarose gels show that the negative effect observed by semi-diluted aqueous suspensions at low frequencies and at low electric field strengths (the so called "anomaly') disappears. The absolute value of the low frequency effect increases 3-4 times and the amplitude of modulation decreases faster compared to that of the suspensions. This together with decreased decay relaxation times in gels make the possibilty that the PTFE particles orientation in gels is not due to dipolar but to electrophoretic orientation mechanism quite probable. Similar change in the orientation mechanism could be expected also for suspensions of higher concentrations. The further elucidation of the orientation mechanism using fractions with lower polydispersity, broader ranges of experimental conditions (particle concentration, ionic strength and composition, electric field strengths, frequencies, etc.) could be interest for several fields: colloid electro-optics and especially that of concentrated colloids, pulsed field gel electrophoresis of DNA (and especially its sinusoidal biased field variant) and of nucleoprotein complexes and for the gel research.

Divalent paramagnetic counterions site binding in polyelectrolyte solutions. Analysis of the frequency dependence of the water protons magnetic relaxation and the characteristic parameters of "site binding".

Chemical shift and relaxation time measurements on the water protons in polyelectrolyte solutions containing divalent paramagnetic counterions have shown the existence of three types of counterions: - site bound with loss of water molecules and partial or complete release of the electrostriction in the first hydration sphere, - atmospherically trapped with no change in hydration, - free. The overall stoichiometry of the two former is in agreement with Manning's fraction of condensed counterions. A complete analysis of the frequency dependent contribution of site bound counterions to the water protons relaxation times leads us to interesting conclusions on the modifications of the first hydration shell and on the life time of site binding.

[Damage control laparotomy for haemorragic abdominal trauma. A retrospective multicentric study about 109 cases]. / La laparotomie écourtée dans les traumatismes abdominaux hémorragiques. Etude multicentrique rétrospective sur 109 cas.

AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.

[The tibial slope. Proposal for a measurement method]. / La pente tibiale. Proposition pour une méthode de mesure.

The posterior inclination of the tibial plateaus relative to the longitudinal axis of the bone, also called tibial slope, is important to know for the pathology of the cruciate ligaments and to lay some knee prostheses. We have chosen a reproducible method to measure it, on the basis of a large radiograph of the lower limb. A radio-anatomical analysis of the morphology of the tibia has first been carried out to properly choose axes that are easy to find and useful in practice. The accuracy of the measurement is to within one degree. In adults, the slope ranges from 0 to 18 degrees, according to the subjects, with variations form one knee to the other.

[Acute intrahepatic lithiasic cholecystitis. Apropos of a case]. / Cholécystites aiguës lithiasiques intra-hépatiques. A propos d'un cas.

Pre-operative diagnosis in a case of acute intrahepatic lithiasic cholecystitis was an intrahepatic cystic formation. Treatment was by cholecystectomy. A review of the published literature demonstrated that the usual pre-operative diagnosis in these cases was either a cystic formation or an intrahepatic tumor. When cholecystectomy is not possible, therapy involves extraction of all gallbladder stones and main biliary tract drainage.

[Orientation and stretching of DNA chains during pulsed field gel electrophoresis]. / Orientation et déformation des chaînes d'ADN pendant l'électrophorèse sur gel en champ pulsé.

The quantitative analysis of the decay of birefringence accompanying gel electrophoresis leads to the characterization of two phenomena respectively attributed to alignment of the tube and to overstretching of the chain in its tube. The major contribution to the molecular orientation is given by the overstretching which relaxes according to a stretched exponential law. The other process, slow, is characterized by a reptation time and a mean orientation factor in good agreement with the biased reptation model without overstretching.

Field and pore size dependence of the electrophoretic mobility of DNA: a combination of fluorescence recovery after photobleaching and electric birefringence measurements.

By combining an electrophoretic cell with a setup of fluorescence recovery after photobleaching (FRAP) we can measure the electrophoretic mobility mu of double-stranded lambda DNA in agarose gel as a function of electric field E and gel concentration C. Mobility varies linearly with the field in agreement with the biased reptation model with fluctuations. The slopes are analyzed in term of orientation and compared with birefringence results. The mobility extrapolated at zero field follows the prediction of the reptation theory; we deduced the variation of the pore size with the agarose concentration. With a special use of our setup, we measure directly the free-mobility mu 0 of the DNA.

Simultaneous measurements of mobility, dispersion, and orientation of DNA during steady-field gel electrophoresis coupling a fluorescence recovery after photobleaching apparatus with a fluorescence detected linear dichroism setup.

Orientation of molecules is responsible for the loss of separability during steady-field gel electrophoresis. In this work we develop a technique to measure simultaneously the relevant parameters involved in the separation mechanism: electrophoretic mobility, band broadening, and molecular orientation. To do that we have associated a fluorescence recovery after photobleaching (FRAP) apparatus with a fluorescence detected linear dichroism setup. This coupling allows one to follow the buildup of orientation during the FRAP experiment. Because orientation involves a change in the angular distribution of fluorescence, we have added a fluorescence polarization setup which can be used in parallel with the FRAP and gives an exact value of the steady-state orientation factor. We illustrate the possibilities of these combined experiments by analyzing the coupling of electrophoretic transport and orientation of lambda DNA in 1% agarose gels.