IGLIAS: A new experimental set-up for low temperature irradiation studies at large irradiation facilities.

We designed and built a mobile experimental set-up for studying the interaction of ion beams with solid samples in a wide temperature range from 9 to 300 K. It is either possible to mount up to three samples prepared ex situ or to prepare samples by condensation of molecules from gases or vapours onto IR or Visible-ultraviolet (Vis-UV) transparent windows. The physico-chemical evolution during irradiation can be followed in situ with different analysis techniques including Fourier transform infrared spectroscopy, Vis-UV, and quadrupole mass spectrometry.

Ureteroscopic management of lower-pole renal calculi: technique of calculus displacement.

PURPOSE: We review our technique of ureteroscopic management of lower pole renal calculi with Nitinol basket displacement and holmium laser stone fragmentation. METHODS: Lower pole calculi are identified with a 7.5F flexible ureteroscope. In patients in whom the laser fiber reduces ureteroscopic deflection, precluding reentry into the lower pole, a Nitinol basket or grasper is used to displace the calculi into an upper pole calix for easier fragmentation. RESULTS: The Nitinol device can be passed into the lower pole through the fully deflected ureteroscope without any loss of deflection. Irrigation is significantly reduced by the basket, but this factor does not impede stone retrieval. CONCLUSIONS: Ureteroscopic management of lower pole stones is a reasonable alternative to SWL or percutaneous nephrolithotomy in low-volume stone disease. If the stone cannot be fragmented in situ, Nitinol basket capture through a fully deflected ureteroscope into a less dependent position facilitates stone fragmentation.

Soluble intercellular adhesion molecule 1 in spondylarthropathies.

The aim of the study was to evaluate the soluble form of intercellular adhesion molecule 1 (sICAM-1), a ligand of LFA-1, in the serum of patients with spondylarthropathies (SpA) and to look for a correlation with several inflammatory parameters. sICAM-1 levels were measured by ELISA in 25 SpA patients, 20 healthy controls and 20 patients with rheumatoid arthritis (RA). Results showed that sICAM-1 levels were increased (but not significantly) in SpA patients compared with controls; high levels (> 400 ng/ml) where found in 28% of SpA patients but in none of the RA or control groups. In SpA, correlations were found between sICAM-1 and erythrocyte sedimentation rate, C-reactive protein and interleukin 6, but not with tumour necrosis factor alapha or IgA. These correlations were absent in RA. In conclusion, these results suggest that sICAM-1 levels in SpA may reflect the acute phase of inflammation.

Amyloid arthropathy revealed by RS3PE syndrome.

Amyloid arthropathy is a form of primary AL amyloidosis with a monoclonal component in the blood and/or urine, and RS3PE syndrome is acute edematous polysynovitis in subjects older than 60 years. A 74-year-old man was diagnosed with both disorders. He was admitted for benign acute polyarthritis of the hands and feet and reported carpal tunnel symptoms predominating on the right. A synovial biopsy at the right wrist disclosed deposits that stained with Congo red even after potassium permanganate treatment (positive Wright's test). Articular AL amyloidosis was diagnosed. The symptoms resolved under glucocorticoid therapy alone, casting some doubt on their relationship with the amyloidosis. Roentgenograms showed geodes, a feature not present in RS3PE. Whether RS3PE may be among the possible presentations of articular amyloidosis is discussed.

Advances in the surgical management of nephrolithiasis.

The surgical management of urinary calculus disease has undergone a dramatic evolution over the past 2 decades. Twenty years ago, open surgical procedures for urinary calculi were some of the most frequently performed urologic procedures. Since then, however, stone management has been at the forefront of "minimally invasive" intervention. Specifically, the initiation and refinement of percutaneous and ureteroscopic access to the upper tracts, along with the rapid and nearly simultaneous development of both extracorporeal and intracorporeal lithotripsy techniques, has limited the role of open surgery to less than 1% of patients undergoing intervention for their stone disease. This manuscript will review the current indications for the surgical management of urinary calculi, the basic physics of the most frequently utilized vehicles for both extracorporeal and intracorporeal lithotripsy, and the respective roles of extracorporeal and intracorporeal lithotripsy with percutaneous or ureteroscopic access and open surgery. In addition, the results and complications associated with each of these forms of intervention will be reviewed. Finally, a discussion of specific clinical challenges to the urologist will be presented.

[Human salmonellosis in Ille-et-Vilaine in 1983]. / Les salmonelloses humaines en Ille-et-Vilaine en 1983.

224 salmonella strains from human beings, collected by the public and private laboratories of Ille-et-Vilaine during 1983, were serotyped and tested for their susceptibility to antibiotics. Salmonella typhimurium infections were the most frequent, while the other serotypes constituted a small number of strains, generally susceptible to antibiotics. No outbreak due to a multi-resistant serotype was observed. S. typhi and S. paratyphi B represent 6,25% of the strains isolated in this area during the year. Only 22% of the 224 strains collected were resistant to one or more antibiotics.

[Identification and rapid determination of the antibiotic resistance of enterobacteria with the automated ABAC identibiogram]. / Identification et antibiogramme rapides des entérobactéries à l'aide du système automatisé ABAC-identibiogramme.

Rapid identification and antimicrobial testing of Enterobacteriaceae by an automated system, the ABAC-Identibiogramme. The system was directly inoculated with a dilution of positive blood culture broths. The results were compared with those of API 20E and the disk method for antibiogram. The ratios of agreement of 94.5% for identification and of 93.4% for antimicrobial testing demonstrate a good accuracy of the ABAC-Identibiogramme.

[Malignant hemangioendothelioma of the thyroid. Pathologic study of a case]. / Hémangioendothéliome malin de la thyroide. Etude anatomoclinique d'un cas.

The authors report a case of malignant tumor of the thyroid in a 79 years old woman with a long standing goiter for 20 years but who did not live in endemic mountainous goiter area. The right lobe of the thyroid was surgically removed in February 1992 because increasing in size. Pathologic diagnosis was non malignant cystic lesion. Two months later, a recurrence with dyspnea urged a tracheostomy. The patient died 9 days later because of intra bronchial and pleura hemorrhage. The morphological and immuno-histochemical investigations showed angiosarcomatous features and positive reactivity with Factor VIII and UEA 1 markers in the tumour and pulmonary metastases. The diagnosis of Malignant hemangio-endothelioma was concluded.

[The value of peritoneal cytology in invasive uterine cancers. Analysis of 80 cases]. / Intérêt de la cytologie péritonéale dans les cancers utérins invasifs. Analyse d'une série de 80 cas.

When they analysed 80 cancers of the uterus, the authors showed how valuable it was both for diagnosis and prognosis to carry out cytological lavage of the peritoneum, particularly in cases of endometrial adenocarcinoma. The results of this study are compared with recent extracts appearing in the international literature. This technique makes it possible to identify groups of patients of high risk for recurrences in the pelvis and abdomen who would benefit from adjuvant therapies, demonstrating that this technique is applicable to the diagnosis of gynaecological cancers with intraperitoneal spread which have long been failed to be recognised. The procedure is innocuous and simple and therefore should be carried out widely in the management of uterine cancers.

[Cuniculatum carcinoma. 6 cases and review of the literature]. / Le carcinome cuniculatum. 6 observations et revue de la littérature.

The cuniculatum carcinoma is a rare type of epidermoid carcinoma. We report 6 cases with different localizations ("oral cavity and larynx", vulva, lower limb) treated over a 23-year period. Diagnosis is particularly difficult and requires careful clinical examination completed by deep surgical biopsy for histology. The aetiology of the tumour is not well defined. It presents as a slow growing wart with local malignancy and chronic suppuration. Extension to lymph nodes is rare. Histologically there is proliferative deep malpighian infiltration with an aspect of normal cell maturation. Galeries are hollowed out giving the aspect of a rabbit burrow (cuniculatum). Surgery is the only treatment, generally without lymph node curage. Radiotherapy is contraindicated due to anaplastic transformation.

[Extra-skeletal Ewing's sarcoma. A case report with detailed review of the literature]. / Les sarcomes d'Ewing extra-squelettiques. A propos d'un cas avec revue détaillée de la littérature.

Extra-skeletal Ewing's Sarcoma (EES): a clinico-pathological entity described in 1975 by L. Angervall and F.M. Enzinger. This article reports a new case in which the primary was localized in the right forearm and metastasized to the left lung fourteen years later. A detailed review of the literature emphasized similarities and differences between osseous and extra-osseous Ewing's Sarcoma.

[Streptococcus faecalis: sensitivity to quinolones, penicillins and aminoglycosides alone or in combination]. / Streptococcus faecalis: sensibilité aux quinolones, aux pénicillines et aux aminosides seuls ou associés.

Isolates of Streptococcus faecalis are moderately susceptible to quinolones, penicillins and aminoglycosides used alone. Penicillin-aminoglycosides synergism is not observed against aminoglycosides high-level resistant strains. The combination of an aminoglycoside plus a quinolone was synergistic against susceptible strains of S. faecalis but not against aminoglycosides high-level resistant strains. No antagonistic effect of quinolones plus aminoglycosides or plus penicillin was observed.

[Primary and secondary carcinomas of the thyroid gland with systematic discovery. Apropos of hundred thyroid glands removed at autopsies and review of the literature]. / Carcinomes primitifs et secondaires de la thyroïde de découverte systématique. A propos de cent thyroïdes prélevées au cours d'autopsies et revue de la littérature.

One hundred thyroids from autopsies performed in a Cancer Center were sectioned at 4 mm intervals. Each slice was processed to obtain one or several sections for histologic examination. Five primary microcarcinomas and ten secondary clinically unknown carcinomas were found. This study and the review of the literature confirm that the high prevalence rate of microcarcinomas, most of them papillary, in autopsies does not agree with the clinically diagnosed carcinoma rate. Tumors greater than 5 mm in diameter may sometimes be aggressive. Intrathyroid metastases are relatively frequent in cancerous dissemination observed in autopsies, but raise problems when they precede the primary tumor or are revealed on surgical samples a long time after because of a slow development. The authors emphasize the importance of differential diagnosis between primary and secondary tumors and the value of immunohistochemistry for histological diagnosis.

Simplified ureteral stent placement with the assistance of a ureteral access sheath.

PURPOSE: When using a ureteral access sheath following a ureteroscopic procedure, placement of an internal ureteral stent can be simplified by inserting the stent through the sheath without the need to reinsert the cystoscope. MATERIALS AND METHODS: An indwelling ureteral stent with the pull string attached is inserted over the guide wire into the access sheath followed by the pusher. The guide wire is partially withdrawn allowing the stent to form a coil in the renal pelvis, using the pull string to adjust the stent position. The fluoroscopy unit is then focused onto the bladder and the guide wire is slowly withdrawn until its tip is at the level of pubic symphysis. The pusher and guide wire are then removed and the pull string is cut at the urethral meatus. RESULTS: Among 71 cases studied 60 required ureteral stent placement. In 43 of the 60 cases (72%) the ureteral access sheath greatly facilitated ureteroscopy, and a stent was placed through the access sheath in 34 (79%). Stent placement through the access sheath was successful in all cases, with an average time saving of 2.3 minutes per case, compared to placing the stent by reinserting a cystoscope. CONCLUSIONS: If an access sheath has already been placed during a ureteroscopic procedure and stent insertion is deemed necessary, the stent can be easily placed through the access sheath under fluoroscopic guidance without the need to reinsert the cystoscope. Our experience suggests that all urologists who routinely perform ureteroscopic procedures can easily master this timesaving technique.

Anterior chest wall malignancies. A review of ten cases.

OBJECTIVES: To report the features of malignancies responsible for a chest wall mass and involving the sternum, the sternocostal and/or sternoclavicular joints, the chondrocostal junction and/or the adjacent soft tissues. METHODS: The medical records of patients with a chest wall mass due to malignant disease were reviewed retrospectively. The following data were abstracted from each record: characteristics of the pain and mass, constitutional symptoms, physical findings, laboratory test results, findings from imaging studies (plain radiographs, computed tomography and magnetic resonance imaging of the chest, radionuclide bone scan), histologic features of the biopsy specimen from the chest wall mass and origin of the mass. RESULTS: Seven men and three women with a mean age of 53.1 years were included in the study. A single patient had a history of malignant disease (lymphoma); in the remaining nine patients the chest wall mass was the first manifestation of the malignancy. All ten patients had pain with a mixed time pattern. The mass was located on the sternum in half the patients and in a parasternal location in the other half. Erythrocyte sedimentation rate elevation was found in seven patients, an increased serum level of lactate dehydrogenase in one and a monoclonal immunoglobulin in three. Sternal lesions were visible on plain radiographs in four patients. Computed tomography of the chest consistently disclosed sternal or sternocostal lytic lesions with spread to the adjacent soft tissues; in five cases, enlarged lymph nodes were visible in the anterior part of the mediastinum. Magnetic resonance imaging of the chest did not add to the information provided by computed tomography. Radionuclide uptake on the bone scan was increased, decreased, or normal at the site of the lesion. The cause was Hodgkin's disease in two cases, non-Hodgkin's lymphoma in three, metastatic bone disease in two (from an adenocarcinoma of the lung and a hepatocarcinoma, respectively), multiple myeloma in one, and solitary plasmacytoma in two. CONCLUSION: A chest wall mass can be caused by a known or as yet undiagnosed malignancy. Chest wall involvement due to malignant disease in rare, however. The specific features of sternal metastases, lymphomas involving the sternum, and sternal plasmacytomas are discussed. Nonmalignant chest wall lesions that can manifest as a bulging or swelling of the chest wall are reviewed.

[Influence of vancomycin by venous route on salivary and fecal aerobic floras]. / Influence de la vancomycine par voie veineuse sur les flores aérobies salivaires et fécales.

An IV vancomycin treatment induces a reduction of Gram positive cocci (Staphylococcus, Enterococcus) of the aerobic salivary and fecal flora. Some of these strains persisted during and after treatment, but remained susceptible to vancomycin. Others isolated Gram positive cocci were resistant to vancomycin before and after treatment. They were identified as Pediococcus sp., and Leuconostoc sp. There is a reduction of the number of Gram positive cocci, without increase of Gram negative rods, Lactobacillus, or Candida which are always resistant to vancomycin.

HLA-DRB1 alleles and shared amino acid sequences in disease susceptibility and severity in patients from eastern France with rheumatoid arthritis.

OBJECTIVE: To examine the effects of HLA-DRB1 alleles and amino acid sequences that carry the shared epitope (SE) upon rheumatoid arthritis (RA) susceptibility and disease severity in patients from Eastern France. METHODS: HLA-DRB1 alleles were determined in 120 patients and 104 healthy controls by polymerase chain reaction/sequence specific oligonucleotide probes. Subtyping of DRB1*01 and *04 were performed using sequence specific primers. Patients were retrospectively evaluated for disease duration, age at disease onset, presence of rheumatoid factors, subcutaneous nodules, vasculitis and other extraarticular diseases, for the need for arthroplasty and immunosuppressive/immunoregulatory agents, and for radiographic damage. RESULTS: The prevalence of HLA-DRB1*04 was significantly higher in patients (46.6%) than in controls (17.3%) (Pcorr = 0.000003). HLA-DRB1*0101 and *0401 were the most prominently associated subtypes in patients with RA (33.3%, Pcorr = 0.011, and 28.3%, Pcorr = 0.00008, respectively). A significant fraction of patients (72.5%) expressed one or 2 copies of the SE (p < 0.0000001; OR 4.77, CI 2.61-8.78). The presence of double SE was associated with a higher risk of developing RA (OR 4.83, CI 1.91-12.71; p = 0.0001). No significant differences in the clinical records among patients expressing no RA linked alleles, one and 2 copies of the SE, were observed. However, analyzing the specific effect of each amino acid sequence, we observed a significant association of the QKRAA motif with vasculitis (p = 0.03) and history of joint replacement surgery (p = 0.05), suggesting a role for lysine in position 71 of the shared sequence. CONCLUSION: These findings differ from those of previous HLA-DRB1 allele studies in patients with RA from other regions of France. Thus, the heterogeneity in both the expression of DRB1 alleles and the association of these alleles with disease severity could be relevant within a country such as France.