Ecotoxicological characterisation of sediments from stormwater retention basins.

Retention-detention basins are important structures for managing stormwater. However, their long-term operation raises the problem of managing the sediments they accumulate. Potential uses for such sediments have been envisaged, but each sediment must be characterised beforehand to verify its harmlessness. In this paper we address this issue through the development of a battery of bioassays specifically adapted to such sediments. We tested the method on samples taken from four retention basins in the region of Lyon (France). This battery focuses on the toxic effects linked to both the solid phase (ostracod and Microtox(®) solid-phase tests) and the liquid-phase (interstitial water) of sediments (rotifer and Microtox(®) liquid-phase tests). The results obtained permit the sorting of sediments presenting little toxicity, and which could therefore be potentially exploitable, from those from more polluted areas presenting higher toxicity that limits their use.

Selection of a halophytic plant for assessing the phytotoxicity of dredged seaport sediment stored on land.

The filling of dry quarries in coastal areas with sediments dredged in seaports represents a potentially interesting method of recycling of these materials. However, this recycling requires the prior carrying out of an Environmental Risk Assessment of the scenario concerned. For this, the question arose as to the type of plants capable of developing on the surface of such a deposit and the method to implement for assessing the possible phytotoxicity of dredged sediments. To answer this question, we chose to work with halophytic plants to be free from the salt-related effect and to assess only the effect related to the toxic compounds present. Based on the objectives set, these works led to the use of common plants of the French coast, with direct seeding, and with pollution-sensitive plants. Three species of angiosperms, Armeria maritima, Anthemis maritima and Plantago coronopus, were finally tested. As a result of this work, Armeria maritima was retained as the most suitable plant for testing the possible phytotoxic effect of dredged marine sediments stored on land. The results obtained with this plant are as follows: germination of 40 % of the seeds in 31 days, produced biomass of 493 mg FW in 6 months and a capacity to bioaccumulate metal pollutants in roots with 350 and 720 mg/kg DW for Zn and Cu, respectively.

Implementation of real-time identification analysis and quantification of chemotherapies preparations with a Multispec(®) analyser.

Post-production analytic control of chemotherapies preparations remains a challenge for hospital pharmacists. Indeed, to be feasible, this control needs to be reliable, fast and easy to implement and to use on real life. This is particularly true for teams not familiar with analytic methods. The Multispec(®) analyser has been specially manufactured for that purpose. After several years of daily use, we wanted to focus on its implementation, abilities and defects that should be corrected on the next analyser. Upon 24 months, 23,350 samples have been analysed. Four percent have been rejected on the first analysis, and finally only 0.37% with another sample after homogenization. Eighty-six preparations have been done another time for non-conformity purpose. Difficulties of implementation were in particular on anthracyclins, oxazophosphorins and monoclonal antibodies. However, compared to liquid chromatography for example, the ultraviolet and infrared combination allows a large number of drugs to be recognized and quantified fastly. As a conclusion this analyser is quite helpful and gives a serious alternative to post-production analytic control for chemotherapies preparations. Some points should however be improved, probably on the next analyser, for instance the sample volume necessary for analysis.

Assessment of the phytotoxicity of seaport sediments in the framework of a quarry-deposit scenario: germination tests of sediments aged artificially by column leaching.

The aim of the Sustainable Management of Sediments Dredged in Seaports (SEDIGEST) project is to assess the risks of treated port sediments for terrestrial ecosystems when deposited in quarries. We simulated the "ageing" of these sediments up to the "moment" when plants can germinate. Sediments were leached by water percolating through a laboratory column. Sediments 1 and 2, taken from the port of Toulon (France), were dried and aired. Sediment 3, taken from the port of Guilvinec (France), was stabilised with lime. Phytotoxicity was evaluated on the three artificially aged sediments using germination and early development tests (48 h to 7 days) by Phytotoxkit F(TM) bioassays. The three dilutions tested were performed with the reference "ISO substrate" and with Lolium perenne sp. (rye grass), Sinapis alba (white mustard), and Lepidium sativum (watercress). The tests performed with sediments 1 and 2 showed (1) a decrease of their toxicity to the germination of the species selected following leaching and (2) that L. perenne was the most sensitive species. The tests performed with sediment 3 showed that it was improper for colonisation even after leaching simulating 16 months of ageing. These germination tests on aged sediments identified the effects of leaching and made it possible to appreciate the capacity of the sediments to allow colonisation by plants.

Surgery versus conservative care for Rathke's cleft cyst.

BACKGROUND: Rathke's cleft cysts are benign cystic lesions of the sellar region, which may cause headache, pituitary deficiencies and visual disturbances from mass effect. Their management is not standardized yet. This study is about establishing a consensus for medical care of RCC. MATERIAL AND METHODS: We performed a retrospective observational study of all patients that were diagnosed or followed for RCC between 2008 and 2018 (11 years), in the neurosurgical and the adult endocrine departments of our institution. The study's average time length of follow-up is 72.9 months (from 2 to 385 months). RESULTS: The 57 included patients were divided into 2 groups: group A, which included 39 patients that were conservatively managed and group B, which included 18 surgically treated patients. Group A showed either an improvement or a spontaneous resolution of headaches in 56.1% of the cases (P<0.01); a resolution of hyperprolactinemia in 70% of the cases (P=0.21); and of hypogonadism, ACTH deficiency, growth hormone deficiency in 100% of the cases. There was no spontaneous improvement of visual disturbances (P<0.01) or diabetes insipidus (P=0.29) during follow-up. Regarding group B, surgery allowed improvement or complete resolution of headaches in 60% of the cases; visual troubles in 100% of the cases (P<0.01); and hyperprolactinemia in 100% of the cases. Pituitary deficiencies were not improved by surgery. CONCLUSIONS: This study offers guidance in decision-making regarding the management of RCC patients. Surgery is particularly suitable for treating visual disturbances caused by RCC. Regular follow-up is more appropriate than surgery concerning headaches, hyperprolactinemia, endocrine disruptions and diabetes insipidus.

[Radiofrequency ablation for palliation of soft tissue tumor pain]. / La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles.

PURPOSE: To assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain. MATERIALS AND METHODS: Retrospective study of 12 patients receiving palliative treatment for soft tissue tumors (5 primary tumors including 4 sarcomas and 1 PEComa and 7 metastatic tumors) with pain refractory to standard management. RF ablation was performed under CT or ultrasound guidance. RESULTS: The efficacy was determined by using pain scores and treatment regimen modifications after RF ablation. Response was graded as absent, partial or complete. Short term symptomatic relief was observed in 100% of cases, with complete response in 43% of cases ; Mid term and long term symptomatic relief was observed in 70% and 83% of cases respectively. We also observed dosage reduction for narcotics with corresponding reduction in related side-effects and functional improvement in some patients. A single case of complication with serosanguinous collection within a region of necrosis was observed. CONCLUSION: Radiofrequency ablation for palliation of soft tissue tumor pain may be a useful complement to standard management. It results in symptomatic improvement with few complications.

[Reliable real-time analytical control of monoclonal antibodies chemotherapies preparations on Multispec automaton]. / Contrôle rapide et fiable des préparations de chimiothérapies à base d'anticorps monoclonaux à l'aide de l'automate Multispec.

The aim of our study was the implementation of a systematic control for preparations based upon monoclonal antibodies. Multispec automaton combines ultraviolet (UV) with infrared spectroscopy. Validation of the analytical method was carried out, in terms of qualitative results (with a correct recognition) and quantitative ones. Our first tests tend to show that Multispec automaton is not reliable enough to manage every antibody currently sold on the French market because of a weak correct recognition percentage (around 35 %). When taking into consideration only its own spectra, the improvement is low (50 % recognition). Only a new spectral library with restricted zones in the infrared domain and furthermore with another correlation calculation mode will be able to produce fast and reliable results. In our final library, spectral recognition is correct for 100 % of samples. Quantification achieved thanks to UV is correct in terms of exactness and precision, respectively 6.0 and 8.1 %. To date, we have settled this routine control for every monoclonal antibody available in our institution used in chemotherapies regimens (alemtuzumab, bevacizumab, cetuximab, gemtuzumab ozogamycin, panitumumab, rituximab and trastuzumab). The reliability of our antibody-specific library was demonstrated, likewise the original library for classical chemotherapies.

Management of massive small bowel bleeding: A case of multidisciplinary approach with mini-invasive surgery.

A 78-year-old patient had a massive small bowel bleeding on CT scan. A multidisciplinary approach was purposed, with a super-selective tracking with methylene blue, haemostatic control with embolization, followed by laparoscopy. Evolution was favorable, there was no recurrence.

Daily physicochemical, microbiological and ecotoxicological fluctuations of a hospital effluent according to technical and care activities.

The problem of hospital effluents falls into the framework of hazardous substances due to the specific substances used and discharged for the most part into urban drainage networks without prior treatment. This in-depth study has led to greater understanding of the effluents discharged by hospitals. The experimental program implemented consisted in carrying out parallel sampling of the effluents of one hospital: a 24 h-average sample and 5 periodic samples corresponding to fractions of times and hospital activities. The samples were characterized by physicochemical, microbiological and ecotoxicological analyses. The results highlight that the effluents contained very little bacterial flora and a moderate organic pollution. However, a numerous of specific pollutants were detected: AOX, glutaraldehyde, free chlorine, detergents, Freon 113 as well as alcohols, acetone, formaldehyde, acetaldehyde, ammonium, phenols and several metals. The battery of bioassays showed that the effluents had a high level of ecotoxicity partly linked to particles in suspension and, that pollution fluctuated greatly during the day in connection with hospital activities. Finally, the PNEC values compared to the concentrations of pollutants dosed in the effluents highlighted that their toxicity was mainly due to several major pollutants, in particular free chlorine. Some hypotheses require additional experiments to be carried out. They concern: reactions of fermentations likely to occur in the drainage network and to form secondary toxic compounds, retention of chlorine by particles and physicochemical characterization of suspended solids.

Bioavailability and bioaccumulation of heavy metals of several soils and sediments (from industrialized urban areas) for Eisenia fetida.

Soils and sediments are susceptible to anthropogenic contamination with Metallic Trace Elements (MTEs) and it can present some risks to ecosystems and human health. The levels of Cd, Cu, Fe, Ni, Pb and Zn were assessed in soils (C, G, K, L) from Estarreja (Portugal) and sediments from a stormwater basin in Lyon (DJG), a harbour (LDB) and a Rhône river site (TRS) (France). An ecotoxicological study was performed with Eisenia fetida (E. fetida) to infer about potential transfer risks to the soil invertebrates. To assess risks associated with MTEs contamination, it is important to know their total concentrations, fractionation and the potential available fractions. CaCl2, DTPA and NaOAc extractions were performed to assess the extractable and available MTEs fractions. The studied sediments were much more contaminated than the soils for all the MTEs analysed. The trace elements fraction linked with DTPA extraction shows higher values when compared with the NaOAc and the CaCl2 pools. Low mortality effects were recorded in the tests with E. fetida. The MTEs levels in soils and sediments and the concentrations bioaccumulated in adult earthworms contributed to a reduction in the number of juveniles produced. E. fetida adults and juveniles accumulated ETMs as follows: Cd > Cu = Zn > Ni > Pb > Fe. Determined BAFs were mostly lower than 1 with some higher values for Cd, Cu and Zn. Calculated SET and ERITME indexes allowed to classify the samples from the most to the less toxic for E. fetida as: LDB > DJG > L > G > C > K > TRS. Despite this order of toxicity, the earthworms exposed to the sediment TRS presented the lowest reproduction rate. The combination of "chemical" measurements with the calculation of BAFs, but especially SET and ERITME indexes can be a useful tool in risk assessment.

Dynamics of toxicity within different compartments of a peri-urban river subject to combined sewer overflow discharges.

Combined Sewer Overflows (CSO) in small peri-urban streams and rivers are potentially toxic for their biocenosis. Improving the management of CSO discharges requires better knowledge of their dynamics and toxicity. In view to characterizing this toxicity, we sampled the different compartments (benthic and hyporheic zone) of a peri-urban stream located near the city of Lyon in France. The samples were taken at different distances from a CSO and at three period characteristic of different hydrological conditions. Their toxic effects were assessed by bioassays on the dissolved fraction (D. magna, V. fisheri and B. calyciflorus bioassays) and on the particle fraction (V. fisheri and H. incongruens bioassays). The results highlighted significant toxicity of the particulate fraction for the benthic and hyporheic samples, in particular downstream of the CSO, but with high spatio-temporal variability. This variability can first be attributed to the variability of CSO discharge sampling as a function of season and rainfall, and the dynamics of polluted particles (trapping of transported particles in infiltration zones, mobilization during floods). These parameters play a fundamental role in the distribution of pollutants according to the geomorphology of stream facies. Regarding dissolved pollutants, the chemical exchanges taking place at the "water-sediment" interface trigger the transfer of pollutants from one phase to another, after which the dispersion of these pollutants is governed by hydraulic flows. Finally, critical zones and periods are identified for the peri-urban river toxicity studied: benthic sediments under mean flow downstream; hyporheic sediments after a storm event downstream, close to the CSO. Recommendations are made on the basis of the knowledge obtained to optimize the management of these discharges.

Safety and efficacy of ritonavir and saquinavir in combination with zidovudine and lamivudine.

BACKGROUND: Ritonavir is a potent inhibitor of cytochrome P4503A4 that strongly increases saquinavir bioavailability. In this study we assessed the safety and antiretroviral efficacy of the combination of these two compounds in patients pretreated and receiving continued treatment with zidovudine and lamivudine who were protease inhibitor naive and who had a CD4 cell counts below 200/mm3. METHODS: In this 48-week pilot study, all patients received 600 mg ritonavir and 400 mg saquinavir twice daily. Administration of zidovudine and lamivudine was continued without a change in previous doses. Viral load, CD4 cell count, and the emergence of resistance to the two protease inhibitors were evaluated repeatedly up to week 48. RESULTS: Sixteen patients were included in the study. Previous nucleoside analog treatment duration was 48+/-22 months (mean +/- SD). Two patients quit taking both protease inhibitors within 2 weeks. The ritonavir dose had to be reduced in 10 other patients because of side effects. Between inclusion and week 48, plasma viremia varied from 4.87+/-0.43 to 3.00+/-1.29 log10 copies/mL and CD4 cell counts ranged from 98+/-61 to 250+/-139/mm3. Ten patients (63%) had viral loads below 200 copies/mL and 7 (44%) had viral loads below 50 copies/mL. A single key mutation that conferred ritonavir resistance I84V and V82A/V developed in two patients. A mutation at codon 54 developed in another patient. These mutations were associated with repeated cessations of antiretroviral treatment. No lipodystrophy was observed. CONCLUSION: Ritonavir and saquinavir in combination are quite well tolerated and induce a high and sustained antiretroviral efficacy. A four-drug combination that includes these two protease inhibitors should be considered as a first line of treatment in patients with low CD4 cell counts.

Genetic studies of phenotypic revertants of the vestigial mutant in Drosophila melanogaster, induced by bromouridine and ethyl methanesulfonate.

Phenotypic revertants of the vestigial mutant in Drosophila melanogaster were induced by ethyl methanesulfonate and bromouridine. Genetic analysis showed that the revertant phenotype was due to suppressor genes in most cases. 3 suppressor genes were located. A mechanism of action of the genes on the vestigial phenotype is postulated.

[Agenesis of the right lobe of the liver and portal hypertension]. / Agénésie du lobe droit du foie et hypertension portale.

A case of agenesis of the right lobe of the liver associated with portal hypertension is reported. This uncommon feature was diagnosed by computed tomography which excluded secondary liver atrophy due to cirrhosis or tumour. The main pathophysiological hypothesis for agenesis and portal hypertension, exceptionally associated, is arrest of hepatic development during foetal life.

[Epidemiological study of patients and suicidal patients admitted to a psychiatric emergency department of a general hospital]. / Etude épidémiologique des patients et suicidants admis aux urgences psychiatriques d'un hôpital général.

The present study involves a review of all patients who visited the Emergency Psychiatric Service during the period from December, 6, 1993 to June, 5, 1994. A questionnaire was proposed to 1073 subjects (57.2% females; 42.8% males; mean age = 36.6). Demographic data, familial and personal characteristics, previous contacts with professional health services, and diagnosis (DSM III R criteria) were collected. 52% of them were self-attempters, younger than the general population and more frequently females (61.5%). The parasuicides were more frequent in their families and in their personal past history. The previous contacts with health services (hospitalizations, consultations) were more frequent among patients who were admitted for psychological and/or psychiatric problems. 54% of self-attempters were repeating suicidal patients. There were more depressive disorders, parasuicides and drug/alcohol abuse in their families. A logistic regression analysis (stepwise) revealed the role of these factors in the repetition of parasuicides. This study supports the significance of a better knowledge of the potential significant factors for parasuicide. Preventive measures are necessary.

[Case of cortical deafness sparing the music area]. / Un cas de surdité corticale épargnant en partie la musique.

A 33-year-old woman had developed cortical deafness with profound initial deafness lasting for eleven months after pneumococcal meningitis ten years previously. CT scan demonstrated bilateral temporal lobe lesions, predominantly on the left side where it extended into the adjacent parietal and frontal lobes. Audiometry suggested integrity of the internal ear and brain stem. Early auditory evoked potentials were present, while potentials of moderate latency and delayed potentials were abolished. Neuropsychological investigations demonstrated total absence of spoken language, contrasting with conservation of written language, though with agrammatism and an impossibility of identifying non-verbal noises, spoken language, and music. The patient could not identify rhythms, pitch, melodies or the different types of music. The musical quality of sound stimuli and musical pleasure were, however spared as shown by recognition of tape recorded sound stimuli with written denomination and designation of images in multiple choice tests. The relations between auditory agnosia, "pure" verbal deafness and cortical deafness are discussed. Reported cases are reviewed and an attempt is made to demonstrate the existence of several levels in the integration of musical stimuli, the most elementary of which could be the perception of the musical quality of sounds, as was the case in the present patient.

[Granular cell tumor of a cerebral hemisphere: value of gliofibrillary protein acid assay]. / Tumeur à cellules granuleuses d'un hémisphère cérébral: intérêt de la recherche de la protéine acide gliofibrillaire.

A patient with a left parieto-occipital tumor presented generalized convulsions, and aphasia with alexia and agraphia. Diagnosis was confirmed by CT scan. Partial excision only was possible and was followed by radiotherapy. Histology showed the tumor to be composed of moderate and large sized cells with a granular PAS+ cytoplasm. Protoplasmic astrocytes were numerous at the periphery. Electron microscopy demonstrated typical features of Abrikossof's granular cell tumor: heterogeneous granulations constituted mainly of secondary lysosomes, autophagic vacuoles, multivesicular bodies, and rare angular bodies. The granular cells were interspersed with astrocytes, the feet of which were implanted on the capillary basal membrane. Immunoperoxidases assay of gliofibrillary protein acid demonstrated high levels in the intercellular prolongations, considered here to be astrocytic, but weak concentrations in the granular cells. This suggests uptake by the latter cells of adjacent astrocytic gliofibrillary protein acid, especially as the action of an anti-albumin serum on the tumor demonstrated that the granular cells can take up extracellular proteins by a passive mechanism. These findings stand against an astrocytic origin of the tumor. Comparison with other granular cell tumors, particularly pituicytomas, provides evidence of morphological unity, but cerebral granular cell tumors are rich in astrocytes, whereas these are absent in pituicytomas. The oncogenic unity of these tumors has not been established.

[Adult-onset Still's disease after hepatitis A and B vaccination?]. / Maladie de Still de l'adulte après vaccination contre l'hépatite A et B?

BACKGROUND: Hepatitis A and B vaccination are generally very well tolerated. However, exceptional cases of arthritis and systemic diseases have been reported after hepatitis B vaccination. CASE REPORT: The authors report a case of adult Still's disease apparently triggered by hepatitis A and B vaccination. The patient was a 38-year-old woman who presented with fever, hepatitis, pneumonitis and neurologic symptoms, compatible with the diagnosis of adult Still's disease. DISCUSSION: The authors discuss the rarity of systemic diseases triggered by such vaccination, the link between hepatitis B virus and some vasculitis, and the possibility for viral bacterial infections to trigger adult Still's disease.

[Infectious endocarditis on native valves. Report of a series of 142 surgically treated cases]. / L'endocardite infectieuse sur valves natives. A propos d'une série de 142 cas opérés.

The results obtained in a series of 142 patients operated upon, between December 1978 and December 1987, for infective endocarditis on native valve are reported. 61 patients (group 1) had acute progressive endocarditis and 81 patients (group 2) had subacute old-standing endocarditis. In group 1 patients, hospital mortality (i.e. occurring during the first 30 post-operative days) was 11.5 p. 100. During a mean follow-up period of 37.6 months (1.5 to 104.5 months), the survival rates were 52 p. 100 at 72 months and 37.4 p. 100 at 104.5 months. Mechanical desinsertion without persistence or relapse of the infective process, and recurrent endocarditis accounted for 27.8 p. 100 of deaths of known cause. Prognosis was better in group 2 patients. Hospital mortality was 4.9 p. 100, and during a mean follow-up period of 58 months (2 to 124 months) the survival rates were 84 p. 100 at 72 months and 73.4 p. 100 at 124 months. 60 p. 100 of late deaths of known cause were due to heart failure. In native valve infective endocarditis the post-operative diagnosis depends upon the pre-operative haemodynamic status, and the assessment of this status (notably with echocardiography) is a crucial element in the decision to operate.

[Selective arteriography of the supra-aortic trunks by right humeral approach with a 4F catheter]. / Artériographie sélective des troncs supra-aortiques par voie humérale droite avec un cathéter 4F.

Three hundred and sixty seven patients were studied for cerebrovascular disease with intra-arterial digital subtraction. Examination were performed using a right transbrachial approach with a 4F catheter. Selective catheterization of the carotid arteries was possible in 98% for the left and 99% for the right. Image quality was consistently good or excellent. There was 2 neurologic complications and 1 local complication (hematoma) requiring surgery few weeks later. Selective carotid and vertebral catheterizations by the brachial route is safe, simple, accurate and rapid (15 mn) and can be employed in outpatients.