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Résumé Le traitement des cancers du rectum repose sur une prise en charge pluridisciplinaire et le plus souvent sur une approche multimodale comprenant la gastro-entérologie, l’oncologie médicale, l’oncologie–radiothérapie et la chirurgie. Les différents objectifs qui doivent être discriminés dépendent des caractéristiques de la tumeur. Le défi de la prise en charge des petites tumeurs repose sur la conservation d’un sphincter fonctionnel sans risque de récidive locale. Le traitement standard des maladies localement évoluées vise, par ordre de priorité, à guérir le malade en minimisant les séquelles tardives de la prise en charge. Chacune de ces situations cliniques se trouve désormais démembrée grâce aux progrès de la chirurgie et d’une approche personnalisée au patient à la caractéristique clinique de la maladie. Elles sont désormais l’objet d’études thérapeutiques spécifiques. The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials. [ABSTRACT FROM AUTHOR]

Résumé: Le neurocytome central est une tumeur rare et de pronostic favorable du système nerveux central touchant l’adulte jeune. Des formes typiques et atypiques ont été décrites selon des critères histopathologiques et immunohistochimiques. Le neurocytome central se développe dans les régions périventriculaires et est classiquement révélé par des signes d’hypertension intracrânienne. La tumeur présente des caractéristiques typiques en scanographie et IRM, avec un pic caractéristique de glycine en spectro-IRM. Le traitement de référence est l’exérèse macroscopiquement complète, possible dans la moitié des cas. La radiothérapie externe améliore le taux de contrôle local des neurocytomes centraux atypiques et/ou incomplètement réséqués. La place de la radiothérapie en conditions stéréotaxiques peut être discutée : comme un traitement exclusif, en cas de résidu postopératoire, ou en cas de récidive. La chimiothérapie reste un traitement de dernière ligne dans les formes récidivantes après chirurgie et/ou radiothérapie et dans les formes disséminées neuroméningées et/ou extracrâniennes et les récidives. [Copyright &y& Elsevier]

Résumé: Les lymphomes NK/T sont rares en Europe et aux États-Unis mais relativement fréquents en Asie et en Amérique du Sud. Ils se présentent cliniquement comme des lésions destructrices des voies aérodigestives supérieures, préférentiellement localisées au niveau des fosses nasales, avec une atteinte possible des structures avoisinantes. Le diagnostic positif repose sur une analyse histologique, immunophénotypique et la mise en évidence du virus d’Eptein-Barr. Les modalités de traitement de ces lymphomes restent encore discutées de part le peu d’études dont nous disposons et la rareté de cette pathologie. La radiothérapie permet d’obtenir un contrôle rapide de la maladie et se place comme un traitement majeur des lymphomes NK/T localisés des fosses nasales. Elle délivre une dose 50Gy dans de larges volumes en association à une chimiothérapie à base de l-asparaginase. Nous présentons donc la place de la radiothérapie dans les formes localisées de lymphome NK/T des fosses nasales. [ABSTRACT FROM AUTHOR]

Pendant la période coloniale britannique, le système de gouvernement de Hong Kong était généralement décrit comme un systéme oü le pouvoir exécutif était dominant. Lors de Pélaboration du systéme politique postcolonial de Hong Kong au cours des an-nées 1980, les dirigeants chinois ont décidé de maintenir cette prépondérance de l'exécutif. Toutefois, malgré une vaste gamme de pouvoirs constitutionnels conférés au Chef de l'exécutif par la Loi Fundaméntale et malgré Installation d'une majorité pro-gouvernementale au Conseil législatif (LegCo), à la différence de son prédécesseur colonial, le gouvernement de la Région administrative spé-ciale (RAS) peine á conserver sa position dominante vis-á-vis du pouvoir législatíf dans Pélaboration des politiques. Cet article attribue le dysfonctionnement de ce système aux réticences de Pékin à voir se développer à Hong Kong un mode de gouvernement fondé sur les partis politiques. En marginalisant les partis politiques dans l'organisation des institutions et dans le processus d'élaboration des politiques du gouvernement de la RAS, le pouvoir exécutif s'est déconnecté du pouvoir législatif depuis 1997. De ce fait, la coalition entre un Chef de l'exécutif ne pouvant appartenir á aucun partí et les partis pro-gouvernementaux demeure fragüe. Afin de sortir Hong Kong du bourbier politique actuel, le développement d'un mode de gouvernement qui impliquerait les partis politiques est un enjeu central que le gouvernement chinois et la RAS doivent prendre en considération. [ABSTRACT FROM AUTHOR]

Abstract: The replacement of “patronymic” by “name”, in January 2005, is the result of a long process, which since the late 19th century, has gradually abolished the privileges reserved for the paternal function. It is interesting to note that, during this process, the most important laws that confirmed the division of parental responsibilities between spouses of a couple were enacted in the 1970s, at a time when, following the generalization of the contraceptive pill, other laws both granted young teens free access to condoms, and young women permission to voluntarily interrupt pregnancy. Equality of man and woman in marriage as well as the separation of procreation and sexuality were thus jointly ratified, allowing the question to arise: is there a link between change in paternity and change of sex? A comparison of patri- and matrilineal kinship systems studied by anthropologists tend to show that procreation and sexuality are indeed separated when the representative of the law of the filiation group (role of the maternal uncle) and the representative of the law of exchanges (role of the father) are different. This change of law was no stranger to a change in pedagogy, which from the beginning of the 1980s gave birth to support groups open to parents in educational associations. Integrating children into society was no longer just a question of relying on the group but also on networks of exchange. [Copyright &y& Elsevier]

Abstract: “Growing pains” are a frequent problem in paediatric practice. Over the last years, their diagnostic and therapeutic approaches have changed. Other syndromes than those well-known by paediatricians are to be taken in consideration. Current treatment consists in reassurance of children and their family reactivation of patients (which means to take up a normal physical activity) and treatment of painful crisis as well as complementary therapies. [Copyright &y& Elsevier]

The aim of this study was to determine the prevalence of respiratory symptoms, pulmonary function abnormality and allergic sensitization among grocers in Casablanca. This retrospective cross-sectional epidemiological inquiry among a cohort of 100 grocers and 100 control subjects who were not grocers included an analysis of working conditions and a medical workup (questionnaire, medical examination, spirometry and skin prick testing). Atopy was found in 22% of the grocers, in 18% of the controls. Sixty-seven percent of the grocers reported clinical respiratory symptoms compared to only 24% of the controls. Cough, expectoration, dyspnea, rhinitis, conjunctivitis, symptoms suggestive of asthma and chronic bronchitis were significantly more frequent in the grocers. Pulmonary function tests were abnormal in 39% of the grocers, more so in those who had worked longest. Skin tests were positive to at least one allergen in 53% of the grocers and in 22% of the controls. Sensitivity to common inhalant allergens was found in 6% of the grocers and 12% of the controls. Sensitivity to occupational allergens (such as storage mites, molds and cereal allergens) was 31% among the grocers and 4% among the controls. Among the grocers, 7% were sensitive to spices, 5% to coffee, 5% to tea, and 14% to wheat and rye flour. It is imperative to implement medical and technical prevention measures to reduce the risks related to these allergies. [Copyright &y& Elsevier]

Clarification and dehydration are two important operations in the palm fruit processing technology. Inefficient clarification and a poor dehydration can lead to significant losses of palm oil and damage of organoleptic and nutritive qualities. In Benin, palm oil processors use artisanal and semi-artisanal boilers, dehydrators, and clarifier-dehydrators. The aim of this study is to evaluate the technical performances of these equipments. The results showed that the artisanal, semi-artisanal boilers and clarifierdehydrators had a hourly throughput respectively of 23.33 kg/h; 216.66 and 327 kg/h with palm variety Tenera. The moisture contain of the palm oil obtained with these equipments were respectively 1.20%; 1.05 and 1.3%. The clarification yields were respectively 92.9%; 82.4% and 79.8%. The artisanal, semiartisanal dehydrator and clarifier-dehydrator reduced the moisture content of the boiled oil by nearly 3 to 4 times. However, the threshold of 0.1%, adopted for international standard offering good conservation of oil, was not reached in the majority of cases. To achieve this, the oil should be heated to a temperature of 128 °C. [ABSTRACT FROM AUTHOR]

In recent decades, human activities, particularly agriculture, have led to the gradual transformation of a very large part of the earth's surface. In the Mali cotton zone, this human pressure is relatively high due to an increase in cotton and livestock over the past three decades. In addition to the digital processing of satellite images, the methodology was based on calculations of landscape metrics using the Fragstats software for the quantification of the structure at the scale of the task, and this within the same category of tasks and at the global scale of the landscape. At the level of occupancy classes, heterogeneity is observed mainly related to the increase of the proportion of landscape occupied by the agricultural zone which passed in 30 years from 21.92% to 36.57% to the detriment of the wooded savannah which lost 21.57% of its surface. In terms of landscape dynamics, the introduction of cotton cultivation in this area in the 1990s contributed significantly to an increase of more than 260 km² in the cultivated area. [ABSTRACT FROM AUTHOR]

Introduction et but de l’étude: Les personnes âgées qui se fracturent l’extrémité proximale du fémur dans des conditions banales (chute de leur hauteur), souffrent de sous–alimentation dans près de 80 % des cas. Cette sous-alimentation, par manque d’apports, est surtout protéoénergétique. Plus de la moitié des personnes âgées qui se fracturent vivent chez elles, à domicile, les autres en institutions. La sous–alimentation précède la chute et la fracture de l’os fragilisé. Nous proposons de retenir la fracture de l’extrémité proximale du fémur comme un indicateur de fragilité, de précarité et de carences nutritionnelles des personnes âgées. Pour intervenir auprès des personnes âgées dans nos communautés, il faut déterminer les régions ou les zones socio-sanitaires où il y a le plus grand nombre de fracturés vivant à domicile, où il y a la plus grande incidence et où la moyenne d’âge des fracturés est la plus basse : c’est l’objectif d’un observatoire des fractures de hanche, en particulier quand nos moyens d’intervention sont limités. Un observatoire des fractures de hanche permet aussi de mesurer l’effet des interventions de promotion de la santé, de prévention et de prise en soin ; nous devons pouvoir mesurer les effets sur le nombre, sur l’incidence et sur l’âge moyen des patientes et des patients fracturés. L’observatoire genevois de la fracture de la hanche, initié en 2001, couvre maintenant une décennie de données rétrospectives. Matériel et méthodes: Récolte des 4 000 domiciles des personnes âgées victimes de fracture du col du fémur à Genève entre 1991 et 2000. Résultats: Les premiers résultats issus de l’observatoire mettent en évidence, pour les personnes résidant dans leur domicile privé, un risque accru de fracture de la hanche et un âge de survenu de la fracture plus précoce en ville par rapport à la campagne. En affinant ce résultat, nous avons identifié des quartiers à Genève où l’incidence est plus forte et la moyenne d’âge des fracturés plus basse par rapport à d’autres quartiers (ceci avec contrôle des effets d’âge et de sexe). Ces différences s’expliquent en partie par le revenu médian des quartiers. L’observatoire genevois de la fracture de la hanche apporte donc ici sa contribution selon laquelle le niveau social d’un quartier influence à Genève la santé de ses habitants. Les quartiers ainsi identifiés devraient pouvoir bénéficier en priorité d’actions préventives. Des cartes de la région ont été établies selon le sexe pour l’incidence et l’âge moyen au moment de la fracture. Conclusions: Nous souhaitons poursuivre ce projet en continuant le recueil de données épidémiologiques et en évaluant les effets, sur le risque de fracture et sur l’âge de survenue de la fracture, d’interventions de promotion nutritionnelle, de prévention et de prise en soin. [Copyright &y& Elsevier]

Abstract: During the last two decades, fluoroquinolone use has significantly increased in Europe and in the USA. This could be explained by the arrival of newer fluoroquinolones with antipneumoccal activity. Increased use of fluoroquinolones is associated with higher rates of bacterial resistance to these antibiotics. Resistance of Gram-negative bacilli to fluoroquinolones is increasing in industrialized countries. In addition, fluoroquinolone use has been identified as a risk factor for colonization and infection to methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumanni, extending-spectrum β-lactamase producing Gram negative bacilli, and multidrug-resistant bacteria. Nosocomial infections due to multidrug-resistant bacteria are associated with higher mortality and morbidity rates. This could be related to more frequent inappropriate initial antibiotic treatment in these patients. Limiting the use of fluoroquinolones, limiting the duration of treatment with fluoroquinolones, and using appropriate dosage of these antibiotics could be suggested to reduce resistance to these antibiotics and to reduce the emergence of multidrug-resistant bacteria. [Copyright &y& Elsevier]

Abstract: Acquired arterial pulmonary stenosis is rarely found in adults. Reviews and case reports suggest that tumours of the mediastinum (teratomatas and Hodgkin''s disease) are the most frequent culprits leading to compression of the main pulmonary artery. We present the case of a young patient with chest pain. Compression of the main and left pulmonary artery by an anterior mediastinal nonseminomatous germ cell tumors (GCTs) was diagnosed by transthoracic echocardiography and CT scan. [Copyright &y& Elsevier]

Abstract: The first corresponding table between CFTMEA and ICD-10 was established in 2007. But it was far from exhaustive and only concerned Axis I. The 2010 CFTMEA revision enables item-to-item transcoding and makes the two classifications compatible in daily practice. It also permits Axis II transcoding. Both somatic and environment associated factors, as listed in CFTMEA''s Axis II, are scattered throughout the twenty one ICD-10 chapters, which makes their identification difficult in practice. The simplicity of using Axis II avoids these factors being ignored or neglected by clinicians and makes it easier for researchers. [Copyright &y& Elsevier]

Abstract: Any person travelling in countries where yellow fever (YF) is endemic and without presenting contra-indication for the vaccination against YF may be vaccinated. This vaccination can very rarely induce a potentially lethal neurotropic or viscerotropic disease. In severely immunodeficient patients, the vaccination is contra-indicated because postvaccinal encephalitis may occur after the vaccination, due to vaccine strain pathogenecity. It is important to evaluate the general health status in elderly individuals before vaccinating because of the increased risk of viscerotropic disease in people of 60 years of age and over. Pregnant women should not be vaccinated, except if departure to an endemic zone is unavoidable. YF vaccination is contra-indicated for newborns under six months of age. Solid organ grafts, congenital immunodeficiency, leukemia, lymphoma, cancer, and immunosuppressive treatments are contra-indications for this vaccination. Nevertheless, YF immunization is possible after a bone marrow graft and a two-year period without graft-versus-host disease or immunosuppressive treatment. There is no data to support that immunization of the donor prior to the graft could confer protection against yellow fever to the recipient. Low doses, short courses of corticosteroids either as systemic treatment or intra-articular injections are not contra-indications for YF vaccination. Patients infected with HIV with stable clinical status and T CD4-cell count above 200 cells per millimetre cube may be vaccinated. Thymic diseases, including thymoma and thymectomy, are contra-indications for YF vaccination. Finally, a substantial residual level of antibodies beyond 10 years after the latest vaccination could confer protection, thus avoiding a new vaccination when it is an issue. [Copyright &y& Elsevier]

Abstract: The objective of this study was to evaluate the functionality of two intervertebral fusion implants, a porous nickel-titanium and a conventional titanium cage system in a sheep model. Eighteen sheep each received the two-implant devices at L2–L3 and L4–L5 lumbar levels. The sheep were sacrified at three different postsurgical periods: three, six and 12 months. Lumbar segments were harvested. Qualitative (macroscopic and microscopic) and quantitative (histomorphometric) histological analysis were carried out on histological slides. The results indicated that a porous nickel-titanium had obtained a better osseointegration than the titanium implant. The functionality of two implants seemed to be influenced by the implant structure and shape. However, biocompatibility of two implants seemed comparable. [Copyright &y& Elsevier]

Abstract: Case report of a patient with tonsillitis treated with anti-inflammatory. The patient presented a dyspnoea and finally a cardiac arrest. The oral intubation was impossible and cricothyrotomy had to be performed with a catheter over needle technique. We found a total airway obstruction due to an epiglottis abscess. The patient died few days later of sepsis. We recommend having wire-guided cricothyrotomy technique or catheter-over-needle technique in all prehospital emergency unit and having emergency physician trained to the cricothyrotomy technique. [Copyright &y& Elsevier]