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The concept of at risk mental state for psychosis has been developed in order to detect subjects who are supposed to be in the prodromal phase of psychosis disorder, in an attempt to modify the natural history of the disease. The aim of this thesis was to synthesize the work on this concept with a review of the literature. The concept of at-risk mental state for psychosis was developed from retrospective studies that identified prodromal symptoms. These symptoms were included in the "Ultra-High Risk state for Psychosis" criteria (UHR-P), which is said to describe a late period of the prodromal phase, defining attenuated psychotic symptoms syndrome (APSS), brief limited and intermittent psychotic symptoms (BLIPS), and genetic risk and deterioration syndrome (GRD). In parallel, the basic symptoms (BS), felt subjectively, describe a supposedly earlier period of the prodromal phase. About a third of these screened subjects will develop a psychotic disorder at more than 4 years. For the others, the symptoms may persist, but in about two-thirds of cases there is complete remission in the medium term. High-risk individuals have an increased prevalence of non-psychotic disorders. Several predictive factors of clinical, environmental, and paraclinical transition have been found in this population. This new paradigm has attempted to integrate DSM 5 with the diagnosis of attenuated psychotic syndrome (APS), which has been retained only in section III. Several criticisms come from the decline in transition rates, study methodology, transition threshold, and the concept of "high-risk". This concept tends to adjust, the development of individualized risk calculation tools seems particularly promising. Efforts should continue to lead to the identification and early treatment of subjects with psychotic vulnerability., Le concept d’état mental à risque de transition vers un trouble psychotique a été développé afin de dépister des sujets supposés être en phase prodromique, pour tenter de modifier l’histoire naturelle de la maladie. L’objectif de cette thèse était de synthétiser via une revue de la littérature les travaux portant sur ce concept. Le concept d’état mental à risque a été développé à partir d’études rétrospectives ayant identifié des symptômes prodromiques. Ces symptômes ont été intégrés dans les critères « Ultra-High Risk state for Psychosis » (UHR-P), censés décrire une phase tardive de la phase prodromique, définissant le syndrome des symptômes psychotiques atténués (APSS), l’épisode psychotique bref limité et intermittent (BLIPS), et les traits de vulnérabilité génétique associés à un déclin du fonctionnement psychosocial (GRD). En parallèle, les symptômes de base (BS), ressentis subjectivement, décrivent une phase prodromique supposée plus précoce. Environ un tiers de ces sujets dépistés vont développer un trouble psychotique à plus de 4 ans. Pour les autres, les symptômes peuvent persister, mais dans deux tiers des cas on observe une rémission complète à moyen terme. Les sujets à haut risque ont une prévalence accrue de troubles non psychotiques. Plusieurs facteurs prédictifs de transition cliniques, environnementaux, et paracliniques ont été retrouvés dans cette population. Ce nouveau paradigme a tenté d’intégrer le DSM 5 avec le diagnostic de syndrome psychotique atténué (APS), qui n’a été retenu que dans la section III. Plusieurs critiques proviennent du déclin des taux de transition, de la méthodologie des études, du seuil de transition, et du concept du « haut risque ». Ce concept tend à s’ajuster, le développement d’outils de calcul de risque individualisés semble particulièrement prometteur. Les efforts sont à poursuivre pour amener au repérage et au traitement précoce de sujets présentant une vulnérabilité psychotique.

FCBA et l'INRA ont engagé des recherches il y a maintenant près de 20 ans pour développer une méthode de multiplication végétative performante du pin maritime. Ses applications dans le programme d'amélioration génétique seraient multiples, depuis la gestion durable des ressources génétiques jusqu'à la sélection plus efficace des meilleures variétés et leur déploiement facilité dans les plantations. Suite aux développements pionniers chez l'épicéa auxquels FCBA a contribué (années 80, Afocel) et comme chez la plupart des autres conifères, c'est le processus d'embryogenèse somatique à partir de graines immatures couplé à la cryoconservation des embryons somatiques obtenus qui offre actuellement les meilleures perspectives pratiques. Des progrès importants ont été obtenus pour la maîtrise de cette technologie, particulièrement depuis la mise en place en 2004 (et continue depuis) d'une collaboration spécifique sur ce thème entre les équipes " Biotechnologie & Sylviculture Avancée " de FCBA et "Amélioration, Génétique et Physiologie Forestières " de l'INRA. Nous faisons ici un bilan des avancées majeures à différentes étapes de l'embryogenèse somatique jusqu'à la mise en place d'essais au champ en cours d'évaluation. Nous portons également un regard sur les verrous techniques et les contraintes socio-économiques qu'il faudrait lever pour amener cette technologie prometteuse à franchir les portes de l'application pratique.

Mucoid pseudocysts are infrequent benign tumors which can develop on all peripheral nerves near joints. The origin of these cysts remains to be determined. We searched for arguments favoring an articular origin which would have an impact on management and risk of recurrence.Twenty-three patients (21 men and 2 women, mean age 38 years, age range 13-56 years) presented mucoid pseudocysts and were followed for a mean six years. The mucoid pseudocyst was located on the common fibular nerve at the neck of the fibula in 16 patients, on the tibial nerve at the knee in one, on the median nerve in one, on the ulnar nerve in one, and on the suprascapular nerve in two. Pain was local in 18 patients and irradiated to the concerned nerve territory in 20. Motor deficit was the inaugural feature in 17 patients. EMG was performed in all patients, ultrasound exploration in 15, computed tomography in 7 and magnetic resonance imaging in 10. All patients included in this series underwent surgery: pathological diagnosis of mucoid intra-neural pseudocyst was established in all. Systematic search for communication with the neighboring joint was performed in all cases.An articular communication was found in 17 patients. Mean time to recovery of muscle force (scored 5) and/or normal sensitivity was seven months in 17 patients. One patient did not achieve full recovery. Three patients experienced recurrence and required tibiofibular arthrodesis.Three theories have been proposed (cystic degeneration of schwannoma, degeneration of nerve sheath connective tIssue, and an articular origin). The articular theory appears to be the most probable. The presence of an articular pedicle in 60% of the patients, the anatomic juxtaposition between the nerves involved and neighboring joints, and occasional migration along the articular nerve as well as the cyst's mucoid content argue in favor of the articular theory. The notion of recurrence after complete minute excision is also in favor of an articular pathogenic mechanism. The diagnosis of mucoid cyst should be retained as a possibility in patients with rapidly progressive signs of nerve compression near a joint. It is important to search for articular communication before and during the surgical excision in order to limit the risk of recurrence.

Axillary nerve injuries still go undiagnosed far too often despite their frequency. However the quality of the outcome depends on expert management and prompt surgery. To optimise the latter, we re-examined 83 operated cases of traumatic lesions of the axillary nerve. We analysed the neurological and functional recovery of these patients by means of a follow-up evaluation at 6 years postop. The results were classified by age, mechanism of injury, delay to surgery and the presence or otherwise of associated neurological or osteo-articular lesions. We highlighted that a high index of suspicion ought to exist in all cases of trauma to the shoulder in a patient aged more than 40, any injury associated with palsy of the long head of triceps and in the case of an osteo-articular lesion due to high-velocity trauma. A complete lack of shoulder abduction must always prompt a search for a lesion of the axillary nerve as well as a suprascapular nerve palsy or rotator cuff lesion. There are few literature reports of surgical management of this particular nerve injury. An early MRI scan as part of the management should improve results by a reduction in the delay before surgery. As a result of our investigation we conclude that a lesion of the axillary nerve without signs of recovery at 3 months should be referred to a centre specialized in peripheral nerve surgery.

Radial palsy is a serious complication of humeral shaft fractures. The risk results from the anatomic position of the radial nerve which turns around the distal portion of the humeral shaft, in contact with the bone. As a rule, radial palsy regresses spontaneously, but in a few cases surgery may be required to achieve neurological recovery. We conducted a retrospective study of thirty cases of radial palsy after humeral fracture treated surgically. Our objective was to define causes of non-recovery and assess therapeutic efficacy, searching for the characteristic features of the fractures involved.We limited our analysis to post-humeral fracture radial palsies, which were operated due to the absence of neurological recovery. We recorded the type of fracture, treatment used to achieve bone healing, surgical approach, and type of radial nerve surgery. The series included 30 patients, predominantly male, mean age 38.4 years. The fractures were situated in the middle or lower third of the humeral shaft. Most were spiral fractures. Plate fixation (30%) or nailing (33%) were generally used for fixation. There were six cases of iatrogenic palsy, all after plate fixation. A revision procedure was required in one-third of the cases due to nonunion. Exploration of the radial nerve demonstrated compression at the intermuscular septum in one-third of the cases and a direct conflict with the fixation plate in one-fifth of the cases. Neurolysis was required in 23 cases, nerve grafts in five and first-intention tendon transfer in two.Results of nerve surgery were assessed with the Alnot classification at a mean follow-up of 6.3 years. Outcome was rated good or very good in 22 patients, fair in one and poor (failure) in three. First-intention tendon transfers were performed in two patients and two patients were lost to follow-up. Mean delay to recovery was seven months after neurolysis and fifteen months after nerve grafts.Our experience and data in the literature suggest that several factors could be involved in persistent radial palsy after humeral shaft fracture. The greatest risk of radial nerve injury or absence of recovery after the primary lesion is encountered after fracture of the lower third of the humerus, spiral fracture, and plate fixation. Particular features observed in our series were nonunion and compression in the intermuscular septum.

Earlier work has demonstrated possible paralysis of the long head of the triceps brachii (LTB) after surgical repair of traumatic injury to the axillary nerve. Anatomy textbooks describe the motor branch of the LTB arising from the radial nerve within the body of the triceps. We studied the position of the motor branch for the LTB to determine its exact origin.Three groups were studied: Group I included 9 traumatic injuries of the axillary nerve associated with clinical involvement of the LTB; Group II included 20 secondary posterior trunks dissected from cadaver specimens; Group III included 15 dissections of the infraclavicular plexus with complete dissection of the secondary posterior trunk. The position of the axillary nerve injury was retrieved from the operative reports for Group I. The precise origin of the motor branch for the LTB was identified for Group II. Neurostimulation was used to identify the origin of the motor branch for the LTB in Group III.For Group I: injury to the axillary nerve was situated 10 mm (mean) from the bifurcation of the secondary posterior trunk in 6 cases and at the bifurcation in 3. Type IV injury was identified in 4 cases and type V in 5. For Group II: the motor branch for the LTB arose 6 mm (mean) from the bifurcation of the secondary posterior branch in 13 cases, at the bifurcation in 5, and 10 mm proximally in 2, but never from the radial nerve. For Group III: the motor branch for the LTB arose 4.5 mm (mean) from the bifurcation of the secondary posterior trunk in 11 cases, at the bifurcation in 4, and never from the radial nerve.Observed injuries to the axillary nerve with an associated paralysis of the long head of the triceps brachii were located proximally and were severe. Our dissections always located the motor branch of the LTB arising from the axillary nerve or the secondary posterior branch. We thus deducted that associated LTB paralysis is a sign of poor prognosis. In patients with axillary nerve injury it is a sign favoring a proximal and severe lesion of the axillary nerve.When examining patients with traumatic injury involving the axillary nerve, it is important to search for paralysis of the long head of the triceps brachii. If present, it is a sign of a severe axillary nerve lesion requiring early repair at 3 months.

The aim of this study was to assess the results of a prospective study of 138 cases with carpal tunnel syndrome operated on by a percutaneous technique.One hundred and twenty-nine patients (108 women and 21 men, with a mean age of 49.9 years) underwent preoperative assessment via a questionnaire and a clinical examination (the Weber test, buckle test, Kapandji test, Tinel test, Phalen test, Vainio test and grip force assessment). The surgical technique was singularised by the insertion of a probe cannula in the carpal tunnel so that the blade could be guided during annular ligament section.The results were assessed at one, three and six months follow-up: 98.5% very good and good results were obtained (Kelly criteria); two patients presented with an algodystrophic syndrome. No vascular, tendinous or neurological complications were noted, and the procedure was in no instance switched to an open technique.The main advantages of this technique are a rapid recuperation of hand function, with an average of 22.6 days off work, a low complication rate, and simple equipment.

Common peroneal nerve lesion on the lateral aspect of the knee is one of the most frequent neurologic injury of the lower limb. We reported the results of surgical procedure for each etiological group.In the peroneal nerve entrapment group, we individualised 62 fibular tunnel syndroms (55 idiopathic, 4 postural, 3 dynamic), and 16 external compression. Traumatic causes were represented by 22 varus injuries of the knee and by 11 fractures, 16 iatrogenic lesions, 2 wounds, 5 wound sequelae, 2 contusions and 1 burn. Tumoral group was represented by 7 intraneural ganglionic cyst and 2 extraneural tumour (1 exostosis and 1 chondromatosis of the proximal tibio fibular joint). All patients underwent surgical procedure. Neurolysis was performed when the nerve was in continuity. Suture or nerve grafting was performed in the other cases. In the case of intraneural ganglionic cyst, a complete tumoral excision was realised.Eighty-three per cent of excellent and good results were obtained for the fibular tunnel syndrom, 62.5 per cent for external compression, 36 per cent for varus injury of the knee, 78 per cent for the other traumatic causes and 89 per cent for tumoral lesions.This report confirms that the result depends on the etiology of the common peroneal nerve lesion. We propose surgical treatment within 2 to 4 months for the patients without clinical and electrophysiological improvement. If there is doubt on the continuity of the nerve, we propose an earlier surgical treatment. Our results were in general satisfactory except when a nerve graft was necessary furthermore if it was a traction injury and if the length of the graft was longer than 6 centimeters.

Transdermal penetration of drugs is currently much studied because it presents several attractive aspects, avoiding first past effects and offering means of immediate breaking of the therapeutic in case of hitch. But it must overcome the very efficient hindrance of the epidermal barrier. Few among the molecules have prerequisite structural and pharmacodynamical aspects necessary to this way of penetration. Substances belonging to diverse chemical families enhance sometimes largely this passage; they are named "penetration enhancers". In this review are listed the ideal properties of enhancers, the chemical structure of the currently more used ones, the possible interaction with other components of the formula in the case of TTS and towards the patient.

Multiple trauma requires immediate and combined resuscitation and surgery. For resuscitation, the neurological condition must be assessed prior to any sedation, as well as the respiratory and hemodynamic condition, in order to carry out first aid (tubing, ventilation, infusion...). The surgeon who is present must contribute in the quick clinical assessment of the lesions, perform temporary hemostasis as well as hemostatic and anti-infectious dressing, find out associated vascular complications and possible injuries to the spine and cord. Various blood samples must be taken before setting up the venous pathways (peripheral and central), and the various parameters will be followed up. Thoracic aspiration will sometimes be essential for better ventilation. Radiographs of the chest and of the pelvis will be taken with the injured person on the stretcher, without displacing him/her. The rest of the assessment will be performed only when the person with multiple trauma has been resuscitated and is hemodynamically stable, and it will include various radiographs, ultrasound and CT studies, and even angiograms, of the skeleton and of the cranial contents, of the thorax and of the abdomen. However, all these explorations are somewhat time-consuming, and involve a risk of neurological, hemodynamic or ventilatory aggravation. Therefore they must be organized into a hierarchy, and only those that are essential will be performed to avoid delaying the treatment. Neither must the effectiveness of resuscitation be too reassuring, as the morbidity of the lesions increases with the number of units of transfused blood. The vital prognosis is often worsened when a lesion is not recognized or when complications occur.

A case of post-traumatic hepaticoportal arteriovenous fistula between common hepatic artery and portal vein is reported. This localization of the lesion is exceptional, and early, marked clinical manifestations allow rapid diagnosis and treatment before the development of a portal hypertension.

The authors have treated 7 fracture-dislocations of the humeral head by blind pinning. The fractures were reduced by traction under general anaesthesia. 3 or 4 pins were then introduced into the olecranon fossa and driven up through the humeral head. After an average follow up of 29 months, the results were excellent in 9 cases, good in 5 and fair in 3. In 3 cases only, necrosis of the humeral head was noted.

Dans le cadre de l'amélioration de C. canephora, après avoir doublé le génome de ce dernier, on a entrepris l'hybridation entre C. canephora autotétraploïde artificiel et C. arabica tétraploïde naturel. Par trempage dans des solutions plus ou moins diluées de colchicine de graines déparchées et prégermées et de plantules de C. canephora on a obtenu 75 individus tétraploïdes. Le dénombrement des chromosomes somatiques a été entrepris aussitôt que possible sur pointes de racines ou très jeunes feuilles. Les 52 premiers caféiers tétra et mixoploïdes obtenus ont été plantés à Bingerville en déc. 1964. Les principales caractéristiques morphologiques et biologiques de C.c. tétraploïde sont données mais on note une faible fructification. On s'efforce d'obtenir le maximum de recombinaisons entre tétraploïdes par pollinisation libre ou dirigée

The treatment was tested on 260 15-45 year old women, for 2918 cycles, as a contraceptive and to treat several menstrual dysfunctions. It consisted of 22 tablets, the first 7 of which contained 80 mcg of mestranol, and the other 15, 75 mcg of mestranol and 2.5 mg of lynestrenol; they were taken once a day from the beginning of menstruation, with a 6-day interval between cycles. The purpose of this treatment is to combine the excellent tolerance of sequential treatment and the contraceptive efficacy of the traditional methods. Results were very good, with respect to both safety and efficacy. Tolerance was much higher than in the case of traditional treatment; treatment had to be discontinued in only 8 cases. As a contraceptive, the corrected Pearl index was 0 (there was 1 pregnancy because the patient had forgotten to take the drug on 3 consecutive days). Considerable improvement was reco rded when the method was used to treat a number of menstrual dysfunctions.

The new International Health Regulations (IHR) 2005 adopted by WHO has set the rules of a new organization and therules for improved cooperation among states and for strengthening WHO's actions in fighting epidemics.Implementing IHR is complex and requires states to put in place systems that must be supported by an operationalmethodology guide. We analyzed their organizations to understand what were the weak points and to try to remedy by simple managementprocesses adapted and coherent with surveillance systems. To achieve this result we have developed and implemented a methodology applied worldwide. This methodological framework in 6 phases is based on a process approach with a map of surveillance systems, positioning in the principlesof performance improvement and the PDCA, while relying on ISO 9001 as a reference. This methodology has enabled the analysis of surveillance systems worldwide and assessing consistency with the IHR requirements. We made a parallel with ISO 9001 in order to determine if it was possible to introduce a dematerialized system as in the case of epidemic disease surveillance systems, using a known and proven reference framework. This work led us to propose a model based on quality performance management, more flexible than the ISO 9001, which is too rigid for dematerialized systems such as surveillance systems., Le nouveau Règlement Sanitaire International (RSI) de 2005 adopté par l’OMS a posé les règles d’une nouvelleorganisation et de règles pour une meilleure coopération entre les Etats et un renforcement des actions de l’OMS enfaveur de la lutte contre les maladies épidémiques.L’application du RSI est complexe pour les Etats et nécessite une organisation qui doit être soutenue par un guideméthodologique opérationnel.Nous avons analysé leurs organisations pour comprendre quels étaient les points de faiblesse et tenter d’y répondre parun référentiel de management simple, adapté et cohérent vis à vis des systèmes de surveillance.Pour obtenir ce résultat nous avons développé et déployé une méthodologie appliquée au niveau mondial. Cetteapproche méthodologique en 6 temps est basée sur une approche processus avec une cartographie des systèmes desurveillance, un positionnement dans les principes de l’amélioration de la performance et le PDCA tout en s’appuyant surla norme ISO 9001 comme référentiel d’étude.Cette méthodologie a permis l’analyse des systèmes de surveillance dans le monde entier et l’évaluation desconcordances avec les exigences du RSI. Nous avons fait un parallèle avec la norme ISO 9001 afin de voir s’il étaitpossible de positionner un système dématérialisé comme les systèmes de surveillance des maladies épidémiques surun référentiel connu et éprouvé.Ce travail nous a amené à proposer un modèle basé sur le management de la qualité par la performance, plus soupleque la norme ISO 9001, trop rigide pour des systèmes dématérialisé comme les systèmes de surveillance qu’il convientmaintenant de rédiger et de déployer.