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The stimulation of spermatogenesis is the best treatment of infertility for male hypogonadotropic-hypogonadism. The results are very pleasing because a real improvement of semen is sometimes obtained with spontaneous pregnants describing in the literature but after a long duration of treatment, often many months. Sometimes, the treatment improves the technical conditions of ICSI for the embryologists. Stimulation of spermatogenesis by gonadotrophins rFSH and/or hCG is the most used but others treatments, like pulsatile GnRH therapy or clomifene citrate can be used. The purpose of this review is to described the different protocols of stimulation of spermatogenesis and explain their results and finally to see if others indications of stimulation of spermatogenesis are existing.

Incidence of urolithiasis is increasing in industrialized countries. Amendments can be explained among others by dietary changes. More and more young patients have urolithiasis. The objective of this study was to analyze and update the epidemiology of stones in south of France about age and gender.A retrospective single-center study from 2009 to June 2015 included all urolithiasis analyzed by infrared spectroscopy. Groups were composed according to the mineral content (oxalocalcic with whewellite and weddelite, calcium phosphate stones, uric acid stones…).A total of 749 stones were analyzed. The sex ratio was 1.96 all aged confused. The most common stones were oxalocalcic (51.3 %), followed mixed stones (21.2 %) and calcium phosphate stones (11.9 %). The calcium oxalate stones are mainly composed of whewellite (42 %) and calcium phosphate stones of carbapatite (18.6 %). The stones of whewellite were more frequent in men (P=0.0009), as well as uric acid stones (P=0.01) and mixed stones in women (P=0.00003), as well as calcium phosphate (P=0.0005).Epidemiology of stones has changed with an increased incidence in women, and nephrolithiasis patients getting older. A change in the type of stones is observed with increasing the proportion of mixed stones especially among women. Nutritional and metabolic studies are needed to find the etiology of the change in the epidemiology of urolithiasis.4.

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Incidence of renal cell carcinoma (RCC) is increasing over the 25 last years. Pancreatic metastases of RCC are rare. The aim of this work was to study overall survival of patients operated for pancreatic metastases of RCC in Montpellier cancer institute.Between 2000 and 2012, a retrospective monocentric study was performed at Montpellier cancer institute. We evaluated the outcomes of curative pancreatic metastases from renal primary and the impact of targeted therapies.Thirty-eight patients were treated in our center for pancreatic metastases of RCC. Twelve patients had a curative surgery of metachronous pancreatic metastases. Four patients were without recurrence after pancreatic resection (33.3%). None had adjuvant therapy. Six patients were treated by targeted therapies, because of metastatic progression. Five of 6 died, the sixth evolved with targeted therapies by thyrosine kinase inhibitor. Average deadline between appearance of metastases and death was 89.9 months for operated patients. Average deadline between appearance of c metastases and death was 33.1 months for the others (P=0.004).Surgical treatment of pancreatic metastases should increase life expectancy of patients. Others studies are necessary to prove the impact of targeted therapies in metastatics patients in this indication.5.

Estimate the feasibility and the results of the realization in consultation of a flexible videocystoscopy in blue light preceded by an instillation of Hexvix(®) (GE Healthcare) for the initial diagnosis or the surveillance of vesicals tumors (VT). The objective of this study was to compare the number of hurts seen in white light and in blue light, and to estimate in which percentage of case the use of the Hexvix(®) in consultation modified the care.Thirty consecutive patients (26 men and four women) were estimated prospectively by vesical videofibroscopy in blue light (Wolf's PD videofibroscope) realized 1 hour after an endovesical instillation of Hexvix(®). All the examinations were realized in external consultation under local anesthetic by xylocaine gel: 23 (76.6%) patients within the framework of a surveillance of VT and seven (23.4%) for the diagnosis of a hematuria with normal echography. When a suspect hurt or a VT was discovered, the patients benefited from an endoscopic resection under anesthesia with new cystoscopy in blue light.Suspect hurts were revealed in 10 out of 30 patients, five in white and blue light, five in blue light only. Among the five only visible hurts in blue light, three were urothelial tumors (any pTa of bottom-rank, less of 5 mm) and two non-specific hurts. No CIS's hurt was revealed during this study. The fibroscopy in blue light allowed to diagnose invisible hurts in white light in three patients (10%) and has modified the care of five patients (16.7%). The duration of the cystoscopy was on average of 9.5 minutes. The tolerance of the examination was good and no complication arose.The use of the flexible videocystoscopy in blue light +Hexvix(®) has allowed to improve the rate of detection of VT. Except CIS's hurts, this improvement was bound to the diagnosis of little aggressive small-sized VT. The indications must be specified by studies of bigger scale and a medical economic evaluation.

Head and neck cancers can be revealed by pain symptoms caused by an excess of nociception. Other pain sometimes occurs during the cancer's progression such as neuropathic or mixed pain. These should incite the clinician to be watchful so as not to miss recurrence of the cancer. Treatment is complex, requiring management by a multidisciplinary team.

Sudden death during sport is a rare and unexpected event. It essentially affects young males, and a cardiomyopathy that had not been diagnosed during medical examinations is present in the majority of cases. In young subjects, there is generally hypertrophic cardiomyopathy or arhythmogenic right ventricular dysplasia. This is revealed during sporting activity, and sudden death is often the first symptom of the disease. Competitive sport increases the relative risk of sudden death to 2.5 compared to the risk in a non-sporting subject. The prevalence of sudden death during competitive sport is poorly understood. From the rare studies available, it could be estimated at 2.3/100,000 athletes per year. In Europe, it essentially occurs during football matches. However, the prevalence of sudden death during so-called 'recreational' sports is not precisely known. It could be much higher because these activities involve a larger number of people, and take place without supervision and usually without a medical examination beforehand. The participants are older, and coronary pathology is usually implicated.

The purpose of the study was to determine the possible mechanisms of presyncope in patients who have paroxysmal junctional tachycardias (PJT) and a normal surface ECG between tachycardias.Among 419 patients consecutively recruited for PJT, aged from 10 to 88 years (47+/-19), 78 of them had presented at least one syncope; they had a normal ECG in sinus rhythm. Transesophageal programmed atrial stimulation was performed using one and two atrial extrastimuli delivered in control state and if necessary after infusion of 20-30 microg of isoproterenol; arterial blood pressure was monitored; vagal maneuvers and tilt test (n=25) were performed; echocardiogram was systematic.Age, sex, method of induction, tachycardia mechanism and the mean heart rate in tachycardia were similar in patients with and without syncope. Syncope was related to a vagal reaction induced by the PJT in 31 patients, to a fast rate during PJT in 15 patients, to a sinus node dysfunction in six patients, to a coronary ischemia in five patients, to a tetany induced by PJT in three patients, to an advanced age in three patients, to multiple causes in three patients and remained unexplained in eight patients. Radiofrequency ablation of reentrant circuit, performed in 28 patients, suppressed syncope in 26 of them.Presyncope or syncope occurred in 18% of patients who had a history of paroxysmal junctional tachycardia. Several mechanisms were implicated; the most frequent causes were coronary ischemia or sick sinus syndrome in old patients, vasovagal reaction or fast rate in tachycardia or tetany in patients of all ages.

A prospective analysis of pain intensity and related factors observed when removing a Blake suction drain after head and neck surgery.An inception cohort of 100 patients managed at a single institution (university teaching and tertiary referral center), by 10 surgeons, during the months of March-July 2004. Two different scales were used to evaluate pain (see and ). The variables under analysis were: age, gender, comorbidity, overall pain and psychological status, anti-pain treatment, type of disease (benign vs malignant), type of surgery performed, location of the drain, number of drains removed and delay from surgery.No complications were noted at the time of drain removal. The volume drained varied from 10 to 450 cc (mean value 90 cc). At the time of drain removal no pain was noted in 50% to 60% of patients according to the scale used. Minimal pain and strong pain were noted in 45% - 36% and 5% - 4% of patients, respectively. Among the variables under analysis, the age of the patient was the only variable significantly related to the intensity of pain noted at the time of removal of the drain whatewer scale was used for analysis. Pain was statistically more pronounced as age declined (p=0.011 and p=0.04 according to the scales used).At our department, due to its very good drainage ability, its facility of use and the very low intensity of pain noted at the time of removal, the Blake drain has replaced the time honoured Redon-Jost drain conventionally used after head and neck surgery.

Arch wires used in orthodontic treatment must conform to the shape of the dental arches so that in their final positions teeth will be set in a pathway of neuromuscular equilibrium. However, sometimes distortions of the alveoli deform the shape of the arch. In such cases the treatment charts constructed on the actual alveolo-dental relationship will not reflect desired objectives. We believe that the transverse muco-gingival dimension Andrews called the Wala line responds better to therapeutic requirements. Moreover, molar attachments, key elements of a full-banded appliance, are in harmony with it. So the type of chart that the authors propose for use with the Straight Wire technique, one based on the Wala line, will help orthodontists place teeth at the conclusion of orthodontic treatment in the best possible relationships to patients' specific anatomic configurations.

The follow up of patients with chronic liver diseases and the data from multicentric clinical studies are affected by the variability of assay results for the same parameter between the different laboratories. Today, the main objective in clinical chemistry throughout the world is to harmonise the assay results between the laboratories after the confirmation of their traceability, in relation to defined reference systems. In this context, the purpose of our study was to verify the homogeneity of haptoglobin, apolipoprotein A1, total bilirubin, GGT activity, ALAT activity results, which are combined in Fibrotest and Actitest, between Dimension Analysers RXL, ARX and X-PAND (Dade Behring Society). Moreover, we verified the transferability of Fibrotest and Actitest results between the RXL, and either the BN2 (haptoglobin and apolipoprotein A1) or the Modular DP (total bilirubin, GGT and ALAT activity concentrations). The serum samples from 150 hospitalised patients were analysed on the different analysers. Specific protein assays were calibrated using solutions standardised against reference material on Dimension and BN2 analysers. Total bilirubin assays were performed by a diazoreaction on Dimension and Modular DP analysers. The GGT and ALAT activity measurements on the Dimension analysers were performed in accordance with the reference methods defined by the International Federation of Clinical Chemisty and Laboratory Medicine (IFCC). On the Modular, enzyme activity measurements were performed according to the Szasz method (L-gamma- glutamyl-4-nitroanilide as substrate) modified by Persijn and van der Slik (L-gamma- glutamyl-3-carboxy- 4-nitroanilide as substrat) for GGT and according to the IFCC specifications for ALAT. The methods of enzymatic activity measurement were calibrated on the Modular only. Liver fibrosis and necroinflammatory activity indices were determined using calculation algorithms, after having adjusted each component's result of Fibrotest and Actitest for gender and age. Our study has shown, for each parameter, harmonious results between the Dimension analysers and between RXL and BN2- Modular DP. Disregarding alpha-2 macroglobulin which cannot be assayed on RXL, the results of Fibrotest and Actitest were similar as performed on BN2- Modular DP and RXL.

The aim of this work was to investigate if sex, age, family history, season and hypothyroidism have any influence on the type of episodes (manic, depressive, mixed) seen in bipolar patients. This retrospective study concerns a sample of 208 patients with a diagnosis of bipolar disorder (type I or II), who were admitted in one of two psychiatric centers between July 1996 and June 2000. The sex-ratio was 2.8 females for 1 male. Sex, family history and hypothyroidism were not associated with any type of episode. A higher percentage of depressive episodes was observed in the patients who were older than 50 and the average age of depressive patients was higher than that of other patients. There was no seasonal pattern in this study and the season did not influence the type of episode. The results indicate no influence of sex, season, family history and hypothyroidism on the type of episode presented. On the opposite, age seems to favour depression episode.

It seems that SSRI (moreover than being antidepressant) may reduce alcohol consumption by decreasing desire, craving and liking for alcohol. The 5-HT reuptake inhibitors may be helpful for the treatment of alcoholism by reducing relapse frequency and severity. Moreover, if depression or anxiety is present, it should be effective to give them immediately because of the frequent association between these pathologies and alcoholism.

The adolescents responsible for sexual abuses on children confront the medico-psycho-social workers with many questions. In this article, thanks to a bibliographical approach, we first discuss the definitions concerning sexual abuses and paedophilia as well as family, psychodynamic and legal specificities of adolescents. We then mention a few epidemiological facts as well as the different behavioural cognitive, psychodynamic and family hypotheses related to that problem. We finally illustrate all this through two clinical cases encountered during our ambulatory exercise and submit some thinking to readers.

Long term treatment by fibrates could induce chronic hepatitis associated with auto-antibodies. The aim of this study was to assess the features of this hepatitis.Baseline clinical and biological features, and liver biopsy in 5 patients with fibrate-induced chronic hepatitis were studied, as well as their outcome.At enrollment, patients (4 men, mean age 65 years) had highly (n = 3) or mildly (n = 2) increased serum aminotransferase activity, hypergammaglobulinemia and high titers of anti-nuclear antibodies (with homogenous fluorescence in 3 cases). Liver biopsies demonstrated a lympho-plasmocytic infiltrate in all cases. Hepatocellular necrosis was multilobular in 2 cases, and mild to moderate, located in lobular and periportal areas in 3 cases. Cirrhosis was found at presentation in 3 cases and developed within a few months in the 2 other patients. After discontinuation of fibrates, aminotransferase activity normalized within 6 weeks either spontaneously (n = 3) or under immunosuppressive treatment (n = 2). Immunosuppression was rapidly withdrawn in 2 patients (18 months) without relapse, while one patient was treated for 4 years because of relapse after early withdrawal. A second liver biopsy performed 6 months after discontinuation of fibrates in an untreated-patient showed no inflammation or necrosis.These observations suggest that fibrates could trigger chronic liver disease resembling type I auto-immune chronic hepatitis, which resolves after drug withdrawal.

We recall the particular features of head and neck cancer in terms of the patient's image of his body and discuss the main character traits encountered in patients with this type of cancer. Psychological factors which must be taken into consideration in therapeutic management are presented. Five specific situations are discussed: announcing the diagnosis, proposing the initial therapeutic scheme, palliative treatment, end of life situations. The role of each member in the health care team is discussed in light of what the patient expects.

This work briefly assesses the history of the AIDS epidemic in different geographic regions and examines factors that render developing countries particularly vulnerable. It reviews the three main techniques of traditional therapeutic systems and examines their implications for psychiatric treatment of AIDS patients from developing countries. Young age structures, low rates of condom usage, women's lack of education and of sexual bargaining power, and the deficiencies of health and educational facilities are among factors that increase risks of HIV in developing countries. Health education geared to specific audiences should encourage condom use and other preventive measures. Among factors to encourage condom use, group decision making appears to be of greatest potential influence on behavior in sub-Saharan Africa and among African immigrants to Europe. To encourage preventive measures and to understand reactions of non-Western populations to HIV, it is desirable to understand the deeper meanings of their cultures and of traditional therapies. It is difficult and misguided to pose a diagnosis according to the criteria of Western psychiatry. Western psychiatry has been proven incompetent in its attempts to treat members of traditional societies, whether immigrants or in their countries of origin. And attempts to integrate traditional healing into a western medical system have not been successful. Traditional systems accomplish therapeutic goals by three major techniques, possession, shamanism, and clairvoyance, or their numerous variants. It is recommended that group sessions be held with immigrants requiring treatment, in which the principal therapist is assisted by translators, who help create a space for the patient intermediate between the two cultures, where the therapies can coexist without conflict.

We first propose a simple method for helping the acoustician to estimate the effects of meteorological conditions on noise propagation, at least qualitatively. This method is based on a double-entry grid that only requires simple meteorological observations. We then compare the qualitative estimations given by the grid to the results of an outdoor experiment. Human evaluation of climatic conditions is shown to be satisfactory for a qualitative estimation of their effects on noise measurements

When lasting pain occurs after surgery of head and neck cancer, tumoral recurrence should be considered. In addition to curative treatment, relief of pain is often provided by opioid analgesics. Doses vary according to tolerance and patient. Other than digestive routes of administration may be required. Here are two clinical reports: the first case with cervical epidural analgesia by ambulatory autoadministration device (Patient control analgesia), the other one with intrathecal in C7-T1 catheter with port access in which morphine was injected every 24 hours resulting in efficient analgesia, in metastatic Pancoast's syndrome. Surgical or radiotherapy sequelae sometimes bring about pain; bilateral cervicalgy described as burns associated with pain-related depression, 18 months after glotto-subglottic partial laryngectomy, requires psychological support and carbamazepine for desafferation pain removed within 6 months. When the only treatment left appears to be analgesia after surgery of head and neck cancer, follow-up in a multidisciplinary pain treatment centre allows a therapeutical management with optimum tolerance and efficiency.

A new case of pseudo-diastrophic dysplasia in a boy born to consanguineous parents is reported. The patient developed neurologic (hydrocephalus) and respiratory anomalies and died at the age of 11 months of an unknown cause. Features that distinguish this chondrodysplasia from diastrophic dysplasia include decreased height of vertebral bodies and anomalies of the pelvis with short iliac wings and a horizontal orientation of the internal spine of the acetabular roof.

Gastric peristalsis has not been studied extensively in patients with dyspepsia. The aim of our study was to further characterize gastric peristalsis in such patients using a newly described fluorographic method. Thirty-two patients with dyspepsia and 18 healthy volunteers were included in our study. Four hours after a standard solid-liquid meal, the subject swallowed 250 ml of a baryum sulfate solution and (100 mm x 100 mm) fluoroscopy of the stomach was performed every 2 s during 30 s. Spot films were analyzed using a graphic table and a amateur microcomputer program. For each subject, the instant velocity, vi, and mean velocity, V, of gastric peristalsis were calculated and used to generate a time-space diagram of contractions, a velocity histogram and an index of propagation, Ip. These parameters were compared to normal values (V = 2.2 +/- 0.2 mm/s; Ip = 2.2 +/- 0.4). When compared with normal values, 3 different motility patterns appeared in dyspeptic patients with a high correlation between V and Ip (P less than 0.01): normoperistalsis (n = 8; 1.8 less than V less than 2.6 mm/s); 1.4 less than Ip less than 30); hypoperistalsis (n = 7; V less than 1.8 mm/s; Ip greater than 3.0) and hyperperistalsis (n = 7; V greater than 2.6 mm/s; Ip less than 1.4). In a 4th group (n = 5), a retroperistalsis was effect observed with Ip less than 0. For 5 other patients, Ip or V was abnormal with atypical motor activity detected on the time-space diagram.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional assistance was given by percutaneous endoscopic gastrostomy to 174 patients with neurological diseases (80 cases), tumours of the ear, nose and throat (ENT) region (70 cases) or malnutrition (24 elderly people). These patients had either deglutition disorders with inhalation or severe malnutrition, or could not tolerate a nasogastric tube. The endoscopic catheter (Bioser) was installed by the pull technique under general anaesthesia (26 percent), neuroleptanalgesia (16 percent), premedication (14 percent) or without sedation (44 percent). Installation was possible in 98 percent of the cases. Twenty-nine percent of the patients were treated in an outpatient clinic. The problems encountered (21 percent) were mainly due to blockade of the flange and rupture of the thread. Transoperative accidents, such as dyspnoea, bleeding or cardiac arrest, all without sequelae, were noted in 5 percent of the cases. The catheter remained in situ for a mean period of 3.9 +/- 0.3 months (range: 0.1 to 20 months). The following complications were observed: short-term (15 percent), hyperthermia (5), local infection (6), abscess of the abdominal wall (3), meteorism (9), pneumoperitoneum (1), subocclusion (2); long-term (25 percent), inflammatory reactions (13), leakage (19), catheter displacement (8) and catheter rupture (3). Local infections were more frequent in patients with ENT tumours than in the others. Percutaneous endoscopic gastrostomy is a fast and reliable technique preferable to surgical gastrostomy. Complications are frequent (46 percent) but usually minor (42 percent). Contra-indications must be respected, and the catheter must be introduced with the utmost care.

Thirty one cases of accidental hypothermia have been taken in care by the SAMU de Paris during the year of 1987. The accidental hypothermias happening in the cities are, most of the time, moderated and not very serious. The search for a cause is a prime necessity. The prognosis is based on that search to guide and advise the patients.

A familial form of incomplete androgen insensitivity syndrome (AIS) is reported. The index case was first seen at 9 months of age for ambiguous genitalia. Diagnosis of AIS, suspected but first discarded on the basis of an androgen sensitivity test, was finally made at puberty on the discordance between poor virilization and elevated levels of both testosterone and LH, a florid gynecomastia, and the exclusion of any enzymatic defect in testosterone biosynthesis of 5 alpha-reductase deficiency. Androgen receptors in public skin were within the limits of normal for total number, with normal affinity. Familial occurrence included 2 first cousins born 7 and 10 years later, a maternal grand-uncle with similar ambiguous genitalia, and a maternal uncle with the gynecomastia-preserved fertility syndrome. This case report illustrates the heterogeneity of AIS in a given family and the difficulty of and early positive diagnosis in a newborn presenting with sexual ambiguity.

An assay for urinary gonadotropins (UG) performed after acetone extraction is presented. This dosage was performed either on a sample of the 24 assay urine, or on the fractionated 12 hr/12 hr urines (night/day) in normal children whose ages ranged from 2 to 20 years and in children presenting with various endocrine diseases (on about 2,000 urine samples). Normal values were established according to sex and stage of puberty. In boys, the lack of overlap between values of LH (UI/24 hr) observed in stage I (prepubescent, 9-13 yrs) and those observed in stage II represents an obvious biological marker of the onset of puberty. The night/day ratio of LH also increases close to puberty, reflecting the onset of the well-known night secretion of LH, at the time of the first stages of puberty. In girls, the preferential increase in FSH is the best criterion for the onset of puberty. In children with endocrine diseases, assay for UG/24 hr is a valuable parameter of the gonadotropic function allowing 1. to separate delayed puberty from hypogonadotropic hypogonadism; 2. to confirm a diagnosis of precocious puberty and 3. to control a treatment with LHRH analogous.

The gratuitousness is a positive social measure, particularly specific of the psychosocial patients, but applied in a dissatisfying context because the financial aspect is the only considered and because the other therapeutic exigences, implicitly in such a measure contained, are in that way eluded.

4 cases of hepatic adenoma in young women are presented. The 4 patients had been taking estro-progestative contraceptive agents. The adenomas were single, double or multiple; some could be treated surgically, some were not treated because of the risk involved. In the 4 cases, the tumor was benign. The relationship between hepatic adenoma and estro-progestatives, and more generally between hepatic tumors and steriods is studied. Hepatic adenomas appear to be much more frequent than had been believed. Latent forms are probably relatively frequent. It is very likely that estro-progestatives are responsible for the benign tumors, but also for some of the malignant ones. This type of lesion also carries a risk of hemorrhage. Therefore it is crucial to detect them. In their conclusion, the authors emphasize the necessity of taking into consideration some of the serious risks which come with oral contraception, some of which are hepatic tumors, thrombosis, cerebral vascular accidents and colitis.

The authors describe an experience of sensibilisation to the relation through utilisation of role game with medical students. The game, which scenario is elaborated by the participants, is realised in small groups, and the discussion is an emotional experience of the played situation. The magnetic recording of the game and its audition in a big group permit congrontation between various modes of reaction to the same situation, and bring some new insight to the students on their being and feeling. Even tuestionnaire and most of them discover emotional dimensions of the relationship.

In 3 cases of MPH due to 17-ketosteroid reductase defect, the pattern of testicular biosynthesis studied after incubating homogenates of testicular tissue with 14C-Progesterone and 3H-Pregnenolone was very similar. The most striking finding was the excessive production of delta 4-Androstenedione contrasting with the small amount of testosterone formed. Conversion of DHA to delta 5-Androstenediol was also limited. In addition, 3 pairs of substrates, namely 14C-testosterone and 3H-delta 4-androstenedione; 14C-estradiol and 3H-estrone; 14C-delta 5-androstenediol and 3H-DHA, were incubated for various length of time. Homogenates of testicular tissue from 2 cases presenting with the biosynthetic defect were studied as to compare to testicular tissues from 2 subjects with normal testicular biosynthesis. Different degrees in the impairment of the reduction or the oxydation were observed for the different pairs of substrates in pathological as well as in normal tissues. This suggests that the extent of the enzyme defect would differ for the 3 pairs of substrates.

The authors report a case of a two para who was admitted as an emergency after collapsing at the end of her pregnancy. Various clinical examinations carried out on admission showed that she was in a state of hypovolemic shock with a marked drop in her blood pressure and a fast pulse as well as pain in the left hypochondrium radiating up to her shoulder. From the obstetrical point of view, there had been no bleeding and no uterine contractions and the fetal heart tracing showed a rate of 135. After intensive efforts at resuscitation an urgent laparotomy was carried out with as a first step Caesarian section which confirmed that there was no pathology in the placenta or uterus, followed by exploration of the abdominal cavity which revealed a large retro-peritoneal haematoma together with a ruptured aneurysm in the hilum of the spleen. Splenectomy was carried out after haemostasis of the splenic pedicle had been performed and this allowed her to recover without complications. Following this case the authors looked up the world literature and confirmed that the pathology was classic but very rare indeed, there being only 66 published cases. As far as its aetiology was concerned this aneurysm is not the same as a classical splenic aneurysm. The development of the aneurysm seems to take place during the pregnancy and the reason for this arterial aneurysm and its rupture in unknown. A theory has been advanced that circulatory and haemodynamic factors acquired in pregnancy reveal the congenital factor that is already present.(ABSTRACT TRUNCATED AT 250 WORDS)

Repair of loss of substance of the lower lip has been the object of numerous studies. Each author has used his own ingenuity to describe a new type of flap aimed at restoring a particular form of loss of substance. The techniques suggested here are capable of solving a majority of problems on the basis of simple and original solutions. These flaps make it possible to resolve the problems posed by most cases of loss of substance of the lower lip. The choice of these plastic procedures permits restoration which is at one and the same time functional and anesthetic.

In this report, we examined the sensitivity and specificity of pancreatic fine needle aspiration cytology in the diagnosis of pancreatic cancer. Aspiration cytodiagnosis was performed in 45 patients (36 cancers and 9 benign pancreatic lesions) using a 22 Gauge fine needle either percutaneously in 25 patients with real-time ultrasonic guidance or during surgery in 20 patients. Cytologic examination included a precise description and the classification in one of the 4 Papanicolaou classes, the fourth only being considered as positive in terms of cancer. No complication occurred with either technic. Overall sensitivity was 75 p. 100, 74 p. 100 percutaneously and 77 p. 100 intraoperatively, but specificity was 78 p. 100 due to two false-positive results recorded among the 9 benign lesions. Retrospective analysis of cytologic examinations of the 29 class IV lesions led us to differentiate cases with "sure malignancy" (20 cases) from those with "strong suspicion of malignancy" (9 cases including the 2 false-positives). Only class IV lesions with "sure malignancy" call for aggressive treatment, whereas a "strong suspicion of malignancy", which may result from carcinoma or severe cellular abnormalities occasionally found in inflammatory pancreatic lesions, should lead to a second pancreatic aspiration.

Measurements of urinary steroids do not allow a precise supervision of the evolution and treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Thirty-one cases with a 2 year follow-up allowed a trial of estimation of the progress that could be obtained with plasmatic dosages of renine, testosterone, A.C.T.H. and 17-hydroxyprogesterone (17-O.H.P.) activities. The best way for reaching diagnosis is presently 17-O.H.P. However, the amplitude and variability of nyctemeral changes of 17-O.H.P. as well as A.C.T.H. activities do not allow to use these two dosages for a precise supervision of therapeutic effects. On the contrary, the dosage of testosterone allows the appreciation of the risk of virilization and its reliability gives a precise control of the effects of steroid therapy. The dosage of the renine activity disclosed unknown or not well controlled sodium-losses, and allowed to adjust the dosage of 9-alpha-fluorohydro-cortisone, while limiting glucocorticosteroids. It gave also evidence of the usefulness of prolonged steroid therapy until the end of the growth period.