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A performance gap between the CPU and the memory is growing more and more : the CPU is waiting the information. The development of new technologies of memories is becoming a necessity to support the evolution of microelectronics. Among them, resistive memories represent the best candidates for the development of new systems capable of boosting the performances of a computer. However, such memories have to be integrated in series with a Back-End selector device in order to achieve their full performances. The aim of this thesis is to studied the electrical ovonic threshold switching (OTS) in amorphous chalcogenides targeting the development of selector devices. An experimental work evaluate different materials based on the Ge30Se70 and As2Te3 coumpounds. For each material, the structural, optical and electrical properties are characterized. The benchmark and the correlation between the materials highlight the impact of the different elements of the composition on the OTS mechanism. Finally, trade-off, guidlines and methodology are given in order to drive the development of OTS selector according to the specifications to achieve.; Dans le domaine des mémoires pour la microélectronique, il apparait que les performances des technologies traditionnelles se font de plus en plus dépasser par les performances de l'unité de calcul : le processeur attend l'information. Le développement de nouvelles technologies mémoires devient donc nécessaire pour supporter l'évolution de la microélectronique. Les mémoires résistives représentent des candidates pertinentes pour développer de nouveaux systèmes permettant de booster les performances d'un ordinateur. Cependant, afin d'atteindre leur pleines performances, elles doivent être intégrées en série avec un dispositif sélecteur Back-End.L'objectif de cette thèse est d'étudier la commutation ovonique (appelée Ovonic Threshold Switching, OTS) dans les matériaux chalcogénures amorphes pour la conception de tels dispositifs sélecteurs. Un travail expérimental évalue différents matériaux chalcogénures à base des matériaux Ge30Se70 et As2Te3, dans le cadre de leur application en tant que dispositif de sélection dans les matrices de mémoires résistives. Pour chaque famille de matériaux, les propriétés structurales, optiques et électriques des matériaux ont été caractérisées, ainsi que les performances électriques des dispositifs sélecteurs. L'analyse approfondie de ses résultats a permis de mettre en valeur des corrélations entre les paramètres, éclairant ainsi l'impact des différents éléments de la composition des matériaux sur le mécanisme de commutation à la base de la fonctionnalité du sélecteur. Grâce à la synthèse de ses résultats, certains compromis sont mis en évidence et des lignes directrices ainsi qu'une méthodologie sont formulées à destination des concepteurs de matrices de mémoires résistives pour le choix des matériaux chalcogénures visant cette application.

Le développement hydroélectrique du fleuve Churchill au Labrador est une histoire de conflits entre les provinces du Québec et de Terre-Neuve-et-Labrador qui se poursuit dans le présent. Le conflit prend son origine du contrat signé le 12 mai 1969 entre Hydro-Québec et la Churchill Falls (Labrador) Corporation (CFLCo) qui garantit près de la totalité de la capacité du barrage de Churchill Falls à Hydro-Québec. Cette électricité se vend à Hydro-Québec à des tarifs dérisoires pour une durée de 65 ans, soit jusqu’en 2041. Très peu d’études permettent de comprendre le contexte politique et frontalier qui a donné lieu à cette situation et comment cela impacte les identités et le territoire de chacune des provinces. D’ailleurs, la vaste littérature sur l’hydroélectricité au Québec n’inclut pas la contribution majeure du barrage de Churchill Falls dans son développement hydroélectrique. L’objectif central de cette thèse est donc de comprendre comment les contextes interterritoriaux dans lesquels s’est développé le fleuve Churchill affectent les territoires et les identités de part et d’autre de la frontière du Labrador. Afin de répondre à cet objectif, une analyse historique et géographique du développement hydroélectrique du fleuve Churchill et de ses conséquences a été réalisée. De manière conceptuelle, cette recherche démontre l’importance de l’interterritorialité dans la compréhension de la construction des territoires et des identités et du fonctionnement des frontières. L’interterritorialité est ici initiée par le projet de développement hydroélectrique « conjoint » entre les provinces du Québec et de Terre-Neuve, Churchill Falls, ainsi que par le contrat qui régit la relation interterritoriale. La présente thèse démontre, à travers plusieurs exemples empiriques, que cette interterritorialité est influencée initialement par les frontières et les identités mais qu’elle contribue également à leur construction. De manière empirique, la recherche établit que le projet hydroélectrique de Churchill Falls a principalement servi à développer d’autres projets hydroélectriques dans la province du Québec. Cette thèse confirme que cette situation s’explique par le pouvoir du Gouvernement du Québec sur le territoire frontalier du fleuve Churchill qui lui permet de contrôler ce territoire. Churchill Falls permet la reproduction du territoire de barrages hydroélectriques du Québec qui est central à la construction de l’identité québécoise projetée par Hydro-Québec et le Gouvernement du Québec. L’identité québécoise associée à sa fierté nationale, qui semble provenir originellement de son développement hydroélectrique dans le Nord du Québec, provient finalement d’un barrage hydroélectrique localisé à l’extérieur de ses frontières formelles., The hydroelectric development of the Churchill River in Labrador is a story of ongoing conflict between the provinces of Quebec and Newfoundland and Labrador. The dispute originated from the signature of the contract on May 12, 1969 between Hydro-Québec and Churchill Falls Corporation (Labrador), which guarantees close to the entire capacity of the Churchill Falls dam to Hydro-Québec. This electricity is sold to Hydro-Québec at ridiculous rates for a period of 65 years, that is until 2041. Very few studies contribute to understanding the political and border context in which this situation was unfolded and how these impact the identities and the territory of each province. Moreover, the vast literature on hydroelectricity in Quebec does not include the major contribution of the Churchill Falls dam in its hydroelectric development. The central objective of this dissertation is thus to understand how interterritorial contexts in which the Churchill River was developed affect the territories and identities of both sides of the Labrador border. To meet this objective, a historical and geographic analysis of the Churchill River hydroelectric development and its consequences will be conducted. Conceptually, this research demonstrates the importance of interterritoriality in understanding the construction of territories and identities and the changing nature of borders. Interterritoriality is in this case initiated by the "joint" hydroelectric development project between the provinces of Quebec and Newfoundland, Churchill Falls, as well as with the contract governing the interterritorial relationship. This research demonstrates through many empirical examples that this interterritoriality is first influenced by the borders and identities but that it also contributes to their construction. Empirically, this research demonstrates that the Churchill Falls hydroelectric project primarily contributed to the development of more hydroelectric projects in the province of Quebec. This thesis confirms that this situation is explained by the power of the Government of Quebec on the border territory of the Churchill River which allows it to control this territory. Thus, Churchill Falls allows the reproduction of the territory of hydroelectric dams in Quebec which is central to the construction of the Quebec identity projected by Hydro-Québec and the Government of Quebec. The Quebec identity associated with its national pride, which comes initially from its hydroelectric development in Northern Quebec, is finally also the result of a hydroelectric dam located outside its formal borders.

The thesis' goal is to develop global test strategy in order to reduce test cost and ensure total test cover. OFDM millimeter communications will a point of interest in this thesis. The investigation has to reach the circuit BIST implementation to release constraint over test environment. The test environment contains ATE and test interface. Our approach consists in using a standard ATE and implementing few components on test interface. BIST specification and modules of test interface must be precise and realistic in order to ensure the physical implementation. To reach these goal, we will first rely on models of different blocks and appropriate simulations to identify relevant test parameters. Secondly, we will produce test solution that ensure the measure of each relevant parameters. Relevant test parameters are parameters that allow to test the system quickly, wih maximal test cover. These parameters can be computed using both functional model and structural model. Functional model is used to detect catastrophic faults, and structural model determines each blocks performance to improve efficiency. Dealing with structural test, individual block performances can be determined using BIST, or computing correlation between local blocks parameters and global system parameters (ie. EVM, or any relevant parameter)., L’objectif de cette thèse est de développer une stratégie de test globale pour réduire le cout du test tout en garantissant une couverture de test complète. On s’intéressera plus particulièrement aux communications millimétriques à base de modulation OFDM. Les investigations devront être orientées vers l’implémentation de « BIST » dans le circuit pour relaxer les contraintes sur l’environnement de test. L’environnement de test est composé de l’ATE et de l’interface de test. Pour relaxer les contraintes sur l’environnement de test et ainsi réduire le cout du test, notre approche est d’opter pour un « ATE » standard » et d’implémenter le minimum possible de composants dans l’interface de test. Les spécifications des BIST et éventuellement des modules à implémenter dans l’interface de test devront être suffisamment précis et réalistes pour permettre une implémentation physique. Pour atteindre ces objectifs notre approche est de s’appuyer sur les modèles des différents blocs et de procéder à des simulations appropriées pour identifier les paramètres de test pertinents d’abord et ensuite proposer une solution de test qui permet de mesurer chaque paramètre. Les paramètres de test pertinents sont les paramètres qui permettent de tester le système de communication en un temps minimal avec une couverture de test convenable. Ces paramètres de test peuvent être déterminés en combinant le test fonctionnel au test structurel. Le test fonctionnel permet de détecter l’existence de fautes catastrophiques en un minimum de temps et le test structurel permet de localiser les fautes catastrophiques et de déterminer les performances individuelles des blocs critiques pour améliorer le rendement. Pour le test structurel, les performances individuelles des blocs critiques peuvent être déterminées directement au moyen de BIST dédiés ou indirectement en procédant à une corrélation entre les paramètres des blocs et un paramètre global tel que l’EVM ou tout autre type de paramètre adapté.

Cancer is a real model of acquired hypercoagulable state. A close interaction exists between venous thromboembolic disease and cancer. Tumor progression is associated with an activation of coagulation and fibrinoformation which are both implicated in cancer proliferation and metastasis dissemination. The pathogenesis of haemostatic troubles described in cancer patients is particularly complex and it reflects the multiple connexions with inflammation and hemostasis systems. In this review, we will identify the numerous factors inducing such a prothrombotic state and the reason why their combined action contributes to cancer development. The relation between cancer and thrombosis seems reciprocal: cancer predisposes to thrombosis and tumor progression is deeply linked to this hypercoagulable state.

Heparin-induced thrombocytopenia (HIT) is a serious immune complication of heparin therapy and presents a risk of severe thromboembolic events. Withdrawal of heparin together with administration of an alternative antithrombotic agent is always necessary in patients with suspected HIT. Diagnosis of this complication, however, is often difficult, particularly in hospitalized patients. The aim of this study was to evaluate the impact of multidisciplinary consultation on the appropriate prescription of danaparoid, widely used as an alternative antithrombotic treatment in HIT.Multidisciplinary consultation between clinician, hematologist, and pharmacist called for reassessment of the HIT diagnosis at day 3 and between day 3 and 10 after the beginning of danaparoid treatment. Continuation or stopping treatment depended on their joint conclusion. All danaparoid prescriptions were evaluated according to this procedure for one year.HIT was suspected in 26 in-patients. The multidisciplinary approach made it possible to reassess the HIT diagnosis on day 3 and stop the alternative treatment in 42.3% of cases. Danaparoid use decreased by 52% compared with the previous year.Multidisciplinary consultations between clinician, hematologist, and pharmacist appear useful for minimizing inappropriate prescription of this alternative treatment in cases of suspected HIT.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

International audience; P. 9. Préface / Alix GicquelP. 11. Introduction : le réseau Plasmas froids et la Mission des Ressources et Compétences Technologiques du CNRS / Gérard Lelièvre, Françoise Massines et Elodie Girard I - Génération et dissipation d'énergie P. 17. I-1. Absorbtion et dissipation d'énergie dans un plasma hors équilibre / J.-P. Bœuf P. 49. I-2. Plasmas hors-équilibre à des pressions atmosphériques / K. Hassouni, F. Massines, J.-M. Pouvesle P. 109. I-3. Les plasmas thermiques / A. Gleizes II - Accès aux caractéristiques et aux espèces du plasma P. 141. II-1. Le plasma d'arc dans le procédé de projection thermique / J.-F. Couderc P. 159. II-2. Mesures de sondes électrostatiques en plasma basse pression / S. Béchu P. 225. II-3. Diagnostics laser et spectroscopie de masse dans les plasmas réactifs / J. Jolly P. 255. II-4. Saturation optique et autres pièges en spectroscopie laser / N. Sadeghi P. 275. II-5. Pièges en spectroscopie de masse / A. Granier P. 297. II-6. Source d'ionisation par micro pointes pour la spectroscopie de masse spatiale / F. Cipriani, J.-M. Illiano, J.-J. Berthelier III - Technologie des réacteurs à plasmas P. 323. III-1. Plasmas micro-onde basses pressions excités à la résonance cyclotronique électronique / Y. Arnal P. 353. III-2. Technologie des réacteur à plasma: Dimensionnement des réacteurs à Plasma micro-onde haute pression / F. Sylva, G. Hagelaar, K. Hassouni, A. Gicquel P. 367. III-3. Technologie des réacteurs à plasmas: Plasmas inductifs et capacitifs en basse pression / Ph. Lefaucheux P. 391. III-4. Les Plasmas thermique / C. Verdy, R. Boblot, H. Deng, P. Gougeon, C. Coddet

Low-molecular-weight heparins (LMWH) had official approval for use for venous thromboembolism prophylaxis only for surgery patients when this survey was conducted, but were nevertheless often used in non-surgery patients. We conducted this "before and after" survey from May 1998 to April 1999 to assess the impact of the recommendations implemented in the beginning of 1999.Data on the use of LMWH were collected on three different days within a three week interval in all non-surgery departments at the Tenon hospital before distribution of expert recommendations early in 1999. Published in La Presse Médicale in January 2000, these recommendations issued from an external panel of 43 experts who were contacted to establish a consensus opinion using the Delphi method. Data were again collected on three different days after implementation of the recommendations. Implementation was based on a patient-specific prescription order form requested by the hospital pharmacy for delivery to the department.Data were collected for 121 prescriptions prior to the recommendations and for 158 after. Sex-ratio, mean age and percentage of LMWH prescriptions did not differ significantly between the two periods. There was a lower number of non-appropriate prescriptions after implementation of the recommendations from 54.5% to 35.4% (p = 0.01) with better conformity for recommendation A (high-risk patients) (36% versus 43%, NS) and for recommendation B (= 2 risk situations or = 1 risk situation and = 2 aggravating factors) (10% versus 22%, p = 0.01). Better conformity of LMWH prescriptions in oncology and radiotherapy departments partially explained this general improvement, but the difference remained significant when excluding these two departments (p = 0.04).This study shows that physician compliance with recognized expert recommendations can improve their implementation. This procedure is now in general use in the Tenon hospital.

The pathophysiology of thrombotic events remains unclear among women undergoing ovulation induction. In this review, present knowledge is summarized from the literature. Prospective studies are needed to determine risk factors and therapeutic approach of these thrombotic complications.

The efficiency of venous thromboembolism prophylaxis with low molecular weight heparins (LMWH) has not been established in non surgical patients, so their official preventive use has been limited in France since 1995 to surgery. However, a survey conducted in 5 university hospitals in non surgical patients showed that 21-29% of patients still received a LMWH prescription. It seemed necessary to define the medical conditions for which the practical use of these heparins would be justified. We contacted external experts to obtain a consensus by using the Delphi method.The Delphi method, created by the "Rand Corporation" in the USA and used in medicine since the nineteen seventies, is based on a light logistic, with questionnaires been sent by mail with a feed-back report A total of 48 experts were chosen by local staff teams in the 5 hospitals. For the 3 rounds, from March to October 1998, questions were devised by a multicentred staff team.Among the 48 experts contacted, 32 completed the 3 questionnaires, 7 of them did for 2, and 43 did for at least one questionnaire. The experts first defined a list of 12 risk or high risk situations and 11 aggravating factors. For any high risk situation, prescription is justified. For other cases, 2 risk situations are required, or one risk situation with at least 2 aggravating factors, to justify a prescription. If no risk situation is present, prescription is, according to experts, usually not justified.The maximal agreement defines the situations in which one use of low molecular weight heparins is proposed to prevent deep venous thrombosis in non surgical inpatients, in most current hospital situations and for more than 24 hours of hospitalization. Clinical trials are needed, to validate their effectiveness and define the optimal dose in these indications. To date, epidemiological studies should be conducted to evaluate the experts proposals by estimating risk factors for deep venous thrombosis.

The etiology and pathogenesis of intrauterine fetal death, preeclampsia or fetal growth retardation remain still unknown in many cases. However, placental thrombosis and/or infarction might lead to inadequate maternal-fetal circulation. So, the relevance of an additional thrombotic risk factor that enhances the physiological hypercoagulable state of gestation has been suggested in the development of these adverse outcomes of pregnancy. Several genetic mutations are newly recognized associated with an increased frequency of venous thrombosis: mutation of adenine to guanine at nucleotide 506 in the factor V gene, mutation of cytosine at nucleotide 677 in the methylenetetrahydrofolate gene and mutation of guanine to adenine at nucleotide 20210 in the prothrombin gene. In this issue, a review of literature has allowed us to evaluate the prevalence of these genetic predisposing thrombotic factors with the development of obstetrical complications. Furthermore, therapeutic approach is considered.

The presence of the R506Q mutation of the factor V gene is associated with an increased risk of thromboembolism, particularly during pregnancy. Recently, its involvement in the development of obstetrical complications, such as preeclampsia and fetal losses, has been evoked. The resulting factor VQ506 (factor V Leiden) has arginine 506 replaced by glutamine at the factor Va cleavage site for activated protein C (APC) which induces APC-resistance. During pregnancy, an acquired resistance to APC is observed without the presence of the factor V Leiden mutation which leads to an inappropriate realization of the more expensive DNA analysis. This resistance is at least partly explained by an increase of the factor VIII. In this study, we have compared three reagents: the original test Coatest APC Resistance (Chromogenix) and two modified tests using factor V depleted plasma: Coatest APC Resistance V (Chromogenix) and Accélérimat (BioMérieux). The last test is not influenced by the factor VIII by the adjunction of activated factor X. For each test, the coefficient of discrimination, between carrier and non-carrier of the R506Q mutation of the factor V gene, has been determined on 43 pregnant women (33 non-carriers and 11 heterozygotes) and 51 unselected non pregnant patients with clinically suspected thrombosis (40 non-carriers and 11 heterozygotes). The predilution of the patient's plasma with factor V deficient plasma (Coatest APC Resistance V and Accélérimat) enhances the discrimination between carriers and non-carriers in both groups. However, using Coatest APC Resistance V, a significant difference of results is observed between the two populations in the non-carriers patients. Thus, Accelerimat is probably more efficient than Coatest APC Resistance for the detection of the factor VQ506 during pregnancy.

Under physiological conditions, in healthy subjects, there is a perfect equilibrium between coagulation activation and inhibition systems. During a surgical operation, dysfunction of the coagulation activation system, responsible for haemorrhage, can be induced by the extent of the anatomical lesions or the pre-existence of a quantitative or qualitative platelet abnormality and/or one or several plasma clotting factors. In contrast, the postoperative period is dominated by the risk of thrombosis and this risk is increased in subjects with a deficit of a coagulation inhibitory protein. The patient's haemorrhagic and thrombotic risk must therefore be evaluated prior to any surgical procedure. The information obtained by clinical interview concerning the patient's personal and family history, combined with a few simple clotting tests generally allows prevention of haemorrhagic or thrombotic accidents.

Anticoagulants are widely used in the prevention of thromboembolic disease (particularly during the postoperative period) and in the curative treatment of deep vein thromboses. Two classes of anticoagulants are currently available: heparins (standard heparin, low molecular weight heparin) and coumarin anticoagulants. The choice of anticoagulant must take into account the clinical context (preventive or curative treatment), as well as the pharmacological and pharmacokinetic properties of the anticoagulant. This treatment requires laboratory monitoring adopted to the anticoagulant selected.

Lupus anticoagulants (LA) are immunoglobulins which interfere with in vitro phospholipid-dependent coagulation tests. Its presence is associated with thromboembolic events. Laboratory recognition of these inhibitors is therefore of increasing clinical importance. A variety of tests has been introduced to detect LAs. In this study, 'IL Test LAC Screen/LAC Confirm', a new sensitive LA test, is evaluated on 23 LA-positive and 70 LA-negative plasmas. In this procedure, a dilute Russell's viper venom is served as a screening test with addition of phospholipids as a confirmatory test. A correct sensitivity for LAs is observed. This new approach for biological LA diagnosis may contribute to an accurate LA recognition in association with one or more phospholipid-dependent coagulation tests.

Verdy Andrée. Classe de CM2 : du village à la ville. In: Géographes associés, hors-série 1995. Actes de l'université d'été Annonay 1995. pp. 81-88.

Neonatal thrombocytopenia has benefited from the advances achieved during the last few years in platelet immunology and foetal therapy. The major risk of the disease is cerebral haemorrhage resulting in death or neurological sequelae. Establishing the aetiological diagnosis of immune thrombocytopenia makes it possible nowadays to apply the appropriate treatment and eventually to take care of future pregnancies. Treatments in utero of foeto-maternal alloimmunization have radically altered the natural course of foetal thrombocytopenia, thereby permitting the management of pregnancies at risk. On the other hand, so far no prenatal treatment has proved to be effective against thrombocytopenia due to maternal autoimmunity.

Standard artificial feeding is not suitable for patients with acute respiratory failure due to the increase in CO2 production it entails, effect of carbohydrate metabolism. Randomized use of an enteral diet comprising 55% of fats in 10 patients with chronic pulmonary disease during an acute phase, receiving mechanical ventilatory support, achieved a rapid decrease of VCO2 value, 243 to 215 ml.min-1, while it increased to 250 ml.min-1 with the control diet. These variations are metabolic and not ventilatory in origin for they are not accompanied by changes in plasmatic total CO2 rate.

Several authors have insisted on the role of a glucose 6-phosphate deshydrogenase (G6PD) deficiency in the occurrence of neonatal jaundice which can be severe, leading to exchange transfusion. Considering the fact that haemolysis, occuring in deficient patients, is most of the time induced, our aim was to search if a neonatal hyperbilirubinemia could be explained by the sole G6PD deficiency or by extra "oxidant stress". Red blood cell G6PD activity of 289 newborn babies of African or Antillian origin was tested by a Tetrazolium linked method. 21 newborns were deficient. 8 female babies were heterozygous for G6PD deficiency. No neonatal jaundice was observed. With Bienzle and all., we can suppose that the "environment" takes an important part in the incidence of neonatal jaundice among G6PD deficient newborn of African or Antillian origin. However as triggering factors could be ignored, we think compulsary to search a G6PD deficiency in every neonatal jaundice necessitating an exchange-transfusion.

A group of 37 patients with myocardial infarction less than 6 hours old was given 5,000 IU of heparin and 0.75 mg/kg of tissue plasminogen activator (rt-PA) (Group A, N = 18) or placebo (Group B, N = 19) intravenously over 90 minutes in a double blind study. Blood sampling was performed before, during and after treatment. The plasma rt-PA concentrations (micrograms/ml) of Group A were as follows: (Table: see text) The concentrations of plasminogen and antiplasmin have decreased significantly as did the fibrinogen level: a concentration of 1 g/l was observed in 7 cases during rt-PA therapy, lasting for 4 to 8 hours after the end of the infusion of rt-PA in 3 cases. The increase of FDP during rt-PA (m = 551 and 222 micrograms/ml at the 60th and 90th minutes) was relatively moderate considering the average level of defibrination (61%). No significant biological changes were observed in Group B. These results support those of our in vitro trials: at comparable thrombolytic activities, the reduction of plasma fibrinogen is less with rt-PA than with streptokinase (SK) or urokinase (UK). However, at concentrations 1 microgram/ml, rt-PA causes almost complete defibrination.

The physiopathological role of antithromboplastin-type circulating anticoagulants in habitual abortion may be envisaged since the presence of antithromboplastin has been reported in most studies on women at high risk of abortion. To avoid a possible statistical bias, we conducted a prospective study in a sufficiently large group of women with habitual abortion (n = 99) compared with a control group of women with normal fecundity (n = 50). In addition, all women were investigated for lupus symptoms. The circulating antibody was detected by the diluted thromboplastin time and activated cephalin time methods. The results were considered positive when the patient/control diluted thromboplastin time ratio was 1.2 and/or when the increase in activated cephalin time was not corrected by a control plasma. In the patients' group, 10 women (10%) had an anti-thromboplastin type circulating anticoagulant, whereas no circulating anticoagulant could be detected in the control group. Three women with circulating anticoagulant had signs of systemic lupus erythematosus. None of the patients presented with Soulier-Boffa syndrome. These data have established a significant correlation between habitual abortion and circulating anticoagulant whilst avoiding statistical bias. Our results suggest that women with idiopathic habitual abortion should be subjected to systematic immunological exploration and that a small number of them should be followed attentively.

The relationship between abortive disease and systemic lupus erythematosus is complex as shown by data from the literature and by our 9 patients selected for presenting with abortive disease, circulating anticoagulant and biological signs of autoimmunity. The risk of transformation into a systemic disease is real, although difficult to evaluate in the absence of prospective studies, but the major problem with these patients is the severity of the obstetrical pathology. The sombre foetal prognosis, already reported in the literature, requires close supervision and sustained treatment during pregnancy. For these reasons we suggest calling autoimmune abortive disease the disease which affects women with signs of autoimmunity who have had several, often late foetal deaths associated with the presence of circulatory anticoagulant thought to interfere with placental blood flow.

163 patients aged from 27 to 70 years (mean 52 +/- 10 years), including 152 men and 11 women, received a thrombolytic treatment within the first 6 hours (mean 192 +/- 73 mn) of a myocardial infarction. 61 patients received streptokinase (SK) intravenously (group 1), 64 patients, single-chain rt-PA (group 2), 11 patients, two-chain rt-PA (group 3), 11 patients, rt-PA followed by intracoronary streptokinase (group 4), and 16 patients, acyl enzyme (group 5). In addition, all patients had heparin and 86 (53%) had aspirin. Immediately after thrombolysis, coronary arteriography was performed in 95 patients (58%), and this was followed by transluminal angioplasty in 49 of them (30%). The infarction was either anterior (n = 81) or inferior (n = 78) or lateral (n = 4). No fatal or neurological bleeding occurred. 17 haemorrhagic complications were observed; 5 of these (3%) were severe, requiring blood transfusion and, in 1 case, surgery; 12 were significant (7.4%) and produced changes in haematocrit. Nine of the 17 haemorrhages were associated with catheterization and localized to the site of arterial puncture. Severe bleeding occurred in patients treated with intravenous SK (3/61) or with rt-PA followed by intracoronary SK (2/11). There was a significant difference in the incidence of spontaneous bleeding between the SK group (4/61) and the single-chain rt-PA group (0/64; p less than 0.05). In the latter group, the minimum fibrinogen level was lower in patients who had a haemorrhagic complication.(ABSTRACT TRUNCATED AT 250 WORDS)