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This study reports the first isolation and partial genetic characterization of Chikungunya virus (CHIKV) from patients during a 2006-2007 dengue-like syndrome outbreak in Gabon. The isolated viruses were phylogenetically close to strains isolated in the Democratic Republic of the Congo 7 years ago and to strains isolated more recently in Cameroon. These results indicate a continuing circulation of a genetically stable CHIKV population during 7 years in Central Africa.

All components of the sacrum (bone, cartilage, bone marrow, meninges, nerves, notochord remnants, etc.) can give rise to benign or malignant tumours. Bone metastases and intraosseous sites of haematological malignancies, lymphoma and multiple myeloma are the most frequent aetiologies, while primary bone tumours and meningeal or nerve tumours are less common. Some histological types have a predilection for the sacrum, especially chordoma and giant cell tumour. Clinical signs are usually minor, and sacral tumours are often discovered in the context of nerve root or pelvic organ compression. The roles of conventional radiology, CT and MRI are described and compared with the histological features of the main tumours. The impact of imaging on treatment decisions and follow-up is also reviewed.

MR Imaging is the most sensitive technique for detecting breast cancer. In patients with breast cancer, the additional value of MRI is validated in patients candidates for a breast-conserving surgery and when: cancer is occult, size evaluation is difficult at standard imaging, parietal involvement is suspected, and before neoadjuvant chemotherapy. In fatty breasts, MRI is not routinely recommended, because of same performances as in standard imaging. In dense breasts, MRI becomes significantly more sensitive than mammography for detecting multifocality and multicentricity with a positive predictive value of 60% for detected additional foci. Thus, a decision of mastectomy should not be made solely on the basis of MRI and may require additional tissue sampling of areas of concern identified by breast MRI. The additional value of breast MRI is particularly useful in patients with dense breasts and high risk factors for local recurrence: young age (< 40 years), familial high risk, or because of a high-grade invasive cancer greater than 2 cm in size. Performing breast MRI in such patients underlies requirements: an expert breast imaging team, optimal MRI protocols, and radiologists working in concert with the multidisciplinary treatment team.

Resume Objectif Evaluer l’interet de l’IRM dans le bilan d’extension locale de la maladie de Paget du sein. Materiels et methodes Les donnees cliniques, radiologiques (mammographies, IRM) et histologiques ont ete analysees chez 6 patientes presentant une maladie de Paget du sein. En IRM, les criteres d’analyse etaient les suivants : morphologie (epaississement, regularite du contour) et type de rehaussement apres injection de produit de contraste (courbe intensite de signal/temps) de la plaque areolo-mamelonnaire (PAM), detection de rehaussements anormaux dans la glande mammaire, aires ganglionnaires. Resultats Aucune patiente ne presentait de masse palpable, ni d’anomalie mammographique suspecte. En IRM, la PAM etait morphologiquement anormale dans 4 cas, avec un rehaussement suspect dans 2 cas (2 CCIS) et un rehaussement normal dans 2 cas (un CCIS). Dans les 2 autres cas, la PAM etait normale (un CCIS). Un rehaussement anormal a distance de la PAM etait note dans 2 cas (un CCIS et un benin). Conclusion L’aspect IRM de la PAM dans la maladie de Paget concorde peu avec les resultats histologiques. L’interet de l’IRM reside dans la detection de lesions a distance de la PAM en l’absence de signe clinique ou mammographique suspect.

L’evaluation de reponse tumorale est fondee sur les modifications du nombre et de la taille de « cibles » mesurables. Les regles de l’Organisation Mondiale de la Sante (OMS), qui definissaient les methodes de mesure et les criteres de reponse ne sont plus adaptees a l’evolution technique de l’imagerie. Les nouveaux criteres edites par le Response Evaluation Criteria in Solid Tumors (RECIST) Group restent fondes sur la mesure de la taille des cibles. Ce seul critere de taille doit etre discute a la lumiere des nouvelles possibilites de l’imagerie dite fonctionnelle (echographie-Doppler avec produit de contraste, scanner ou IRM dynamiques, imagerie de diffusion, spectroscopie par resonance magnetique, imagerie ciblee, TEP scanner) susceptible de fournir des informations sur la vascularisation, le metabolisme ou la viabilite des tumeurs, parametres dont les modifications traduisent la reponse au traitement avant la diminution de volume.

Resume Ameliorer nos competences communicationnelles est une obligation pour mieux repondre a la demande legitime des patients et des familles d’une meilleure information et d’une amelioration de leur prise en charge a tous les niveaux. Un certain nombre de plaintes et de reproches adresses a l’encontre du corps medical ont pour cause un defaut ou une mauvaise communication. Or les competences dans ce domaine s’acquierent ou se renforcent par l’apprentissage d’un certain nombre de techniques et l’application de regles de base. Les recommandations jusqu’ici publiees sont avant tout destinees aux medecins traitants et s’appliquent moins directement aux radiologues. En s’en inspirant, des outils specifiques ont ete developpes pour la pratique de l’echographie perinatale puis de la radiopediatrie. Il s’agit d’integrer simplement les points essentiels necessaires a l’optimisation des relations entre les jeunes radiopediatres, les patients et leurs familles. Nous avons nous-memes adapte ces regles a la radiologie en oncologie en recitant le CREDO du radiologue que l’on peut egalement proposer pour la radiopediatrie.

Positron emission tomography (PET)/computed tomography (CT) imaging is frequently requested in Oncology. Radiologists and nuclear medicine physicians are often asked to perform a panel of imaging examinations as part of the initial staging or follow-up of cancer patients. Medical imaging must therefore integrate polyvalent skills enabling imaging specialists to understand and interpret all types of images. In this context, PET imaging combined with non-enhanced CT, and diagnostic quality contrast-enhanced CT scan and optimisation of CT settings, is part of this multidisciplinary approach requiring the specific skills of a radiologist and a nuclear medicine physician. This approach must therefore be conducted in both directions: radiologists and nuclear medicine physicians should both know how to correlate PET and CT images, while preserving the specificities of each discipline. Radiologists need to be aware of several aspects of PET imaging: PET technology, the examination procedure and injection of iodinated contrast agent for high quality diagnostic CT, ideally followed by double interpretation of CT images, PET images and fused images. Radiologists should be familiar with PET imaging, as this procedure may be associated with several pitfalls and artefacts that need interpretation by a trained specialist. The authors analyse the examination technique of PET combined with non-enhanced and/or contrast-enhanced CT and the proposals for optimal interpretation of normal or pathological PET/CT fusion images.

Magnetic resonance imaging (MRI) is the best technique for bone marrow imaging. The MRI signal of bone marrow depends on the quantity of fat it contains and on its cellularity. Evaluation of marrow of patients treated for cancer is complicated by age and osseous site related changes in the distribution of normal haematopoietic (red) and fatty (yellow) marrow and by the changes induced by treatments: decrease in pathological cellularity, increase in fat proportion, conversion of red marrow to fatty marrow or, conversely, reconversion of fatty marrow in normal haematopoietic red marrow. The treatments used in oncology modify pathological marrow but also normal marrow and may sometimes lead to complications. These modifications may be focal or diffuse, homogeneous or patchy and symmetrical or asymmetric. The knowledge of bone marrow physiological status and post-therapeutic patterns is important for the interpretation of marrow disorders and effects of therapy and to avoid false-positive diagnosis of marrow metastases and tumour progression. The aim of this paper is to recall the MRI patterns of normal bone marrow and normal variations and to show the effects of treatments on bone tissue and normal bone marrow and treatment-related modifications on pathological marrow.

Resume Les protocoles enoncant les regles de base de la relation medecin-malade qui ont ete proposes jusqu’ici dans la litterature, sont surtout destines aux medecins traitants, en particulier oncologues. En ce qui concerne l’amelioration des competences communicationnelles des radiologues, un outil simple, le RADPED a ete developpe pour aider les residents de radiopediatrie a memoriser les points forts de la rencontre radiologue-patient. Nous proposons ici un protocole, le CREDO, plus specifiquement destine a la pratique de l’imagerie medicale, en particulier en cancerologie. Ce protocole concerne non seulement la relation du radiologue avec les malades mais aussi les regles communes a l’ensemble de l’equipe et a l’organisation des services. Il s’agit de C onstruire une relation partenaire avec le patient (ce pourquoi nous suggerons d’utiliser le modele PERLES : partenariat, excuses, respect, legitimation, empathie, support) de R ealiser l’examen dans les meilleures conditions, d’Ecouter ce que le patient veut nous dire, de Donner les informations et enfin d’Organiser les services autour du malade.

The aim of imaging during and after neoadjuvant therapy is to document and quantify tumor response: has the tumor size been accurately measured? Certainly, the most exciting information for the oncologists is: can we identify good or nonresponders, and can we predict the pathological response early after the initiation of treatment? This review article will discuss the role and the performance of the different imaging modalities (mammography, ultrasound, magnetic resonance imaging and FDG-PET imaging) for evaluating this therapeutic response. It is important to emphasize that, at this time, clinical examination and conventional imaging (mammography and ultrasound) are the only methods recognized by the international criteria. Magnetic resonance imaging and FDG-PET imaging are very promising for predicting the response early after the initiation of neoadjuvant chemotherapy.

Along with advances in medicine and social evolution, we are seeing an increase in the number of patients afflicted with cancer, and a change in the doctor-patient relationship. Patients' rights are now registered in the Hospitalised Patient's Charter, the Huriet Act and the Act of March 4, 2002. The evolution in cancer diseases is monitored by a range of imaging examinations, putting the radiologist in the front line. Lesions are typically first detected by the radiologist. This task is complicated by the fact that radiologists usually have no formal training with regards to the disclosure of cancer diagnoses to patients. There is a great risk of inappropriate responses which can have a profoundly damaging effect on the patient's state of mind. Even if we have the best of ideals and intentions, there is a great need for us to examine and improve our modes of interaction, in dealing with the patient's need for information. The radiologist possesses technical know-how, but technique alone is not enough - the right amount of information, based on clinical competence, is required; but so is empathy towards the patient, and respect for his or her wishes and rights.

Progress in medicine and changes in our society have led to an increasing number of patients with cancer and a change in the doctor–patient relationship. Patients rights are now defined in several countries by laws. The course of cancer involves numerous imaging examinations in which the radiologist is primarily involved. It is often the radiologist who discovers abnormalities and who must break the news to the patient. This task is made all the more difficult by the radiologist’s lack of specific training in the management of difficult situations such as announcing bad news. There is a high risk of inappropriate responses that can have a seriously damaging effect on the patient’s state of mind. Even with the best intentions, it can be very profitable to review and improve our relational modalities and to more effectively meet the patient’s increasing demand for information. The radiologist’s technical know-how is not sufficient, as he must also be able to give just the right amount of information based on his clinical competence, and his relationship with patients while respecting their wishes and their rights.

The objective of our study was to describe and determine the feasibility of an MR washout quantification method in patients with breast cancer under preoperative chemotherapy.Nineteen patients with breast T2 or T3 tumors were enrolled in a previous study for tumor response evaluation during chemotherapy based on dynamic contrast-enhanced MRI. We retrospectively used the dynamic acquisition data to produce parametric images representing the washout pattern. Two radiologists unaware of the final pathologic results measured the volume of pixels exhibiting washout within the tumor before chemotherapy (volume 1), after two courses of chemotherapy (volume 2), and before surgery after four courses of chemotherapy (volume 3). The interobserver variability and intraobserver variability were calculated to evaluate the reproducibility of our method with the Pearson's correlation coefficient and the concordance correlation coefficient. We correlated the washout changes by means of a Student's t test and noted the histopathologic final outcome.A washout pattern was present in all patients on the initial MR study. The quantification method of the washout changes was reproducible with good interobserver agreement (r = 0.85, p10(-5)) and an excellent intraobserver agreement (r = 0.94, p10(-5)). A significant decrease of the washout volume was observed after two courses of chemotherapy (p = 0.004), whereas no significant modification was observed between two and four courses of chemotherapy (p = 0.52).Quantification of the washout variation in breast tumor based on the use of parametric images is feasible and reproducible. It may add information to the evaluation of tumor response to preoperative therapy.

Accurate presurgical evaluation of residual disease appears essential for successful clinical outcome in patients with breast cancer who are undergoing chemotherapy. Our objective was to study the impact on surgical planning of adding serial MRI evaluations of the tumor to standard non-MRI assessments.MR images of breast tumors obtained before, during, and after preoperative chemotherapy were reviewed in 30 patients. Tumor response was assessed using both size and morphologic MRI criteria. We compared the actual surgical decisions made prospectively on the basis of standard (clinical, mammographic, and sonographic) assessments of response with decisions that would have been made had MRI findings also been considered. MRI investigators were blinded to the ultimate surgical results. Successful breast-conserving surgery was judged on pathologic confirmation of excision margins that were negative for cancer.The standard evaluation led to 16 successful breast-conserving and 14 mastectomy procedures. Using MRI results would have led to major beneficial therapeutic changes in six (20%) of the 30 patients: five patients undergoing primary mastectomy (chemotherapy avoided) and one patient undergoing postchemotherapy mastectomy (unsuccessful breast-conserving surgery avoided). MRI would have added valuable information in 14 (46.7%) of the 30 patients. In seven (23.3%) of the 30 patients, the decision to perform postchemotherapy mastectomy would have been unchanged. In one patient (3.3%), MRI results would not have prevented unsuccessful breast-conserving surgery. In two patients (6.6%), MRI results would have prevented successful breast-conserving surgery from being performed.Although the ultimate incidence of breast conservation was potentially similar for the patients (16/30, 53%) in whom the standard evaluation was used and for the patients (14/30, 47%) in whom the MRI-added evaluation was used, MRI was useful in establishing the final treatment earlier in the process, avoiding unnecessary preoperative chemotherapy, or selecting high-risk breast-conserving procedures.

New guidelines to evaluate the response to treatment in solid tumors using imaging techniques have major limitations and important implications for radiological workload. This consensus statement from the International Cancer Imaging Society (ICIS) reviews the RECIST criteria and addresses several challenges regarding tumour measurement. Recommendations are made regarding tumour measurement and other issues are raised. The growing need to introduce a multimodality approach to monitoring response is recognized. ICIS welcomes a dialogue with the authors of RECIST to address issues raised in this review.

Le role de l’imagerie chez les patientes traitees par des therapies neo–adjuvantes pour un cancer du sein n’est pas seulement d’evaluer la diminution de la masse tumorale, mais aussi de predire la reponse histologique a la chimiotherapie, facteur correle a la survie. L’intervention chirurgicale et l’analyse anatomo–pathologique apres le traitement neo–adjuvant permettent de controler objectivement la fiabilite des modalites d’imagerie pour l’evaluation de la reponse. Le but de cette etude est de comparer l’interet des differentes techniques d’imagerie morphologiques et fonctionnelles dans la determination de la reponse au traitement neo–adjuvant du cancer du sein.

Resume Objectif de l'etude. – Etudier differentes methodes de recalage d'images tomodensitometriques et d'IRM chez des patients traites par curietherapie prostatique. Comparer les resultats de l'etude dosimetrique realisee sur les coupes scanographiques et sur les images recalees. Materiel et methodes. – Il s'agit d'une etude retrospective portant sur 14 patients traites par iode 125. La scanographie a ete realisee avec des coupes de 5 mm jointives et l'IRM avec une antenne de surface et des coupes jointives de 3 mm. Pour le recalage d'images, seule la sequence d'IRM ponderee en T2 a ete utilisee. Deux methodes de recalage ont ete realisees pour chaque patient. La premiere utilisait les reperes osseux du pelvis et la seconde utilisait comme reperes les grains implantes. Une appreciation quantitative et qualitative a ete realisee par les operateurs pour chaque patient et chaque methode de recalage. L'etude dosimetrique obtenue grâce a un logiciel dedie a ete realisee sur les images tomodensitometriques et sur chaque type d'image recalee. Les indices dosimetriques habituels (D90, V100 et V150) ont ete compares pour chaque type d'image. Resultat. – L'analyse des resultats quantitatifs affiches par le logiciel de recalage a montre une precision superieure du recalage fonde sur les points de reperes osseux. A l'inverse, l'analyse des resultats qualitatifs et quantitatifs obtenus par les operateurs a montre une precision superieure du recalage fonde sur les grains d'iode. Pour deux des trois patients dont la D90 etait inferieure a 145 Gy avec la tomodensitometrie, la D90 etait superieure a cette norme lorsque la dosimetrie etait effectuee sur les images recalees, quelle que soit la methode de recalage utilisee. Conclusion. – La methode de recalage d'image fondee sur la mise en coincidence des grains apparait plus precise que celle utilisant les reperes osseux. L'etude dosimetrique realisee sur les images recalees permettrait de corriger d'eventuelles erreurs dues principalement aux difficultes de delimitation de la prostate sur les images tomodensitometrique.

Reaction rates included in photochemical models of planetary atmospheres carry with them a level of imprecision. This imprecision leads to an uncertainty in computed mole fractions of chemical species. We present estimations of the uncer- tainties on mole fraction profiles, obtained using a 1-D photochemical model applied to the study of hydrocarbon compounds in Saturn's atmosphere. We calculate the uncertainties as a function of altitude for each compound and derive the mean value and the standard deviation of the mole fraction. We show that the uncertainties on the mole fraction of hydrocarbons determined from a photochemical model are very significant. Ethane and acetylene, the most abundant hydrocarbons in Saturn's atmo- sphere after methane, are affected by an uncertainty factor of about 1.5, and the mole fraction of complex hydrocarbons, which are the products of a more complex chemistry, are affected by a large uncertainty factor which can reach 24. We discuss the implications for the determination of the eddy diffusion coefficient. In particular, we show that uncertainties on the calculated mole fractions produce a large uncertainty on the eddy diffusion coefficient profile in the lower atmosphere.

Resume Meningite aseptique medicamenteuse au cours d’une endocardite infectieuse. Introduction. – Les meningites medicamenteuses sont une complication rare du traitement. Les anti-inflammatoires non steroidiens representent la majorite des cas publies. Exegese. – Nous rapportons le premier cas d'un syndrome meninge febrile, apres la prise d'ornidazole, avec une meningite biologique aseptique a predominance lymphocytaire et une guerison spontanee sans sequelle en quelques jours. Le patient etait porteur d'une endocardite infectieuse ayant revele un carcinome intramuqueux du sigmoide. Le reste du bilan etiologique est demeure negatif. Conclusion. – Nous avons conclu a une meningite medicamenteuse en retenant comme tres probable la responsabilite de l'ornidazole. Le diagnostic doit etre evoque devant un syndrome meninge recidivant, d'ou l'importance de l'anamnese, apres elimination des autres causes. Dans l'attente d'une preuve formelle habituellement apportee par le test de reintroduction, une antibiotherapie est indispensable, car il s'agit avant tout d'un diagnostic d'elimination.

Monitoring response of tumours to treatment is an integral and increasingly important function of radiologists working in oncological imaging. Imaging studies play a pivotal, objective role in quantifying tumour response to a variety of physical and pharmaceutical treatments. Objective tumour shrinkage has been widely adopted as a standard end-point to select new anti-cancer drugs for future study, as a prospective end-point for definitive clinical trials designed to estimate the benefit of treatment in a specific group of patients, and is widely used in everyday clinical practice to guide clinical decision-making. In the late 1970s it became apparent that a common language was necessary to report the results of cancer treatments in a consistent manner. Standardized criteria for measuring therapeutic response were adopted in 1981 but have been modified by various cancer organizations [1–3]. The World Health Organisation (WHO), the National Cancer Institute and the European Organisation for Research and Treatment of Cancer have recently adopted a new set of tumour response criteria (Response Evaluation Criteria in Solid Tumours (RECIST)) [4]. The RECIST criteria have been introduced to unify response assessment criteria, to define how to choose evaluable lesions and to enable the use of new imaging technologies (spiral CT and MRI). The RECIST documentation goes beyond lesion selection, measurement and assessment of response. It also makes specific recommendations on the usage of imaging techniques. The CT protocols are particularly detailed (imaging parameters for incremental and spiral machines, use of contrast enhancement and the presentation of images). The implications of this document are wide ranging and are likely to have cost and manpower implications for radiology departments in cancer treatment centres. This Commentary highlights these issues. The RECIST response criteria are largely based on a retrospective statistical evaluation of measurements (not original imaging data) obtained in eight pharmaceutical-sponsored clinical trials where 569 patients were assessed for tumour response [5]. The data analysed were selected by their ‘‘availability’’ but did have a broad range of tumours and serial measurements, with outcomes recorded. The quality control of the measurements themselves is unknown. In an attempt to simplify tumour measurements, unidimensional and bidimensional evaluations were compared and the new criteria selected are chosen because of the link between change in diameter, product and volume of spherical lesions (Table 1). It has recently been noted that the two measurement methods continue to show good concordance for 4613 patients [6]. The new RECIST response criteria are designed to replace existing WHO criteria; the two sets of criteria are compared in Table 2. It is important to note that the RECIST criteria still rely on size change of lesions to make response assessments. RECIST acknowledges that tumour shrinkage may not be an appropriate end-point in the investigation of new cytostatic agents currently in phase 1 and 2 clinical trials [7]. RECIST guidance defers the issues relating to functional tumour response and unique complexities of specific tumours or anatomical sites. There

A new photochemical model of Saturn’s atmosphere, which includes hydrocarbon (up to C 4 compounds) and oxygen compounds, is presented. This model derives from Neptune’s model established by Dobrijevic et al. (2000 . Planet. Space Sci., submitted). In this one-dimensional model, we consider vertical transport driven by molecular and eddy diffusion. Downward flux of atomic hydrogen from the upper atmosphere and the ionosphere, and external fluxes of oxygenated material are included. Concerning hydrocarbons, calculated abundances agree with observations for methane and acetylene, whereas the ethane and methyl radical disagree. Methyl (CH 3 ) abundance is widely overestimated, suggesting an underevaluation of methyl recombination rates. Moreover, further investigations of the chemical scheme and dynamics are needed. Water and carbon dioxide, whose column abundances in Saturn’s stratosphere have been inferred by ISO observations ( Feuchtgruber et al., 1997 . Nature 389, 159–162), originate in an external flux of oxygenated material. We find an agreement with ISO values ( η H 2 O =6.8×10 14 molecules cm −2 and η CO 2 =7.8×10 14 molecules cm −2 ) for an external flux of material with a cometary-like composition (Φ H 2 O =10 6 molecules cm −2 s −1 , Φ CO =2×10 5 molecules cm −2 s −1 and Φ CO 2 =6×10 4 molecules cm −2 s −1 ). These external fluxes cannot reproduce the abundance of CO inferred by Noll and Larson (1991. Icarus 89, 168–189), suggesting that CO has an internal origin. More generally, we find that a total influx of oxygen atoms between 10 6 and 10 7 atoms cm −2 s −1 is necessary to reproduce oxygen compound abundances. The precise determination of this flux depends on the nature of the entering materials.

To the Editor: Infectious diseases are the main cause of illness for armed forces in conflict (1), resulting in decreases in operational efficiency. The International Security Assistance Force (ISAF) in Afghanistan is a multinational force operating under the auspices of the North Atlantic Treaty Organization (NATO). As part of ISAF, French troops operate in Kabul and its surroundings, within a 70-km radius. French medical facilities consist of a French field hospital and a primary care center. The facilities support 4,000 soldiers, 1,048 of whom are French. Troop disease, including acute respiratory disease (ARD), is routinely monitored through French Army and NATO surveillance systems. We report an outbreak of ARD in the multinational force in which pertussis cases were identified by using laboratory tests and epidemiologic criteria. In November 2006, a substantial increase of ARD was detected in soldiers of different nationalities (Figure), with a 10-fold increase among French troops at week 51. Patients with persistent cough or dyspnea were referred to the field hospital, in a nonrandomized manner, and those with a 2-week history of cough underwent serologic tests. Samples were sent to France and were analyzed at Hopital Saint Anne, Toulon, France. Immunoglobulin (Ig) G antibodies to Bordetella pertussis antigens (pertussis toxin, filamentous hemagglutinin, and adenylcyclase) were determined by a Western blot assay (MarDx Diagnostics, Carlsbad, CA, USA). Recent infection was diagnosed by finding high levels of antibodies to pertussis toxin compared to results for standardized positive and negative samples, in concurrence with the fact that no soldier had been vaccinated against pertussis after childhood. IgG and IgA antibodies to Chlamydia pneumoniae were determined by a semiquantitative method that assessed samples’ absorbance value in optical density (SeroCP Quant IgG and Quant IgA, Savyon Diangostics, Ashdod, Israel). Recent infection to Mycoplasma pneumoniae was assessed by detecting IgM antibodies with a specific enzyme immunoassay (Platelia Mycoplasma pneumoniae, Biorad, Hercules, CA, USA) and by using a semiquantitative method to detect IgM and IgG antibodies with patented gelatin particles sensitized with cell membrane components of M. pneumoniae (Serodia Myco II, Fujirebio, Malvern, PA, USA). Coxiella burnetii infection was assessed by indirect immunofluorescence assay (Coxiella burnetii Spot IF, bioMerieux, Marcy l’Etoile, France). Figure Number of acute respiratory diseases cases, according to troop nationality. UK, United Kingdom. A color version of this figure is available online: www.cdc.gov/EID/content/14/7/1173-G.htm Statistical analysis was performed with Epi Info v3.4 software package (Centers for Disease Control [CDC], Atlanta, GA, USA). Quantitative variables were compared by using the Kruskall-Wallis test. From the third week of December 2006 until the third week of January 2007, 209 French soldiers sought treatment at the French medical facilities for stereotyped acute febrile respiratory infection, which represents a cumulative attack rate of 20% on clinical grounds. Thirty-nine French soldiers and 10 non-French soldiers or local civilian workers were then referred to the field hospital. All patients had a 24-h history of fever >38.5°C and nonspecific ear, nose, and throat symptoms, mainly a sore throat. Cough was unremarkable, without whoops. Fourteen of the 49 patients were hospitalized for severe dyspnea. The difference in median age was not significant between inpatients (26 [range 20–57] years) and outpatients (36 [range 21–53] years, p = 0.15). Twenty-seven blood samples were taken, 24 from French troops, 2 from British troops, and 1 from Polish patients. Six patients, including 3 French soldiers, had recent pertussis. No significant difference in age was found between patients with pertussis and those with non–pertussis ARD (36 [range 27–51] versus 33 [range 20–63] years; p = 0.39). No pertussis patient had been vaccinated against the illness since childhood. One patient had evidence of recent infection with M. pneumoniae, and another with C. pneumoniae. No recent infection involved C. burnetii. All patients with ARD had a favorable outcome. This outbreak of ARD among troops in Afghanistan highlights the importance of nontraumatic illness in wartime when military field conditions enhance exposure to, and incidence of, endemic diseases. Although our study did not include systematic laboratory confirmation for all cases of ARD in soldiers because of field conditions, this outbreak was mainly due to pertussis: most cases were defined by a cough lasting >2 wk, took place in an outbreak setting, and were (for 6 patients) confirmed by laboratory tests. CDC requirements were followed to ascertain confirmed cases (2). This outbreak also involved British troops; after the 2 cases we described, 2 additional serologically confirmed cases and 1 probable confirmed case were discovered among symptomatic British returnees (3). Pertussis, which remains endemic in developing countries (4), was reported in northeastern Afghanistan in 2002 (5), but was never biologically ascertained nor reported in Kabul. This outbreak elicits 3 main questions. First, how can ARD transmission be stopped under field conditions? Besides prophylactic antibiotherapy, isolation of suspected case-patients is not achievable because of limited number of beds in medical facilities and high-person density in barracks and dining halls. To minimize transmission, patients and caregivers should wear masks. Second, what prophylactic antibiotherapy should be given? We recommend a 3-day regimen of azithromycin because it is as efficient as erythromycin in preventing spread of pertussis (6), targets most intracellular bacteria involved in ARD, and offers the best compliance (7). Finally, should soldiers be vaccinated against pertussis for overseas campaigns? In France, no booster vaccination is given after 13 years of age (8). Because acellular vaccines do not ensure immunity for >6 years (5), no French soldier has immunity to pertussis. We therefore advocate booster vaccination before overseas campaigns. Pertussis vaccination is widely available in combination with vaccination against, at minimum, diphtheria and tetanus, but these combination vaccines can only be administered once in an adult’s life and only 2 years after previous vaccination against diphtheria or tetanus. Monovalent vaccines against pertussis must be made more widely available for multinational troops in field conditions.

The diversity of a set of breeds or species is defined in the Weitzman approach by a recursion formula using the pairwise genetic distances between the elements of the set. The algorithm for computing the diversity function of Weitzman is described. It also provides a taxonomy of the set which is interpreted as the maximum likelihood phylogeny. The theory is illustrated by an application to 19 European cattle breeds. The possible uses of the method for defining optimal conservation strategies are briefly discussed., Un aperçu sur l’approche de la diversité selon Weitzman. La diversité d’un ensemble d’espèces, ou de races, est définie par Weitzman de façon récursive ; les données de départ sont les distances génétiques entre les éléments de l’ensemble pris deux à deux. L’algorithme de calcul de la diversité fournit, comme résultat intermédiaire, un arbre de classement des espèces en présence, qui est interprété comme une phylogénie du maximum de vraisemblance. La théorie est illustrée par un exemple d’application à 19 races bovines européennes, et les utilisations possibles de la méthode pour définir des stratégies optimales de conservation sont discutées brièvement.

PURPOSE We evaluated the impact of an evaluation committee (EC) on patients' overall response status in a large multicenter trial in oncology. We identified reasons for disagreements between investigators and the EC. MATERIALS AND METHODS The Cancer Renal Cytokine (CRECY) study was a French multicenter trial that tested cytokine therapy in 489 patients with metastatic renal cell carcinoma. Objective response (OR) evaluation included medical imaging and was studied according to international guidelines. A blinded peer review of all responders and litigious cases was performed by an EC. RESULTS Major disagreements occurred in 40% and minor disagreements in 10.5% of the reviewed files. The number of significant tumor responses was reduced by 23.2% after review by the EC. Reasons for disagreements included errors in tumor measurements, errors in selection of measurable targets, intercurrent diseases, and radiologic technical problems. These reasons for disagreements are analyzed and discussed. CONCLUSION We conclude that all therapeutic trial results should be reviewed by peer analysis of all presumed responders by an EC. International guidelines for response evaluation should be updated by including more reliable methods of measurements and definition of minimal imaging procedures.

Objective Preventive measures were implemented in the French armed forces to limit the measles outbreak that occurred in 2010 and 2011. This study aimed to obtain feedback concerning the management of this outbreak by the French military general practitioners. Method A cross-sectional study was conducted among the general practitioners (GPs) in military units located in metropolitan France. The 60 military units that reported at least one measles case in 2011 were included. Data were collected using self-administered questionnaires. Results The acceptance of preventive measures against measles was good (measures “totally justified” for 77.8%) and most of the military GPs considered that the outbreak had no significant impact on their activities. The management of measles cases was perceived as not very problematic but difficulties were encountered in the identification of contacts around cases (48.1% of respondents) and in the identification of vaccine recipients among these contacts (more than 80% of respondents reporting difficulties in the collection of measles and vaccination histories). The organization of vaccination around cases was also perceived as difficult. Conclusions Preventive measures around measles cases were well accepted by the military GPs, which could reflect their preparedness in the face of the outbreak. However, vaccination did not seem to be well understood or accepted by military patients, underlining the essential role of military GPs in patient information. Difficulties in the collection of vaccination and measles histories among contacts could be overcome by an early transcription of individual medical records in the military medical files of newly enlisted personnel. A more generalized use of oral fluid testing devices, which can be shipped at ambient temperature, would simplify diagnosis in the armed forces.

Characterisation of genetic diversity in a large number of European pig populations has been undertaken with EC support. The populations sampled included local (rare) breeds, national varieties of the major international breeds, commercial lines and the Chinese Meishan breed. A second phase of the project will sample a further 50 Chinese breeds. Neutral genetic markers (AFLP and microsatellites), with individual or bulk typing, were used and compared.DNA from 59 European pig populations was extracted on samples of about 50 individuals per population. Individuals were typed for 50 microsatellites and for 148 AFLP bands. A subset of 25 populations was typed for 20 microsatellites on pools of DNA. Allele frequencies were estimated by direct allele counting for the co-dominant markers. Frequencies of AFLP negative alleles (absent bands) were obtained by taking the square root of absent band frequencies. Within-breed variability was summarised using standard statistics: expected and observed heterozygosity, mean observed and effective numbers of alleles, and F statistics. Between-breed diversity analysis was based on a bootstrapped Neighbor-Joining (NJ) tree derived from Reynolds distances (DR). The standard distance of Nei (DS) was also calculated.

A comparison has been performed on 3 recently published linkage maps of the pig, hereafter designated as the American (A), European (E), and Swedish (S) maps. The cumulated distances between common markers in these 3 maps were in the ratio 1.00 (A): 0.88 (E): 0.77 (S), in keeping with the ratio of the percentages of domestic genome in the reference families used to build the corresponding maps, i.e., 1.00 (A): 0.81 (E): 0.50 (S). From further recombination frequencies reported in wild boars (in the S report), the wild pig genome length (in centimorgans) is expected to represent 66% of the domestic pig genome length. These observations tend to confirm a general result of Burt and Bell (Nature (London), 326: 803–805 (1987)), showing higher chiasma frequencies in domestic mammalian species compared with wild species. Consequences for mapping studies are discussed.Key words: recombination, pig, microsatellites, chiasmata.

Introduction En France, la surveillance epidemiologique du paludisme, effectuee par un Centre national de reference (CNR), repose sur un reseau sentinelle de laboratoires hospitaliers, qui capture environ 50 % des cas. L’incidence est ainsi estimee a environ 4000 cas par an. En parallele, les cas survenant chez des militaires sont declares au Centre d’epidemiologie et de sante publique des armees (CESPA) par les medecins des armees. L’objectif de ce travail etait d’evaluer la possibilite d’utiliser le Sniiram-PMSI pour mettre en œuvre une surveillance epidemiologique du paludisme exhaustive sur la population. Methodes L’algorithme d’identification des cas a ete construit en deux etapes. Premierement, les cas possibles ont ete recherches sur la periode du 1er juillet 2013 au 30 juin 2014, en utilisant les donnees des hospitalisations et celles des remboursements de ville. Deuxiemement, pour augmenter la specificite de l’algorithme, sept regles d’exclusion ont ete definies sur avis d’expert, en se fondant sur la description des donnees et l’identification de valeurs aberrantes. Les performances de l’algorithme ont ete evaluees en comparant les distributions demographiques (âge, sexe), spatiales et temporelles des cas avec les donnees du CNR et du CESPA. Aucun appariement n’a ete realise en l’absence d’autorisation. Resultats L’algorithme a permis d’identifier 4248 cas incidents de paludisme, correspondant a 4099 patients distincts. Pour la meme periode, 2222 cas ont ete declares au CNR du paludisme et 197 au CESPA. Aucune difference significative n’a ete retrouvee en population generale d’une part, entre les cas identifies a partir du Sniiram-PMSI et ceux declares au CNR et en population militaire d’autre part, entre les cas identifies comme militaires au sein du Sniiram-PMSI et ceux declares au CESPA. Discussion/Conclusion Les resultats de l’etude sont coherents avec les donnees de la surveillance epidemiologique du paludisme en France. L’exhaustivite du Sniiram-PMSI sur la population permet d’etudier l’ensemble des cas, y compris ceux non captures par les systemes de surveillance actuels.

Chondrosarcoma is the commonest primary sarcoma of bone in adults, with a male predominance. Patients are usually between 30 and 70 years old. Clinical symptoms are pain and tenderness with or without a mass, the average duration of symptoms being 1–2 years, but growth may be very slow, especially for pelvic tumours [1]. Chondrosarcomas characteristically produce coalescent cartilage lobules of various size. The center often becomes necrotic or cystic [1].

Phase II trials demonstrate the activity of cisplatin in patients with refractory Ewing sarcoma family tumours (ESFT) and also the feasibility of giving cisplatin with oral VP16 in a variety of different cancers. This trial was conducted to evaluate the activity and toxicity profile of this combination delivered as outpatient therapy in patients with refractory/relapsed ESFT.Cisplatin was administered on days 1, 8 and 15 and days 29, 36 and 43 (70 mg/m(2)/dose for patients21 years of age and 50 mg/m(2)/dose ≥21 years). VP16 was administered at a dose of 50 mg/m(2) on days 1-15 and days 29-43 inclusive. A three-stage Fleming statistical design was used for analysis.Between January 2003 and October 2006, 45 patients aged between 5 and 46 years (median 19) were enrolled. Thirty-eight were evaluable for response. Patients had previously received one to three lines of chemotherapy (median = one). Seventy-three per cent of the patients had grade 3/4 neutropenia, 20 % developed fever, 40 % had grade 3/4 anaemia, 68 % grade 3/4 thrombocytopenia and 16 % grade 2/3 ototoxicity. Measured response after 2 cycles: 0 CR, 7 PR (18 %), 13 SD (34 %), 18 PD (48 %). There was excellent concordance between unidimensional and bidimensional criteria in 31 of 33 responses (94 %). PFS at 1 year was 39 %, with a median PFS of 6 months. Overall survival at 1 year was 44 %; median survival was 11 months.Cisplatin combined with oral VP16 is well tolerated and has acceptable side effects, but limited clinical activity in refractory/relapsed ESFT.

Background: Treatment effect is categorised into four classes by RECIST based on the evolution of the size of target lesions and the occurrence of new lesions, irrespective of tumour growth kinetics before treatment. This study aimed at evaluating the added value of tumour growth kinetics assessment to RECIST in patients treated with molecularly targeted agents (MTAs). Methods: On-study imaging, along with pre-baseline imaging, of patients treated with MTA(s) in clinical trials at Institut Curie were centrally reviewed. The tumour growth ratio (TGr), defined as the ratio of the slope of tumour growth before treatment and the slope of tumour growth on treatment between the nadir and disease progression, was calculated for each patient. Results: A total of 50 patients included in 18 trials were eligible for the study. Among the 44 patients who withdrew from the study because of disease progression according to the investigators' assessment, 18 patients (41%) had a TGr

Si l’on resume la meta-analyse publiee par Houssami et Hayes en 2008, analysant 19 etudes (total de 2 610 patientes, 9 prospectives, aucune avec randomisation) sur 35 publiees entre 1966 et 2007, la prevalence mediane des lesions surnumeraires homolaterales au cancer index detectees par l’IRM seule etait de 16 % (6–34 %). La valeur predictive positive (VPP) de l’IRM de ces anomalies surnumeraires etait de 66 % (IC 95 % de 52 a 77 %) avec un rapport vrais positifs/faux positifs de 1,91 soit, pour 3 patientes avec un rehaussement IRM additionnel, une patiente avec un faux positif de l’IRM [1]. Ces faux positifs (pas de preuve histologique avant chirurgie) ont ete a l’origine d’un sur-traitement chirurgical chez 6,6 % des patientes (1,1 % de conversion en mastectomie — IC 95 % de 0,3 a 3,6) — et 5,5 % de chirurgie conservatrice plus extensive — IC 95 % de 3,1–9,5). Si on s’interesse aux etudes ou la malignite des foyers additionnels IRM a ete prouvee, on obtient les resultats suivants : taux de conversion en mastectomies de 8,1 % (IC 95 % de 5,9 % a 11,3 %) et conversion en chirurgie conservatrice plus extensive de 11,3 % (IC 95 % de 6,8 % a 18,3 %).

French Guiana is a French Province located on the northern coast of South America that had 221,500 inhabitants in 2008 (1). Malaria is endemo-epidemic to the Amazon basin. Since 2000, the annual number of Plasmodium falciparum and P. vivax malaria cases in French Guiana has ranged from 3,500 to 4,500 (2). Approximately 3,000 French military personnel are deployed annually in French Guiana, and malaria occasionally affects their operational capabilities. Only military personnel on duty in the Amazon basin are required to take malaria chemoprophylaxis; personnel deployed in coast regions are not. Until February 2001, the chemoprophylaxis regimen consisted of chloroquine (100 mg/d) and proguanil (200 mg/d). During March 2001–October 2003, mefloquine (250 mg/wk) was used. Since November, 2003 malaria chemoprophylaxis has been doxycycline (100 mg/d), which is initiated on arrival in the Amazon basin. All chemoprophylaxis is continued until 4 weeks after departure. Because of the absence of marketing authorization as chemoprophylaxis by the French Medicines Agency, primaquine was not used until recently. Other individual and collective protective measures did not change during 1998–2008. Despite the availability of chemoprophylaxis, since 2003, several malaria outbreaks have been identified after operations against illegal mining in the Amazon basin (3,4). The purpose of those studies was to describe outbreaks and determine factors related to malaria cases. We report French military health surveillance epidemiologic data on malaria among military personnel deployed to French Guiana during 1998–2008.

To ensure vision readiness on the battlefield, the French military has been providing its soldiers with eyewear since World War I. A military refractive surgery program was initiated in 2008. A prospective questionnaire-based investigation on optical correction and quality of vision among active duty members with visual deficiencies stationed in Djibouti, Africa, was conducted in 2009. It revealed that 59.3% of the soldiers were wearing spectacles, 21.2% were wearing contact lenses--despite official recommendations--and 8.5% had undergone refractive surgery. Satisfaction rates were high with refractive surgery and contact lenses; 33.6% of eyeglass wearers were planning to have surgery. Eye dryness and night vision disturbances were the most reported symptoms following surgery. Military optical devices were under-prescribed before deployment. This suggests that additional and more effective studies on the use of military optical devices should be performed and policy supporting refractive surgery in military populations should be strengthened.

The definition of the optimal dose of a new compound and the design for identifying this dose have been set up for treatment with cytotoxic activity. The optimal dose is typically the Maximum Tolerated Dose (MTD) defined by the occurrence of severe toxic side effects during the first course of treatment. In the era of molecularly targeted therapies (MTA), where the mechanistic relations between the dose, the activity and the toxicity are probably different, how relevant these definitions and designs are?We present here a review of the outcomes of potential interest for defining the optimal dose and we present several statistical innovative dose finding methods. Longitudinal data (tumour growth, repeated evaluation of toxic side effects) and continuous outcomes appear particularly promising for early phase trials.Phase I dose finding method for molecularly targeted agents should continue to identify the MTD, but the dose recommended for phase II trials should not be systematically defined as the MTD and should incorporate other endpoints. In particular, more sensitive and more discriminatory endpoints are necessary. They needn't be good surrogate of the clinical benefit, but they should allow for ranking several doses. Experience from other medical specialties, such as phase II dose-ranging trials could be considered.

In 2006, a French Army unit reported 39 malaria cases among service persons returning from Ivory Coast. Thirty, including three serious forms, occurred after the return to France. The risk of post-return malaria was higher than the risk in Ivory Coast. Half of the imported cases had stopped post-return chemoprophylaxis early.

Despite an increase in foreign tourism and in the numbers of foreign military personnel deployed to Djibouti, little is known about the risk of gastrointestinal illness in this country in eastern Africa. To assess risk and to describe common features of gastrointestinal illnesses, reports of illness derived from military health surveillance data collected during 2005-2009 among French service members deployed to Djibouti were reviewed. Diarrhea was the most common problem; it had an annual incidence ranging from 260 to 349 cases per 1,000 person-years. The risk was higher among soldiers deployed short-term (four months) than among soldiers deployed long-term (two years). This five-year review of French health surveillance data documents a significant burden of diarrhea among French soldiers in Djibouti. The identification of factors associated with risk may permit efficient targeting of interventions to reduce morbidity from gastrointestinal illness.

Although stingray injuries have always been frequent in the Republic of Djibouti, it was not until July 2008 that the Bouffard Hospital developed a standardised management protocol. The purpose of this report is to describe that protocol and evaluate its impact on the outcome of stingray injuries based on a prospective study for the period between July 2008 and July 2009. During the study period, 12 stingray stings were treated. The treatment protocol that is based on a multidisciplinary approach involving the intensivist, anaesthesiologist, and surgeon achieved wound healing within one month. This outcome contrasts with previous publications that have generally described longer healing times with frequent infectious complications.

Background The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known. Methods The compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months) in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model. Results The averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028), a medical history of clinical malaria (p < 0.001) and a perceived mosquito attractiveness inferior or superior to the others (p < 0.007). Correct compliance was significantly associated with the systematic use of protective measures against mosquito bites (p < 0.001), the type of military operations (combat vs. training activities, p < 0.001) and other individual factors (p < 0.05). Conclusions The identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.

To investigate the clinical accuracy of magnetic resonance imaging-guided breast vacuum-assisted biopsy (MR-VAB). Of 97 scheduled MR-VAB for single MRI lesions (negative second-look sonography) categorised as BI-RADS 4 or 5, 4 were cancelled (undetected lesion = 2, technical problems = 2). Twenty-one patients lost to follow-up were excluded. Twenty-three patients (median age 51 years) were at high risk (BRCA1 = 11, BRCA2 = 7, familial risk = 5), 23 had a suspected local recurrence of breast cancer. Seventy-two imaged lesions (focus = 1, mass enhancement = 32, non-mass-like enhancement = 39) were targeted with a 10-gauge VAB probe using MRI guidance, with a median of 18 specimens per lesion (median procedural time 72 min, range 50–131 min) followed by clip placement. In the case of benignity, MRI follow-up was performed (19 patients, median 389 days, range 33–1,592) or mammography (3 patients, median 420 days, range 372–1,354). According to histopathology results, 29 lesions were benign, 10 were high-risk (papillary = 2, radial scar = 1, atypical epithelial hyperplasia = 7) and 33 malignant (ductal carcinoma in situ = 8, invasive cancers = 25). Three false negative results and 3 complications occurred (1 malaise, 1 skin defect, 1 infection). MRI-guided VAB represents an accurate tool for the histological diagnosis of lesions visible only at MRI.

Non-occupational HIV exposure in the French forces has been placed under epidemiological surveillance since 2000. This surveillance programme provides an indirect indicator of risky sexual behaviour among military personnel.All cases of non-occupational exposures in French military personnel that meet the notification criteria, wherever they occur, are reported by a military physician, with data being collected from 2005 to 2007.Between January 2005 and December 2007, 2241 cases of sexual exposure within the French forces were filed. The annual incidence was 214.3 per 100,000 with an average patient age of 26 years. Sexual exposures concerned men in 99.2% of cases and occurred overseas in 92.9% of cases. Partners were sex-workers in 66.7% of cases. Failure to use condoms adequately during sexual intercourse was reported in 15.5% of cases. In cases where condoms were used, exposure to HIV resulted either from condom rupture or slippage. Postexposure HIV prophylaxis was prescribed in 70.5% of cases.The majority of cases of sexual exposure reported in the French armed forces involved high risk of HIV transmission. However, since the beginning of surveillance in 2000, no cases of HIV seroconversion have been reported following postexposure antiretroviral prophylaxis. The non-occupational postexposure prophylaxis strategy is not in question.

Pertussis surveillance in the French general population was stopped in 1986. Pertussis was added to the list of illnesses surveyed by the military epidemiological surveillance network because of outbreaks having occurred among French servicepersons and in military high schools. This study had for aim to report the results of the first year of surveillance.Pertussis declaration criteria were those recommended in 2006 by the French council for public hygiene. The data concerning active military servicepersons was collected by physicians of all military medical units. An anonymous declaration form was used for data collection.In 2007, 66 cases of pertussis were reported in the military forces, 10 of which were excluded after a negative biological test. The classification of the 56 included cases was: 46% biologically confirmed cases, 20% clinically confirmed cases, 14% suspected cases, and 6% epidemiologically confirmed cases. The incidence density rate was 16.3 cases for 100,000 servicepersons-years. Age under 20 was associated with a 4.6 fold higher risk to develop pertussis.The high incidence rate observed in individuals under 20 years of age could reflect a shift of pertussis reservoir to young adults, as observed in industrialized countries after generalization of vaccination programs. However, several years of surveillance will be needed to confirm this hypothesis. Meanwhile, the military epidemiological network could constitute an important surveillance marker of pertussis among adults in France.

Incidence of malaria is increasing in travelers and soldiers. In 2006, a survey was performed in a French battalion returning from a malaria-endemic area. According to the chemoprophylaxis plasma concentration and the individuals’ reports, the noncompliance rates were high, respectively, 63.4 and 54.7%.