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Dopamine receptor agonists (DA) are assuming an increasing importance in the treatment of both early and advanced symptoms of Parkinson's disease (PD). However, choosing the right DA for patients with PD unfortunately remains more a pragmatic medical art than a science. The aim of this review is to provide a realistic point of view on the strengths and weaknesses of five DAs: bromocriptine, ropinirole, pergolide, pramipexole and piribedil. This has been done by analysing their respective: (1) flexibility in PD, i.e. in monotherapy, in early and in late combination with levodopa; (2) safety profile and (3) titration schedule. These five DAs are not evenly matched regarding these three criteria. The differences observed highlight the therapeutic value of piribedil, which has a flexible indication, adapted to all stages of PD, a safer profile and the most simple initiation schedule.

Double differential hydrogen isotope production cross sections have been extracted in 62.7 MeV neutron induced reactions on a lead target. The angular distribution was measured at eight angles from 20degrees to 160degrees allowing the extraction of angle-differential, energy differential, and total production cross sections. A first set of comparisons with several theoretical calculations is also presented.

Introduction – objectifs L’epidemie regionale a Enterobacteries Hautement Resistantes aux antibiotiques nous a incites a rechercher systematiquement un portage non connu d’E-BMR chez les patients entrant dans notre etablissement. Materiels et methodes Il s’agit d’une enquete prospective realisee durant un mois au sein d’un SSR de la region PACA de 148 lits. Chaque nouveau patient entrant etait inclus quel que soit l’etablissement d’origine. Un ecouvillonnage rectal et un ECBU dans les 48 heures suivant l’admission etaient realises systematiquement. Les E-BMR etaient definis par la detection d’une cephalosporinase dereprimee, d’une Betalactamase a Spectre Elargi (BLSE) ou d’une carbapenemase. La notion de portage d’EBMR du patient reposait sur le document d’admission ou l’information est systematiquement renseignee. Resultats 124 patients etaient inclus, dont 2 etaient declares colonises a E-BMR, et provenaient de 8 etablissements differents. Un total de 121 ECBU et 116 ecouvillonnages rectaux etaient realises. Neuf patients (7 %) etaient porteurs d’E-BMR, diagnostiques dans 2 cas par l’ECBU seul, dans 3 cas par le prelevement rectal seul, et dans 4 cas l’ECBU et le prelevement rectal etaient concordants. Les bacteries identifiees etaient : E. Coli (7/9), E. Cloacae (1/9), K. pneumoniae (1/9). Les mecanismes de resistance etaient une BLSE chez 8 patients et une cephalosporinase dereprimee chez 1 patient. Aucune carbapenemase n’etait detectee. Aucun de ces 9 patients detectes porteurs d’EBMR n’etaient declares porteur par les etablissements d’origine mais 8/9 avaient ete exposes a un antibiotique. Conclusion Notre SSR est expose a une population entrant avec des EBMR (1/14 entrees) sans que cela soit connu, ni meme identifie en hospitalisation d’amont. Cela implique d’adapter nos mesures d’hygiene ainsi que les protocoles d’antibiotherapie probabiliste. Le reperage de ces patients pourrait etre base sur les anteriorites d’antibiotherapie.

Introduction – objectifs Description des caracteristiques des meningites sur breches osteo-meningees (MBOM). Materiels et methodes Etude retrospective (2006–2013) monocentrique des MBOM du sujet adulte. Resultats Cent-vingt-trois patients ont presente au moins une meningite bacterienne documentee dont 19 etaient porteurs d’une breche (15 %). L’âge moyen etait de 51,2 ans. Onze sujets (57,9 %) etaient des hommes. Treize patients (68,4 %) ont necessite un sejour en reanimation et 2 (10,5 %) sont decedes. L’origine de la breche etait un traumatisme crânien (TC) dans 7 cas (36,8 %), postchirurgicale dans 10 cas (52,6 %). Le delai entre la formation de la breche et la survenue de la meningite etait tres variable. Une fuite de LCR etait cliniquement constatee chez 58 % des patients (n = 11). L’imagerie objectivant la breche etait un scanner simple dans 6 cas, un scanner avec coupes fines osseuses et/ou une IRM a ete necessaire dans les autres cas. En post-TC, la localisation de la breche etait frontale ou au niveau du rocher. Le pneumocoque etait retrouve dans 57,9 % des cas (11/19), et dans 100 % des breches existant depuis plus d’un an (n = 8). En cas de breche plus recente, le staphylocoque et les BGN etaient predominants. La fermeture chirurgicale de breche (parfois repetee) ou la mise en place d’une derivation ventriculaire externe etaient souvent requises. Tous les patients ont recu une antibiotherapie. Seuls 8 patients (42,1 %) ont recu une corticotherapie concomitante. Huit patients (42,1 %) seulement ont ete vaccines apres leur premier episode. Trois patients (15,8 %) ont presente au moins une recidive. Conclusion La MBOM est une pathologie grave et non rare (15 % des patients ayant presente au moins une meningite). Elle necessite une prise en charge medico-chirurgicale experimentee, une recherche radiologique specifique et une vaccination preventive.

Total joint replacement of the trapezio-metacarpal (TMC) joint is one of the procedures available for the surgical treatment of degenerative osteoarthritis or rheumatoid arthritis of the first carpometacarpal joint. A four French Alpine surgeon group, (C. Lebrun, P. Massart, F. Moutet and C. Sartorius) have developed a new cementless total TMC joint prosthesis: the Roseland prosthesis. Such a device tries to improve the biomechanical conditions of the La Caffinière's implant, which was introduced in 1973. Clinical data of a 24 patients with a 38 month mean follow-up series are reported.

The full understanding of the kinetics of a subcritical assembly is a key issue for its online reactivity control. Point kinetics is not sufficient to determine the prompt reactivity of a subcritical assembly through the response to a dirac pulse, in particular in the cases of a large reflector, a small reactor, or a large subcriticality.Taking into account the distribution of intergeneration times, which appears as a robust characteristic of each type of reactor, helps to understand this behaviour.Eventually, a method is proposed for the determination of the prompt reactivity. It provides a decrease rate function depending on the prompt multiplication coefficient Keffp. Fitting a measured decrease rate with this function, calculated once for the reactor, gives the true value of keffp. The robustness of the method is tested. (Elsevier)

Reaction mechanisms and multifragmentation processes have been studied for Zn-64 + Ni-58 collisions at intermediate energies with the help of antisymmetrized molecular dynamics (AMD-V) model calculations. Experimental energy spectra, angular distributions, charge distributions, and isotope distributions, classified by their associated charged particle multiplicities, are compared with the results of the AMD-V calculations. In general the experimental results are reasonably well reproduced by the calculations. The multifragmentation observed experimentally at all incident energies is also reproduced by the AMD-V calculations. A detailed study of AMD-V events reveals that, in nucleon transport, the reaction shows some transparency, whereas in energy transport the reaction is much less transparent at all incident energies studied here. The transparency in the nucleon transport indicates that. even for central collisions, about 75% of the projectile nucleons appear in the forward direction. In energy transport about 80% of the initial kinetic energy of the projectile in the center-of-mass frame is dissipated. The detailed study of AMD-V events also elucidates the: dynamics of the multifragmentation process. The study suggests that, at 35A MeV, the semitransparency and thermal expansion are the dominant mechanisms for the multifragmentation process, whereas at 49A MeV and higher incident energies a nuclear compression occurs at an early stage of the reaction and plays an important role in the multifragmentation process in addition to that of the thermal expansion and the semitransparency.

A facility for measurements of neutron-induced double-differential light-ion production cross-sections, for application within, e.g., fast neutron cancer therapy, is described. The central detectio ...

Two-neutron correlation functions are measured in the 40Ar + 197Au reaction at 60 MeV/nucleon to study the space-time characteristics of neutron emitting sources. The source temperatures and velocities are deduced by fitting the single-neutron energy spectra with a three-source model. A comparison of the correlation data with the predictions of the model of moving sources and with the dynamical Landau-Vlasov model suggests the relevance of a multisource description. Particular care has been paid to the influence of the relative source abundance on the shape of the correlation function.

Neurotoxicity can be induced by the synergistic or additive effects of cytotoxic treatments, and nervous system exposure is related to routes and doses.The improvements in treating systemic malignancy have been accompanied by reports of neurologic toxicity, which has an important impact on the quality of life and may even limit the use of the treatment.It demands out a continuous clinical evaluation to detect their appearance. When neurological complications are diagnosed later, they are rarely reversible. Neuroprotective agents are still being evaluated.

The epidemiology of brain or central nervous system metastases is poorly documented. Retrospective studies based on autopsies that were aimed at investigating the incidence and prevalence of brain metastases have revealed the shortfalls in tumour registers. The exact role of cerebral metastases has not been addressed within the scope of cancer considered as a public health issue.The prognosis of brain metastases should not be considered either on general or a priori basis as being poorer than that of other metastatic sites. Evaluation of the role of focal radiation therapy and chemotherapy is still in progress. Appropriate use of therapeutical strategies directed at brain tumors generally improves the condition of most patients. It also usually increases survival and enhances the quality of life.The role of chemotherapy in current therapeutical strategies has not yet been defined and should be investigated and developed.

Spallation neutron production in proton induced reactions on Pb targets at 0.8, 1.2, and 1.6 GeV has been measured at the SATURNE accelerator. Double-differential cross sections were obtained over a broad angular range from which averaged neutron multiplicities per reaction were inferred for energies above 2 MeV. The results are compared with calculations performed with a high energy transport code including two different intranuclear cascade (INC) models: it is shown that the Cugnon INC model gives a better agreement with the data than the Bertini one, mainly because of improved nucleon-nucleon cross sections and Pauli blocking treatment. © 1999 The American Physical Society.

The aim of this study was to perform a multivariate analysis including clinical and biological prognostic factors on glial tumor outcome. Seventy-nine patients were analyzed (48 men and 31 women; mean age = 56 years, range = 16-77 years): 7 had a benign glial tumor (grades 1 and 2), 21 had an anaplastic glial tumor (grade 3), and 51 had a glioblastoma (grade 4). Median follow-up was 17.9 months for patients who survived (50 patients died). Biopsies were obtained at time of diagnosis (complete tumor resection in 62 patients and stereotaxic biopsies in 17 patients). Epidermal growth factor receptor (EGFR) was measured by a binding assay, and labeling index (LI) was measured by tritiated thymidine incorporation. EGFR varied from 4 to 73,110 fmol/mg protein (mean = 3912 fmol/mg protein; median = 374 fmol/mg protein; n = 79). LI varied between 0.1 and 16.5% (mean = 6.2%; median = 5.2%; n = 40). Log10 EGFR was significantly and positively correlated with patient age. LI was significantly different according to tumor histology. Univariate Cox analysis (end point was cancer death) showed that age (P = 0.027), log10 EGFR (P = 0.025), and LI (P = 0.0019) were significant continuous variables, the survival being shortened when the covariable increased; tumor resection (P = 0.015, relative risk = 0.45) and histology (P = 0.0009) were significant categorical factors. A multivariate Cox analysis (forward selection) including age, histology, tumor resection, log10 EGFR, and LI revealed that log10 EGFR, LI, and tumor resection were the only independent significant predictors of survival. This multivariate approach reveals that the clinical prognostic factors of glial tumors, namely age and tumor histology, disappear, to the benefit of intrinsic characteristics of the tumor, i.e., EGFR expression and LI, suggesting that coupled EGFR and LI determination could be a useful tool for better evaluation of glial tumor outcome.

Seizures are common in patients presenting with intracranial tumors. Nevertheless, the incidence of cancer is not higher in patients with seizures. We attempted to summarize situations that can lead to the diagnosis or treatment of seizures in patients presenting with cancer.Focal neurological signs on clinical examination when seizures occur for the first time in patients with cancer lead to brain imaging. As a result of recent advances in neuro-imaging techniques, the presence of a tumor is now more frequently observed in patients with seizures.As it may have irritating effects on the cerebral cortex, chemotherapy is able to either increase or induce seizures in patients presenting with cancer. Potential pharmacological interactions between antiepileptic and cytotoxic drugs thus require close surveillance in patients with cancer.

The tyrosine kinase family includes growth factor receptor and cytoplasmic enzymes. It plays a key role in normal cell division and abnormal cell proliferation and differentiation. The most common tyrosine kinases are the epidermal-growth factor (EGFR) and platelet-derived growth factor (PDGF) receptors, and a chromosome Philadelphia product, the Bcr-abl oncogene. Many studies have attempted to correlate clinical evolution of tumors with tyrosine kinase expression. However, clinical application of these new prognostic factors has not yet been demonstrated. More recently, tyrosine-phosphorylation inhibitors (tryphostin) have been developed in phase I studies. Results that were obtained show some objective responses in patients with glioblastoma and polymetastatic cancer. Another approach to block tyrosine kinase expression is the use of monoclonal antibodies. Trials using such antibodies have shown interesting preliminary results.

Plasma alpha 1 antitrypsin (alpha 1 AT) is the major serine protease inhibitor (Pi) in plasma. It is a glycoprotein, which presents many molecular variants. Allelic phenotypes are classified alphabetically according to their electrophoretic mobility in the Pi (Proteases inhibitor) system. More than 75 distinct protease inhibitor subtypes have been identified using isoelectric focusing (IEF). The major interest for detecting its microheterogeneity is the rare possibility of deficient alleles, which are responsible of low amounts in the alpha IAT production. The clinical use of the alpha 1AT phenotyping is the diagnosis of hereditary alpha 1AT deficiencies. The most common normal phenotype is MM; the major deficient phenotypes are MS, MZ, SS, SZ and ZZ. Hereditary deficiencies of the Pi, the most common inborn error in European people, lead to pulmonary emphysema in young adults or liver cirrhosis in children. IEF on polyacrylamide gels is the reference method for alpha 1AT phenotyping, but is very difficult to standardize. In the present study, we have developed IEF on agarose gels for Pi subtyping within a number of technical improvements. A 0.5 mm thin agarose gel (1.6%) is cast on polyester film; focusing is performed using carrier ampholines (pH = 4.2-4.9), using a very high voltage. Staining is done with a simplified silver nitrate method. The patterns of the different Pi phenotypes obtained with our technique are very attractive. The common subtypes corresponding to the alleles M1, M2, M3, S, Z are univocally demonstrated. Agarose gel allows the advantage of using a non toxic substance. Further the gels are easy to produce and the method is accessible to all clinical laboratories.

The results of analysis of two-neutron correlations in the region of small relative velocities are presented. The influence of spurious correlations on the form of correlation function is considered in detail. Data analysis and computer simulations were performed for a specific detector configuration with close angular position and different distances between the target and detector modules. The features of different methods of cross-talk elimination are examined. The proposed method is verified and the first results of cross-talk free correlation functions are presented for the ArAu reaction at 60 MeV u measured with the DEMON detector at GANIL.

We present the results of a multidisciplinary study of the Ms = 6.2, 1995, June 15, Aigion earthquake (Gulf of Corinth, Greece). In order to constrain the rupture geometry, we used all available data from seismology (local, regional and teleseismic records of the mainshock and of aftershocks), geodesy (GPS and SAR interferometry), and tectonics. Part of these data were obtained during a postseismic field study consisting of the surveying of 24 GPS points, the temporary installation of 20 digital seismometers, and a detailed field investigation for surface fault break. The Aigion fault was the only fault onland which showed detectable breaks (