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Background: Ectopic pregnancy is a frequent early complication of pregnancy associated with significant rates of morbidly and mortality. The positive diagnosis of this condition is established through transvaginal ultrasound scanning. The timing of diagnosis depends on the operator expertise in identifying the signs of ectopic pregnancy, which varies dramatically among medical staff with heterogeneous training. Developing decision support systems in this context is expected to improve the identification of these signs and subsequently improve the quality of care. In this article, we present a new knowledge base for ectopic pregnancy, and we demonstrate its use on the annotation of clinical images., Results: The knowledge base is supported by an application ontology, which provides the taxonomy, the vocabulary and definitions for 24 types and 81 signs of ectopic pregnancy, 484 anatomical structures and 32 technical elements for image acquisition. The knowledge base provides a sign-centric model of the domain, with the relations of signs to ectopic pregnancy types, anatomical structures and the technical elements. The evaluation of the ontology and knowledge base demonstrated a positive feedback from a panel of 17 medical users. Leveraging these semantic resources, we developed an application for the annotation of ultrasound images. Using this application, 6 operators achieved a precision of 0.83 for the identification of signs in 208 ultrasound images corresponding to 35 clinical cases of ectopic pregnancy., Conclusions: We developed a new ectopic pregnancy knowledge base for the annotation of ultrasound images. The use of this knowledge base for the annotation of ultrasound images of ectopic pregnancy showed promising results from the perspective of clinical decision support system development. Other gynecological disorders and fetal anomalies may benefit from our approach.

Background and Aims: Lipoprotein(a) (Lp[a]) is a strong genetic risk factor for cardiovascular disease (CVD). The American Heart Association has prioritised seven cardiovascular health metrics to reduce the burden of CVD: body mass index, healthy diet, physical activity, smoking status, blood pressure, diabetes and cholesterol levels (together also known as ideal cardiovascular health). Our objective was to determine if individuals with high Lp(a) levels could derive cardiovascular benefits if characterized by ideal cardiovascular health., Methods: A total of 14,051 participants of the EPIC-Norfolk study were stratified according to the cardiovascular health score (based on the number of health metrics with an ideal, intermediate or poor status). Of them, 1732 had a CVD event during a mean follow-up of 11.5 years. Cox proportional hazards models were used to describe the association between the cardiovascular health score and Lp(a) level or genotype (as estimated by the rs10455872 variant) with the risk of CVD., Results: We observed little or no differences in serum Lp(a) levels across the seven cardiovascular health metric categories. Among participants with high serum Lp(a) levels ≥50 mg/dl), those in the highest (i.e. healthiest) cardiovascular health score category (10-14) had an adjusted hazard ratio for cardiovascular disease of 0.33 (95% CI = 0.17-0.63, p = 0.001) compared to participants in the lowest (i.e. unhealthiest) cardiovascular health score category(0-4). Similar results were obtained when we replaced Lp(a) with rs10455872., Conclusions: Although Lp(a) levels are only slightly influenced by cardiovascular health metrics, an ideal cardiovascular health could substantially reduce CVD risk associated with high Lp(a) levels or genotype., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Mass spectrometry (MS) in Selected Reaction Monitoring (SRM) mode is proposed for in-depth characterisation of microorganisms in a multiplexed analysis. Within 60-80 minutes, the SRM method performs microbial identification (I), antibiotic-resistance detection (R), virulence assessment (V) and it provides epidemiological typing information (T). This SRM application is illustrated by the analysis of the human pathogen Staphylococcus aureus, demonstrating its promise for rapid characterisation of bacteria from positive blood cultures of sepsis patients.

Disorders of Sex Development (DSD) are a heterogeneous group of disorders affecting gonad and/or genito-urinary tract development and usually the endocrine-reproductive system. A genetic diagnosis is made in only around 20% of these cases. The genetic causes of 46,XX-SRY negative testicular DSD as well as ovotesticular DSD are poorly defined. Duplications involving a region located ∼600 kb upstream of SOX9, a key gene in testis development, were reported in several cases of 46,XX DSD. Recent studies have narrowed this region down to a 78 kb interval that is duplicated or deleted respectively in 46,XX or 46,XY DSD. We identified three phenotypically normal patients presenting with azoospermia and 46,XX testicular DSD. Two brothers carried a 83.8 kb duplication located ∼600 kb upstream of SOX9 that overlapped with the previously reported rearrangements. This duplication refines the minimal region associated with 46,XX-SRY negative DSD to a 40.7-41.9 kb element located ∼600 kb upstream of SOX9. Predicted enhancer elements and evolutionary-conserved binding sites for proteins known to be involved in testis determination are located within this region., (© 2015 Wiley Periodicals, Inc.)

Agri-food is one of the most important sectors of the industry and a major contributor to the global warming potential in Europe. Sustainability issues pose a huge challenge for this sector. In this context, a big issue is to be able to predict the multiscale dynamics of those systems using computing science. A robust predictive mathematical tool is implemented for this sector and applied to the wine industry being easily able to be generalized to other applications. Grape berry maturation relies on complex and coupled physicochemical and biochemical reactions which are climate dependent. Moreover one experiment represents one year and the climate variability could not be covered exclusively by the experiments. Consequently, harvest mostly relies on expert predictions. A big challenge for the wine industry is nevertheless to be able to anticipate the reactions for sustainability purposes. We propose to implement a decision support system so called FGRAPEDBN able to (1) capitalize the heterogeneous fragmented knowledge available including data and expertise and (2) predict the sugar (resp. the acidity) concentrations with a relevant RMSE of 7 g/l (resp. 0.44 g/l and 0.11 g/kg). FGRAPEDBN is based on a coupling between a probabilistic graphical approach and a fuzzy expert system.

Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) represents a revolution in routine pathogen identification in clinical microbiology laboratories. A MALDI-TOF MS was introduced to tropical Africa in the clinical microbiology laboratory of the Hôpital Principal de Dakar (Senegal) and used for routine pathogen identification. Using MS, 2,429 bacteria and fungi isolated from patients were directly assayed, leading to the identification of 2,082 bacteria (85.7%) and 206 fungi (8.5%) at the species level, 109 bacteria (4.5%) at the genus level, and 16 bacteria (0.75%) at the family level. Sixteen isolates remained unidentified (0.75%). Escherichia coli was the most prevalent species (25.8%) followed by Klebsiella pneumoniae (14.8%), Streptococcus agalactiae (6.2%), Acinetobacter baumannii (6.1%), Pseudomonas aeruginosa (5.9%), and Staphylococcus aureus (5.9%). MALDI-TOF MS has also enabled the detection of rare bacteria and fungi. MALDI-TOF MS is a powerful tool for the identification of bacterial and fungal species involved in infectious diseases in tropical Africa., (© The American Society of Tropical Medicine and Hygiene.)

Biting midges of the genus Culicoides are implicated as vectors for a wide variety of pathogens. The morphological identification of these arthropods may be difficult because of a lack of detailed investigation of taxonomy for this species in Africa. However, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) profiling is efficient for arthropod identification at the species level. This study established a spectrum database of Culicoides spp. from Senegal using MALDI-TOF. Identification of Culicoides insects to the species level before mass spectrometry was performed on the basis of morphological characters. MALDI-TOF MS reference spectra were determined for 437 field-caught Culicoides of 10 species. The protein profiles of all tested Culicoides revealed several peaks with mass ranges of 2 to 20 kDa. In a validation study, 72 Culicoides specimens in the target species were correctly identified at the species level with a similarity of 95 to 99.9%. Four Culicoides protein profiles were misidentified. Nevertheless, six SuperSpectra (C. imicola, C. enderleini, C. oxystoma, C. kingi, C. magnus, and C. fulvithorax) were created. Abdomens of midges were used to amplify and sequence a portion of the mitochondrial cytochrome oxidase I gene (COI). The results obtained using the MALDI-TOF MS method were consistent with the morphological identification and similar to the genetic identification. Protein profiling using MALDI-TOF is an efficient approach for the identification of Culicoides spp., and it is economically advantageous for approaches that require detailed and quantitative information of vector species that are collected in field. The database of African Culicoides MS spectra created is the first database in Africa. The COI sequences of five Culicoides species that were previously noncharacterized using molecular methods were deposited in GenBank., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

Purpose: To retrospectively evaluate the added value of one-view breast tomosynthesis in adjunct with mammography to characterize breast lesions., Materials and Methods: Our institutional ethics committees approved the study and granted a waiver of informed consent. One hundred fifty-five women (mean age, 51.3 years, range: 24-92 years) who systematically underwent mammography and breast tomosynthesis with subsequent percutaneous biopsy were analyzed. Four radiologists (two seniors, R1 and R2, and two juniors, R3 and R4 with 30, 10, 3 and 1 years of experience in breast imaging, respectively) independently reviewed exams in two steps: mammography alone and tomosynthesis in adjunct with mammography. The lesions in the cohort included 39.3% (61/155) cancers, 2.5% (4/155) high-risk lesions and 58.1% (90/155) benign lesions. A receiver operating characteristic (ROC) curve analysis was performed to compare the results of the two readings., Results: There was almost perfect agreement irrespective of reader experience for the reading of the mammography in adjunct with tomosynthesis, whereas agreement was poor between junior and senior readers for the reading of mammography alone. Area under the ROC (Az) values for the tomosynthesis in adjunct with mammography were significantly better than Az values for mammography alone for all readers except the most experienced, for whom only a tendency was noted. The proportion of cancers undiagnosed by mammography alone that were well diagnosed by tomosynthesis in adjunct with mammography was 6.5% (4/61), 13.1% (8/61), 27.8% (17/61) and 26.2% (16/61) for Readers 1, 2, 3 and 4, respectively. The proportion of false positive cases induced by the addition of breast tomosynthesis to mammography was 2.1% (2/94), 2.1% (2/94), 9.5% (9/94) and 12.7% (12/94) for Readers 1, 2, 3 and 4, respectively., Conclusion: Adding breast tomosynthesis to mammography improved sensitivity and negative predictive value for all readers except for the most experienced one, in whom only a tendency for improvement was noted., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Ripening descriptors are the main factors that determine consumers' preferences of soft cheeses. Six descriptors were defined to represent the sensory changes in Camembert cheeses: Penicillium camemberti appearance, cheese odor and rind color, creamy underrind thickness and consistency, and core hardness. To evaluate the effects of the main process parameters on these descriptors, Camembert cheeses were ripened under different temperatures (8, 12, and 16°C) and relative humidity (RH; 88, 92, and 98%). The sensory descriptors were highly dependent on the temperature and RH used throughout ripening in a ripening chamber. All sensory descriptor changes could be explained by microorganism growth, pH, carbon substrate metabolism, and cheese moisture, as well as by microbial enzymatic activities. On d 40, at 8°C and 88% RH, all sensory descriptors scored the worst: the cheese was too dry, its odor and its color were similar to those of the unripe cheese, the underrind was driest, and the core was hardest. At 16°C and 98% RH, the odor was strongly ammonia and the color was dark brown, and the creamy underrind represented the entire thickness of the cheese but was completely runny, descriptors indicative of an over ripened cheese. Statistical analysis showed that the best ripening conditions to achieve an optimum balance between cheese sensory qualities and marketability were 13±1°C and 94±1% RH., (Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Motivation: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has been broadly adopted by routine clinical microbiology laboratories for bacterial species identification. An isolated colony of the targeted microorganism is the single prerequisite. Currently, MS-based microbial identification directly from clinical specimens can not be routinely performed, as it raises two main challenges: (i) the nature of the sample itself may increase the level of technical variability and bring heterogeneity with respect to the reference database and (ii) the possibility of encountering polymicrobial samples that will yield a 'mixed' MS fingerprint. In this article, we introduce a new method to infer the composition of polymicrobial samples on the basis of a single mass spectrum. Our approach relies on a penalized non-negative linear regression framework making use of species-specific prototypes, which can be derived directly from the routine reference database of pure spectra., Results: A large spectral dataset obtained from in vitro mono- and bi-microbial samples allowed us to evaluate the performance of the method in a comprehensive way. Provided that the reference matrix-assisted laser desorption/ionization time-of-flight mass spectrometry fingerprints were sufficiently distinct for the individual species, the method automatically predicted which bacterial species were present in the sample. Only few samples (5.3%) were misidentified, and bi-microbial samples were correctly identified in up to 61.2% of the cases. This method could be used in routine clinical microbiology practice.

1-Palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC), a lipid comprising a saturated and an unsaturated acyl chain, belongs to the class of glycerophosphatidylcholines, major lipids in eukaryotic cell membranes. To get insight into the structural properties of this lipid within monolayers as membrane models, we performed molecular dynamics (MD) simulations of POPC monolayers under compression at the air/water interface. MD simulations were carried out at 300 K and at different surface pressures using the all-atom general Amber force field (GAFF). A good agreement was found between the simulated data and experimental isotherms. At surface pressures greater than 15 mN/m, two orientations of the head groups clearly appear: one nearly parallel to the monolayer interface and another one pointing toward the water. On the basis of the analysis of headgroup dihedral angles, we propose that the conformational variations around the bonds connecting the phosphorus atom to the adjacent oxygens are involved in these two orientations of the headgroup. The glycerol group orientation is characterized by a large distribution centered around 50° with respect to the monolayer normal. The acyl chains are predominantly in trans configuration from 7.5 to 43 mN/m surface pressures. Moreover, the calculated order parameter profiles of both chains suggest an independent behavior of the saturated and unsaturated chains that could be correlated with the formation of chain-type clusters observed along the simulated trajectories.

Multiple artefacts and pitfalls may occur with breast MRI. Artefacts are secondary to the MR technique itself while pitfalls often are the result of human error. The most common artefacts include motion, pulsation, chemical shift and magnetic susceptibility. The most common pitfalls include improper contrast injection, poor patient positioning, improper placement of the ROI and improper characterization of physiological and iatrogenic contrast enhancement. The identification of these artefacts and pitfalls on breast MR images may reduce their impact or even eliminate them. The use of optimized protocols is necessary. It is important to explain to patients the sequence of the examination, ensure proper placement of the breasts in the coil and optimize the contrast injection. The ROI should always be placed over the most suspicious region of the lesion. Finally, it is recommended to perform the MRI during the second week of the menstrual cycle and to discontinue the use of HRT 2 months prior to scanning when possible., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

Purpose: To retrospectively determine the value of adding perfusion-weighted (PW) and diffusion-weighted (DW) sequences to a conventional magnetic resonance (MR) imaging protocol to differentiate benign from malignant tumors., Materials and Methods: The institutional ethics committee approved this retrospective study and waived the requirement to obtain informed consent. MR images in 87 women (age range, 25-87 years) who underwent imaging before surgery for complex adnexal masses-excluding endometriomas and cystic teratomas-were analyzed. Conventional morphologic, perfusion, and diffusion MR criteria of malignancy were recorded. Three independent observers reviewed images in four steps: conventional MR images alone, conventional MR images and PW images combined, conventional MR images and DW images combined, and conventional, PW, and DW MR images combined. Receiver operating characteristic curve analysis was performed to compare the results of the readings. A recursive partitioning model was built to establish a multivariate decision tree., Results: There was almost perfect agreement for lesion characterization regardless of the reader experiment or step considered (κ = 0.811-0.929). Area under the receiver operating characteristic curve values were higher for conventional and DW images combined, conventional and PW images combined, and conventional, DW, and PW images combined compared with conventional MR images alone (P < .05). For all readers, the accuracy of conventional, PW, and DW imaging combined was higher than that of conventional MR imaging alone for benign masses (P < .01) but not for malignant masses (P = .24). The addition of both PW and DW images led to a correct change in the diagnosis in 19% (11 of 57 patients), 23% (13 of 57 patients), and 24% (14 of 57 patients) of cases for readers 1, 2, and 3, respectively, with no incorrect changes. Conventional, PW, and DW MR imaging criteria were combined to generate a decision tree giving an accuracy of 95%., Conclusion: The addition of PW and DW sequences to a conventional MR imaging protocol improved the diagnostic accuracy in the characterization of complex adnexal masses., (© RSNA, 2011.)

Modeling the cheese ripening process remains a challenge because of its complexity. We still lack the knowledge necessary to understand the interactions that take place at different levels of scale during the process. However, information may be gathered from expert knowledge. Combining this expertise with knowledge extracted from experimental databases may allow a better understanding of the entire ripening process. The aim of this study was to elicit expert knowledge and to check its validity to assess the evolution of organoleptic quality during a dynamic food process: Camembert cheese ripening. Experiments on a pilot scale were carried out at different temperatures and relative humidities to obtain contrasting ripening kinetics. During these experiments, macroscopic evolution was evaluated from an expert's point of view and instrumental measurements were carried out to simultaneously monitor microbiological, physicochemical, and biochemical kinetics. A correlation of 76% was established between the microbiological, physicochemical, and biochemical data and the sensory phases measured according to expert knowledge, highlighting the validity of the experts' measurements. In the future, it is hoped that this expert knowledge may be integrated into food process models to build better decision-aid systems that will make it possible to preserve organoleptic qualities by linking them to other phenomena at the microscopic level., (Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the efficacy of transcervical resection of submucous fibroids according to type and size., Materials and Methods: Retrospective follow-up of 235 women with submucous fibroids at outpatient hysteroscopy who underwent a hysteroscopic transcervical resection. The main indications were the abnormal uterine bleeding and fertility problems. Thirty-seven percent of patients had an associated endometrial ablation and 32% had a polyp resection. Fifty-one percent of women were menopausal. In cases of incomplete resection a repeat procedure was offered., Results: Intra-operative complications were rare (2.6%) and there was no major complication. Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18-66 months). The procedure was classed as a success in 94.4% of patients. Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up., Conclusion: The hysteroscopic transcervical resection of submucous fibroids is a safe and highly effective long-term therapy for carefully selected women presenting with abnormal uterine bleeding and fertility problems. It produces satisfactory long-term results with few complications.

Introduction: Women with persistently high resistance in uterine arteries have an increased risk of the subsequent development of preeclampsia. Doppler investigation provides a non-invasive method for the study of the uteroplacental blood flow. In pregnant women the antiphospholipid syndrome is associated to an increased risk of preeclampsia and complications related to uteroplacental insufficiency, and the role of uterine artery Doppler is discussed., Current Knowledge and Key Points: In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. In women with preeclampsia or related complications, the abnormal persistence of high resistance to flow in the uterine arteries correlates with maternal and neonatal outcome. In one study including patients with antiphospholipid syndrome, a high resistance index in the uterine arteries at 22-24 weeks gestation strongly predicted the subsequent development of preeclampsia. In another study including patients with lupus anticoagulant, persistent bilateral notches at 22-24 weeks gestation may identify preeclampsia and fetal growth restriction with a high sensitivity, specificity, positive and negative predictive value. The treatment may improve the uteroplacental blood flow and is a possible confounding factor which needs further evaluation. FUTURE PROSPECTS AND PROJECTS; In patients with antiphospholipid antibodies a higher impedance has been observed in the uterine artery, suggesting a possible vascular dysfunction precluding to impaired trophoblastic invasion and placental thrombosis, as probable mechanisms in the complications. If confirmed, these findings might have important implications for the management of these patients.

Objective: The purpose of this study was to estimate spiral artery subchorionic flow at 8-11 gestational weeks (GW) by Doppler ultrasound and then to analyze these vessels in the decidua basalis using histologic, morphometric and immunohistochemical analyses., Methods: Subchorionic spiral arteries were evaluated in 5 women scheduled for aspiration at 8-11 GW. Flow velocity waveforms were sought using color and pulsed Doppler, and the diastolic/systolic (D/S) index was calculated. Transcervical biopsy specimens and aspiration products were thoroughly examined to investigate the structure of the spiral artery at the implantation site using cytotrophoblastic and arterial smooth muscle cell immunohistochemical markers (anti-cytokeratin 7 and anti-actin monoclonal antibodies). Spiral artery cross-sectional inner areas were measured and compared with the D/S index in each case., Results: Low-impedance pulsatile flow could be detected below the trophoblastic ring in all cases. Complete obstruction of a spiral artery lumen was never observed and cytotrophoblastic cells were incorporated into the vessel wall starting from the perivascular cuff., Conclusion: Both techniques evidenced that decidual spiral arteries in the placental bed are not completely obstructed at 8-11 GW., (Copyright 2005 S. Karger AG, Basel.)

High-resolution endovaginal sonography has considerably improved ectopic pregnancy imaging. In conjunction with serum hCG measurements, it allows early detection of ectopic pregnancy (EP) and has significantly reduced the morbidity and the mortality of this disease. The major sonographic finding is the uterine vacuity, the diagnosis of ectopic pregnancy is quite sure in case of absence of intra-uterine pregnancy (IUP) associated with serum hCG above 1500 mUi/ml. Conversely, the presence of IUP excludes practically the diagnosis of EP, but IUP must be distinguished from a pseudosac. The visualization of an ectopic sac that contains an embryo or a yolk sac clearly allows the diagnosis of EP, but its sensitivity is only 25%. The most common sonographic finding is a hematosalpinx, which looks like an echogenic adnexal mass, next to the ovary containing the corpus luteum. Color Doppler is useful to enhance ectopic trophoblastic flow, but it is only a complementary technique of endovaginal sonography. Finally, if the first sonography is inconclusive, a follow-up examination must be performed 2 or 4 days later.

Rupture of vasa praevia is associated with a high rate of fetal or neonatal mortality. Since the recent development of color and spectral Doppler sonography, prenatal diagnosis of vasa praevia has been increasing but is not yet consistent. We report 2 cases that were diagnosed prenatally, enabling cesarean section to be performed under optimal conditions to prevent complications. A better knowledge of the characteristic Doppler sonographic appearances and the risk factors associated with vasa praevia could greatly facilitate the prenatal diagnosis of this condition and hence the fetal prognosis., (Copyright 2002 Wiley Periodicals, Inc.)

Menorrhagia after age 40 can have functional, general, local, or organic reasons. The most frequent are: submucous myomas, adenomyosis, polyps. Submucous myomas: a transvaginal scan (TVUS) specifies the type of myoma according to its situation within the uterine cavity: intracavitary myoma or submucous. A transvaginal scan is performed to assess myomas before operative HSC. There are three criteria to check: myomas diameter must be less than 5 cm; 5 mm or more of normal myometrium should be present between myoma and external wall; the myoma must not be in contiguity with a subserosal myoma. Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. Pathology may be proximal or distal, focal or diffuse. Transvaginal US shows: cystic dilatation of heterotopic glands, heterogeneity of the myometrial echotexture, antero-posterior asymmetry of the uterus. TVUS has a sensitivity of 62 to 89% and a specificity of 89 to 96%. Polyps are most often hyperechoic: this makes the diagnosis more difficult in luteal phase; Power Doppler shows the vascular central pedicle. TVUS has a sensitivity of 75%. The polyps smaller than 3 mm are not visible in a reliable way without the help of a contrast media in the cavity.

Objective: To compare the efficiency of air-filled albumin microspheres (Infoson) with saline solution in determining Fallopian tube patency during hysterosalpingo contrast sonography (HyCoSy)., Methods: This was a prospective randomized multicenter study with a sequential design. Over a 10-month period, 23 patients (mean age, 33 years) referred for infertility were examined by HyCoSy (saline or Infoson) before conventional hysterosalpingography (Iopamiron 370), performed during the same session. Contrast agents were administered through a 5-F Ackrad balloon catheter inserted transcervically into the uterine cavity. HyCoSy was performed with a 7-MHz transvaginal probe using both B-mode and color Doppler, and tubal patency was demonstrated by the appearance of contrast agent in the peritoneal cavity near the ovaries. Data were registered for each patient during the examination and the results were monitored by sequential analysis., Results: Mean volumes of contrast injections were 35.3 mL of saline, 14.4 mL of Infoson, and 13.8 mL of Iopamiron 370. Infoson-enhanced HyCoSy provided a significantly larger (P = 0.006) number of correct diagnoses (20/22 Fallopian tubes) than did saline HyCoSy (12/24 Fallopian tubes), and the same number as that achieved by hysterosalpingography., Conclusion: A positive ultrasound contrast agent appears to be more efficient than saline solution at determining Fallopian tube patency in infertile women by means of HyCoSy, and as efficient as an iodinated contrast agent in the same population explored by HSG. HyCoSy could be used to screen infertile women, thereby avoiding the use of iodinated contrast medium and exposure to ionizing radiation during conventional HSG in patients with patent Fallopian tubes.

The purpose of this study was to describe magnetic resonance findings of intradural spinal canal secondaries and to select the best way of investigating this condition. Thirty patients with a known malignancy [breast carcinoma (n = 14), lung carcinoma (n = 10), other sites (n = 6)] and unexplained neurologic signs were studied with pre- and post-contrast T1-weighted images and T2-weighted images. Cerebrospinal fluid cytology was available in 16 patients and positive in 11 patients. In all the patients, post-contrast T1-weighted images demonstrated abnormal enhanced lesions. Most of them were nodular, located on the conus medullaris and the cauda equina. Few lesions appeared at the thoracic or cervical levels, as nodular or thin areas of enhancement. Pre-contrast T1-weighted sequences failed or were equivocal to detect the lesions. Eighteen of 30 patients had cerebral metastases. Fourteen had osseous metastases. In conclusion, post-contrast T1-weighted sequence is the optimal modality for the diagnostic of intradural spinal canal metastases. Axial and coronal images may be a useful adjunct to precise anatomic changes. T1-weighted and T2-weighted sequences remain necessary when further information is expected on vertebra or soft tissue.

Sonohysterography versus hysteroscopy: the assessment of the uterine cavity: a series of 84 cases. We study indications, advantages, limits of a technic of investigation of uterine cavity: sonohysterography. Our results show that sonohysterography is as effective as hysteroscopy in the diagnosis of intrauterine conditions. It is painless, no time consuming. There is no adverse effects and it is helpful in the diagnosis of intrauterine abnormality as a complement of transvaginal scanning.

Sonohysterography consists in injecting a saline solution into the uterine cavity and performing transvaginal sonography. The purpose of this procedure is the pre-operative assessment of intracavitary anomalies, especially polyps, myoma, adhesions, congenital abnormalities such as septate uterus. Technical aspects are shown. This procedure is painless, atraumatic and no adverse effect is seen if the usual precautions before hysterography are taken. The right place of this exam is between hysterography and hysteroscopy, but more widespread use is required before a final opinion can be reached.

The effects of topical pretreatment of CF1-Swiss mice with TCDD on the carcinogenesis induced by DMBA were studied. We also determined the intrinsic features of DMBA as an aryl hydrocarbon hydroxylase (AHH) inducer through either its binding ability to Ah receptor or its inducing effects on benzo(a)pyrene (BP) hydroxylase or DMBA hydroxylase. DMBA is a poor ligand of the Ah receptor (26-fold and 4.3-fold weaker than 3-methylcholanthrene and BP respectively) and a very weak AHH inducer (ten million-fold weaker than TCDD). Nevertheless, DMBA induces a specific isozyme of cytochrome P-450 1A1 since, for an equal dose administered to C57BL/6 mice (200 mg/kg body weight), the DMBA-hydroxylase activity was 1.72-fold increased by DMBA while it remained unchanged after BP treatment. In contrast, the BP-hydroxylase activity was 1.91-fold increased by BP and only 1.47-fold by DMBA. A dose-dependent relationship exists between the increasing dose of TCDD (from 0.001 to 1 microg per mouse) applied to mouse skin and the induction of AHH activity of skin microsomes (from 1 to 60-fold increase). For carcinogenesis experiments, mice were either untreated or pretreated with single different doses of TCDD and, after 24h, DMBA (10 or 25 microg per mouse) was applied to the skin. The average number of papillomas per mouse was dependent on 1) the dose of DMBA and 2) the metabolic capacity of the skin. For 10 microg DMBA, the TCDD only exerts an anticarcinogenic effect (from 5.5 to 0.6 tumor per mouse) whereas for 25 microg DMBA, TCDD exerts a dual effect: first, a cocarcinogenic effect (from 6.2 to 9 and 11.5 tumors per mouse for 0.001 and 0.01 microg TCDD respectively) then an anticarcinogenic effect (2.3 and 1.5 tumors per mouse for 0.1 and 1 microg TCDD respectively). The discussion underlines the decisive importance of two factors: 1) the effective dose of the ultimate carcinogen in contact with cellular targets during a sensitive step of the cell cycle and 2) the time-persistence of a high steady state level of the carcinogen.

Cultured and cocultured rat hepatocytes were used to study the effects of ethanol and clofibrate on cytochrome P-450 (P-450) enzymes and epoxide hydrolase. We showed that in the presence of ethanol, clofibrate or both compounds, rat hepatocytes were able to express, after 3 days of pure culture, quantitatively and qualitatively reasonable levels of most cytochrome P-450 enzymes and epoxide hydrolase, compared to freshly isolated hepatocytes. However, ethanol induced the P-450IA subfamily, and clofibrate the P-450-IVA subfamily. In cocultures, after 6 days, most P-450 enzymes were still expressed while P-450IIC11 was completely lost. Ethanol and clofibrate had the same effect as in pure culture. These results show, by modifying culture medium conditions and cell-cell interactions, that it is possible to maintain reasonable xenobiotic-metabolizing-enzyme expression; however, these conditions have to be improved in order to preserve better P-450 expression. The mechanism of these effects and the inducibility of these systems remain to be elucidated by a study at molecular level.

The increase in serum gamma-glutamyl transpeptidase (GGT) is a well known marker of chronic alcoholism in man. We have previously shown that ethanol (180 mM) induces GGT activity 2-3-fold in the C2 rat hepatoma cell line. In this study, we have analyzed the interaction of ethanol with steroid hormones and drugs in this well defined cell culture system. Dexamethasone (100 nM), a synthetic glucocorticoid agonist, completely prevented the induction of GGT by ethanol, but had no effect when added alone. This inhibitory effect was also observed with other corticosteroids, but not with sex steroids; it was prevented by RU 486, a glucocorticoid antagonist. These observations suggest that dexamethasone acts through a high affinity glucocorticoid receptor. Conversely, ethanol did not interfere with the glucocorticoid induction of alanine aminotransferase in the same cell. We have analyzed the metabolism of ethanol in the C2 cells. These cells lack significant alcohol dehydrogenase activity as well as any cytochrome P-450 Alc immunoreactivity. Dexamethasone did not modify the disappearance of ethanol in the culture medium of those cells. We conclude that glucocorticoid hormones interact with ethanol at the cellular level, and that this interaction does not involve a modification of alcohol metabolism.

Ultrasonographic findings in 22 patients with hepatic amebic abscesses are described. All patient were febrile, complained of pain in the liver region, and had a raised ESR with polymorphonucleosis, and enhanced immunofluorescence or hemagglutination. Initial ultrasonography demonstrated a preferential site for the lesion in the right side of the liver, with three non-specific types of image. Indirect signs and the severity of the disease could be determined. Patients were followed up during specific treatment with metronidazole by means of clinical, biological, and ultrasonographic examinations, confirmation of healing depending entirely upon clinical evidence of absence of hepatic signs. Three types of healing, as shown by ultrasonography, are described: the homogeneous hypoechogenic form, known as the slow healing form, can raise ultrasonographic diagnostic difficulties. Apart from routine straight radiography of the chest and abdomen, ultrasonography was, in the majority of cases, the only radiological examination conducted, even in cases of recurrence or relapse; it enables the puncture to be controlled directly. Scintigraphy and scanning were rarely employed, except when ultrasonography was ineffective, and arteriography was reserved for certain very particular differential diagnosis problems. An algorithm, employed for facilitating diagnosis of hepatic amebic abscesses, emphasizes the primary role played by ultrasonography.