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AIM: Ultraviolet light (UV) is known to cause DNA damage in the epidermis. The damaged DNA is repaired or deleted by apoptosis to prevent the generation of cancer. It has been suggested that a deficient apoptotic mechanism may predispose individuals to skin cancer. Therefore, the response of normal controls and patients with basal cell carcinoma (BCC) to UV irradiation was investigated. METHODS: The buttock skin from normal volunteers and patients with BCC was irradiated using solar simulated radiation (SSR). SSR mimics the effect of natural sunlight. Skin biopsies were excised and examined for p53, p21, and Bax protein expression and for the induction of apoptosis. RESULTS: At 33 hours after UV irradiation, the induction of apoptosis was significantly higher (p = 0.04) in patients with BCC than in normal volunteers (Mann Whitney test). A trend towards higher p21 expression was found at 33 hours in patients with BCC (mean, 18.69 positive cells/field) than in normal volunteers (mean, 9.89), although this difference was not significant (p = 0.05 positive cells/field). CONCLUSION: These results may imply that patients with BCC have enhanced sensitivity to UV irradiation or that there is some defect in the cell arrest or repair pathways, which results in damaged cells been pushed into apoptosis rather than repair.

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BACKGROUND: Ultraviolet radiation (UVR) damages keratinocytes. Direct DNA damage may undergo enzymatic repair followed by resumption of the normal cell cycle. Cells may also be eliminated without inflammation by the error-free process of programmed cell death or apoptosis. Necrosis of cells can occur after overwhelming damage. Failure of apoptosis leads to retention of cells with persistent mutations. OBJECTIVES: This study investigates p53-dependent apoptotic responses in normal skin following solar-simulated radiation (SSR). METHODS: Sun-protected buttock skin from normal volunteers with no history or clinical evidence of skin cancer was exposed to graded doses of SSR, 0.5, 1, 2 and 3 times the minimal erythema dose (MED). Biopsies taken at a range of time points (4.5, 9, 24, 33, 48 and 72 h) after UVR, quantified the time course and dose-response of apoptosis and the expression of the relevant proteins, p53, p21waf1/Cip1 and Bax, by single and double labelling techniques. RESULTS: Apoptosis was upregulated in a dose-dependent manner as was the expression of p53, p21waf1/Cip1 and Bax in response to SSR. Following exposure to 3 MEDs it was found that: (i) the maximum number of apoptotic cells occurred at 48 h; (ii) p53 protein expression was upregulated from 4 to 72 h preceding peak p21waf1/Cip1 protein expression (9-48 h) and peak Bax protein expression (33 h). CONCLUSIONS: These results suggest that, following SSR, normal human skin induces apoptosis by the p53, p21waf1/Cip1, Bax pathway in vivo. In addition, induction of apoptosis and expression of p53, p21waf1/Cip1 and Bax occurs in a dose-dependent manner.

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An original case of bilateral knee flexion of sixty degrees is reported in a twenty-four year old mean, with a beta-thalassemia diagnosed at three years old. The defect of straightening is the result of premature epiphysis fusion, only posterior in this case, and affecting preferentially the tibia. That is the reason why the flexion has been corrected by a bilateral tibial soustraction osteotomy, under the tibial tuberosity. The consolidation of the osteotomies has been obtained without any complications, with a complete extension and normal walk in a man moving only with a wheelchair before surgery. No similar case seems to be described in this kind of pathology.

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The present paper reports on studies to determine the influence of body position on uterine blood flow. In ten pregnant patients (around the 35th week of gestation), over 700 measurements of systolic/diastolic action in the uterine vessels were made by Doppler sonography with the patients in various positions: lying down, standing, and sitting on the couch and the balance-variable chair; from the relationship between the systolic and diastolic levels conclusions were then drawn about the uterine blood flow in various body positions. It was found that it was best when the patient was lying down or sitting on the special chair without angling the hips; in contrast, diastole was lower in relation to systole with the patient standing and sitting on the examination couch. This means an increase in resistance or a reduction in blood flow. It appears reasonable to conclude that sitting on the balance-variable chair can be recommended to pregnant patients with signs of deficient fetal blood supply, in addition to bedrest, which is customarily advised. Apart from this, it is wise to use Doppler sonography to establish the body position in which uterine blood flow is best.

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The encouraging results obtained using pulsed Doppler sonography for antepartal diagnosis gave cause to use the method during labor. For this purpose a group with normal course of pregnancy was examined by Doppler sonography. This group was compared with a similar group examined by the same method at onset of labor with the cervix beginning to dilate, or with premature rupture. A comparison of the usual Doppler parameters, uterine arteries, umbilical artery and fetal aorta, recorded in contraction-free phases, showed no differences between the two groups. A third group was examined by Doppler sonography during labor with average or late cervix dilatation. In this case the Doppler parameters for the contraction phases were compared with those for the contraction-free phases. With adequate utero-placental supply during labor, the changes in the Doppler parameters for the uterine arteries due to contraction indicate a reduction in blood flow. The blood flow in the umbilical artery remains unaffected during normal labor. In the fetal aorta the blood flow velocity drops significantly due to contractions, while the peripheral resistance is unchanged. The elimination of the end-diastolic shift in frequency in the fetal aorta during labor indicates a fetal supply deficiency, as shown by Doppler measurements during birth in cases with pathologic cardiotokograms.

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From the anatomic element known with the man by the name of soft palatal-pharyngeal sphincter and which takes a major part in the phonation, the swallowing, the breathing, we have studied the evolutive morphology of the soft palatal-pharyngeal unity in several mammals. This unity which includes the levator palati and palatopharyngeus muscles is confirmed by the phylogenic and embryologic investigations. The comparative anatomy of the rat, rabbit, sheep and lion, allows to make obvious a evolutive line characterized by the gradual divergence of the axis of the two muscles common to the soft palatal and pharyngeal musculature, which could correspond with a phylogenic evolution.

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In order to assess superficial displacements under load in human lumbar vertebrae, the authors used three different optical methods: photogrammetry under non coherent light; double-exposure holographic interferometry; speckle granularity under laser exposure. Without any structural interposition, the displacements are measured within 10 mu for linear variations and 0.1 degrees for angular variations. Photogrammetry seems to be more adequate for the study of large range of displacements while holographic and speckle techniques are useful to assess, in the displacements, the part of the disc and the osseous structure deformation respectively.

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The authors report the main anatomical features of a twin holoacardius amorphus monster. Diagnosis of the abnormality was assured by echography at the end of a "normal" gemellary pregnancy. Echograms were consistent with the diagnosis of "amorphus monster" and this was supported by dissection. The caudal extremity of the fetus was clearly identified by the presence of recognizable lower limbs in spite of the several abnormalities of the pelvic area. The cephalic extremity was characteristic of the malformation. Examinations of visceres allowed to precisely identify digestive structures such as intestinal loops (with disseminated atresias). It could not be find any kidney structure. Medially, a small rounded mass was observed and could be identified as hypoplasic cardiac structure. Other main anatomic features consisted of an enormous liquid-filled cavity largely communicating with both the lower part of the neural tube and the basis of the cranium. The placenta was unique and two umbilical with several and large anastomotic by-passes were increased from it.

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The authors present their experience with benign ovarian cysts based upon a series of 22 cases. Occurrence age displayed 2 peaks neonatal and para-pubertal. Ultrasound and coelioscopic examination would help in the management of such functional cysts where spontaneous regression must be weighted with potential complications.

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The authors report the clinical, biological, radiological findings of 109 infants hospitalised for acute bronchiolitis. A prospective study was possible in 74 of them with an average of follow up of 18 months. After the admission, 31% were asymptomatic, 56% suffered at least one or several episode of wheezing, 13% have recurrent or chronic bronchopulmonary symptoms including cough and airway obstruction. Three points appeared determinant to predict recurrent wheezing: the rate of IgE, a familial history of atopy, and radiological pulmonary hyperexpansion. There was no statistic difference of evolution between the infants with wheezing at the admission and the others. The main prospective studies were analysed for discussion of the prognostic problems.

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The present study reviews 62 children who where admitted to the department of pediatrics for acute bronchiolitis. We adopted the following therapeutic protocol: treatments were applied randomly and we administered a fast action theophylline solution (Theophylline Bruneau R) or a placebo solution every six hours by oral route or stomach probe at 10 mg/kg between 2 and 6 months, 12 mg/kg between 6 and 12 months and 16 mg/kg between 12 and 24 months. Evaluations of theophylline levels were systematically carried out (immunoenzymatic method) for every infant on day 1, day 3, and day 4 two hours after morning administration and the results studied to see if any changes were necessary. This treatment was well tolerated. Statistical analysis was performed before removal of blind. The homogeneity of the two groups was respected if we considered ages (placebo group: 7.1 months +/- 1.0, theophylline group: 5.6 months +/- 0.6), the initial seriousness as evidenced by hypoxemia (placebo group 61 +/- 2 Torr, theophylline group: 58 +/- 3 Torr) hypercapnia (placebo group: 37.8 +/- 1.0, theophylline group: 35.5 +/- 2) and chest retractions.(ABSTRACT TRUNCATED AT 250 WORDS)

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Three cases of sleeve fractures of the patella are reported. These lesions are epiphyseal fractures. Attention is drawn to the fact that the diagnosis may be missed. Surgical treatment is necessary to attaining and maintaining reduction. The authors focus on that avascular necrosis is important in sleeve fractures and the open reduction increases this risk.

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