Bone formation and resorption biological markers in cosmonauts during and after a 180-day space flight (Euromir 95).

Long-term spaceflights induce bone loss as a result of profound modifications of bone remodeling, the modalities of which remain unknown in humans. We measured intact parathyroid hormone (PTH) and serum calcium; for bone formation, serum concentrations of bone alkaline phosphatase (BAP), intact osteocalcin (iBGP), and type 1 procollagen propeptide (PICP); for resorption, urinary concentrations (normalized by creatinine) of procollagen C-telopeptide (CTX), free and bound deoxypyridinoline (F and B D-Pyr), and Pyr in a 36-year-old cosmonaut (RTO), before (days -180, -60, and -15), during (from days 10 to 178, n = 12), and after (days +7, +15, +25, and +90) a 180-day spaceflight, in another cosmonaut (ASW) before and after the flight. Flight PTH tended to decrease by 48% and postflight PTH increased by 98%. During the flight, BAP, iBGP, and PICP decreased by 27%, 38%, and 28% respectively in CM1, and increased by 54%, 35%, and 78% after the flight. F D-Pyr and CTX increased by 54% and 78% during the flight and decreased by 29% and 40% after the flight, respectively. We showed for the first time in humans that microgravity induced an uncoupling of bone remodeling between formation and resorption that could account for bone loss.

Serum levels of tumor markers and presence of human antimouse antibodies: implications for diagnosis and treatment with radiolabeled monoclonal antibodies.

Our study is based on 100 radioimmunodetections and five immunotherapies in 84 patients with advanced carcinomas. We used a monoclonal anti-CEA F(ab')2 and anti-CA 19.9 F(ab')2 antibody "cocktail" in 75% of the cases and monoclonal anti-alpha FP, anti-beta HCG, and OC 125 F(ab')2 antibodies in the other cases. In all cases, we determined plasma tumor marker levels immediately before imaging. The positivity of the scans was analyzed in relation to the levels of plasma markers. We found that the imaging should be planned only in the cases in which marker levels exceed minimum thresholds. We developed an enzymoimmunologic assay to measure antimouse antibodies. We found that patients who received monoclonal antibodies developed in the mouse produce such antimouse antibodies. The kinetics of this production are analyzed to define the optimal sequence for more than one administration of monoclonal antibodies.

[Hemodynamic and angiographic aspects of endomyocardial fibrosis. Apropos of 19 cases]. / Aspects hémodynamiques et angiographiques des fibroses endomyocardiques. A propos de 19 observations.

19 cases of endomyocardial fibrosis were studied. Angiocardiography localises the site of fibrosis and seems to be the best diagnostic method. All cases in this series had left ventricular involvement which resulted in changes of the silhouette (square, polylobulated or deformed like the shape of a heart on a playing card) and of the ventricular contour (smooth, lacunar or "doubled"). Ten patients had mitral incompetence. The ejection fraction was normal in 8 patients but significantly reduced in the series as a whole (EF = 0,56, p less than 0,05). 15 patients had right ventricular involvement. Apart from the smooth contour of the anterior wall, the only abnormality in the mild cases, the most suggestive feature was an amputation of the ventricular apex, giving rise to a ventricular appearance of a narrow, akinetic (apart from the infundibular region) tube. The catheter data demonstrated the haemodynamic changes due to the fibrosis. A constrictive syndrome was observed in all the severe poorly tolerated cases. This was not apparent under basal conditions in milder cases. The value of pharmacodynamic testing and endomyocardial biopsy in cases where the diagnosis is uncertain should be stressed. The results of resection of the fibrosis and valvular replacement in severe cases depend to a large extent on the degree of myocardial involvement.

[Quantitative echocardiography using a minicomputer (author's transl)]. / Echocardiographie quantitative à l'aide d'un miniordinateur.

Echocardiography should not remain merely qualitative but every effort should be made to make it quantitative, providing the clinician with numerical values. Three items are necessary: a graphic table, a minicomputer and an electronic reprograph, all small in size. The tracings obtained in TM technique are digitalised using the graph table, and the computer provides the results in the form of listings and graphs. The latter are of two types: --some are used for the analysis of the respective chronology of the various phenomena: left ventricular diameter and its normalised derivative, apexocardiogram or carotid pulse, movement of the greater cusp of the mitral valve, thickness of the myocardium, heart sounds; --the others are used for study, with the aid of an X-Y representation in the form of loops, of variations in one phenomenon in relation to the other. Deformation of such loops makes it possible to detect poor synchronisation between 2 phenomena.

[Recording of His potentials from surface chest leads using a computer]. / Enregistrement des potentiels hisiens à partir d'électrodes thoraciques de surface à l'aide d'un moyenneur.

Under certain circumstances it is possible to record His potentials using surface chest leads. These potentials have a very low intensity over the thorax, and must be separated from the "background noise" by an averaging technique. The desired activity occurs before the R wave and has a constant relationship to it; the potentials picked up by the chest leads are amplified, coded numerically, and presented to the memory store which accepts only those potentials which precede the R wave. It then summates the successive cycles, using a synchronising signal to ensure that they coincide. All this is carried out with an averager. In the 80 patients studied, a signal which seems very likely to reflect His activity was obtained in slightly more than a third of cases. The findings were correlated in 14 cases with those produced by invasive techniques, and showed that the main source of error was the after-potential of the P wave after a short PR interval--this occurred in one case; in the other 13 cases, the correlation was good. This method needs to be refined before it can be used clinically. It seems unlikely that it will replace the invasive technique which is so important for stimulation tests, and so necessary for studies of dynamic pharmacology.

Right atrial myxoma: an echocardiographic study.

A case of right atrial myxoma is reported in a 29-year-old man. Though it was a large tumour, the diagnosis remained unsuspected for a long time. Multiple echo recordings strongly contributed to the diagnosis. After surgical removal, the post-operative course was uneventful.

[Interventricular communication caused by nonpenetrating injury of the thorax]. / Communication interventriculaire par traumatisme non pénétrant du thorax.

Previously fatal in the majority of cases, traumatic interventricular communications are now curable by surgery. This is illustrated by the case described here of a 20 year old man. 62 other cases were found in the literature. A systolic murmur is the essential feature in diagnosis but it may be discovered some time after the accident. The demonstration of cardiomegaly has less diagnostic significance than ECG signs suggestive of an infarction. Haemodynamic studies are essential to confirm the diagnosis and to provide an accurate assessment of the lesion. The spontaneous course is serious since death results in two thirds of cases. Surgery is indicated, other than in well tolerated forms with a minimal shunt. The approach used has almost always been right cardiotomy. However, incision of the left ventricle offers better visibility of the lesions which may be masked by the papillary muscles when a right-sided approach is adopted. This was used in the present case with an excellent result since the patient was able to continue the military career for which he had opted.

[The possibility of the detection of His bundle potentials using thoracic surface electrodes (author's transl)]. / Possibilité de détection des potentiels hisiens à partir d'électrodes thoraciques de surface.

Under certain conditions, it is possible to record His bundle potentials from thoracic surface electrodes. These potentials, which are extremely weak on the chest wall, must be extracted from the "background noise" using an averaging method. The required signal being situated before the R wave, and at a constant distance from the latter, the potentials collected from the thoracic electrodes are amplified, numerised and despatched to a memory which retains only the values preceeding the R wave and produces a summation of successive cycles, causing them to coincide using a synchronisation signal. This is achieved with the aid of a correlator. Amongst 66 patients studied, a signal which most likely corresponded to His bundle activity was obtained in 1/3 of cases. Correlation obtained in 7 cases by the use of invasive techniques indicated that the principal source of error was the "after potential" of the P wave when the PR interval is short. This was seen in one case, correlation in the other 6 being good. The method will require further work before being available for clinical use, where its primary indication would seem to be the study of long PR intervals.

[Determination of first signs of pacemaker failure. Oscilloscopic study before and after removal]. / Détermination des premiers signes de défaillance des pace-makers. Etude oscilloscopique avant et après ablation

An oscilloscopic study aimed at determining the first signs of pacemaker failure was carried out in vitro after removal in 95 cases. Using a differential apparatus with a 1 megahertz passing band, the following parameters were measured: interspike interval, amplitude, duration and morphology of the spike. During the course of the study, signs of pacemaker failure were seen in 66 cases. It may be concluded that the interspike interval represents the easiest and most precise measurement, making it possible alone to detect dysfunction in 70 per 100 of cases. However, in 30 per 100 of cases, represented by certain types of pacemaker, its alteration is preceded by a decrease in voltage. Whilst the latter may be precisely and easily measured in vitro, the same does not apply when the pacemaker is in situ and only large changes may be taken to be significant and interpreted in relation to the number of batteries in the model studied. Study of the vectrocardiogram should be added to the measurements mentioned above, any sudden change in axis of the spike being an argument in favour of a fault in the conductor. In the future, measurement of the area of the spike, a reflection of the energy delivered the histogram of the RR intervals giving an idea of the respective durations of function and of inhibition in demand models will provide additional information.

[Fibroblastic constrictive endocarditis. Apropos of a form localized in the left ventricle]. / Endocardite constrictive fibroblastique. A propos d'une forme localisée au ventricule gauche

The authors report a case of a localised form of this strange disorder which was confined to the left ventricle, and in which the diagnosis was tentative for a long time. In this case it was possible to carry out a removal of the fibrous plaque after opening the apex of the left ventricle, the mitral valve being preserved, as described by Dubost; the functional and haemodynamic results of this procedure were very satisfactory.

[Liebow desquamative interstitial pneumopathy. Review of the literature; discussion of a new case]. / La pneumopathie interstitielle desquamative de Liebow. Revue de la littérature. A propos d'une nouvelle observation.

After a new observation, the authors make as complete a review as possible of the literature on this disease right up to the end of June 1974. They counted 104 observations and analyzed 91 of them. They think the clinical description could be enlarged to include the extra-thoracic signs. Similarly they point at biological peculiarities which unfortunately have only been looked for in a small number of the observations. Out of 77 cases they draw the main evolutive lines of the disease treated or untreated, debating on the reaction to corticosteroids. Finally they debate on the pathogenic hypotheses mainly on histological grounds.

[Overcoming the obstacles of contraception]. / Vaincre les obstacles à la contraception.

PIP: The chief obstacles to birth control in France, 10 years after Neuwirth overcame the resistance of the Parliamentary Assembly, are the medical profession, fertile men and women, and young people. Many physicians are reticent to prescribe contraception until after an abortion. They dislike tampering with the natural course of demographic growth and with social customs. Women manifest their resistance by forgetting contraceptive pills; men fear the loss of 1 of their principal sources of power: control of women's reproduction. These obstacles are not absolute since contraception, especially in the rural regions of France, has existed for years. People recognize legitimate indications for contraception and wanted planned childbirth. The last obstacle is the youth who act as if they want adult pleasures without responsibilities. Those faced with the task of inculcating mature sexuality in the young deserve respect.^ieng

[Diagnosis of myxomas of the left auricle by ultrasonic echography]. / Diagnostic des myxomes de l'oreillette gauche par échographie ultrasonore

The two case histories of myxoma of the left auricle reported in this paper illustrate how echography is a diagnostic method which is non-invasive, simple, and relatively accurate provided that different angles of incidence are used, and especially the "root aorta-left auricle" incidence. It is indicated especially in cases with variable mitral murmurs on auscultation, but also where there is a very large left auricle, heart failure of unknown cause, or even an apparently straightforward case of mital stenosis. Moreover, as one of these case histories demonstrates, the technique allows both short and long term postoperative follow-up to be carried out with ease and safety, so that a possible recurrence can be picked up later.