Outcomes of antifungal prophylaxis for newly diagnosed AML patients treated with a hypomethylating agent and venetoclax

Antifungal prophylaxis (AFP) is recommended for acute myeloid leukemia (AML) patients receiving the combination of venetoclax (VEN) and a hypomethylating agent (HMA), but the benefit of this practice is unclear. We identified 131 patients with newly diagnosed AML who received frontline VEN/HMA and evaluated the use of AFP and its association with invasive fungal infections (IFIs) and AML outcomes. Seventeen percent of our patients received AFP at any time. Overall incidence of any IFI ('possible,' 'probable,' or 'proven' infection, as defined by the European Mycoses Study Group) was 13%, and the incidence did not differ based on AFP use (p=.74). Median overall survival did not differ based on AFP use or lack thereof (8.1 vs. 12.5 months, respectively; p=.14). Our findings suggest that, at an institution where the incidence of fungal infections is low, there does not appear to be a role for AFP in newly diagnosed AML patients receiving VEN/HMA.

Cell-Free DNA in Blood Reveals Significant Cell, Tissue and Organ Specific injury and Predicts COVID-19 Severity

COVID-19 primarily affects the lungs, but evidence of systemic disease with multi-organ involvement is emerging. Here, we developed a blood test to broadly quantify cell, tissue, and organ specific injury due to COVID-19, using genome-wide methylation profiling of circulating cell-free DNA in plasma. We assessed the utility of this test to identify subjects with severe disease in two independent, longitudinal cohorts of hospitalized patients. Cell-free DNA profiling was performed on 104 plasma samples from 33 COVID-19 patients and compared to samples from patients with other viral infections and healthy controls. We found evidence of injury to the lung and liver and involvement of red blood cell progenitors associated with severe COVID-19. The concentration of cfDNA correlated with the WHO ordinal scale for disease progression and was significantly increased in patients requiring intubation. This study points to the utility of cell-free DNA as an analyte to monitor and study COVID-19.

Face Transplantation in a Highly Sensitized Recipient

Face transplantation was performed in a highly sensitized recipient with positive preoperative crossmatch and subsequent antibody-mediated rejection. The recipient was a 45-year-old female with extensive conventional reconstructions after chemical burns over the majority of the body. Residual quality of life and facial functions were poor. Levels of circulating anti-human leukocyte antigen (HLA) antibodies were high, and panel reactive antibody score was 98%. A potential donor was identified; however, with positive T and B cell flow crossmatches. The transplant team proceeded with face transplantation from this donor, under tailored immune suppression and with available salvage options. The operation was successful. Plasmapheresis and induction immune suppression (i.e., thymoglobulin followed by mycophenolate mofetil, tacrolimus, and steroids) were provided. Five days later, there was significant facial swelling, rising anti-HLA antibody titers, and unprecedented evidence of C4d deposits on skin. High doses of steroids and thymoglobulin were provided; however, rejection increased such that by day 19 it was diagnosed grade III in the BANFF scale. After stopping thymoglobulin because of serum sickness, combination therapy of plasmapheresis, eculizumab, bortezomib, and alemtuzumab was provided. HLA antibody levels decreased while swelling and redness improved. At 3 months, there were no longer signs of rejection on biopsy.

Initial experience of dual maintenance immunosuppression with steroid withdrawal in vascular composite tissue allotransplantation

Current immunosuppression in VCA is largely based on the experience in solid organ transplantation. It remains unclear if steroids can be reduced safely in VCA recipients. We report on five VCA recipients who were weaned off maintenance steroids after a median of 2 months (mean: 4.8 months, range 2-12 months). Patients were kept subsequently on a low dose, dual maintenance consisting of tacrolimus and mycophenolate mofetil/mycophenloic acid with a mean follow-up of 43.6 months (median = 40 months, range 34-64 months). Early and late acute rejections responded well to temporarily augmented maintenance, topical immunosuppression, and/or steroid bolus treatment. One late steroid-resistant acute rejection required treatment with thymoglobulin. All patients have been gradually weaned off steroids subsequent to the treatment of acute rejections. Low levels of tacrolimus (<5 ng/mL) appeared as a risk for acute rejections. Although further experience and a cautious approach are warranted, dual-steroid free maintenance immunosuppression appears feasible in a series of five VCA recipients.

Meniscus matching: evaluation of direct anatomical, indirect radiographic, and photographic methods in 10 cadaver knees

INTRODUCTION

When performing meniscus transplantation, allograft size must be carefully matched to the host knee anatomy. The radiographic method devised by Pollard et al. is the current reference standard for meniscus size matching. The primary objective of this study was to compare the accuracy of radiographic measurement according to Pollard, direct anatomic measurement, and photographic measurement.

HYPOTHESIS

Anatomic and photographic allograft size measurement is as reliable as radiographic host-knee sizing according to Pollard et al.

MATERIALS AND METHODS

Three methods for measuring meniscal width and length based on reliable landmarks were assessed in 10 cadaver knees: direct measurement of anatomic specimens, measurement of photographs, and the radiographic method described by Pollard et al.

RESULTS

No significant differences were found between the anatomic and radiographic methods, whereas the anatomic and photographic methods produced significantly different results. Compared to the anatomic method, mean overall measurement error was 7.9% for the radiographic method and 24.1% for the photographic method.

DISCUSSION

The photographic method used in everyday practice during allograft harvesting is not reliable. Correcting for magnification bias might improve the performance of the photographic method. The radiographic method described by Pollard et al. is acceptable, with a margin of error of about 10%, which is considered tolerable. In practice, however, the radiographic method is burdensome to use.

CONCLUSION

The best measurement method is direct measurement of the specimen during allograft harvesting.

LEVEL OF EVIDENCE

Level IV.

Cytochemical studies on GERL, provacuoles, and vacuoles in root meristematic cells of Euphorbia

The genesis of plant vacuoles has been studied by high-voltage and conventional electron microscopy. Vacuole genesis is a lysosomal multistep process: (i) GERL (Golgi-associated Endoplasmic Reticulum from which Lysosomes apparently form) produces provacuoles into which lysosomal enzymes and probably other materials appear to be concentrated and packaged; (ii) GERL-derived provacuoles cooperate to drive a programmed cellular autophagy leading to young vacuoles; and (iii) the young vacuoles swell and fuse together into a few large mature vacuoles which continue to collect the GERL-derived provacuoles throughout the life of the cell.

[Emergencies and urgent consultation in non-urban Swiss general practices]

The upcoming shortage of general practitioners in Switzerland will be a big challenge for medical out-of-hours services. Regionally ver different exists only few datas about organisational matters of and problems seen in "out-of-hours" care and "urgent consultations". Our Pilot present the prevalence of "out-of-hours care" in a general practitioner setting describes and classifies the problems seen using ICPC-2.

Antifungal use in HIV infection

Systemic fungal infections continue to be a major cause of morbidity and mortality among HIV-infected patients. Mucosal candidiasis remains the most common fungal disease in this population, while cryptococcosis and aspergillosis are associated with significant mortality. Histoplasmosis and penicilliosis are relatively common in some areas. Blastomycosis, coccidioidomycosis and paracoccidioidomycosis have also been described in association with HIV. Over the last decade, a number of clinical trials have evaluated the use of antifungal therapies in this population and shaped our approach to prophylaxis and therapy. This report outlines the state of the art in the management of HIV-associated fungal infections and discusses the unique difficulties and drug-drug interactions associated with managing fungal infections in this population. Deoxycholate or liposomal formulations of amphotericin B and the triazoles fluconazole and itraconazole are the most commonly used antifungal agents. Healthcare providers should be familiar with the appropriate antifungal management and its limitations. Possible interactions with antiretrovirals should be considered when prescribing antifungal treatment. An exciting new decade in antifungal therapy is beginning, in which the second-generation triazoles and echinocandins will hopefully help us to overcome the limitations of the current antifungal arsenal.

Neurosyphilis presenting as herpes simplex encephalitis

We report the case of a 55-year-old man with neurosyphilis that presented with features of herpes simplex encephalitis. Neurosyphilis is easily diagnosed and treated and should be included in the differential diagnosis of herpes simplex encephalitis.

Tonoplast subcellular localization of maize cytochrome b5 reductases

Plant cytochrome b5 reductases (b5R) are assumed to be part of an ER-associated redox chain that oxidizes NADH to provide electrons via cytochrome b5 (cyt b5) to ER-associated fatty acyl desaturase and related hydroxylases, as in mammalian cells. Here we report on cDNA cloning of a novel maize b5R, NFR II, strongly related to a previously cloned cDNA, NFR I (Bagnaresi et al., 1999, Biochem. J. 338, 499-505). Maize b5R isoforms are produced by a small multi-gene family. The NFR cDNAs were shown to encode active b5Rs by heterologous expression in yeast. Both reductases, in addition to Fe3+-chelates, efficiently reduced Cu2+-chelates. Using a polyclonal antibody able to recognize both NFR I and NFR II isoforms, no ER or mitochondrial localization could be detected in maize roots. Unexpectedly, maize b5Rs were found to be targeted to the tonoplast. Using the most specific assay to measure NFR activity, we confirmed that the highest NFR specific activity is associated with tonoplast-enriched maize root fractions. Tonoplast targeting is not consistent with a role in desaturase reactions or with the other functions ascribed to date to plant b5R. This indicates that alternative ER-associated electron donors for desaturases need to be sought, and that plant b5Rs may have previously unexpected functions.

Desiccation and osmotic stress increase the abundance of mRNA of the tonoplast aquaporin BobTIP26-1 in cauliflower cells

Changes in vacuolar structure and the expression at the RNA level of a tonoplast aquaporin (BobTIP26-1) were examined in cauliflower (Brassicaoleracea L. var. botrytis) under water-stress conditions. Gradual drying out of slices of cauliflower floret tissue caused its collapse, with a shrinkage in tissue and cell volumes and an apparent vesiculation of the central vacuole, whereas osmotic stress resulted in plasmolysis with a collapse of the cytoplasm and the central vacuole within. Osmotic stress caused a rapid and substantial increase in BobTIP26 mRNA in slices of floret tissue. Exposure of tissue slices to a regime of desiccation showed a slower but equally large rise in BobTIP26 mRNA followed by a rapid decline upon rehydration. In situ hybridization showed that BobTIP26-2 mRNA is expressed most highly in meristematic and expanding cells of the cauliflower florets and that desiccation strongly increased the expression in those cells and in differentiated cells near the xylem vessels. These data indicate that under water-deficit conditions, expression of the tonoplast aquaporin gene in cauliflower is subject to a precise regulation that can be correlated with important cytological changes in the cells.

Two-dimensional magnetic particles

Single two-dimensional (2D) atomically thick magnetic particles of cobalt and iron with variable size and shape were fabricated by combining a mask technique with standard molecular beam epitaxy. Reduction of the lateral size of in-plane magnetized 2D cobalt films down to about 100 nanometers did not essentially modify their magnetic properties; although the separation of boundaries decreased greatly, neither domain penetrated the particle, nor was any sizable shape anisotropy observed. The mutual interaction of 2D cobalt particles was negligible, and the magnetic state of a single particle could be switched without modifying the state of the neighbors. Perpendicularly magnetized iron particles did not exhibit such responses. These results suggest that only a few atoms forming a 2D in-plane magnetized dot may provide a stable elementary bit for nanorecording.

A putative vacuolar cargo receptor partially colocalizes with AtPEP12p on a prevacuolar compartment in Arabidopsis roots

Targeting of protein cargo to the vacuole/lysosome is a multistep process that appears to have conserved features between mammalian, yeast, and plant cells. In each case, some soluble vacuolar/lysosomal proteins are believed to be bound by transmembrane cargo receptors in the trans-Golgi network (TGN) that redirect these proteins into clathrin-coated vesicles. These vesicles then appear to be transported to the prevacuole/endosome by a trafficking machinery that requires components identified in other vesicle-targeting steps such as N-ethylmaleimide-sensitive factor (NSF), soluble NSF attachment protein (SNAP), SNAP receptors (SNAREs), rab-type GTPases, and Sec1p homologs. Two likely members of this trafficking machinery have been characterized from Arabidopsis thaliana: AtPEP12p, a t-SNARE that resides on a what we now call a prevacuolar compartment, and AtELP, a protein that shares many common features with mammalian and yeast transmembrane cargo receptors. Here, we have further investigated the intracellular distribution of AtELP. We have found that AtELP is located at the trans-Golgi of Arabidopsis root cells, and that its C terminus can preferentially interact in vitro with the mammalian TGN-specific AP-1 clathrin-adapter complex, suggesting a likely role in clathrin-coated, vesicle-directed trafficking at the TGN. Further, consistent with a role in trafficking of vacuolar cargo, we have found that AtELP partially colocalizes with AtPEP12p on a prevacuolar compartment.

Socialization of hospice volunteers: members of the family

The purpose of this study is to examine the turning points volunteers found important in their hospice training and volunteer experiences. Seventeen individuals who had recently completed hospice training were asked about the turning points in their training and volunteering that were important in their becoming and remaining a hospice volunteer. The study finds that volunteers have a wide variety of intrapersonal, interpersonal, and group reasons for becoming and remaining a hospice volunteer. The findings suggest that hospice staff need to create a wide variety of events which volunteers can identify with to help people want to become and remain volunteers.

Immunologic thrombocytopenic purpura as presenting symptom of hepatitis C infection

We report on 3 female patients with immunologic thrombocytopenic purpura (ITP) for whom diagnostic procedures evidenced a chronic Hepatitis C virus (HCV) infection. In 2 cases, a transfusion performed more than 10 years ago represented the probable way of contamination. One patient received a course of steroids, which normalized the platelet counts. Another one has been treated with repeated IV immunoglobulins, which induced partial responses of variable duration. HCV is responsible for many autoimmune manifestations and a search for this virus seems warranted for exploring patients with ITP.

Tonoplast intrinsic proteins from cauliflower (Brassica oleracea L. var. botrytis): immunological analysis, cDNA cloning and evidence for expression in meristematic tissues

The vacuolar membrane (tonoplast) of plant cells contains aquaporins, protein channels that facilitate the selective transport of water. These tonoplast intrinsic proteins (TIPs) of 23-29 kDa belong to the ancient major intrinsic protein (MIP) family. A monospecific polyclonal antiserum directed against a 26 kDa intrinsic protein from the tonoplast of meristematic cells from cauliflower (Brassica oleracea L. var. botrytis) was used to screen a cDNA library. Two distinct cDNAs have been isolated. Both clones, c26-1 and c26-2, encode closely related TIPs. The c26-1 insert, consisting of 933 bp upstream of the poly(A) tail, is a full-length cDNA with an open reading frame encoding a protein of 251 amino acids with a calculated M(r) of 25,500. The c26-2 insert is a 5' truncated cDNA. The two cDNAs share 90.5% sequence identity within their overlapping coding regions but only 35% sequence identity in the 3' untranslated regions, indicating that highly related TIP-encoding genes are expressed in meristematic cells. Although TIPs have previously been found in a variety of cell types, they have not been found in meristems. The derived amino acid sequences (BobTIP26-1 and BobTIP26-2, respectively) closely resemble the aquaporin gamma-TIP from Arabidopsis thaliana. Northern blot analysis and in situ hybridization show that BobTIP26 mRNAs preferentially accumulate in highly meristematic cells, mostly before and during cell enlargement, and in the living cells of the xylem. This differential pattern of expression is also found by immunodetection of BobTIP26 polypeptides. The gene expression patterns are discussed with respect to the probable function of the gene products.

The syntaxin homolog AtPEP12p resides on a late post-Golgi compartment in plants

Soluble proteins are transported to the plant vacuole through the secretory pathway via membrane-bound vesicles. Targeting of vesicles to appropriate organelles requires several membrane-bound and soluble factors that have been characterized in yeast and mammalian systems. For example, the yeast PEP12 protein is a syntaxin homolog that is involved in protein transport to the yeast vacuole. Previously, we isolated an Arabidopsis thaliana homolog of PEP12 by functional complementation of the yeast pep12 mutant. Antibodies raised against the cytoplasmic portion of AtPEP12 have been prepared and used for intracellular localization of this protein. Biochemical analysis indicates that AtPEP12 does not localize to the endoplasmic reticulum, Golgi apparatus, plasma membrane, or tonoplast in Arabidopsis plants; furthermore, based on biochemical and electron microscopy immunogold labeling analyses, AtPEP12 is likely to be localized to a post-Golgi compartment in the vacuolar pathway.

Ultrastructural and biochemical characterization of autophagy in higher plant cells subjected to carbon deprivation: control by the supply of mitochondria with respiratory substrates

Autophagy triggered by carbohydrate starvation was characterized at both biochemical and structural levels, with the aim to identify reliable and easily detectable marker(s) and to investigate the factors controlling this process. Incubation of suspension cells in sucrose-free culture medium triggered a marked degradation of the membrane polar lipids, including phospholipids and galactolipids. In contrast, the total amounts of sterols, which are mainly associated with plasmalemma and tonoplast membranes, remained constant. In particular, phosphatidylcholine decreased, whereas phosphodiesters including glycerylphosphorylcholine transiently increased, and phosphorylcholine (P-Cho) steadily accumulated. P-Cho exhibits a remarkable metabolic inertness and therefore can be used as a reliable biochemical marker reflecting the extent of plant cell autophagy. Indeed, whenever P-Cho accumulated, a massive regression of cytoplasm was noticed using EM. Double membrane-bounded vacuoles were formed in the peripheral cytoplasm during sucrose starvation and were eventually expelled into the central vacuole, which increased in volume and squeezed the thin layer of cytoplasm spared by autophagy. The biochemical marker P-Cho was used to investigate the factors controlling autophagy. P-Cho did not accumulate when sucrose was replaced by glycerol or by pyruvate as carbon sources. Both compounds entered the cells and sustained normal rates of respiration. No recycling back to the hexose phosphates was observed, and cells were rapidly depleted in sugars and hexose phosphates, without any sign of autophagy. On the contrary, when pyruvate (or glycerol) was removed from the culture medium, P-Cho accumulated without a lag phase, in correlation with the formation of autophagic vacuoles. These results strongly suggest that the supply of mitochondria with respiratory substrates, and not the decrease of sucrose and hexose phosphates, controls the induction of autophagy in plant cells starved in carbohydrates.

Monoclonal antibody TeM 106 reacts with a tonoplast intrinsic protein of 106 kDa from Brassica oleracea L

A monoclonal antibody, designated TeM 106, that recognizes an intrinsic protein from the vacuole membrane (tonoplast) of cauliflower (Brassica oleracea L. var. botrytis) is described. Mice were immunized with a tonoplast fraction that had been purified from differentiating meristematic cells from the cauliflower head. Hybridomas were generated and screened by means of Enzyme Linked Immuno Sorbent Assays for differential reactivity to tonoplast over non-related proteins (bovine serum albumin). One out of 14 reactive murine clones was selected on the basis of its stability, secretory efficiency, and high affinity of the secreted antibodies. TeM 106 is an IgM which was shown by indirect immunofluorescence microscopy of frozen thin sections to bind specifically to the tonoplast of highly vacuolated cells as well as to the tonoplast of small vacuoles in meristematic cells. The molecular specificities of TeM 106 were preliminarily determined using electrophoretic transfer procedures (immunoblotting). TeM 106 reacted with a single protein band of 106,000 M(r) from the tonoplast of cauliflower. Using two-dimensional gel electrophoresis, it was shown that the epitope is borne by a single polypeptide. The antigen is a glycopeptide containing mannose and/or glucose residues in the oligosaccharide side chain but the epitope, resistant to the metaperiodate oxidation, is contained in the polypeptide backbone. Salt elution experiments indicated that the antigen, unlike several proteins from the tonoplast, is not eluted from the membrane by KCl treatments and is, therefore, tentatively considered as a tonoplast intrinsic protein, designated TIP 106.

Antibodies to the tonoplast from the storage parenchyma cells of beetroot recognize a major intrinsic protein related to TIPs

A vacuole membrane (= tonoplast) subfraction was purified by sedimentation in a discontinuous sucrose gradient (0.6 M/0.3 M) from a crude vacuole fraction isolated from red beetroot storage cells. The vacuole membrane-enriched fraction was injected into the popliteal lymph nodes of rabbits to raise polyclonal antibodies. The resultant serum was tested by indirect immunofluorescence microscopy on cryosections of shoot meristem. Antibodies specifically bound to the tonoplast but not the cytoplasm or the nucleus. By immunogold microscopy of ultrathin frozen sections, the anti-tonoplast antibodies were shown to label the luminal (exoplasmic) surface of the vacuole membrane and vesicular elements of the Golgi complex. Almost all of the antibodies were directed against a polypeptide with an M(r) of 27,000 as determined by Western blotting. A 30,000 M(r) polypeptide was occasionally detected in tonoplast-enriched fractions. It was weakly labeled by the crude immune serum, but not by the serum purified by affinity on the M(r) 27,000 band. The 27 kDa polypeptide which accounted for 10 to 15% of the total membrane proteins was partially characterized. The M(r) 27,000, but not the M(r) 30,000 polypeptide, had Triton X-114 binding properties and was extracted by chloroform:methanol, indicating its high hydrophobicity. On the basis of their partitioning in detergent/aqueous phases it is suggested that the 27 kDa and the 30 kDa polypeptides belong to the tonoplast and to the vacuolar sap, respectively. Neither polypeptide binds to Con A or is sensitive to Endo F digestion, suggesting that they are either unglycosylated polypeptides or glycopeptides with modified oligosaccharides. When separated by SDS-PAGE under non-reducing conditions, the 27 kDa antigen displays a small increase in apparent relative mobility. Its NH2-terminal amino acid sequence shares homology with plant members of the MIP channel family. As suggested by its relative molecular mass, its high hydrophobicity and its NH2-terminal amino acid sequence, the M(r) 27,000 polypeptide from the tonoplast of beetroot may be a new member of the TIP family. It appears to represent a useful specific marker for the vacuole membrane at all developmental stages of the storage parenchyma cells.

Minimal spanning tree analysis of biological structures

A new approach to study order and disorder in biological membranes and more generally in biological structures is developed. It is based on a graph constructed on the set points representing the position of particles. From this graph, which is called the minimal spanning tree, it is possible to deduce two parameters, namely the average length m and the standard deviation sigma which are characteristic of the repartition to be studied. The use of a diagram involving both m and sigma makes it possible to determine the degree of order by taking a simple reading in the (m, sigma) plane.

Pregnancy-specific beta 1-glycoprotein (SP1) after in vitro fertilization and embryo transfer

Recent reports indicate that SP1, a "pregnancy-specific beta 1-glycoprotein", can be used as a biological marker for very early pregnancy and occult abortion. In this investigation, SP1 serum concentrations were measured in the luteal phase of 48 menstrual cycles stimulated for in-vitro fertilization (IVF) and embryo transfer (ET). All patients received hMG for ovarian stimulation. Ovulation was induced by beta-hCG and also administered to support the luteal phase. In the 8 pregnancies arising after ET, SP1 (less than 0.5 ng/ml) was not detected before 13 to 19 days after laparoscopy. In contrast, the pregnancy-dependent beta-hCG increase was detectable earlier than SP1 despite the administration of hCG given for luteal support. However, low SP1 readings (0.5-1.1 microgram/ml) as early as 3 days after laparoscopy were observed in 11 cycles without a positive sign of beta-hCG production. Our results suggest that SP1 determinations cannot be used as a marker for occult abortion; also, positive SP1 readings without increase beta-hCG, especially during the early luteal phase after ET, have to be interpreted with caution.

Subcutaneous tissue in the scalp: anatomical, physiological, and clinical study

The galea aponeurotica has been used by various surgeons either as a supporting sheet or as a blood carrier for bringing flaps to various areas of the face. In this study, we first reviewed the anatomy of the scalp vascularization by means of cadaver injections. The arteries and veins are mainly located in the galea and numerous anastomotic vessels are present over the vertex. The physiology of this vascularization has been studied by percutaneous PO2 registration after occlusion of various vessels by means of a tourniquet placed around the head. The superficial temporal arteries have been found to be the most important vessels for designing flaps over the head. On the basis of these experiments, several patients have been operated upon. The possibility of using a skin island from the retroauricular region based on subcutaneous tissue only is described.

Subcutaneous tissue flaps in the limbs: an anatomical and clinical approach

We present an anatomical study and clinical applications of a subcutaneous tissue flap in the limbs. This tissue, located between dermis and muscular aponeurosis, is an anatomical entity nourished by a well-developed vascular network. It is used mainly as a local flap able to bear a skin graft. Elastic, resistant, and well padded, it gives good coverage for soft tissue defects while leaving the surrounding skin untouched. In some circumstances, this simple technique can avoid delicate procedures, such as free flaps, or unsightly donor site defects after fasciocutaneous flaps.

The subcutaneous tissue flap and the misconception of fasciocutaneous flaps

The authors report an anatomical study on the vascularisation of the subcutaneous tissue, which is an anatomical entity with a very rich vascular network. This leads to the concept of an original flap and suggests a modification of the concept of the fasciocutaneous flap.

Quantitative characterization of a biological membrane by means of its spatial autocovariance

Profiles for the exoplasmic face (EF) of the freeze-fractured plasma membrane from the root storage tissue of red beets are reconstructed by microdensitometry of micrographs of surface-shadowed-platinum carbon replicas. Autocovariance functions (ACFs) are computed from those profiles. The initial portions of the ACFs have a Gaussian form whose parameters (root mean square surface roughness and autocovariance length) are estimated. The parameter estimates are used to show that the pits on the EF faces are in good complementarity with the intramembrane particles seen on the complementary protoplasmic fracture faces.

[Intravenous digital subtraction angiography in intensive care]

Intravenous digital subtraction angiography (IVDSA) was performed in 11 patients aged from 23 to 62 yr to visualize vascular disease that required to be treated without delay: 7 were in shock preceded by a cardiac arrest in 5 of them; 4 suffered from acute renal failure, 8 from acute respiratory failure and one from brain death. 5 pulmonary, 2 thoracic aortic, 3 abdominal aortic, 1 right subclavian and 1 renal arterial angiographies were carried out by this method. In all the cases described, we either confirmed the diagnosis (rupture of thoracic aorta, type I aortic dissection, aneurysm of abdominal aorta, complete occlusion of the distal abdominal aorta, pulmonary embolism) or set aside diagnosis (lesion of the subclavian vessels, pulmonary embolism) or visualized the renal vasculature before removing the organ. No incident was observed. Conventional angiography remained a reference method but it presented risks which were not to be neglected in critically ill patients. Despite the theoretical limits set by the technical demands (absolute motionlessness, apnoea) and few other restrictions found in the literature, IVDSA seemed to offer distinct advantages under such conditions. Only requiring an injection using a catheter placed in a peripheral vein, this method was fast, safe and easy; it gave a close enough approach to the diagnosis to be able to help decide on specific treatment or on orientation towards a specific hospital department.

[Post-traumatic pneumobladder. Apropos of a case]

The authors report an uncommon case or perineal impalment with perforation of the rectum and the bladder. They stress the importance of X ray investigation in emergency, which enables to confirm the diagnosis, to appreciate the other possible injuries and to guide the surgical treatment.