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The risk of developing a tumor of the nervous system in humans is analysed in several studies of populations, exposed to ionising radiation for medical reasons, or exposed to military or occupational radiation. The main data come from series of patients who underwent radiotherapy during childhood: a high incidence of tumors of the nervous system is found after irradiation of one to a few grays as treatment of a benign disease (especially tinea capitis), as well as after irradiation at higher doses of a few tens of grays for the treatment of cancer (in particular cerebral irradiation in acute lymphoblastic leukaemia). The type of radiation-induced tumors is variable, but meningioma is more frequent after low doses and glioma and sarcoma after higher doses used in the treatment of neoplastic diseases. A dose-effect relationship appeared between the risk of tumor of the nervous system and the radiation dose. The risk was higher when radiation was delivered at a younger age. Much less data are available after radiotherapy in the adulthood, but an increased risk of cerebral tumor appears in the series of ankylosing spondylitis patients. As for the exposures to radiodiagnosis exams, the main problem is the risk of cerebral tumor in children whose mother has undergone abdominal or pelvic X-rays during pregnancy. No risk of neurologic tumor was found in the A-bomb survivors irradiated at Hiroshima and Nagasaki. Occupational exposure to ionising radiation has been incriminated in the first radiologists exposed to high doses. In nuclear industry workers, the results of epidemiological studies are contradictory and at the present time it is not possible to link their radiologic exposure with a risk of tumor of the nervous system. In populations living near nuclear plants, mortality due to tumors of the nervous system was not increased.

With over 70,000 patients treated worldwide, protontherapy has an evolution on their clinical applications and technological developments. The ballistic advantage of the Bragg peak gives the possibility of getting a high conformation of the dose distribution to the target volume. Protontherapy has accumulated a considerable experience in the management of selected rare malignancies such as uveal melanomas and base of the skull chordomas and chondrosarcomas. The growing interest for exploring new and more common conditions, such as prostate, lung, liver, ENT, breast carcinomas, as well as the implementation of large pediatric programs advocated by many experts has been challenged up to now by the limited access to operational proton facilities, and by the relatively slow pace of technical developments in terms of ion production, beam shaping and modelling, on-line verification etc. One challenge today is to deliver dynamic techniques with intensity modulation in clinical facilities as a standard treatment. We concentrate in this paper on the evolution of clinical indications as well as the potentialities of new technological concepts on ion production, such as dielectric walls and laser-plasma interactions. While these concepts could sooner or later translate into prototypes of highly compact equipments that would make easier the implantation of cost-effective hospital-based facilities, the feasibility of their clinical use must still be proved.

Acute alcohol ingestion can induce drug interactions, either pharmacokinetic or pharmacodynamic. Metabolically, they especially result from interference in the enzymatic systems which catalyse ethanol oxidation, the blocking of alcohol dehydrogenase, blocking of the microsomal oxidation system of ethanol with accumulation of the xenobiotic and risk of overdose, and blocking of acetaldehyde dehydrogenase with an antabuse effect. Pharmacodynamically, the main interactions result from the action of drugs having a sedative effect, such as tranquilizers but also antidepressants, neuroleptics, analgesics, H1 antihistamines, central antihypertensive drugs (CNS depressant?), etc. This sedative effect is increased by ethanol, which can be dangerous in at-risk situations.

Epidemiological studies have shown the role of alcohol in esophageal cancer in the West of France. Experiments were undertaken on Wistar rats to study the effect of locally consumed alcoholic beverages on the esophagus. Neither histological modifications, precancerous lesions nor cancer were observed in the animals. There was no significant excess of benign or malignant tumours in treated animals when compared with controls.

Early and appropriate treatment of acute pancreatitis (AP) depends on early causal diagnosis. Published studies have shown favourable results following sphincterotomy performed within the 72 hours of onset of severe gallstone-associated AP. Among the various bio-clinical indices, the lipase/amylase (L/A) ratio, computed within 72 hours after onset, has been shown to discriminate between alcoholic and non alcoholic AP. Our study evaluates the data of biochemical disorders in 51 patients presenting with an episode of AP; these patients were divided into 3 groups: A: alcoholic AP, n = 15; B: biliary AP, n = 25; and C: post-ERCP AP, n = 11. These 3 groups were similar with respect to clinical severity of AP and CT scan. The time delays between onset of the symptoms and the biochemical assay were 1.9 +/- 0.3, 1.9 +/- 0.2 and 0.6 +/- 0.3 d (P < 0.01). AST, ALT, bilirubin, GGT and alkaline phosphatase were significantly (P < 0.05) greater in group B. Blamey's score was 0.5 +/- 0.2, 2.8 +/- 0.2 and 2.5 +/- 0.4 in groups A, B and C respectively. Serum amylase, serum lipase and L/A ratio were identical in groups A and B. The decrease in serum amylase after 48 hours was more important only in group B (56 +/- 8, 80 +/- 4, 47 +/- 3% respectively in groups A, B and C). L/A ratio was significantly greater in group C when compared with group A and B (1.7 +/- 0.4, 1.5 +/- 0.2 and 2.2 +/- 0.3 in groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatocellular carcinoma has as poor prognosis. Curative surgical treatment remains the first-line treatment. However, because of the limited indications and the high recurrence rate of this cancer, nonsurgical treatments have been developed. Intraarterial chemotherapy (with or without embolization or lipiodol), although effective on tumour bulk, has not yet been demonstrated to be effective on survival in the controlled studies published to date. Ultrasound-guided percutaneous alcohol injection, which is a more recent method, is simple, inexpensive and well tolerated. The inclusion of patients into controlled therapeutic protocols remains essential for both of these methods. Outside of the context of these studies, inoperable hepatocellular carcinoma without extrahepatic metastases can be treated by chemo-embolization in the case of unilobar tumours, without portal thrombosis, or major hepatocellular insufficiency or renal failure, and by alcohol injection in the case of small tumours, limited in number, without any serious clotting disorders or abundant ascites. When these two methods are contraindicated, endocrine therapy by tamoxifen remains an alternative to symptomatic treatment. In contrast, external beam radiotherapy, systemic chemotherapy and intraarterial chemotherapy without Lipiodol or embolization are no longer indicated. Finally, internal radiotherapy by intraarterial injection of lipiodol radioactive iodine is currently under evaluation.

The aim of this study was to determine whether there was any relationship between alcohol consumption, cirrhosis and Helicobacter pylori associated antral gastritis. One hundred and forty-four patients undergoing upper gastrointestinal endoscopy were prospectively included and classified in four groups. The first group of 23 patients had cirrhosis and an alcohol consumption below 80 g per day. The second group of 31 patients had cirrhosis and an alcohol consumption over 80 g per day. The third group of 34 patients had an alcohol consumption over 80 g per day without cirrhosis. The fourth group of 56 patients had an alcohol consumption below 80 g per day without any preexisting liver disease and underwent upper gastrointestinal endoscopy for non specific digestive symptoms. The diagnosis of Helicobacter pylori was made at histological examination using the hematoxylin and eosin stain and the Whartin-Starry stain in each case. Histopathological results were confirmed by a bacteriological study in 15 cases. One hundred and twelve of 144 patients (78 percent) had gastritis. Gastritis was more frequent (p less than 0.01) when Helicobacter pylori was present than when it was not (90 percent vs 68 percent). Gastritis was more frequent when alcohol consumption was high (86 percent vs 72 percent). Helicobacter pylori was found in 26 percent of the first group, 48 percent of the second group, 65 percent of the third group and 45 percent of the fourth group. These differences were significantly different (p less than 0.05). A statistically significant relationship between high alcohol consumption and the presence of Helicobacter pylori was noted, even in the presence of cirrhosis (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Fatal complications of percutaneous ethanol injection for the treatment of hepatic tumors are rare events. We report a case of massive hepatic necrosis after treatment by percutaneous ethanol injection of a 4 cm diameter hepatocellular carcinoma, which resulted in the death of the patient. The mechanism of this complication was probably an intratumoral aterioportal shunt, which allowed ethanol to spread through the blood vessels.

1. The technique of chronic alcohol intoxication by inhalation of alcohol vapor was developed in rats. 2. The blood alcohol level value of rats staying in an alcohol-containing atmosphere increases (from 0 to 4 mg/l) in terms of the atmospheric alcohol level (from 0 to 20 mg/l). 3. The mean blood alcohol level of a group of animals maintained during 20 days in an atmosphere containing 15 mg/l of air, increases regularly during 7 days, and then decreases slowly. 4. Animals that are staying in an atmosphere with a regularly increasing alcohol level can breathe an air containing 20 mg/l of alcohol. This dose is early lethal when used in other animals from the beginning of treatment, what confirms the metabolic tolerance. 5. Withdrawal signs characterized by a central nervous system hyperexcitability are shown by animals which had a high blood alcohol level during 4 or 5 days, when they are back into the ambient atmosphere.

During the last 50 years the increase of life expectancy has been dramatic in all Western countries. In France, the life expectancy in 1988 was 80.6 years for women and 72.3 years for men. In 1980, the life expectancy at the age of 60 was more than 20 years in women and 16 years in men. Side by side with this increase of life expectancy there has been a change in the structure of the causes of death. Cardiovascular diseases accounted for 15.6 percent of all causes in 1930, 31 percent in 1950 and 37.4 percent in 1980. Cardiovascular diseases therefore rank very high among the causes of mortality, and one of the principal reasons for this is ageing of the population. Studying the epidemiology of cardiovascular ageing is tantamount to determining the part played by prevention in these diseases. There are wide fluctuations in cardiovascular mortality rate according to some demographic variables: men are more affected than women, the poorer subjects more than the richer subjects, and people living in the North of France more than those living in the South. These disparities are real, irrespective of age, and they can be explained, at least partly, by differences in the prevalence of well-known risk factors. Cardiovascular ageing plays a role, probably important, in the genesis of physical and mental disabilities, but markers that would measure them precisely are lacking. The development of such indicators is a major line of research which should make it possible to evaluate the prospective results of a policy of prevention in a segment of the population where people aged 60 or more accounted for 19.1 percent in 1990 and will account for 25 percent in the year 2020.