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Monseigneur, Il n’est pas que Votre Altesse, versee dans les auteurs de l’Antiquite comme elle l’est, ne connaisse l’histoire touchante d’Oreste et de Pylade, qui etaient deux heros fameux par leurs malheurs et par leur amitie. Il accomplit sa destinee entre les quatre colosses du continent, ferme, solide, impenetrable, noeud de civilisation, asile de science, refuge de la pensee, obstacle aux envahissements injustes, point d’appui aux resistances legitimes.

Trahie par un etranger qui se trouve parmi ses suivans, elle tombe avec le fort qu’elle defend au pouvoir de l’ennemi qui fait pendre ses soldats, et l’oblige elle-meme d’assister a l’execution une corde au cou. Dans les tout premiers temps, il lui arrivait, au Bois, soit qu’il galopat seul a la rencontre de Hilda, soit que la jeune fille et lui trottassent ensemble, d’apercevoir soudain, surgissant au detour d’un sentier, l’ecuyer et son falot profil a la Don Quichotte.

Apres s’etre recueillie un instant dans sa gloire, et avoir joui de ses pensees314, l’ame heureuse reprend la parole et fait briller aux yeux du Dante les principales lumieres qui composent avec lui cette croix. La premiere fois que le president visite les bosquets, le kiosque, le pavillon turc, d’un style et d’une architecture si bizarres, si differents de ce qu’il voit a Versailles, il prend peur et se croit un instant transporte dans les jardins du grand Seigneur.

Je trouvai a Posen tous les officiers du quartier general, qui n’avaient pas accompagne l’Empereur a Dresde, ainsi que plusieurs regiments de la garde imperiale, des troupes appartenant aux differents corps d’armee, des trains d’artillerie, des equipages de toute espece. La necessite de supposer que les germes des etres vivants sont, au moins dans un grand nombre de cas, enfermes les uns dans les autres, conduit a supposer aux derniers d’entre eux une petitesse hors de proportion avec tout ce que nous pouvons imaginer.

Les equipages, qui avaient pris depuis longtemps les devants, nous attendaient a Smolensk; je leur ordonnai de nous suivre; d’autres colonels envoyerent les leurs en avant, et l’on en sauva quelques-uns. Il ne pouvait dire; mais une singuliere aversion pour la profession qu’il avait embrassee s’emparait de lui, et il pensait qu’il lui etait tout-a-fait inutile de perdre son temps a se chercher un autre patron sous les auspices duquel il put continuer ses etudes legales.

Il s’emeut pour un oiseau captif, pour un pauvre ane qui, accoutume aux coups, le regarde d’un air resigne, comme pour lui dire de ne point le battre trop fort, mais que cependant, s’il veut, il peut le battre. C’etait par une de ces chaudes et claires soirees si communes a Mulhouse, a cette heure ou les ouvriers quittant leurs fabriques, montent sur les coteaux qui bordent le canal et y font entendre des choeurs qui, de la, vont se prolongeant dans toute la vallee.

La maison d’Estrees, pour etre voisine de Villers-Coterets, ne s’accommode pas a son usage; nous allons droit a Saint-Germain, elisa massage lyon et si la marquise de Coeuvres a fait autrement, c’est en cela que je me declare son ennemi capital.

elisa massage lyon

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Girod (de l’Ainproposa, par voie d’amendement, cette redaction qui fut adoptee: Le recouvrement de la retribution ne donnera lieu qu’au remboursement des frais par la commune, sans aucune remise au profit des agents de la perception. Pauvre homme qui ne connaissait ni Paris, ni Versailles, ni la Cour, ni son etiquette, et qui, de son desert canadien, tombait au milieu de tout cela, sans autre bagage que sa fidelite, son drapeau et son heroique naivete!

Quelques-uns inclineront peut-etre a penser que la transformation commenca a devenir visible meme avant qu’il fut empereur; que l’enlevement illegal et l’execution arbitraire du duc d’Enghien furent le symptome initial. DecesAvisRemerciements Les personnes qui n’auraient pas recu avis du deces de Mme veuve Gustave LEMAITRE, nee Marie-Elisabeth BOUTRY, decedee a Lille, le 6 janvier 1916, a l’age de 79 ans, sont priees de considerer le present comme en tenant lieu. Le sergent assistait au dejeuner; lorsqu’on fut au dessert, mon oncle le pria d’aller a la Croix-des-Michelins porter une table, une boite et deux chaises dont il avait besoin pour son duel, et d’y allumer un grand feu avec les echalas de la vigne voisine, puis il demanda du cafe.

La grande difference entre les poissons qui vivent sur les deux versants opposes de la plupart des chaines de montagnes continues, dont la presence a, des une epoque tres reculee, empeche tout melange entre les divers systemes de rivieres, parait motiver la meme conclusion. Helas, la petite flamme tremblotante alla se refleter sur les feuilles les plus proches, mais la se borna sa faible action; en definitive elle n’aboutit qu’a faire paraitre plus epais, plus impenetrable, le cercle de tenebres qui se resserrait autour du jeune homme.

Les Etats de l’Empire qui nous persecutent, elisa massage lyon a l’instigation du roi de Prusse, pour avoir la paix, se plaindront de ce que nous aggravons les sujets de discorde et attirons sur eux la vengeance des Francais. Gontran etait dans une angoisse inexprimable: son beau visage, douloureusement contracte, exprimait la haine, la rage, le desespoir; mais on aurait dit qu’une mysterieuse influence empechait l’explosion de ces violents ressentiments.

Ce qui sans doute donna a cet auteur l’audace d’engager avec Moliere une sorte de lutte, c’est que sa comedie de la Femme juge et partie, representee en meme temps que le Tartuffe, mais sur une autre scene, balanca le succes du chef-d’oeuvre du grand auteur comique. L’archevesque de Rains chanta la grant messe; apres ce que il l’ot chantee, il mist la couronne sur le chief la royne Marie, et la sacra et beney ainsi comme il ont acoustume en France, et fu droitement le jour de la feste saint Jehan-Baptiste, l’an de grace mil deux cens soixante et quinze.

C’etait Julien qui avait de la prudence, et c’etait seulement quand il etait question de danger qu’elle ne cedait pas a sa volonte; mais soumise et presque humble avec lui, elle n’en montrait que plus de hauteur envers tout ce qui dans la maison l’approchait, parents ou valets.

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Management of Tennis Elbow with sodium hyaluronate periarticular injections

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Abstract
Objectives:
To determine the efficacy and safety of peri-articular hyaluronic acid injections in chronic lateral epicondylosis (tennis elbow).
Design:
Prospective randomized clinical trial in primary care sport medicine.
Patients:
Three hundred and thirty one consecutive competitive racquette sport athletes with chronic (>3 months) lateral epicondylosis were administered 2 injections (first injection at baseline) into the subcutaneous tissue and muscle 1 cm. from the lateral epicondyle toward the primary point of pain using a two-dimensional fanning technique. A second injection was administered 1 week later.
Outcomes measures:
Assessments were done at baseline, days 7, 14, 30, 90 and 356. Efficacy measures included patient’s visual analogue scale (VAS) of pain at rest (0-100 mm) and following assessment of grip strength (0-100 mm). Grip strength was determined using a jamar hydraulic hand dynamometer. Other assessments included patients’ global assessment of elbow injury (5 point categorical scale; 1 = no disability, 5 = maximal disability), patients’ assessment of normal function/activity (5 point categorical scale), patients/physician satisfaction assessment (10 point categorical scale), time to return to pain-free and disability-free sport and adverse events as per WHO definition. Differences between groups were determined using an intent-to-treat ANOVA.
Results:
Average age of the study population was 49 years (± 12 years). One hundred and sixty-five patients were randomized to the HA and 166 were randomized to the control groups. The change in VAS pain was -6.7 (± 2.0) for HA vs -1.3 (± 1.5) for control (p < 0.001). The VAS post handgrip was -7.8 (± 1.3) vs +0.3 (± 2.0) (p < 0.001) which corresponded to a significant improvement in grip of 2.6 kg in the HA vs control groups (p < 0.01). Statistically significant improvement in patients’ global assessment of elbow injury (p < 0.02), patients’ assessment of normal function/activity (p < 0.05) and patients/physician satisfaction assessment (p < 0.05) were also observed favoring the HA group. Time to return to pain-free and disability-free sport was 18 (± 11) days in the HA group but was not achieved in the control group. VAS changes were maintained in the HA group at each followup while those in the control significantly declined from baseline. Assessment of patient and physician satisfaction continued to favor the HA group at subsequent followup.
Conclusion:
Peri-articular HA treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing. Further, HA treatment was highly satisfactory by patients and physicians and resulted in better return to pain free sport compared to control.
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Efficacy of Celecoxib, a COX-2–Specific Inhibitor, and Naproxen in the Management of Acute Ankle Sprain

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Objective: To assess the efficacy and safety of celecoxib and naproxen in the treatment of acute ankle sprain.
Design: Double-blind, parallel-group, randomized trial.
Setting: Multicenter outpatient.
Patients: Adult patients (n = 397) with acute first-degree or second-degree ankle sprain.
Interventions: Patients randomized to celecoxib 200 mg BID (n =198) or naproxen 500 mg BID (n = 198) for 7 days.
Main Outcome Measures: Primary measures of efficacy were Patient’s Assessment of Ankle Pain Visual Analogue Scale (VAS) and Patient’s Global Assessment of Ankle Injury. Secondary efficacy measures included Physician’s Global Assessment of Ankle Injury, Patient’s Return to Normal Function/Activity, and Patients’ and Phy-sicians’ Satisfaction Assessments. Adverse events (AEs) were re-ported by investigators during the study.
Results: For the primary endpoints at day 4, the mean pain VAS scores were 31.9 mm ± 1.96 for celecoxib and 29.0 mm ± 1.91 for naproxen, and the responder rate for Patient’s Global Assessment of Ankle Injury was 71% in the celecoxib group and 72% in the naproxen group, differences that were not statistically significant. In addition, noninferiority analysis demonstrated treatment differences that were within prespecified minimal clinical important differences. Gastrointestinal AEs were the most common AE, accounting for 14% in the celecoxib group and 21% in the naproxen group. The incidence of dyspepsia was 3% for celecoxib compared with 12% for naproxen (P= 0.032).
Conclusions: Celecoxib is as effective as naproxen in treating acute first-degree or second-degree ankle sprains but causes significantly less dyspepsia.
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Hyaluronic Acid for the Treatment of Knee Osteoarthritis

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Long-Term Outcomes from a Naturalistic Primary Care Experience

ABSTRACT

Petrella RJ: Hyaluronic acid for the treatment of knee osteoarthritis: Long-term outcomes from a naturalistic primary care experience. Am J Phys Med Rehabil 2005;84:278–283.

Objective:
Intraarticular hyaluronic acid is indicated for patients with osteoarthritis of the knee. However, clinical experience, especially efficacy and adverse events, with repeated injection series in
the long term are limited.

Design:
Patients were referred to a large primary care center for management of osteoarthritis of the knee. All were naive to intraarticular hyaluronic acid therapy and met our entry criteria, including resting visual analog scale pain of 45 mm, radiographic confirmation of unilateral knee grade 1–3 osteoarthritis, and willingness to receive intraarticular therapy. Patients received a three–intraarticular injection series with Suplasyn (10 mg/ml, 2-ml injection) over 3 wks. Patients were instructed to return for consideration of repeat injection series based on their perception of pain restricting daily activity and a resumption of severity similar to their initial presentation. This prospective naturalistic cohort was followed for 6.7 yrs. Patients completed baseline assessment of rest and walking visual analog scale pain (primary efficacy variable), completed a 5-point categorical global satisfaction score, and recorded adverse events and concomitant therapeutic modality use at each study visit. Patients returned for consideration of a repeat injection series based on their perception of symptom severity and were eligible if their resting visual analog scale pain was 45 mm. The three-injection series and data collection were repeated, and again, patients were given similar instructions regarding consideration of a third injection series.

Results:
Of 897 referral patients, 537 (mean age, 68 ± 8 yrs; mean duration of symptoms, 7.4 ± 4.1 yrs) met our criteria, and only 21 patients did not return for a second injection series. The mean time between first and second series was 27 ± 7 wks. The change in walking visual analog scale pain was significantly improved from baseline after the first series (81.3%, P<0.001) and second series (86.7%, P < 0.0001). Similarly, resting visual analog scale pain was significantly decreased from baseline after the first (P <0.001) and second (P<0.001) series, and patient satisfaction was significantly improved with each injection series (P<0.03 and P<0.01). Very few adverse events were recorded and were limited to local pain and swelling. Use of concomitant therapeutic modalities at presentation for a second injection series included: nonsteroidal anti-inflammatory drugs/cycloox- ygenase-2 medications (37%), acetaminophen (31%), oral nutraceuticals (12%), and physical therapy and bracing (12%).

Conclusions:
Intraarticular hyaluronic acid injections were highly effective in improving resting and walking pain in patients with osteoarthritis of the knee on a first and a second treatment series. Duration of symptom control was about 6 mos, and the therapy was highly satisfactory to patients and was associated with very few local adverse events and limited use of concomitant therapeutic modalities. These data support the potential role of intraarticular hyaluronic acid as an effective long-term therapeutic option for patients with osteoarthritis of the knee.

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