Artrodesis de tobillo: resultados comparativos de diferentes técnicas

INTRODUCTION: Ankle arthrodesis in an intervention that may be performed using a variety of surgical approaches. The joint may be stabilized using diferent systems, with or without bone graft. MATERIAL AND METHODS: Retrospective study that collected the results of 40 patients who underwent ankle arthrodesis; the complications that arose were analyzed, results according to the AOFAS clinical rating system, global patient satisfaction and the relationship with the articular approach route, the !xation system or the usage of grafts.RESULTS: 55% of the patients presented one or more complication that motivated a total of 12 re-interventions in 10 patients (excludes removal of osteosynthesis material). The absence of consolidation, which required a new arthrodesis was more frequent in patients where osteosynthesis was not used (two out of three cases) than in those using screws (four out of 24 cases), while there was no register of this in 13 patients in which intramedullary pin. The use of the distal extreme of the fibula or the iliac crest as bone graft has failed to improve the consolidation. Arthroscopic approaches avoid the appearance of soft tissue complications, although the consolidation disorders were more frequent. The average score on the AOFAS clinical rating system was 56.4±21.2 and 55% of the patients were satisfied. CONCLUSIONS: Although the case histories fail to provide significant results, it is a demanding intervention, with an elevated complication rate. Intramedullary pins seem to favor improved consolidation.

Fractura bilateral de calcáneo en edad pediátrica. A propósito de un caso

OBJECTIVE: Propose and debate the treatment management for unusual traumatic pathology, both due to the age of the patient and the bilateral location. CLINICAL CASE: Bilateral calcaneal fracture in a ten year old male, after falling three meters to land on his heels. Examination revealed pain and swelling at that level, with no distal neurovascular alterations. After the clinical study, x-rays were taken, as well as a CAT scan which revealed a complex fracture of both calcanei. After 72 hours and verifying that the soft tissue was in optimal condition, the left calcaneus was immobilized with a closed cast while the right was trans!xed with a Steinmann pin following the Essex-Lopresti technique, achieved under scope to attain an acceptable reduction of the fracture and the congruency of all a"ected joints.

Medial femoral condyle fracture as a complication of antegrade intramedullary nailing.

A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol. At 3-month follow-up the patient still demonstrated poor knee function and pain. A plain X-ray and a CT scan of the left knee revealed a displaced fracture of the medial femoral condyle. Analysis of the postoperative imaging suggests that the fracture occurred during the insertion of the IM nail. The nail possibly hit the Steinmann traction pin in the distal femur causing the medial condyle fracture. The patient was reoperated; open reduction and internal plate and screw fixation were performed with satisfactory clinical progress postoperatively. The description and illustration of this case is intended to make trauma surgeons aware of this rare but serious complication of IM femoral nailing.

Reflux vésico-­‐urétéral et atteinte rénale: rôle de l'albuminurie

Introduction :¦Le reflux vésico-urétéral (RVU) touche environs 1% des nouveau-nés et est retrouvé chez 25 à 30 % des enfants ayant une pyélonéphrite. Le RVU peut être associé à une hypoplasie/dysplasie rénale ou/et à des cicatrices rénales causées par les pyélonéphrites. Ces changements morphologiques sont plus ou moins importants selon le grade du reflux et peuvent conduire à une insuffisance rénale chronique et potentiellement évoluer en une insuffisance rénale terminale.¦La microalbuminurie (MA) reflète une augmentation anormale de la perméabilité capillaire glomérulaire et est un indicateur prédictif de la péjoration de la fonction rénale vers l'insuffisance chronique. La MA est également un facteur de risque cardiovasculaire.¦Objectif :¦Le but de cette recherche transversale est d'évaluer la présence de MA chez des patients atteints de RVU et de voir s'il est possible de corréler la MA avec le degré de reflux, la présence d'une hyperfiltration et le degré de l'insuffisance rénale.¦Patients et méthode :¦Une base de données de 160 dossiers médicaux du service de pédiatrie du CHUV, portant sur les années 2007, 2008, 2009 et 2010, va être investiguée. Ces dossiers regroupent tous les patients atteints de RVU ayant eu une exploration fonctionnelle rénale, dont l'âge varie du nouveau-né au jeune adulte âgé de 21 ans. Les variables suivantes seront considérées et analysées en détail: âge, sexe, taille, type de RVU, taux de filtration glomérulaire (TFG), flux plasmatique rénal (FPR), fraction de filtration (FF), albuminurie, rapport albumine/créatinine.¦- Les RVU sont classés en cinq grades (I, II, III, IV, V) et peuvent être uni- ou bilatéraux¦- Le TFG est calculé avec la clairance à l'inuline, un polymère de glucose filtré, non réabsorbé, ni sécrété, qu'on perfuse au patient. TFG = Uin V/Pin (ml/min)¦- Le FPR est calculé avec la clairance au PAH (acide para-amino-hippurique), une substance entièrement filtrée et sécrétée au premier passage et qu'on injecte au patient. FPR = UPAHV / PPAH (ml/min)¦- La FF est la proportion du FPR qui est filtrée.¦FF= TGF / FPR ou FF = Cl in / Cl PAH¦- La MA a été mesurée par la méthode Immulite (Siemens) jusqu'en fin août 2010 et par la méthode ALBT2 (Roche Diagnostics) à partir d'octobre 2010. Le taux normal d'albuminurie est de moins de 20 mg/l sur un échantillon d'urine.¦- Le rapport albumine urinaire / créatinine urinaire permet d'éviter les problèmes de variation de volume urinaire lors de l'analyse d'échantillon urinaire d'une seule miction. Le rapport normal est de moins de 2,5 g/mol de créatinine.¦Un questionnaire sera envoyé aux patients pour obtenir des précisions sur la fréquence et la sévérité des infections urinaires éventuellement survenues depuis.¦Les dossiers seront revus pour connaître l'évolution du RVU.¦Résultats attendus et discussion: Les résultats nous permettront :¦1) De savoir si les patients avec un RVU ont une MA¦2) De savoir si la MA varie en fonction du grade de leur reflux¦3) De savoir si la MA varie en fonction de l'hyperfiltration mesurée par la FF.¦Interprétation :¦Si la MA varie en fonction de la FF cela indiquera que la MA est la conséquence directe de l'hyperfiltration compensatrice de la perte de la masse néphronique et qu'elle est ainsi le reflet d'une cause principalement mécanique. Si la MA ne varie pas en fonction de la FF cela indiquera qu'elle est liée à l'hypoplasie/dysplasie ou/et aux cicatrices dues aux pyélonéphrites. Elle pourra alors être par exemple la conséquence d'une néphropathie glomérulotubulointerstitielle.¦Du point de vue pratique, cette étude permettra de déterminer si la simple mesure da la MA peut aider à prédire le degré de l'atteinte rénale et/ou le degré de l'hyperfiltration dans ce groupe de patients atteints de RVU.¦Bibliographie¦1. Silbernagl S, Despopoulos A. Atlas de poche de physiologie. Paris : Flammarion médecine-sciences; 2004.¦2. Brenner BM, Rector FC. The Kidney . Philadelphia : WB Saunders Company; 1996.¦3. Brandström P, Esbjörner E, Herthelius M, Holmdahl G, Läckgren G, Nevéus T, et al. The Swedish Reflux Trial in Children: I. Study Design and Study Population Characteristics. The Journal of Urology. 2010;184:274-279.¦4. Holmdahl G, Brandström P, Läckgren G, Sillén U, Stokland E, Jodal U, et al. The Swedish Reflux Trial in Children: II. Vesicoureteral Reflux Outcome. The Journal of Urology. 2010;184:280-285.¦5. Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S. The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern. The Journal of Urology. 2010;184:286-291.¦6. Brandström P, Nevéus T, Sixt R, Stokland E, Jodal U, Hansson S. The Swedish Reflux Trial in Children: IV. Renal Damage. The Journal of Urology. 2010;184:292-297.¦7. Ruggenenti P, Remuzzi G. Time to abandon microalbuminuria? Kidney Int. 2006;70:1214-1222.¦8. Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA, Brenner BM. Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. J. Am. Soc. Nephrol. 2001;12:1315-1325.¦9. Basic J, Golubovic E, Miljkovic P, Bjelakovic G, Cvetkovic T, Milosevic V. Microalbuminuria in children with vesicoureteral reflux. Ren Fail. 2008:639-643.¦10. González E, Papazyan JP, Girardin E. Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. The Journal of Urology. 2005;173:571-575.

Two cases of "cannabis acute psychosis" following the administration of oral cannabis.

BACKGROUND: Cannabis is the most commonly used illegal drug and its therapeutic aspects have a growing interest. Short-term psychotic reactions have been described but not clearly with synthetic oral THC, especially in occasional users. CASE PRESENTATIONS: We report two cases of healthy subjects who were occasional but regular cannabis users without psychiatric history who developed transient psychotic symptoms (depersonalization, paranoid feelings and derealisation) following oral administration of cannabis. In contrast to most other case reports where circumstances and blood concentrations are unknown, the two cases reported here happened under experimental conditions with all subjects negative for cannabis, opiates, amphetamines, cocaine, benzodiazepines and alcohol, and therefore the ingested dose, the time-events of effects on behavior and performance as well as the cannabinoid blood levels were documented. CONCLUSION: While the oral route of administration achieves only limited blood concentrations, significant psychotic reactions may occur.

Early Variscan I-type pluton in the pre-Alpine basement of the Western Alps: The ca. 360 Ma Cogne diorite (NW-Italy)

Located at the internal border of the Grand-Saint-Bernard Zone, the diorite and its aureole lie on top of intensively studied Alpine eclogitic units but this pluton, poorly studied yet, has kept locally almost undeformed. The pluton intruded, at similar to 360 Ma, country-rocks mostly composed of dark shales with Na2O > K2O and minor mafic intercalations of tholeiitic basalt affinity. This association is characteristic of the Vanoise (France) basement series, where available age determinations suggest an Early Paleozoic age. Parts of the pluton, and of its hornfels aureole that is evidenced here for the first time, in the Punta Bioula section of Valsavaranche valley (NW-Italy), have been well-preserved from the Alpine deformation. Syn-emplacement hardening, dehydration-induced, probably prevented strain-enhanced Alpine recrystallization. Magmatic rock-types range continuously from subordinate mafic types at SiO2 similar to 48%, of hornblendite with cumulative or appinite affinities, to the main body of quartz diorite to quartz monzonite (SiO2 up to 62%). P-T estimates for the pluton emplacement, based on the abundance of garnet in the hornfelses, using also zircon and apatite saturation thermometry and Al-in-hornblende barometry, suggest T similar to 800-950 degrees C and minimum P in the 0.2-0.5 GPa range, with records of higher pressure conditions (up to 1-2 GPa?) in hornblendite phlogopite-cored amphibole. The high-K, Na > K, calcalkaline geochemistry is in line with a destructive plate-margin setting. Based on major element data and radiogenic isotope signature (epsilon Nd-360 Ma from -1.2 to + 0.9, Sr-87/Sr-86(360 MA) from 0.7054 to 0.7063), the parental magmas are interpreted in terms of deep-seated metabasaltic partial melts with limited contamination from shallower sources, the low radiogenic Nd-content excluding a major contribution from Vanoise tholeiites. There is no other preserved evidence for Variscan magmatism of similar age and composition in the Western Alps, but probable analogs are known in the western and northern parts of French Massif Central. Regarding the Alpine tectonics, not only the age of the pluton and its host-rocks (instead of the Permo-Carboniferous age previously believed), but also its upper mylonitic contact, suggest revisions of the Alpine nappe model. The Cogne diorite allegedly constituted the axial part of the E-verging ``pli en retour [backfold] du Valsavaranche'', a cornerstone of popular Alpine structural models: in fact, the alleged fold limbs, as attested here by field and geochemical data, do not belong to the same unit, and the backfold hypothesis is unfounded. (C) 2012 Elsevier B.V. All rights reserved.

Electronic Payments for Driver's Licensing Transactions,December 31, 2008

House File 2196 required the Department of Transportation (DOT) to study the acceptance of electronic payments at its customer service sites and sites operated by county treasurers. Specifically the legislation requires the following: “The department of transportation shall review the current methods the department employs for the collection of fees and other revenues at sites operated by county treasurers under chapter 321M and at customer service sites operated by the department. In conducting its review, the department, in cooperation with the treasurer of state, shall consider providing an electronic payment option for all of its customers. The department shall report its findings and recommendations by December 31, 2008, to the senate and house standing committees on transportation regarding the advantages and disadvantages of implementing one or more electronic payment systems.” This review focused on estimating the costs of providing an electronic payment option for customers of the DOT driver’s license stations and those of the 81 county treasurers. Customers at these sites engage in three primary financial transactions for which acceptance of electronic payments was studied: paying for a driver’s license (DL), paying for a non-operator identification card (ID), and paying certain civil penalties. Both consumer credit cards and PIN-based debit cards were reviewed as electronic payment options. It was assumed that most transactions would be made using a consumer credit card. Credit card companies charge a fee for each transaction for which they are used. The amount of these fees varies among credit card companies. The estimates for credit card fees used in this study were based on the State Treasurer of Iowa’s current credit card contract, which is due to expire in September 2009. Since credit card companies adjust their fees each year, estimates were based on the 2008 fee schedule. There is also a fee for the use of PIN-based debit cards. The estimates for PIN-based debit card transactions were based on information provided by Wells Fargo Merchant Services for current fees charged by debit card networks. Credit and debit card transactions would be processed through vendor-provided hardware and software. The costs would be determined through the competitive bidding process since several vendors provide this function; therefore, these costs are not reflected in this document.

Parâmetros erosividade da chuva e da enxurrada correlacionados com as perdas de solo de um solo Bruno Não-Cálcico Vértico em Sumé (PB)

Foram estudadas correlações lineares simples entre os parâmetros erosividade da chuva e da enxurrada e as perdas de solo provocadas por chuvas erosivas num solo Bruno Não-Cálcico Vértico. Os dados correspondentes aos anos de 1986-1990 foram obtidos na estação experimental de Sumé (PB), pertencente à Universidade Federal da Paraíba-UFPB. Os parâmetros erosividade da chuva e da enxurrada estudados foram: (a) altura total da chuva (P), em mm; (b) intensidades máximas (In), ocorridas nos tempos de 5; 10; 15; 20; 25; 30; 35; 40; 45; 50; 55; 60 e 120 minutos, respectivamente, em mm h-1; (c) energia cinética total, pelo método de Wischmeier e Smith (Ec) e pelo método de Wagner e Massambani (EcW), em MJ ha-1; (d) somatório da energia cinética de intensidades superior a 10 mm h-1 (Ec > 10 e EcW > 10) em MJ ha-1; (e) somatório da energia cinética de intensidades superior a 25 mm h-1 (Ec > 25 e EcW > 25), em MJ ha-1; (f) produtos da energia cinética total pelas intensidades máximas de chuva em intervalos crescentes de tempo (EIn), ou seja: EI5; EI10; EI15; EI20; EI25; EI30; EIW30; EI35; EI40; EI45; EI50; EI55; EI60 e EI120, em MJ mm ha-1 h-1; (g) produtos da altura total da chuva pelas intensidades máximas das chuvas em intervalos crescentes de tempo (PIn), ou seja: PI5; PI10; PI15; PI20; PI25; PI30; PI35; PI40; PI45; PI50; PI55; PI60 e PI120, em mm² h-1, e (h) volume de enxurrada (Vu), em m³. O parâmetro volume de enxurrada (Vu) foi o que melhor estimou (r = 0,812) as perdas de solo em Sumé (PB). Dentre os parâmetros erosividade da chuva, o que melhor se correlacionou com as perdas de solo foi o parâmetro PI25 (r = 0,753). As equações de Wischmeier & Smith e de Wagner & Massambani, utilizadas no cálculo da energia cinética total da chuva, apresentaram o mesmo grau de precisão na estimativa das perdas de solo.

Effets du cannabis oral et du dronabinol sur la capacité à conduire [Effects of oral cannabis and dronabinol on driving capacity]

Two retrospective epidemiologic studies have shown that cannabis is the main psychoactive substance detected in the blood of drivers suspected of driving under the influence of psychotropic drugs. An oral administration double-blind crossover study was carried out with eight healthy male subjects, aged 22 to 30 years, all occasional cannabis smokers. Three treatments and one placebo were administered to all participants at a two week interval: 20 mg dronabinol, 16.5 mg D9-tétrahydrocannabinol (THC) and 45.7 mg THC as a cannabis milk decoction. Participants were asked to report the subjective drug effects and their willingness to drive under various circumstances on a visual analog scale. Clinical observations, a psychomotor test and a tracking test on a driving simulator were also carried out. Compared to cannabis smoking, THC, 11-OH-THC and THC-COOH blood concentrations remained low through the whole study (<13.1 ng THC/mL,<24.7 ng 11-OH-THC/mL and<99.9 ng THC-COOH/mL). Two subjects experienced deep anxiety symptoms suggesting that this unwanted side-effect may occur when driving under the influence of cannabis or when driving and smoking a joint. No clear association could be found between these adverse reactions and a susceptibility gene to propensity to anxiety and psychotic symptoms (genetic polymorphism of the catechol-O-methyltransferase). The questionnaires have shown that the willingness to drive was lower when the drivers were assigned an insignificant task and was higher when the mission was of crucial importance. The subjects were aware of the effects of cannabis and their performances on the road sign and tracking test were greatly impaired, especially after ingestion of the strongest dose. The Cannabis Influence Factor (CIF) which relies on the molar ratio of active and inactive cannabinoids in blood provided a good estimate of the fitness to drive.

Pièces relatives à l'histoire de la MAISON D'AUVERGNE (XIIe-XVIIe siècle). II Notes et copies de pièces parmi lesquelles on remarque les suivantes :

Contient : Hommage de Béraud, dauphin d'Auvergne, et de Bertrand de La Tour à l'abbé de Cluny (1376-1394), feuillets d'un registre sur papier de la fin du XIVe siècle ; Mémoire donné au roi, le 15 novembre 1694, sur l'illustration de la famille de Bouillon ; Extraits d'une ancienne généalogie des comtes de Boulogne ; Extrait de la chronique généalogique des seigneurs de Chauvigny ; « Extrait du calendrier des tesmoins vieux et valétudinaires produits par M. le duc de Berry... contre Morinot de Tourzel, seigneur d'Alegre, au mois juillet 1414 » ; Extrait des titres de Turenne ; « Extrait des comptes d'Oliergues, commençant en 1329. » ; Listes de titres communiqués à de Bar par Baluze ; Extraits des titres à l'abbaye du Bouchet (1192-1505) ; Extraits des titres et des obituaires de Brioude ; Lettre de M. d'Anfreville (6 sept. 1708) ; Armoiries diverses envoyées à Baluze et (f. 92) lettre de M. Mantaigue, de Vic-le-Comte (9 octobre 1703) ; Lettre de David, prieur de l'abbaye du Bouchet, s. d ; Copie de lettres de [Gui] Allard relatives à la maison de La Tour du Pin (1698) et de la réponse de Baluze ; Lettre de [Gui] Allard (Grenoble, 10 février 1698) ; Lettre de M. Estienne (14 octobre 1701) ; Comptes de gravures d'armoiries par l'histoire de la maison d'Auvergne

D6PK AGCVIII Kinases Are Required for Auxin Transport and Phototropic Hypocotyl Bending in Arabidopsis.

Phototropic hypocotyl bending in response to blue light excitation is an important adaptive process that helps plants to optimize their exposure to light. In Arabidopsis thaliana, phototropic hypocotyl bending is initiated by the blue light receptors and protein kinases phototropin1 (phot1) and phot2. Phototropic responses also require auxin transport and were shown to be partially compromised in mutants of the PIN-FORMED (PIN) auxin efflux facilitators. We previously described the D6 PROTEIN KINASE (D6PK) subfamily of AGCVIII kinases, which we proposed to directly regulate PIN-mediated auxin transport. Here, we show that phototropic hypocotyl bending is strongly dependent on the activity of D6PKs and the PIN proteins PIN3, PIN4, and PIN7. While early blue light and phot-dependent signaling events are not affected by the loss of D6PKs, we detect a gradual loss of PIN3 phosphorylation in d6pk mutants of increasing complexity that is most severe in the d6pk d6pkl1 d6pkl2 d6pkl3 quadruple mutant. This is accompanied by a reduction of basipetal auxin transport in the hypocotyls of d6pk as well as in pin mutants. Based on our data, we propose that D6PK-dependent PIN regulation promotes auxin transport and that auxin transport in the hypocotyl is a prerequisite for phot1-dependent hypocotyl bending.

Estoques de carbono e nitrogênio e frações orgânicas de Latossolo submetido a diferentes sistemas de uso e manejo

O avanço das fronteiras agrícolas, caracterizado pela substituição de ecossistemas naturais por áreas cultivadas, vem se intensificando nas últimas décadas, acarretando alterações na qualidade do solo e na dinâmica da matéria orgânica do solo (MOS). Assim, o estudo do impacto da adoção de diferentes sistemas de manejo é essencial na definição de melhores estratégias de uso do solo. Este estudo teve por objetivo avaliar diferentes frações da MOS e os estoques de C e N de Latossolo Vermelho distroférrico típico muito argiloso submetido a diferentes sistemas de uso e manejo: mata nativa (MTN), eucalipto (EUC), pinus (PIN), pastagem (PAS), milho no sistema de cultivo mínimo (MCM) e milho no sistema plantio convencional (MPC). As amostras de solo foram coletadas em setembro de 2004, nas profundidades de 0-10, 10-20 e 20-40 cm, para avaliação dos estoques de carbono orgânico (CO) e N total (NT); de 0-5 e 0-10 cm, para realização do fracionamento físico-densimétrico da MO; e de 0-5 cm, para avaliação do C da biomassa microbiana (Cmic). O estoque de CO na área de eucalipto foi maior do que o determinado na área de mata. A proporção relativa do CO nas frações da MOS aumentou na seguinte ordem: C-argila > C-silte > C-areia > C FL. A maior parte (> 90 %) do CO está associada à fração pesada da MOS, com valores próximos a 98 % nos sistemas cultivados com milho (MPC e MCM). Em relação aos teores de CO, o Cmic e o C da fração leve (C FL) são indicadores mais sensíveis das alterações decorrentes da adoção de diferentes sistemas de uso e manejo sobre os compartimentos da matéria orgânica do Latossolo.

Cell polarity in plants: a PARspective on PINs.

Plants have acquired the ability for organized multicellular development independent from animals. Because of this, they represent an independent example in nature for the development of coordinated, complex cell polarity from the simple polarity found in unicellular eukaryotes. Plants display a striking array of polarized cell types, with different axes of polarity being defined in one cell. The most investigated and best understood aspect of plant polarity is the apical-basal polarity of the PIN family of auxin efflux facilitators, which are of crucial importance for the organization of the entire plant body. Striking differences exist between the PAR-polarity modules known in animals and the ways PINs polarize plant cells. Nonetheless, a common regulatory logic probably applies to all polarizing eukaryotic cells, which includes self-reinforcing, positive feedback loops, intricate interactions between membrane-attached proteins, lipid signatures, and the targeting of transmembrane proteins to the correct domains of the plasma membrane.

Chiral unitary approach to eta'N scattering at low energies

We study the eta'N interaction within a chiral unitary approach which includes piN , etaN and related pseudoscalar meson-baryon coupled channels. Since the SU(3) singlet does not contribute to the standard interaction and the eta' is mostly a singlet, the resulting scattering amplitude is very small and inconsistent with experimental estimations of the eta' N scattering length. The additional consideration of vector meson-baryon states into the coupled channel scheme, via normal and anomalous couplings of pseudoscalar to vector mesons, enhances substantially the eta' N amplitude. We also exploit the freedom of adding to the Lagrangian a new term, allowed by the symmetries of QCD, which couples baryons to the singlet meson of SU(3). Adjusting the unknown strength to the eta' N scattering length, we obtain predictions for the elastic eta'N -> etaN and inelastic eta' N -> etaN , piN , KLambda, KEpsilon cross sections at low eta' energies, and discuss their significance.

Trans-SNARE pairing can precede a hemifusion intermediate in intracellular membrane fusion.

The question concerning whether all membranes fuse according to the same mechanism has yet to be answered satisfactorily. During fusion of model membranes or viruses, membranes dock, the outer membrane leaflets mix (termed hemifusion), and finally the fusion pore opens and the contents mix. Viral fusion proteins consist of a membrane-disturbing 'fusion peptide' and a helical bundle that pin the membranes together. Although SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptor) complexes form helical bundles with similar topology, it is unknown whether SNARE-dependent fusion events on intracellular membranes proceed through a hemifusion state. Here we identify the first hemifusion state for SNARE-dependent fusion of native membranes, and place it into a sequence of molecular events: formation of helical bundles by SNAREs precedes hemifusion; further progression to pore opening requires additional peptides. Thus, SNARE-dependent fusion may proceed along the same pathway as viral fusion: both use a docking mechanism via helical bundles and additional peptides to destabilize the membrane and efficiently induce lipid mixing. Our results suggest that a common lipidic intermediate may underlie all fusion reactions of lipid bilayers.