[Lettre autographe signée de Giuseppe Verdi (sans lieu ni date)]

Destinataire non identifié

Grand panorama. Les cuirassiers de Reichshoffen peint par MM. T. Poilpot et S. Jacob... : [affiche] / [non signée]

Référence bibliographique : Broido 501

Ma cure d'eau pour la guérison des maladies et la conservation de la santé (Ed. populaire) / par Séb. Kneipp,... ; [trad. de l'allemand par J. Bechtold qui signe le préambule]

Titre original : Meine Wasserkur

Parésie trochléaire transitoire comme signe neurologique inaugural d'une panartérite noueuse [Transient trochlear nerve palsy as the presenting neurological sign of panarteritis nodosa]

INTRODUCTION: Panarteritis nodosa (PAN) is a systemic vasculitis affecting small and medium-sized arteries. Neuro-ophthalmological complications of PAN are rare but numerous, and may affect the eye, the visual and the oculomotor pathways. Such complications occur mainly in patients previously diagnosed with PAN. OBSERVATION: A 51-year-old woman presented with an isolated right trochlear (IV) palsy, in the setting of headaches and fluctuating fever of unknown etiology. Erythrocyte sedimentation rate was 13 mm and full blood cell count was normal. Previous chest X-ray and blood studies were negative for an infection or inflammation. Orbital and cerebral CT scan was normal. Spontaneous recovery of diplopia ensued over four days. Two days later, paresthesia and sensory paresis of the dorsal portion of the left foot were present. Lumbar puncture revealed 14 leucocytes (76 percent lymphocytes) with elevated proteins, but blood studies and serologies were negative. A diagnosis of undetermined meningo-myelo-radiculoneuritis was made. Because of a possible tick bite six weeks previously the patient was empirically treated with 2 g intravenous ceftriaxone for 3 weeks. Fever rapidly dropped. Six weeks after the onset of diplopia, acute onset of blindness in her right eye, diffuse arthralgias and fever motivated a new hospitalization. There was a central retinal artery occlusion of the right eye. Blood studies now revealed signs of systemic inflammation (ESR 30 mm, CRP 12 mg/L, ANA 1/80, pANCA 1/40, leucocytosis 12.4 G/L, Hb 111 g/L, Ht 33 percent). Biopsy of the left sural nerve revealed arterial fibrinoid necrosis. A diagnosis of PAN was made. CONCLUSIONS: Transient diplopia can be the heralding symptom of a systemic vasculitis such as PAN, giant cell arteritis and Wegener granulomatosis. In this patient the presence of accompanying systemic symptoms raised a suspicion of systemic inflammation, but the absence of serologic and imaging abnormalities precluded a specific diagnosis initially. A few weeks later, the presence of a second ischemic event (retinal) and positive blood studies led to a further diagnostic procedure. Oculomotor and abducens palsies have rarely been reported in association with PAN. We report the first case of trochlear nerve paresis as the inaugural neurological sign of PAN. This case highlights the importance of considering inflammatory systemic disorders in patients with acute diplopia particularly when they are young, lack vascular risk factors or cause, and complain of associated systemic symptoms.

Vertical Clearance Restrictions on Primary Roads and Primary Road Extensions: Standard U.S. Measurements [Vertical Clearance Log], May 1, 2015

The Vertical Clearance Log is prepared for the purpose of providing vertical clearance restrictions by route on the primary road system. This report is used by the Iowa Department of Transportation’s Motor Carrier Services to route oversize vehicles around structures with vertical restrictions too low for the cargo height. The source of the data is the Geographic Information Management System (GIMS) that is managed by the Office of Research & Analytics in the Performance & Technology Division. The data is collected by inspection crews and through the use of LiDAR technology to reflect changes to structures on the primary road system. This log is produced annually.

Convention sanitaire internationale, signée à Paris, le 17 janvier 1912 et ratifiée le 7 octobre 1920 en vue d'arrêter les mesures propres à sauvegarder la santé publique contre l'invasion et la propagation de la peste, du choléra et de la fièvre jaune (rendue exécutoire en France, par décret du 14 octobre 1920, publié au "Journal officiel" du 21 octobre 1920)

[Traité. 1912-01-17. Paris (Français)]

[Lettre autographe signée de Jabrun au docteur Chapellain, 13 août 1835]

"Madame de La Vigne ne pouvant pas se réunir à nous pour dîner à cause d'un empêchement imprévu, nous remettrons, si vous le voulez, la partie à un autre jour..."