[Impact of preoperative breast magnetic resonance imaging on surgical management: experience of two university hospitals]. / Impact de l'IRM mammaire préopératoire sur la prise en charge chirurgicale des cancers du sein: expérience de deux centres hospitaliers universitaires.

OBJECTIVES: Breast magnetic resonance imaging (MRI) has attained a solid position in the diagnosis of breast cancer but its benefit is still to be confirmed in the preoperative staging. The authors assessed the impact of preoperative breast MRI on surgical management of breast cancer in two university hospitals. PATIENTS AND METHODS: This retrospective review was realized in two university hospitals and concerned all patients with breast carcinoma who had a surgical first therapy. We selected 89 patients who underwent preoperative breast MRI in the period between January 2008 and December 2009. RESULTS: The sensitivity of breast MRI for detecting breast tumor was 95%. Fourteen percent of patients had a multifocal disease, 10% a multicentric disease and 2% a synchronous bilateral cancer. The correlation of radiological tumor size with histopathological size was r=0.68 in IRM compared to r=0.45 in conventional imaging (P<0.001). Nineteen additional biopsies were performed and 9.9% of false-positive findings were detected. Retrospectively, planned surgical management was altered in 9% of patients, resulted from use of breast MRI. Six patients had conversion of planned breast conservation to mastectomy and two patients underwent contralateral lumpectomy after discover synchronous bilateral cancer. DISCUSSION AND CONCLUSION: Breast MRI was very sensitive for the detection of breast carcinoma and improved local staging in almost 9% of patients. But, low specificity of this imaging requires a systematically validation of additional lesions by biopsy before surgical planning.

[Acute myelitis and Lyme disease]. / Myélite aiguë et neuroborréliose.

INTRODUCTION: Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. In the literature, simultaneous spinal MRI and cerebrospinal fluid (CSF) investigations are presented for only 8 cases. We describe here 3 cases of acute Lyme myelitis. METHOD: In a cohort of 45 patients with neuroborreliosis, diagnosed between January 1998 and January 2005, 3 had acute myelitis. Clinical, biological and radiological data were studied. CASE REPORTS: The three patients had motor, sensorial and sphincter involvement. Extra-spinal involvement, such as fever and headache for one, facial nerve palsy for the second and subarachnoid hemorrhage for the third, was also noted. Pleocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in CSF for all. Intrathecal anti-Borrelia antibody index was positive or intermediate for all three patients. Spinal cord MRI revealed a large hyperintense zone involving more than 3 vertebral segments. Myelitis was central, posterior or transverse in the axial plane. The clinical course was favorable after a three-week course of appropriate antibiotics. CONCLUSION: These 3 cases and the others from the literature show the diversity of the clinical and radiological features of acute myelitis: transverse, central or posterior myelitis. Thus, Lyme serology in CSF in indicated for patients presenting acute myelitis, particularly in endemic areas.

Host-based divergence in populations of the pea aphid: insights from nuclear markers and the prevalence of facultative symbionts.

In North America, the pea aphid Acyrthosiphon pisum encompasses ecologically and genetically distinct host races that offer an ideal biological system for studies on sympatric speciation. In addition to its obligate symbiont Buchnera, pea aphids harbour several facultative and phylogenetically distant symbionts. We explored the relationships between host races of A. pisum and their symbiotic microbiota to gain insights into the historical process of ecological specialization and symbiotic acquisition in this aphid. We used allozyme and microsatellite markers to analyse the extent of genetic differentiation between populations of A. pisum on pea, alfalfa and clover in France. In parallel, we examined: (i) the distribution of four facultative symbionts; and (ii) the genetic variation in the Buchnera genome across host-associated populations of A. pisum. Our study clearly demonstrates that populations of A. pisum on pea, clover and alfalfa in France are genetically divergent, which indicates that they constitute distinct host races. We also found a very strong association between host races of A. pisum and their symbiotic microbiota. We stress the need for phylogeographic studies to shed light on the process of host-race formation and acquisition of facultative symbionts in A. pisum. We also question the effects of these symbionts on aphid host fitness, including their role in adaptation to a host plant.

[Autoimmune peripheral neuropathies with anti-MAG antibodies and hematological disorders. Five cases]. / Neuropathies périphériques auto-immunes à anticorps anti-MAG et hémopathies. A propos de 5 observations.

OBJECTIVE: The aim of this study was to report our experience with autoimmune neuropathies associated with hematological disorders and to describe their etiological and clinical polymorphism. PATIENTS AND METHODS: A retrospective study was conducted in five patients with autoimmune peripheral neuropathies with anti-MAG (myelin-associated glycoprotein) antibodies. RESULTS: Autoimmune neuropathies were associated with Waldenström's macroglobulinemia (n=2), Hodgkin disease (n=1), chronic lymphocytic leukemia (n=1) and idiopathic polyclonal B lymphoproliferation (n=1). Most of the patients had a sensorial polyneuropathy, predominant in the legs, exhibiting slow progress. Our patients showed a disappointing response to chemotherapy with stabilization or short response.

A conserved sorting-associated protein is mutant in chorea-acanthocytosis.

Chorea-acanthocytosis (CHAC, MIM 200150) is an autosomal recessive neurodegenerative disorder characterized by the gradual onset of hyperkinetic movements and abnormal erythrocyte morphology (acanthocytosis). Neurological findings closely resemble those observed in Huntington disease. We identified a gene in the CHAC critical region and found 16 different mutations in individuals with chorea-acanthocytosis. CHAC encodes an evolutionarily conserved protein that is probably involved in protein sorting.

Hyperkinesia contralateral to acute hemiplegia: relevance of previous frontal lesions.

Two patients with a hyperkinetic syndrome contralateral to acute hemiplegia are presented. One patient showed a right-sided hemiplegia associated with abnormal movements of the left upper limb. In the other patient hemiplegia was localised on the left side while abnormal movements involved the right lower limb. Brain imaging showed acute infarctions (respectively left middle cerebral artery area and right lacunar infarctions) associated with a pre-existing contralateral infarction involving anterior non-primary motor areas. Hyperkinetic syndromes in stroke are mainly related to acute lesion of the contralateral subcortical areas. In our patients, the acute lesions were located ipsilateral to the hyperkinetic body part while the pre-existing lesions were located contralateral to the hyperkinetic side. We speculated that these pre-existing lesions might play a role in the pathophysiology of this clinical syndrome.

[Rhabdoid tumor of the central nervous system. Ultrasonographic, computed tomographic and MRI aspects apropos of a case in an infant]. / Tumeur rhabdoïde du système nerveux central. Aspect échographique, scanographique et IRM à propos d'un cas chez un nourrisson.

We report a case of rhabdoid tumor which developed in the IV ventricle in a 4-month-old boy. Cranial ultrasonography, CT-scan and MRI findings are reported and compared with data in the literature.

[Intraspinal epidermoid cyst]. / Kyste épidermoïde intrarachidien.

Epidermoid cysts are rare intradural extramedullary tumors. There are two types of lesions: congenital spinal cysts frequently associated with other bone or skin malformations (spina bifida aperta, dermal sinus ...) and iatrogenic spinal cysts resulting from lumbar puncture. In both situations, clinical and the radiologic findings are similar. We describe an epidermoid cyst in a 52-year-old female affected with a lumbar pain and recent urinary disorders. Symptoms were slow to appear and dependent on the location of the cyst. Epidermoid cyst contained keratin, cholesterol crystals and desquamed epithelial cells. On CT, epidermoid cyst was a hypodense lesion on MR. On T1 weighted images the tumor was hypointense. The signal appeared heterogeneous. There was no enhancement after Gadolinium DTPA injection. Differential diagnosis included: ependymoma, hemangioblastoma, neurinoma, meningioma and metastasis, but all these lesions are enhanced by contrast injection.

[The ophthalmologist-internal medicine duo: apropos of a case of chronic uveitis]. / Le duo ophtalmologiste-médecin interniste: à propos d'un cas d'uvéite chronique.

The ophthalmologist is often faced with recurrent or apparently primitive uveitis. The specialist in internal medicine almost never meets first with this type of disease. Taking advantage of a seldom seen sarcoidosis case (almost exclusively ocular), the authors point out the interest of a systematic collaboration when confronted with an endocular disease so called "inflammatory", or vascular and in appearance isolated.