[Contribution of the pathology examination in the operating theatre in patients with skin cancer: retrospective analysis of 388 patients]. / Intérêt de l'examen histologique extemporané dans les carcinomes cutanés: étude rétrospective de 388 patients.

INTRODUCTION: Pathological examination in the operating theatre in patients undergoing resection of a skin cancer is one of the most adapted therapeutic approaches. We present our experience with 388 patients, comparing the rate of recurrence with or without operating-theatre pathological examination. MATERIAL AND METHOD: The study population included 388 patients, mean age 69.5 years (28-98 years) who underwent resection of 544 skin tumors (520 primary and 36 recurrent), 76.6% unique tumors. The pathological examination of the surgical specimen was performed immediately after removal. This method was systematic procedure for spinocellular carcinomas, was not performed for basocellular carcinomas measuring less than 1 cm when well circumscribed and not peri-orifice, and when reconstruction was not planned. RESULTS: The pathological examination was not performed in the operative theatre for 76 tumors; for 470 examinations performed in the operative theatre, at least one surgical margin was positive in 93 (19.8%). Anatomic regions concerned most were the tip of the nose and the eyelids. Recurrent tumors (5.0% of resections) accounted for 27% of the positive pathological results. Thirty-one patients had to have revision surgery, four after a false negative on the pathological examination performed in the operative theatre, four patients for a healing problem and 23 because of tumor recurrence (4%). DISCUSSION: Pathological examination in the operative theatre can help decrease the rate of recurrence in comparison with classical surgery using empiric margins. This method is reliable if performed by an experienced pathologist so that reconstruction can be undertaken before the definitive pathological results are obtained, improving patient comfort. These therapeutic options have a cost however in terms of equipment and personnel. Indications should be well chosen and balanced against the advantages of a two-phase classical procedure.

[Goal cell carcinoma: really a low malignancy tumor?]. / Les carcinomes cutanés basocellulaires méritent-ils leur réputation de tumeurs à faible malignité?

Although basal cell carcinoma often presents as a fairly "benign" lesion early in its course, it remains the most frequent malignancy worldwide. Prevention, while possible, is not always optimal. We show that advanced basal cell carcinoma can be mutilating or even life threatening depending on location, type of lesion, or pre-existing co-morbidity. The consequences of this disease can be lessened if initial treatment does not underestimate its potential severity.

Cyclic ketone inhibitors of the cysteine protease cathepsin K.

Cathepsin K (EC 3.4.22.38), a cysteine protease of the papain superfamily, is predominantly expressed in osteoclasts and has been postulated as a target for the treatment of osteoporosis. Crystallographic and structure--activity studies on a series of acyclic ketone-based inhibitors of cathepsin K have led to the design and identification of two series of cyclic ketone inhibitors. The mode of binding for four of these cyclic and acyclic inhibitors to cathepsin K is discussed and compared. All of the structures are consistent with addition of the active site thiol to the ketone of the inhibitors with the formation of a hemithioketal. Cocrystallization of the C-3 diastereomeric 3-amidotetrahydrofuran-4-one analogue 16 with cathepsin K showed the inhibitor to occupy the unprimed side of the active site with the 3S diastereomer preferred. This C-3 stereochemical preference is in contrast to the X-ray cocrystal structures of the 3-amidopyrrolidin-4-one inhibitors 29 and 33 which show these inhibitors to prefer binding of the 3R diastereomer. The 3-amidopyrrolidin-4-one inhibitors were bound in the active site of the enzyme in two alternate directions. Epimerization issues associated with the labile alpha-amino ketone diastereomeric center contained within these inhibitor classes has proven to limit their utility despite promising pharmacokinetics displayed in both series of compounds.

Solid-phase synthesis of cyclic alkoxyketones, inhibitors of the cysteine protease cathepsin K.

Using solid-phase synthesis, a library of novel cyclic alkoxyketones has been constructed which show strong inhibitory activity against the cysteine protease, cathepsin K (EC 3.4.22.38).

Low-vision aid using a high-minus intraocular lens.

The theoretical performance and some results from the clinical investigation of a new low-vision aid system are analyzed. This device is composed of a spectacle lens and an intraocular lens. The aberrations of this system have been computed and then reduced by optimal aspherization of the optical surfaces. A specialized sophisticated system for controlling the aspheric surfaces is described briefly. Finally the results of the clinical investigation are presented.

[Prevention of postoperative thrombo-embolic accidents following thoracic surgery by low-dose calcium heparinate: a comparative study (author's transl)]. / Essai de prévention des accidents thromobo-emboliques post-opératoires par les faibles doses d'héparinate de calcium en chirurgie thoracique.

A comparative clinical trial was undertaken in 2420 patients undergoing thoracic surgery during a 4-year period (1973-1977); 40% of the patients had bronchial cancer. Random allocation was not considered as being possible by the surgeons and was replaced by allocation according to the time of operation. There were three protocol groups: Protocol A: First morning operations (1007 patients): subcutaneous calcium heparin, 5000 units (Ul) 2 hours and 30 minutes before surgery then every 12 hours for 15 days. Protocol B: Second morning operations (932 patients): same dose and duration of treatment; the first injection took place 24 to 72 hours after the surgical procedure. The doses were increased from the fourth day after surgery in order to obtain a moderately prolonged partial thromboplastin time (difference patient-control: 7 to 14 seconds). Protocol 0: 481 patients received no anticoagulant treatment because of a contraindication or minor surgical procedure. Preliminary results showed and increase of per-operative bleeding (p less than 0.01) in treated patients; this was very well accepted by the surgeons. Among the heparin-treated patients, 11 pulmonary emboli out of 13 were observed in patients with bronchial cancer. Of these 13, 10 were fatal with 9 being verified at autopsy. The pulmonary emboli episodes occurred significantly earlier in protocol B than in protocol A. Fatal pulmonary embolism in patients with bronchial cancer was significantly more frequent in protocol B (7 cases) than in protocol A (1 case); P less than 0.01. These results have shown a low frequency of fatal pulmonary emboli in patients without bronchial cancer receiving twice-daily subcutaneous injections of heparin (2 of 1102 operated subjects). The rate was higher in patients with bronchial cancer and this results supports a recommended thrice-daily dose in such patients. In addition, the pre-operative administration of heparin is useful in preventing early post-operative pulmonary embolism.