Cardiophrenic angle lymph node is an indicator of metastatic spread but not specifically peritoneal carcinomatosis in colorectal cancer patients: Results of a prospective validation study in 91 patients.

BACKGROUND: The presence of cardiophrenic angle lymph node (CPALN) has been associated with the risk of peritoneal carcinomatosis (PC) in high risk colon cancer patients. Its accuracy to predict PC and its prognostic value in non-selected CRC patients has not been validated prospectively. METHODS: From 2011 to 2013, all patients undergoing colectomy for colon cancer were included prospectively. Presence of CPALN was assessed on preoperative computed tomography scan by two radiologists. Surgical exploration was used as reference for the diagnosis of PC. Factors associated with presence of CPALN and progression-free survival were analyzed. RESULTS: Ninety one patients fulfilled inclusion criteria. CPALN was detected in 36 patients (39.5%) on CT scan. At surgical exploration, PC was found in 6 patients (6.5%). Sensitivity, specificity, negative predictive value, positive predictive value and overall accuracy of CPALN on CT scan for predicting PC were 67%, 62%, 96%, 11% and 63% respectively. In multivariate analysis, the presence of distant metastases whatever the site was associated with the presence of CPALN (p = 0.03; hazard ratio HR = 3.8; confidence interval CI 95% = 1.1-13.3). In the multivariate analysis, only vascular involvement (p = 0.034, HR = 3.574, CI 95% = 1.10-11.60) was associated with progression-free survival whereas CPALN was not found to predict outcome (p = 0.893). CONCLUSION: CPALN is a common finding in non-selected colon cancer patients. Although in the absence of CPALN, PC can almost be excluded, its value for the diagnosis of PC is limited. Our findings support that CPALN is mainly an indicator of metastatic spread of the tumor.

[One day diagnosis for breast lesions: Medical and psychological assessment--EVADIASEIN study]. / Diagnostic en un jour des lésions du sein: évaluation médicale et psychologique de la prise en charge--étude EVADIASEIN.

INTRODUCTION: Breast cancer is the most frequent feminine cancer in France and its incidence increases steadily. The time of access to medical care is an indicator of the quality of the treatments recommended by the Plan Cancer 2009-2013, as it influences the diagnosis and reduces psychological morbidity during the pre-diagnosis phase. The one-day diagnosis is a recently initiated concept, which offers to get the results of the biopsy on the day it is performed and facilitates the setting-up of therapeutic care with the surgeon met during the one-day medical consultations. The aim of this study is to evaluate the satisfaction of patients who benefited from a one-day breast lesion diagnosis, as well as confirm the decrease of time of access to medical treatment. METHODS: This is an observational, non-interventional and single-centre study based on 27 patients who benefited from one-day breast lesions diagnosis over two years. The patients were only included who had a classified lesion ACR 4 or 5 and visible in the ultrasound. We analyzed the histological concordance between the biopsy and the definitive histology, the time of access to medical care, and the therapeutic treatments We analyzed the psychological impact of such an organization by sending to the patients a questionnaire including the Psychological Consequence Questionnaire (PCQ) and the Breast Cancer Anxiety Indicator (BCA) allowing to estimate the anxiety generated by the pre-diagnostic phase, the DC-Sat allowing to estimate the satisfaction of the consultation of announcement, as well as the same day diagnosis benefit. RESULTS: The patients were 59.8 years old in average [33-87]. The average time between the date of the mammography and the one-day diagnosis consultation (including the biopsy) was 15.0 days [0-60]. Fifty-seven percent of the patients considered this time as short. The average time between the biopsy date and the start of the treatment was 15.9 days [4-30]. The one-day diagnosis took an average of 1.6 days [1-5]. The results of the PCQ showed an important emotional impact during the diagnosis phase, and the average BCA score reached an average of 3.9 on a scale of 5. However, the patients were very satisfied with the diagnosis consultation with an average of 8.7 on a scale of 10, and 95% think the one-day diagnosis is beneficial to the patients. DISCUSSION: This study shows that the one-day breast-damage diagnosis enables to improve the time of access to care, and meets the current recommendations. Even though faster access to treatment does not reduce the psychological morbidity of awaiting diagnosis, the patients express their satisfaction and find the rapidity of the pre-diagnosis phase beneficial. CONCLUSION: In view of this study, the one-day breast-damage diagnosis appears to be a quality feature in the process of access to care and treatment of the patients.

Pathways commonly dysregulated in mouse and human obese adipose tissue: FAT/CD36 modulates differentiation and lipogenesis.

Obesity is linked to adipose tissue hypertrophy (increased adipocyte cell size) and hyperplasia (increased cell number). Comparative analyses of gene datasets allowed us to identify 1426 genes which may represent common adipose phenotype in humans and mice. Among them we identified several adipocyte-specific genes dysregulated in obese adipose tissue, involved in either fatty acid storage (acyl CoA synthase ACSL1, hormone-sensitive lipase LIPE, aquaporin 7 AQP7, perilipin PLIN) or cell adhesion (fibronectin FN1, collagens COL1A1, COL1A3, metalloprotein MMP9, or both (scavenger receptor FAT/CD36). Using real-time analysis of cell surface occupancy on xCELLigence system we developed a new method to study lipid uptake and differentiation of mouse 3T3L1 fibroblasts and human adipose stem cells. Both processes are regulated by insulin and fatty acids such as oleic acid. We showed that fatty acid addition to culture media increased the differentiation rate and was required for full differentiation into unilocular adipocytes. Significant activation of lipogenesis, i.e. lipid accumulation, by either insulin or oleic acid was monitored in times ranging from 1 to 24 h, depending on differentiation state, whereas significant effects on adipogenesis, i.e., surperimposed lipid accumulation and gene transcriptional regulations were measured after 3 to 4 d. Combination of selected times for analysis of lipid contents, cell counts, size fractionations, and gene transcriptional regulations showed that FAT/CD36 specific inhibitor AP5258 significantly increased cell survival of oleic acid-treated mouse and human adipocytes, and partially restored the transcriptional response to oleic acid in the presence of insulin through JNK pathway. Taken together, these data open new perspectives to study the molecular mechanisms commonly dysregulated in mouse and human obesity at the level of lipogenesis linked to hypertrophy and adipogenesis linked to hyperplasia.

[Diagnostic value of multidisciplinary meetings on orbital inflammatory pathologies discussed in Nantes University Medical Center]. / Intérêt diagnostique d'une réunion de concertation multidisciplinaire des pathologies orbitaires inflammatoires au CHU de Nantes.

INTRODUCTION: Observational study of the diagnoses and the treatment modalities used for orbital inflammatory pathologies discussed in multidisciplinary meetings (MDM) in Nantes University Medical Center over 4 years. MATERIAL AND METHOD: A multidisciplinary meeting to discuss eyelid and orbital pathologies (excluding cancer) has been held in Nantes three times per year since October 2008. This retrospective study focuses on the cases of orbital inflammatory pathologies discussed at this meeting from October 2008 to October 2012 (49 cases included). RESULTS: Twenty-eight (57%) patients were diagnosed with orbital inflammation, 16 (33%) cases with isolated myositis and 5 (10%) with dacryoadenitis. In the diagnostic work-up, orbital biopsy was performed in 64% of orbital inflammation cases, 38% of myositis cases and 80% of dacryoadenitis cases. These specimens led to the diagnosis of 9 lymphomas, 2 histiocytoses and 1 metastasis. The internal medicine work-up allowed for the diagnosis of 3 granulomatoses with polyangiitis, one patient with sarcoidosis, and one patient with tuberculosis. Despite work-up, there remained 14 (29%) idiopathic orbital inflammatory syndromes (IOIS). DISCUSSION: The MDM of orbital pathology allows for the collective approach to the most difficult cases of management and is not concerned with stable orbitopathies or those presenting no diagnostic dilemma. Despite a multidisciplinary, rational etiologic work-up (frequently involving a biopsy), we find a higher rate of IOIS than reported in the literature. CONCLUSION: A multidisciplinary approach appears to be useful in improving management of orbital disease.

Familial deafness, congenital heart defects, and posterior embryotoxon caused by cysteine substitution in the first epidermal-growth-factor-like domain of jagged 1.

In the present study, we report a kindred with hearing loss, congenital heart defects, and posterior embryotoxon, segregating as autosomal dominant traits. Six of seven available affected patients manifested mild-to-severe combined hearing loss, predominantly affecting middle frequencies. Two patients were diagnosed with vestibular pathology. All patients had congenital heart defects, including tetralogy of Fallot, ventricular septal defect, or isolated peripheral pulmonic stenosis. No individual in this family met diagnostic criteria for any previously described clinical syndrome. A candidate-gene approach was undertaken and culminated in the identification of a novel Jagged 1 (JAG1) missense mutation (C234Y) in the first cysteine of the first epidermal-growth-factor-like repeat domain of the protein. JAG1 is a cell-surface ligand in the Notch signaling pathway. Mutations in JAG1 have been identified in patients with Alagille syndrome. Our findings revealed a unique phenotype with highly penetrant deafness, posterior embryotoxon, and congenital heart defects but with variable expressivity in a large kindred, which demonstrates that mutation in JAG1 can cause hearing loss.

[Gross tumor volume and clinical target volume in radiotherapy. Tumors of the buccal cavity]. / Volume tumoral macroscopique et volume-cible anatomoclinique en radiothérapie. Tumeur de la cavité buccale.

Radiation therapy, either alone or combined with surgery is a cornerstone in the treatment of oral cavity tumors. Target volumes to be treated with external beam radiation must take under consideration the initial tumor location, providing information on satellites lymph nodes to be irradiated as well. Modern imaging, with emphasis on CT scan with injection, is now mandatory for a better analysis of initial lesions including both tumor location and invaded lymph nodes. Tumor volumes based on clinical examination and CT scan analysis might be divided in two groups. First, volumes susceptible to receive a prophylactic irradiation for an hypothetical microscopic spread (CTV) to be treated with a prophylactic dose; second, volumes including lesions visible clinically or on CT scan that should receive a higher radiation dose (GTV). Clinical tolerance will largely be depending upon radiation-induced mucositis, impairing food intake. Radiation techniques aiming at normal tissues preservation should be used, including devices allowing keeping an open mouth during radiation delivery.

[5 conventional radiographic projections are necessary and sufficient for the study of the zygoma. Technics and results]. / Les cinq incidences radiographiques conventionnelles nécessaires et suffisantes pour l'exploration de l'os zygomatique. Technique et résultats.

Though clinic examination gives us much information, radiology still is essential in head trauma. Many standard radiographic projections have been described in the past and yet since the eighties it appears that C.T. scanner (C.T.) has become absolutely necessary to a great number of us. In fact, C.T. is indispensable when there is a matter of vital urgency or when a functional problem appears (diplopia). But most of the time high quality standard radiographic projections are sufficient. We have selected five radiographic projections: the occipito-mental's such as Mahoney's or Blondeau or Louisette, the submento-vertical's, the rotated occipito-mental's. For each of these radiographic projections we have specified the angular definition, the realization techniques, the criterions of quality and the results. The use of conventional radiology gives us images of which the quality is high enough to allow a precise topographical diagnosis and is far cheaper than C.T. So we can assert that standard radiographic projections are necessary and sufficient and that the use of C.T. becomes indispensable only in the few cases of diplopia or enophthalmia or complicated maxillary fracture. In the case of a lateral head trauma, our strategy of radiographic exploration will be represented as indicated on picture n degrees 20.

Hypothermia induced by infusion of methionine sulfoximine into the dorsal raphe nucleus of the rat: involvement of 5-HT1A and GABAB receptors.

L-Methionine-D,L-sulfoximine (MSO) (25 micrograms) infused locally into the dorsal raphe nucleus (DRN) induced a progressive decrease in body temperature in conscious restrained rats kept at an ambient temperature of 23 degrees C. Pretreatment with (+/-)-pindolol (3 mg/kg s.c.) significantly attenuated MSO-induced hypothermia, but pretreatment with ketanserin (0.5 mg/kg i.p.) did not alter either the magnitude or the time course of the decrease in body temperature after intra-DRN infusion of MSO. Local accumulation of gamma-aminobutyric acid (GABA) after infusion of gamma-vinylGABA (10 micrograms) and (+/-)-nipecotic acid (6 micrograms) inhibited MSO-induced hypothermia. Blockade of GABAA receptors by infusion of (-)-bicuculline (25 ng) had no effect on the decrease in body temperature elicited by MSO, but blockade of GABAB receptors by infusion of 2-OH-saclofen (13.3 ng) significantly attenuated MSO-induced hypothermia. In conclusion, local infusion of MSO into the DRN must have slowed down the rate of 5-HT turnover in serotonergic neurons and decreased the release and synthesis of GABA. 5-HT1A somato-dendritic autoreceptors and GABAB postsynaptic receptors both appear to be involved in these neurocytochemical processes leading to hypothermia.

Possible link between brain serotonin metabolism and methionine sulfoximine-induced hypothermia and associated behavior in the rat.

L-Methionine-D,L-sulfoximine (MSO) intraperitoneally or intracerebroventricularly (third ventricle) injected at convulsant doses induced a hypothermia, primarily associated with a syndrome of ataxia, in the restrained rat maintained at an ambient temperature of 23 degrees C. Depletion of brain serotonin (5-HT) by pretreatment with p-chlorophenylalanine (PCPA), p-chloroamphetamine (PCA), and d-fenfluramine (FFA) did not significantly modify the time course and magnitude of MSO-induced developing hypothermia but it enhanced abnormal motor behavior. Enhancement of 5-HT synthesis in MSO-submitted rats pretreated with 5-hydroxytryptophan (5-HTP) (200 mg/kg, IP) alone or 5-HTP (100 mg/kg, IP) preassociated with carbidopa (10 mg/kg, IP) suppressed significantly hypothermia, but it did not greatly modify motor disturbances. In conclusion, the neurocytochemical processes initiating hypothermia following administration of MSO to the rat appear to be linked to a slowdown of the rate of brain 5-HT turnover, maybe at the level of the midbrain raphe nuclei.

Involvement of serotonin receptors in methionine sulfoximine-induced hypothermia in the rat.

L-Methionine-D,L-sulfoximine (MSO), intraperitoneally (i.p.) or intracerebroventricularly (i.c.v.) (third ventricle) injected at a convulsant dose, induced a centrally mediated body hypothermia in the restrained rat maintained at an ambient temperature of 23 degrees C. Pretreatment with (+/-)-pindolol (1.5-3 mg/kg s.c.) significantly attenuated MSO-induced hypothermia, but at a dose of 6 mg/kg s.c. hypothermia developed without any modification of its characteristics. Pretreatment with (-)-propranolol (16-25 mg/kg i.p.) potentiated MSO-induced hypothermia, but pretreatment of MSO-treated rats with ketanserin (0.7-4 mg/kg i.p.) did not significantly modify hypothermia. Selective antagonists for beta-adrenoceptors were used and their effects on MSO-induced hypothermia were compared with those of pindolol and propranolol. Pretreatment with betaxolol (1.5-4 mg/kg s.c.) did not modify the hypothermia following administration of MSO, but potentiation of hypothermia was recorded in rats pretreated with ICI 118,551 (2.26 mg/kg i.p.) then i.p. injected with MSO. These findings favour a control exerted by 5-HT1 receptors in the central development of MSO-induced hypothermia in the restrained rat.

[Malformation of the facial canal, meningitis and cerebrospinal otorrhea]. / Malformations du canal facial, méningite et otorrhée cérébro-spinale.

CSF fistulas into the middle ear due to labyrinthine or tegmental anomalies are well known. They predispose to recurrent meningitis if they do not receive appropriate surgical treatment. CSF fistulas due to facial canal anomalies are extremely rare and predispose to the same risk of meningitis. The case reported enables a comparison to be made with the three other cases of the same form of anomaly found in the literature, and the diagnostic and therapeutic difficulties are also discussed.

Study of the hypothermia induced by methionine sulfoximine in the rat.

L-Methionine sulfoximine (MSO) intraperitoneally injected at subconvulsive and convulsive doses induced a rectal hypothermia in the restrained rat maintained at an ambient temperature of 23 degrees C; this hypothermia developed during the preconvulsive period, and it was not suppressed by simultaneous injection of L-methionine which antagonized the behavioral effects of ammonia elevated contents in the central nervous system. The development of rectal hypothermia was faster when the injection of MSO was made into the lateral cerebral ventricle and particularly into the third ventricle. MSO-induced hypothermia seemed to be a poikilothermia-like state in the cold environment with retention of a normal regulation in the heat environment. Infusion of MSO into the anterior hypothalamic/preoptic (AH/PO) area induced a rapid rectal hyperthermia, but infused into the mammillary region MSO had no effect on rectal temperature. It is suggested that rectal hypothermia induced by MSO may be directly related to a depressive effect on glucose oxidative metabolism in cell structures, maybe astroglial cells, located in the vicinity of the ventricle or the capillary walls.

[Aneurysmal cyst of the petrous bone. Apropos of a case]. / Le kyste anévrismal du rocher. A propos d'une observation.

Aneurysmal bone cyst (ABC) is a rare form of osseous dystrophy. A lesion of the petrous temporal bone appears to be extremely rare. It must be differentiated from a hemangioma which is a hamartoma affecting the geniculate ganglion or the internal auditory meatus. The case described involved a 23-year-old woman. The ABC presented with violent otalgia and severe endolabyrinthic-type perception deafness. It was associated with extensive bony destruction of the petrous temporal and occipital bones. Curettage only led to considerable through temporary regression of deafness and bone reconstruction within a few months. Thrombosis of the internal jugular, confirmed at operation, is an interesting contribution in terms of the pathogenesis of ABC, apparently linked to disturbances of venous pressure. Surveillance is required since this benign condition may be recur.

[Post-traumatic cerebrospinal fluid rhinorrhea and otorrhea disclosing Mondini's syndrome]. / Rhinorrhée et otorrhée cérébro-spinales post-traumatiques, révélatrices d'un syndrome de Mondini.

A mild head injury could have played a role in the development of post-myringotomy cerebrospinal fluid rhinorrhea and otorrhea in an 18-month-old child with Mondini's syndrome. This notion of trauma may prevent exploration of the site of the fistula when these labyrinthic dysplasias are poorly understood. Once suspected, full radiological examination should precede closure of the gap using an otological approach.

[Bilateral recurrent paralysis and his treatment (author's transl)]. / La paralysie récurrentielle bilatérale, son traitement.

The authors give here their conception of physiology of nerves of larynx. They think that among the bilaterals paralysies of vocal cords, the paralysie of dilators is the most frequent one. They offer a technical surgery which consist of linking the muscle thyro-hyoïdien to the vocal cord on both sides. Two cases operated have given a normal functioning of vocal cords and, in consequence, a very good phonetic and a satisfactory breathing.

[Value of the transpalatine approach for surgical access to nasopharyngeal fibromas (author's transl)]. / Intérêt de la voie transpalatine pour l'abord chirugical des fibromes naso-pharyngiens.

Present special investigations offer the possibility of very good assessment of the extension and vascularisation of nasopharyngeal fibromas. It is no longer logical to seek to treat all tumours via wide surgical approaches since tumour size and spread vary from one case to another. Amongst the various surgical approaches available, the transpalatine technique is extremely valuable in the excision of small limited tumours limited to the cavum or to remove the sphenoidal prolongation of a large tumour. In such a case, a combined transpalatine and transantral approach facilitates the operation and ensures perfect control of the whole excision process, which considerably reduces the risk of recurrence.