Sleep oscillations related to memory consolidation during aromatases inhibitors for breast cancer.

Aromatase inhibitors (AIs) are associated with sleep difficulties in breast cancer (BC) patients. Sleep is known to favor memory consolidation through the occurrence of specific oscillations, i.e., slow waves (SW) and sleep spindles, allowing a dialogue between prefrontal cortex and the hippocampus. Interestingly, neuroimaging studies in BC patients have consistently shown structural and functional modifications in these two brain regions. With the aim to evaluate sleep oscillations related to memory consolidation during AIs, we collected polysomnography data in BC patients treated (AI+, n = 17) or not (AI-, n = 17) with AIs compared to healthy controls (HC, n = 21). None of the patients had received chemotherapy and radiotherapy was finished since at least 6 months, that limit the confounding effects of other treatments than AIs. Fast and slow spindles were detected during sleep stage 2 at centro-parietal and frontal electrodes respectively. SW were detected at frontal electrodes during stage 3. Here, we show lower frontal SW densities in AI + patients compared to HC. These results concord with previous reports about frontal cortical alterations in cancer following AIs administration. Moreover, AI + patients tended to have lower spindle density at C4 electrode. Regression analyses showed that, in both patient groups, spindle density at C4 electrode explained a large variance of memory performances. Slow spindle characteristics did not differ between groups and sleep oscillations characteristics of AI- patients did not differ significantly from those of both AI + patients and HC. Overall, our results add to the compelling evidence of the systemic effects of AIs previously reported in animals, with deleterious effects on cortical activity during sleep and associated memory consolidation in the current study. There is thus a need to further investigate sleep modifications during AIs administration. Longitudinal studies are needed to confirm these findings and investigation in other cancers on this topic should be conducted.

[Upper digestive duplications in adults]. / Duplications digestives hautes de l'adulte.

Congenital gastrointestinal duplications are uncommonly diagnosed in adult patients, and generally present as a cystic or occasionally tubular malformation. The duplication is composed of a smooth muscle wall continuous with the muscle layer of the intestinal wall and an inner mucosal lining. From December 1988 to May 1994, five patients were operated for gastrointestinal tract duplications [esophageal (1), gastric (2), duodenal (2)]. Duplications were symptomatic in three patients, and discovered incidentally in the other two. The diagnosis was established by ultrasonography (3 patients) and computed tomography (one patient). One female presented an adenocarcinoma arising in an esophageal duplication and died one year after surgical resection. Because of potential malignant transformation, these malformations must be resected. Preoperative diagnosis is important for conservative resection, except in the presence of malignancy when resection must be curative.

Clinical and hormonal effects of a long-acting somatostatin analogue in pancreatic endocrine tumors and in carcinoid syndrome.

Nine patients with pancreatic apudomas (seven gastrinomas, one glucagonoma, one tumor secreting a substance P-like component) and nine with metastasized carcinoid tumors were treated with a somatostatin analogue (SMS 201-995), administered subcutaneously twice daily for 3 days. Treatment was pursued for 2 to 12 months in nine patients in whom SMS was clinically and/or biologically beneficial. In gastrinomas, SMS decreased plasma gastrin in all but one patient, inhibited the residual gastric acid secretion under H2-blockers and improved diarrhea; in the glucagonoma patient, glucagonemia decreased and skin lesions disappeared. In carcinoid syndrome, clinical efficacy was partial and inconstant; daily 5-hydroxyindole acetic acid (5-HIAA) output was slightly decreased. Plasma substance P levels decreased in six patients with initially high concentrations. No antitumoral activity or side effects have been so far evidenced. SMS 201-995 is a useful, well-tolerated agent in secreting pancreatic apudomas and to a lesser extent in carcinoid syndrome, where high-dosage regimens may be required.

Cystic malformations of the cystic duct.

While cystic malformations of the main biliary tract are wellknown and classified, it is exceptional to find cystic malformations of the accessory biliary tract (cystic duct). An adolescent aged 15 years and an adult of 49 years were operated for cysts of the cystic duct revealed by associated lesions, a cyst of the common bile-duct and gallbladder stones respectively. Ultrasonography showed cystic lesions which opacification during intravenous cholangiography and endoscopic retrograde cholangiography (EPRC) proved to be related to the cystic duct. The radiography outline of the biliary pathways so obtained served as a guide to the operative procedure, consisting of excision of the accessory biliary tract in both cases combined with resection of the common bile-duct cyst in one case. The radiologic, anatomic and histologic findings distinguished the lesions encountered from other malformations of the accessory biliary tract and confirmed their derivation from the cystic duct.