Lessons learned about appendiceal neuroendocrine neoplasms from data analysis of the Belgian Cancer Registry 2010-2015.

BACKGROUND AND STUDY AIMS: Appendiceal neuroendocrine neo-plasms (aNENs) are a diverse group of malignant neoplasms of varying biological behavior for which information about manage-ment and outcome is sparse, with the majority of available studies being retrospective, including only a limited number of patients, and therefore not necessarily reflecting the reality in the community. In the present study clinical, epidemiological and pathological data of appendiceal neuroendocrine neoplasms in Belgium is provided and compared with current literature. METHODS: A population-based study was conducted by linking data of the Belgian Cancer Registry with medical procedures in the Belgian Health Insurance database for patients diagnosed with aNEN between 2010 and 2015. RESULTS: We found an aNEN incidence of 0.97/100.000 person years in Belgium. Neuroendocrine carcinoma of the appendix are rare. Most appendiceal neuroendocrine tumors (aNETs) are small G1 tumors. Positive lymph nodes are often found in tumors larger than 2cm, especially aNET G2. CONCLUSION: A rapid uptake of changing classifications was seen in the community. However, systematic reporting of risk factors for small aNEN can still be improved and should be stimulated. In 9% of cases, reclassifications had to be made, pointing out that in a retrospective analysis, original pathological reports should be checked for specific parameters, before reliable conclusions can be drawn.

Current practice in approaching controversial diagnostic and therapeutic topics in gastroenteropancreatic neuroendocrine neoplasm management. Belgian multidisciplinary expert discussion based on a modified Delphi method.

BACKGROUND AND STUDY AIMS: Neuroendocrine neoplasms (NENs) are relatively rare, with marked clinical and biological heterogeneity. Consequently, many controversial areas remain in diagnosis and optimal treatment stratification for NEN patients. We wanted to describe current clinical practice regarding controversial NEN topics and stimulate critical thinking and mutual learning among a Belgian multidisciplinary expert panel. PATIENTS AND METHODS: A 3-round, Delphi method based project, coordinated by a steering committee (SC), was applied to a predefined multidisciplinary NEN expert panel studying the following controversial topics : factors guiding therapeutic decision making, the use of somatostatin analogues (SSA) in adjuvant setting, the interference between non-radioactive and radioactive SSAs, challenging small intestine neuroendocrine tumor (NET) cases, the approach of the carcinoid syndrome, the role of chemotherapy in well differentiated NET, the relevance of NET G3 and neuroendocrine carcinoma subclassification and the role of imaging techniques in NEN management. RESULTS: A high level of consensus exists regarding the necessary diagnostic work-up, use of imaging techniques and interference between non-radioactive and radioactive SSAs. However, the prognostic impact of tumor functionality might be overrated and adequate diarrhea differential diagnostic work-up in these patients is underused. Significant differences are seen between individual experts and centers regarding treatment preferences both on the treatment modality level, as well as the choice of specific drugs (e.g. chemotherapy regimen). CONCLUSIONS: A Delphi-like multi-round expert discussion proves useful to boost critical thinking and discussion among experts of different background, as well as to describe current clinical practice and stimulate mutual learning in the absence of high-level scientific guidance.

[Custom made chest-wall implant and Poland's syndrome: Between art and science]. / Prothèse sur mesure et syndrome de Poland : entre art et science.

Poland's syndrome is a well-described congenital thoracic deformity with mostly only an aesthetic damage. We report the case of a chest-wall correction of a young male patient by a custom made silicone implant, detailing the original process of manufacturing, and justifying the choice not to use a conventional technique of reconstruction. This alternative enhances the surgeon's therapeutic arsenal, so that he can provide a customized answer, adapted to the requirements and the morphological characteristics of each patient.

The antiproliferative effect of somatostatin analogs: clinical relevance in patients with neuroendocrine gastro-entero-pancreatic tumours.

Somatostatin analogs (SSAs) have an important role in the management of patients with neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP NETs). These compounds can control the symptoms induced by the production of hormones and peptides. The antiproliferative effects of SSAs and especially tumour shrinkage are less obvious in patients with GEP NETs than in those with acromegaly. However, based upon phase II experience there is a strong suggestion of a disease stabilizing effect of SSAs in selected patients. Those patients with a progressive, non-functional GEP NET, positive octreotide scintigraphy, a low proliferation index and in the absence of surgical options may benefit from a first-line medical therapy with SSAs. The exploration of the mechanisms of this effect are unclear and hampered by the lack of suitable preclinical models. The better understanding of the tumour biology of GEP NETs, together with the development of new SSAs with better affinity on all somatostatin receptors, represent an unmet medical need.

[French plastic surgeons: update in 2007]. / Chirurgiens plasticiens français: état des lieux en 2007.

French medical demography is a true public health issue. The medicine doctor's scarcity announced by many will not appear for the plastic surgeons. In this speciality, problems are an excess staff and irregular sharing out. The aim of the study was to make a very sharp update of the speciality thanks to an actual demographic descriptive and analytic study compared with the one realised in 1998 including a French plastic surgeon's activity study. In 2007, there were 889 plastic surgeons in France, so 235 surgeons more than in 1998 and an average of 26 new plastic surgeons a year. The plastic surgeon's density was 1 for 71,174 people, much more important than the recommended value. The distribution of these surgeons is still unequal and the excess staff is getting worse. The plastic surgeon's activity study based on the Information System Medicalisation Program (ISMP) between 2004 and 2006, including 13 classic plastic surgery's procedures, showed an important decrease of the activity especially for the private sector. The analytic study put together the data concerning the demography and the activity considering the economic side of esthetic surgery. Thanks to these data, plastic surgeons will now be able to choose their working area not only based on geographic reasons but also depending on the activity they want and on the importance of the competition. This work stands for a help for plastic surgeons, in the hope of a fair sharing out of these practioners.

[Role of the association artificial dermis and negative pressure therapy: about two cases]. / Intérêt de l'association derme artificiel et thérapie par pression négative : à propos de deux cas.

In our modern health system, the improvement of the medical care cannot come along with an increase of expenses. In this purpose, we tried to bring to light the medical and economic, direct and indirect, benefits which exist with the association of an artificial dermis, Integra, and negative pressure therapy as the vacuum assisted closure (VAC) for wound which would have been treated by Integra alone. While preserving the aesthetic and functional qualities obtained by the artificial dermis alone followed by a skin graft after 21 days of treatment, the association of the negative pressure allows to perform the skin graft after only 10 days of treatment. This gain of time is a financial economy for the medical centers which have to shorten the durations of stay to be profitable. The patient benefits of a shorter hospitalization and will manage to return to work earlier. The quality of the treatment is not only improved by the absentia of immobilization of the patient but also by the decrease of the complications and the infectious risks due to the use of artificial dermis. The results so obtained highlight that in spite of the initial expense caused by this association the advantages are such that the use of the artificial dermis alone will not have interest any more.

[Primary cutaneous mucormycosis: a case report]. / Mucormycose cutanée primaire: à propos d'un cas.

The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunistic fungal infection due to fungi of the group of mucorales present in the environment. There are various clinical forms of the disease; it occurs generally in a predisposed environment. The diagnosis is based on the mycologic and pathologic examination. The therapeutic approach must be multidisciplinary; the vital and functional prognosis depends on early diagnosis and treatment.

["Facial graft": about the first facial allotransplantation of composite tissues]. / Greffe de visage: regards portés sur la première allotransplantation composite partielle de la face.

The first facial allograft was realised in Amiens 2005 November 27th. Breaking the technical limits of the so called possible and in appearance transgressing some cultural forbidden in organ transplantation, this resolutely innovative intervention open more than new perspective in the surgery of the reconstruction after disfigurement, but also a wide field of scientific investigations about dynamic and meaning of the facial function. Obviously, it also deals with numerous ethical and medical problems. The authors here shortly described the technical points of the surgery firstly done to restore oral function and facial expressively, the principles of the immunosuppressive treatment built to control any rejection time episode and the anatomical, neurological and functional results obtained after more than 18 months follow-up. Those perfectly demonstrate the perfect morphological, dynamic and cortical integration of the graft in the recomposed face. They also allow to confirm the legitimacy of the surgical indication and to oppose the factual objective arguments to the ethical reticences dealing with the facial and psychological identity of the receptor.

Characterising error-awareness of attentional lapses and inhibitory control failures in patients with traumatic brain injury.

Awareness deficits are a significant problem following traumatic brain injury (TBI). This study examined error processing as candidate marker of awareness and compared the performance of 18 TBI participants and 18 controls using an online error-monitoring task while participants performed simple go/no-go tasks. Error-monitoring performance was compared where the no-go target was part of (a) a predictive sequence, (b) predictive sequence plus a dual-task element and (c) a random sequence. Results showed that the TBI participants, in contrast to control participants, were significantly impaired at monitoring their errors during both predictive sequence tasks but were not impaired on the random sequence task. These findings suggest that following TBI, when an error is more impulsive it may be more easily monitored, whereas when an error is characterised by attentional drift, subsequent error-processing mechanisms may fail to engage. Higher levels of online error-awareness were also associated with lower levels of anxiety, fewer symptoms of frontal dysfunction and greater competence in everyday functioning.

[Modified Texier mediodorsal transposition island skin flap of the nose. Report of four cases of ala nasi reconstruction]. / Lambeau médiodorsal du nez de transposition en îlot cutané de Texier modifié. A propos de quatre cas de réparations alaires.

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.

[3D evaluation and mammary augmentation surgery]. / Apport de l'imagerie tridimensionnelle à la chirurgie d'augmentation mammaire.

The medical application of the interferometry is valid now. The breast surgery works on the shape and the volume of the tissue. The Inspeck technology is now available and works well in our medical practice. The measurement tools for the lengths, euclidian or projected on surface are working well with the same precision of a manual measurement. The estimation of the volume needs to follow exactly the same procedure to get some good results. The virtual breast modification doesn't work anymore with a scientific precision and does not allowed yet an office use. A development of the software is necessary to use all these data enclosed in the 3D models.

[3 D evaluation and breast plastic surgery: preliminary study]. / Apport de l'imagerie 3D à la chirurgie mammaire: étude préliminaire.

Due to the development of the invasive technique of digital exam, the three-dimensional results are more and more precise, spectacular and helpful. The 3D surfacic model is for a medical approach and non invasive. Early in 2003, we have started a patient evaluation before and after surgery. The most common surgical techniques from the breast reconstruction to the breast augmentation and the lipomodeling have been analyzed. This preliminary study has shown objectively some surgical rules and volumetric results. Those results are the elements of the future development of the 3D surfacic model in plastic surgery.

Early emotional disturbances during nicotine patch therapy in subjects with and without a history of depression.

BACKGROUND: The goal of this study was to compare development of emotional symptomatology during smoking cessation with transdermal nicotine patches in subjects with and without a history of depression. METHODS: Twenty-five subjects, 14 with a history of depression and 11 without such a history, were evaluated before beginning of cessation, on day 8, day 30, day 90 and day 120. RESULTS AND DISCUSSION: On day 120, ten subjects have maintained abstinence: 71.4% of subjects with and 45.5% of subjects without a history of depression relapsed. Both groups presented variable emotional symptomatology and there was no significant differences between subjects with and without a past depression. On the other hand, none of the symptoms which emerged during cessation predicted the issue of cessation. However, some symptoms appearing before beginning of cessation were related to subsequent relapse: lack of pleasure seeking and tiredness. Subsequent relapsers also tended to be more tense on baseline. These early symptoms can not be considered as withdrawal symptoms, they may reflect less confidence in success. It is also suggested that development of anhedonia represents an adaptative strategy to prepare for the withdrawal suffering.

[Psychological aspects of emotional regulation in smoking dependency]. / Aspects psychologiques de la régulation emotionnelle dans la dépendance tabagique.

We reviewed the literature on the relationships between smoking and affect regulation. There is strong evidence that vulnerability to smoking dependence is a function of a high initial sensitivity to nicotine, which produces reinforcing consequences that lead to chronic use. These strong reinforcers of tobacco dependence include regulation of mood and modulation of arousal. We focused on studies concerned with the subjective component of arousal and emotional experience. We discuss first the models and classifications used to differentiate types of smoking as related to the management of emotions and studies evaluating the stimulant and subjective effects of smoking behavior, questioning the paradoxical tranquilizing and anxiety-reducing effects of nicotine. We also looked into the mood regulation effects that may explain the strong relationships observed between depression and smoking and finally focus on some of the personality risk factors that may make individuals more susceptible to these rewarding properties of smoking.

Relationships between sensation seeking and emotional symptomatology during smoking cessation with nicotine patch therapy.

This study explored relationships between the sensation-seeking trait and the development of emotional symptomatology during smoking cessation with nicotine transdermal patches. Twenty-five subjects were evaluated before they stopped smoking, on Day 8, Day 30, Day 90, and Day 120. Initial motives for smoking and the sensation-seeking personality trait were tested as possible predictors for the development of specific mood disturbances. Our subjects scored very high on sensation seeking, consistent with previous results on smokers. This may also be due to the well-known tendency of high sensation-seekers to be willing to try new experiences. The sensation-seeking trait did not predict the issue of cessation. However, it was related to emotional deficit (anhedonia, affective blunting), tiredness, and a lack of energy, before and during smoking cessation. Two different interpretations of emotional deficit are proposed.

Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix.

A series of twelve cases, all of whom had received surgery for the removal of a colloid cyst in the third ventricle, was examined on a series of memory tests. The only consistent predictor of poor memory performance that could be detected from MRIs was the presence of bilateral interruption of the fornix, which occurred in three of the subjects. Although these three cases were poor on tests of learning and recall, there was evidence that recognition was less impaired. The subjects were also tested on a set of recognition and concurrent discriminations that closely matched tests given to non-human primates. Clear parallels were found between the apparent effects of fornix damage in these clinical cases and those observed following more selective surgery in non-human primates. These findings not only indicate that fornix damage is sufficient to induce anterograde amnesia but also support the validity of recent animal tests that are thought to capture aspects of episodic memory.

[Cystic mesothelioma of the peritoneum in a male]. / Mésothéliome kystique du péritoine chez un homme.

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.